A long-term study launched by a team of South African researchers hopes to gain deeper insights into colorectal cancer, and how it affects increasingly younger people.
The CoRECT Cancer Study, based at the Wits Donald Gordon Medical Institute (DGMI), has already marked major milestones, including the first recruitment of patients and a colorectal resection.
“There are still major gaps in what is known about colorectal cancer in South African populations, and we want to understand what causes it, how it can be detected earlier, why it is being seen in younger people and why some treatments work better for certain patients than for others,” said Dr Lisa Campbell-Roper, DGMI project manager.
CoRECT is a longitudinal clinical cohort and biorepository. The study will include people who have been diagnosed with colorectal cancer, as well as people without the disease, who will form a healthy control group.
The aim is to create a rich dataset on clinical, sociodemographic, occupational and dietary details from participants. There will be an overlay of lab information (histopathology), other investigations (such as diagnostic imaging) and then samples to create a biorepository for unpacking the molecular architecture of these tumours.
The research will also unpack the genetic drivers of tumour formation and the role of lifestyle factors, as well as the molecular signatures that determine how individuals respond to treatment – and why some don’t.
Genomic research will examine DNA, while transcriptomic and proteomic studies will investigate gene activity and proteins. Microbiome research will explore the communities of micro-organisms living in the gut and oral cavity, and how they may be associated with colorectal cancer.
“The broader vision for CoRECT is to create a platform for Wits to drive this understudied research forward and to use what we find to create African-informed precision oncology diagnostics and ideally therapeutics,” said Dr June Fabian, director of the DGMI.
Why so many younger people are getting it
Although colorectal cancer has traditionally been associated with older adults, there is growing concern about the number of younger people who are developing the disease
A South African analysis published in 2024, based on National Cancer Registry data, found that a quarter of patients with colorectal adenocarcinoma under 50.
The researchers also found that younger patients were more likely to have African ancestry: they have called for further investigation into the genetic, epigenetic and socioeconomic factors shaping the disease in South Africa.
“CoRECT is not limited to early-onset disease, but places particular emphasis on understanding colorectal cancer in younger people and individuals of African ancestry. Continental Africans are under-represented in studies, with assumptions that diaspora populations, like African Americans, can be used as a proxy,” said Campbell-Roper.
This focus is important because much remains unknown about whether colorectal cancers developing in younger African patients have distinct biological characteristics, environmental drivers or patterns of treatment response.
As the cohort grows, researchers will be able to compare findings across patients of different ages and backgrounds, and between people with and without colorectal cancer.
A platform for collaboration
Wits has provided the platform for the CoRECT Cancer Study, with specialist colorectal surgeons as the clinical leads of the project: Dr Brendan Bebington from the Colorectal Unit at Wits Donald Gordon Medical Centre and Dr Vuyo Soldati, head of Colorectal Surgery at the Chris Hani Baragwanath Academic Hospital. The project investigators are supported by a multidisciplinary healthcare team.
The next step is to grow the number and range of participants so that colorectal cancer in South Africans can be studied with the depth and sustained attention it has long lacked.
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