What’s Missing in Indonesia’s Colorectal Cancer Approach and Why Young Patients Are Paying the Price
PathGen Diagnostik Teknologi ·
A study at Dr. Sardjito General Hospital revealed that 21.65% of Indonesian colorectal cancer (CRC) patients are under 50 years old—nearly triple Western rates—alongside a remarkably high 13.85% prevalence of probable Lynch Syndrome. Because young-onset CRC is particularly aggressive and frequently linked to inherited syndromes, the authors urge Indonesia to update national guidelines to mandate universal, affordable PCR-based MSI/MMR testing for patients under 70, preventing ineffective chemotherapy and ensuring access to targeted immunotherapies.
We conducted molecular profiling research in colorectal cancer (CRC) patients in Dr. Sardjito General Hospital Yogyakarta, from January 2016 to December 2019 that were identified from the hospital-based cancer registry.
Using BioColoMelt-Dx PCR-HRM Kit for molecular detection of MSI, MLH1, BRAF KRAS, NRAS and PIK3CA mutation, the study found that Indonesia has three times more early-onset colorectal cancer than western countries. The study analysed 231 CRC patients and confirmed something shocking that 21.65% were under 50 years old, nearly three times higher than the ~10% typically reported in Europe, the UK, or the US. This aligns with earlier reports suggesting EOCRC may account for up to 30% of CRC cases in Indonesia.
In addition, our finding revealed that CRC patients in Indonesia showed a high frequency of probable Lynch Syndrome (LS) around 13.85%. This is massive. Meanwhile, LS typically accounts for 2-3% of CRC cases in Western populations.
The question is “Why does this matter?”
Young-onset CRC tends to be more aggressive, diagnosed late, less likely to be detected through routine early-detection programs, more likely linked to inherited syndromes like Lynch Syndrome. Yet current clinical pathways in Indonesia remain focused mainly on late-stage treatment rather than early molecular evaluation, especially for young adults.
NICE (UK) and NCCN (US) recommend universal MSI/MMR testing for all CRC patients up to 70 years old. However, Indonesia still lacks for molecular testing. In cases of MSI and LS-related CRCs respond exceptionally well to immunotherapies like pembrolizumab and exhibit poor therapeutic benefit from 5-fluorouracil (5-FU). Without molecular testing, patients may receive ineffective chemotherapy, miss immunotherapy opportunities and not cost effective.
What Indonesia Can Do?
Indonesia stands at a critical point in its fight against colorectal cancer. The high burden of young-onset CRC and Lynch Syndrome is a call to action. Based on the study’s findings, here’s what the country needs urgently:
- Universal MSI/MMR testing for all CRC patients (especially <70 years old)
- Integrate molecular testing into national CRC guidelines
- Affordable PCR-based method
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Molecular Analysis of Colorectal Cancers Suggests a High Frequency of Lynch Syndrome in Indonesia
Susanti Susanti, Satrio Wibowo, Gilang Akbariani, Naomi Yoshuantari, Didik Setyo Heriyanto, Asep Muhamad Ridwanuloh, Hariyatun Hariyatun, Adeodatus Yuda Handaya, Johan Kurnianda, Susanna Hilda Hutajulu, Mohammad Ilyas · Cancers · 13 December 2021
Early-onset colorectal cancer (EOCRC, <50 years old) accounts for nearly 30% of cases in Indonesia—about three times higher than in Western countries. Using the PCR-based N_LyST panel on 231 Indonesian CRC patients, this retrospective study identified a remarkably high potential Lynch Syndrome (LS) prevalence of 13.85%, offering a key explanation for the country's elevated EOCRC rate and highlighting the need for cost-effective hereditary screening.
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