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Colorectal cancer in 18- to 49-year-olds: rising rates, presentation, and outcome in a large integrated health system

  • Nimish Vakil
    Correspondence
    Reprint requests: Nimish Vakil, MD, Aurora Summit Medical Center, 36500 Aurora Dr, Summit, WI 53066.
    Affiliations
    Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

    Department of Gastroenterology, Advocate Aurora Health, Milwaukee, Wisconsin, USA
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  • Kristin Ciezki
    Affiliations
    Department of Gastroenterology, Advocate Aurora Health, Milwaukee, Wisconsin, USA

    Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA
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  • Maharaj Singh
    Affiliations
    Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA

    School of Dentistry, Marquette University, Milwaukee, Wisconsin, USA
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Published:March 29, 2021DOI:https://doi.org/10.1016/j.gie.2021.03.024

      Background and Aims

      Colorectal cancer (CRC) rates are increasing in young people, and new guidelines recommend screening should begin at age 45 years. We aimed to evaluate CRC detection rates in a large integrated healthcare system to assess treatment outcomes in younger CRC patients and to determine factors that could aid in identifying these individuals.

      Methods

      We analyzed confirmed cases of CRC using a cancer database spanning from 1985 to 2017 from a large integrated healthcare system composed of 15 hospitals, 150 outpatient clinics, and 20 outpatient oncology clinics. Three cohorts were evaluated (18-44 years, 45-49 years, and ≥50 years).

      Results

      Significant increases in CRC detection were seen in the cohort aged 18 to 44 (annual percentage change, 2.70%) and the cohort aged 45 to 49 (annual percentage change, 4.15%). A higher proportion of African American, Hispanic, and obese subjects were seen in the younger cohorts. A family history of CRC was found in 49% of patients aged 18 to 44 and 38% of patients aged 45 to 50. Patients younger than age 50 were more likely to have metastases at diagnosis (6.8%) versus the cohort over 50 (4.15%; P < .05). Survival was better in younger cohorts, and they were more likely to receive multimodality treatment (surgery with chemotherapy or radiation). Survival probability was similar in different ethnic groups.

      Conclusions

      CRC is increasing at similar rates in young people aged 18 to 44 and 45 to 49, and they are more likely to present with advanced disease needing multimodality treatment. A family history identifies some patients <50 years. Young patients presenting with changes in bowel habit, rectal bleeding, anemia, and weight loss should undergo colonoscopy. Rectal and anal symptoms should prompt careful physical and endoscopic evaluation.

      Graphical abstract

      Abbreviation:

      CRC (colorectal cancer)
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      References

        • Bhandari A.
        • Woodhouse M.
        • Gupta S.
        Colorectal cancer is a leading cause of cancer incidence and mortality among adults younger than 50 years in the USA: a SEER-based analysis with comparison to other young-onset cancers.
        J Invest Med. 2017; 65: 311-315
        • Sarakarn P.
        • Suwanrungruang K.
        • Vatanasapt P.
        • et al.
        Joinpoint analysis trends in the incidence of colorectal cancer in Khon Kaen, Thailand (1989-2012).
        Asian Pac J Cancer Prev. 2017; 18: 1039-1043
        • Gandhi J.
        • Davidson D.
        • Hall C.
        • et al.
        Population-based study demonstrating an increase in colorectal cancer in young patients.
        Br J Surg. 2017; 104: 1063-1068
        • Siegel R.
        • Miller K.
        • Fedewa S.
        • et al.
        Colorectal cancer statistics.
        CA Cancer J Clin. 2017; 67: 177-193
        • Holowatyj A.N.
        • Ruterbusch J.J.
        • Rozek L.S.
        • et al.
        Racial/ethnic disparities in survival among patients with young-onset colorectal cancer.
        J Clin Oncol. 2016; 34: 2148-2156
        • Arshad H.
        • Kabir C.
        • Tetangco E.
        • et al.
        Racial disparities in clinical presentation and survival times among young-onset colorectal adenocarcinoma.
        Dig Dis Sci. 2017; 62: 2526-2531
        • Wolf A.M.D.
        • Fontham E.T.H.
        • Church T.R.
        • et al.
        Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.
        CA Cancer J Clin. 2018; 68: 250-281
        • Vakil N.
        • Ciezki K.
        • Huq N.
        • et al.
        Multitarget stool DNA testing for the prevention of colon cancer: outcomes in a large integrated healthcare system.
        Gastrointest Endosc. 2020; 92: 334-341
        • Abdelsattar Z.M.
        • Wong S.L.
        • Regenbogen S.E.
        • et al.
        Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
        Cancer. 2016; 122: 929-934
        • Ashktorab H.
        • Vilmenay K.
        • Brim H.
        • et al.
        Colorectal cancer in young African Americans: Is it time to revisit guidelines and prevention?.
        Dig Dis Sci. 2016; 61: 3026-3030
        • Teng A.
        • Lee D.
        • Ai J.
        • et al.
        Patterns and outcomes of colorectal cancer in adolescents and young adults.
        J Surg Res. 2016; 205: 19-27
        • White A.
        • Joseph D.
        • Rim S.H.
        • et al.
        Colon cancer survival in the United States by race and stage (2001-2009): findings from the CONCORD-2 study.
        Cancer. 2017; 123: 5014-5036
        • Rhoads K.F.
        • Patel M.I.
        • Ma Y.
        • et al.
        How do integrated health care systems address racial and ethnic disparities in colon cancer?.
        J Clin Oncol. 2015; 33: 854-860
        • Tawk R.
        • Abner A.
        • Ashford A.
        • et al.
        Differences in colorectal cancer outcomes by race and insurance.
        Int J Environ Res Public Health. 2015 Dec 22; 13
        • Abdelsattar Z.M.
        • Hendren S.
        • Wong S.L.
        The impact of health insurance on cancer care in disadvantaged communities.
        Cancer. 2017; 123: 1219-1227
        • Wisconsin Comprehensive Cancer Control Program
        Colorectal cancer screening collaborative.
        (Available at:)
        https://wicancer.org/projects/csc/
        Date accessed: September 3, 2018
        • Agency for Healthcare Research and Quality
        National healthcare quality and disparities reports. Wisconsin State Dashboard.
        (Available at:)
        • Murphy C.C.
        • Singal A.G.
        • Baron J.A.
        • et al.
        Decrease in incidence of young-onset colorectal cancer before recent increase.
        Gastroenterology. 2018; 155: 1716-1719
        • Jensen B.W.
        • Gamborg M.
        • Gögenur I.
        • et al.
        Childhood body mass index and height in relation to site-specific risks of colorectal cancers in adult life.
        Eur J Epidemiol. 2017; 32: 1097-1106
        • Centers for Disease Control and Prevention
        Prevalence of self-reported obesity by state and territory 2019.
        (Available at:)
        • Weinberg B.
        • Marshall J.
        Colon cancer in young adults: trends and their implications.
        Curr Oncol Rep. 2019; 21: 3
        • Boardman L.
        • Vilar-Sanchez E.
        • You Y.
        • et al.
        AGA clinical practice update on young adult-onset colorectal cancer diagnosis and management: expert review.
        Clin Gastroenterol Hepatol. 2020; 18: 2415-2424
        • Orsini R.G.
        • Verhoeven R.H.
        • Lemmens V.E.
        • et al.
        Comparable survival for young rectal cancer patients, despite unfavourable morphology and more advanced-stage disease.
        Eur J Cancer. 2015; 51: 1675-1682
        • Gryfe R.
        • Kim H.
        • Hsieh E.T.
        • et al.
        Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer.
        N Engl J Med. 2000; 342: 69-77
        • Segev L.
        • Kalady M.F.
        • Church J.M.
        Left-sided dominance of early-onset colorectal cancers: a rationale for screening flexible sigmoidoscopy in the young.
        Dis Colon Rectum. 2018; 61: 897-902
        • US Preventive Services Task Force
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2016; 315: 2564-2575
        • Montminy E.
        • Zhou M.
        • Maniscalco M.
        • et al.
        Contributions of adenocarcinoma and carcinoid tumors to early-onset colorectal cancer incidence rates in the United States.
        Ann Intern Med. 2020;