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

  • Nimish Vakil
    Reprint requests: Nimish Vakil, MD, Aurora Summit Medical Center, 36500 Aurora Dr, Summit, WI 53066.
    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
    Department of Gastroenterology, Advocate Aurora Health, Milwaukee, Wisconsin, USA

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

    School of Dentistry, Marquette University, Milwaukee, Wisconsin, USA
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Published:March 29, 2021DOI:

      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.


      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).


      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.


      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


      CRC (colorectal cancer)
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