Colorectal cancer in 18- to 49-year-olds: rising rates, presentation, and outcome in a large integrated health system
Vakil N, Ciezki K, Singh M. Colorectal cancer in 18- to 49-year-olds: rising rates, presentation, and outcome in a large integrated health system. Gastrointest Endosc. Published online March 29, 2021. doi: 10.1016/j.gie.2021.03.024. Online ahead of print.
BACKGROUND AND AIMS: Colorectal cancer rates are increasing in young people, and new guidelines recommend screening should begin at age 45. We aimed to evaluate colorectal cancer detection rates in a large integrated healthcare system, to assess treatment outcomes in younger colorectal cancer patients, and to determine factors that could aid in identifying these individuals.
METHODS: We analyzed confirmed cases of colorectal cancer using a cancer database spanning 1985 to 2017 from a large integrated health care system comprised of 15 hospitals, 150 outpatient clinics, and 20 outpatient oncology clinics. Three cohorts were evaluated (18-44 years, 45-49 years, and 50 years and over).
RESULTS: Significant increases in colorectal cancer 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 colorectal cancer 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<0.05). 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: Colorectal cancer is increasing at similar rates in young people aged 18 tp 44 and 45 to 49, and they are more likely to present with advanced disease needing multimodality treatment. A family history identifies a minority of patients under 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.