Rising incidence of young-onset colorectal cancer marks the past decade

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016

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San Diego, CA, May 22, 2016—Researchers have documented a continued increase in the number of young-onset (YO) colorectal cancers (CRC) occurring in the United States, with a greater prevalence of advanced stage cancers. They presented their results here at Digestive Disease Week 2016, and stressed the need for clinicians to have a lower threshold for colonoscopy in younger patients with bleeding or any other colorectal complaints in the future, also noting that screening guidelines may need revision.

Take-home messages

  • In the United States over the past 10 years, there has been an increase in the number of young-onset colorectal cancers.
  • Patients with young-onset colorectal cancers tend to present with a greater prevalence of advanced stage cancers compared with those aged 50 years and older.

“Within our group and our practice, we’ve noticed an increased number in patients who are coming to the office with colon cancer at younger ages, before they even have their first colonoscopy screening. We thought that it would be interesting to look, on a national scale, and see if we could find any hard evidence that indeed, the rate of colon cancer is increasing in these younger populations,” explained lead author Elie Sutton, MD, research fellow, surgery, Mt. Sinai St. Luke’s Roosevelt, New York, NY.

Previous researchers had found, using data from the National Cancer Database (NCDB), a significant rise in the number of YO CRCs between 2001 and 2010. Dr. Sutton and colleagues sought to re-evaluate these trends for all CRCs, and in those that were YO.

They searched the NCDB Participant User File for all CRC cases that occurred from 2004 to 2013, and assessed the number of these that were YO CRC. In all, they identified 1,010,530, who had the following specific CRCs:

  • Colon, 70.5%;
  • Rectosigmoid, 7.6%; and
  • Rectum, 21.9%.

During this period, there was a decrease in CRC cases in patients aged greater than or equal to 50 years (by 2.5%), but an increase of 11.4% in those aged less than 50 years.

Upon calculating the annual percent change of YO CRCs from 2004 to 2013, Dr. Sutton and colleagues found a mean increase of 1.28% per year (95% CI: 0.77%-1.78%; P < 0.001). For every additional year, these results suggested that there was an increase of 136.35 cases (P < 0.001). In addition, they found that YO CRC seemed to be more prevalent among nonwhite race/ethnic patients compared with LO disease (16.0% vs 22.1%; P < 0.001).

In addition, they found that subjects who were < 50 years old also had lower percentages of stage 0-2 disease, and more stage 3-4 disease compared with those aged 50 years or greater:

  • Stage 0: 5.2% vs 7.2%, respectively;
  • Stage 1: 18.4% vs 24%;
  • Stage 2: 20.3% vs 25.5%;
  • Stage 3: 30.6% vs 25.1%;
  • Stage 4: 25.6% vs 18.2%.

Differences at each stage between the two age groups were significant (P < 0.001). Liver metastases seemed to be more prevalent in the YO group compared with the LO group (19.4% vs 13.8%; P < 0.001).

When they analyzed data on surgical approach used from 2010 to 2013, researchers found that 47.4% of patients aged < 50 years had undergone a minimally invasive approach, compared with 46.6% of those aged 50 years or older (P=0.004). Length of stay was significantly different between the groups, with 56.6% of younger patients staying 5 days or less compared with 43.3% of older patients (P=0.001). Other differences were found in:

  • 30-day mortality: 0.6% vs 3.5%, respectively; P < 0.001);
  • 90-day mortality: 1.6% vs 6.4%; P < 0.001); and
  • Insurance status (8.5% no insurance vs 2.8% insured: P < 0.001).

“It seems that there is a trend towards increased CRC diagnosis in the young-onset population, people less than 50. It’s important that when a clinician sees a patient with a change in bowel habits, or rectal bleeding, or any other concerning findings on exam, even if they are less than 50, the threshold to perform a colonoscopy should be a little bit lower, so that we don’t miss these cases of potentially treatable CRC,” concluded Dr. Sutton.

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