Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis

Abstract

Background & Aims The incidence of colorectal cancer (CRC) is increasing in the United States (US) among adults under the age of 50 years. Studies of young-onset CRC have focused on outcomes and treatment patterns. We examined patient presentation, provider evaluation, and time to diagnosis, which can affect stage and prognosis. Methods In a retrospective study, we collected data from patients with a diagnosis of colorectal adenocarcinoma, confirmed by pathologists, seen at the Stanford Cancer Institute from January 1, 2008 through December 31, 2014. We compared symptoms, clinical features, time to diagnosis, and cancer stage in patients with young-onset CRC (diagnosed at an age younger than 50 years, n=253) vs patients diagnosed with CRC at an age of 50 years or older (n=232). Results A higher proportion of patients with young-onset CRC were diagnosed with advanced-stage tumors (72%) compared with older patients (63%) (P=.03). Larger proportions of patients with young-onset CRC also had a family history of CRC (25% vs 17% in older patients; P=.03), confirmed or probable hereditary cancer syndromes (7% vs 1% in older patients, P<.01), and left-sided disease (distal colon cancer in 41% vs 34% in older patients; P=.01 and rectal cancer in 40% vs 35% in older patients; P=0.29). Patients with young-onset CRC had a significantly longer median time to diagnosis (128 vs 79 days for older patients; P<0.05), symptom duration (60 vs 30 days for older patients; P<.01), and time of evaluation (31 vs 22 days; P<.05). In multivariable analyses, time to diagnosis was 1.4-fold longer for younger than for older patients (P<.01). Among younger patients, those with stage III or IV CRC had shorter durations of symptoms and evaluations than those with stage I or II CRC. Conclusion In a retrospective analysis of patients with CRC, we found that greater proportions of patients younger than 50 years were diagnosed with advanced stage tumors than older patients; this difference could not be explained simply by delays from symptom onset to diagnosis. Although tumor biology may be an important determinant of stage at diagnosis, clinicians should be aware of CRC alarm symptoms, family history, and genetic Syndromes, to speed evaluation and diagnosis of younger patients and potentially improve outcomes. It remains to be determined whether subgroups of persons at risk for young-onset CRC who benefit from early screening can be identified.

Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

“…The underlying causes for the increased incidence of early‐onset CRC are not fully understood, but recognized risk factors may play an important role. A higher fraction of individuals with early‐onset disease has a family history of CRC or a risk‐inducing genetic mutation compared with adults aged 50 years and older . Several other known CRC risk factors also are likely contributing to early‐onset disease, including increasing trends in obesity, the prevalence of type II diabetes mellitus, and a sedentary lifestyle.…”

“…Delay in diagnosis is a common and concerning feature of young‐onset CRC. One study indicated that the median time to initial clinical presentation after the onset of symptoms was twice as long for patients with early‐onset CRC compared with older patients (60 days vs 30 days), and that patients with early‐onset CRC experienced a longer time to diagnosis after symptom recognition (128 days vs 79 days) . A study of patients with rectal cancer indicated that the time from symptom onset to treatment was more than 4 times longer for patients younger than 50 years (217 days) compared with adults aged 50 years and older (58 days) .…”

“…There is a need for improvement in the knowledge and implementation of these high‐risk screening recommendations by clinicians . A larger proportions of patients with CRC at a young age have a family history of CRC (25% vs 17% in older patients) and a confirmed or probable hereditary cancer syndrome (7% vs 1% in older patients) . These risk factors are often not recognized until patients are diagnosed with CRC, representing missed opportunities for prevention and early detection .…”

Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening

“…Delay in diagnosis is another common and concerning feature of young‐onset CRC. One study found that the median time for initial clinical presentation after the onset of symptoms was twice as long for patients with young‐onset CRC compared with older patients (60 days vs 30 days) and that patients with young‐onset CRC experienced a longer time to diagnosis after symptom recognition (128 days vs 79 days) . A study of patients with rectal cancer found that the time from symptom onset to treatment was more than 4 times longer for patients younger than 50 years (217 days) compared with adults aged 50 years and older (58 days) .…”

Low Prevalence of Criteria for Early Screening in Young-Onset Colorectal Cancer

“…7 This study's aims are to determine the fractions of young-onset CRC patients in the same cohort who had recognized risk factors for early CRC, as a function of age by decade. It is hypothesized that only a minority at all ages would qualify for early screening based on existing recommendations.…”