Patterns and outcomes of colorectal cancer in adolescents and young adults

Teng, Annabelle; Lee, David Y.; Cai, Jenny; Patel, Shivani; Bilchik, Anton J.; Goldfarb, Melanie

doi:10.1016/j.jss.2016.05.036

Cited by 51 publications

(47 citation statements)

References 43 publications

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“…The incidence of early onset CRC in the US has been increasing as noted through other databases such as the Surveillance, Epidemiology, and End Results Program (SEER) database or the North American Association of Central Cancer Registries (NAACCR) dataset (1)(2)(3)6,16,18,19). While these studies have focused on either the disparate demographic aspects or the pathologic features associated with early onset CRC, our study sought to look at both sets of characteristics and determine the association of these variables with OS of patients ≤50 and ≥60 years.…”

Section: Discussionmentioning

confidence: 99%

Age-related rates of colorectal cancer and the factors associated with overall survival

Gabriel

Attwood

Al-Sukhni

et al. 2018

J. Gastrointest. Oncol.

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Background: The purpose of this study was to identify differences in both demographic and pathologic factors associated with the age-related rates of colorectal cancer (CRC) and overall survival (OS). Methods: The National Cancer Data Base (NCDB), [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013], was queried for patients with CRC. Patients were stratified by age (≤50 vs. ≥60 years). Multivariable analysis was performed to identify factors associated with OS.Results: A total of 670,030 patients were included; 488,121 with colon, and 181,909 with rectal or rectosigmoid cancer. For colon cancer, patients ≤50 years had higher proportions of pathologic stage III and IV disease than patients ≥60 (III: 33.7% vs. 28.6%, IV: 25.5% vs. 14.3%, respectively; P≤0.001). Similar differences were found for patients with rectal cancer (III: 35.8% vs. 28.6%, IV: 16.5% vs. 11.6%, respectively for age ≤50 and ≥60 years; P≤0.001). More aggressive pathologic factors were identified in the ≤50 cohort and were associated with worse OS, including higher tumor grade, lymphovascular invasion (LVI), perineural invasion (PNI), and elevated serum carcinoembryonic antigen (CEA). Disparities associated with OS were also identified for both colon and rectal cancer. For patients ≤50 with CRC, African-American and Hispanic race, lower income and lower education were associated with increased risk of mortality compared to the ≥60 cohort. Conclusions: There are clear differences in biological factors and in racial and socioeconomic disparities of patients with early onset CRC. Earlier screening should be seriously considered in patients under 50 years who are African-American and Hispanic, as these populations present with more aggressive and advanced disease. Changes in risk factors among younger adults over time, including diets higher in fat and increasing obesity, are also in part, contributing to this rising trend (8,9).In addition to these biologic etiologies, disparities in access to care for diagnosis and treatment of CRC among young adults has also been described. Several studies have characterized differences in the treatment of CRC, including access to surgery and chemotherapy based on age, race, geographic location and other socioeconomic factors like insurance status and income (10)(11)(12)(13)(14)(15). Importantly, differences in access to these treatments have been associated with worse survival outcomes for patients with early-onset CRC of minority racial populations (16,17). The purposes of this study were to identify differences in both demographic and pathologic factors associated with the age-related rates of CRC and to assess the interaction these variables on overall survival (OS) in early onset CRC. Methods PatientsJointly sponsored by the American Cancer Society and the American College of Surgeons, the National Cancer Data Base (NCDB) captures approximately 70% of the country's cancer cases through its participating hospitals. A query of the NCDB 2006-2012 participant user files (PUFs) was performed to identify ...

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Section: Discussionmentioning

confidence: 99%

Age-related rates of colorectal cancer and the factors associated with overall survival

Gabriel

Attwood

Al-Sukhni

et al. 2018

J. Gastrointest. Oncol.

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“…In the USA, there is already evidence that at least one preventable cancer, such as colorectal cancer, that is decreasing in incidence among adults and it is linked to diet, obesity, diabetes and sedentary lifestyle, is on the rise among adolescents and young adults. 4 Therefore, interventions among children to prevent the adoption of unhealthy diets and lifestyles are imperative. These interventions need to target points of purchase, schools, homes, and places of recreation.…”

Section: Discussionmentioning

confidence: 99%

“…3 Diet and physical activity prevention strategies need strong components focusing on childhood, as this will impact adult cancer risk, either through reducing obesity and/or diabetes, or directly through benefits specific to diet or exercise and sedentary behavior. For example, the incidence of colorectal cancer is increasing among adolescents and young adults in the USA, 4 and diet, obesity and a sedentary lifestyle are known contributing factors for colorectal cancer; thus, their role in childhood might be relevant. Therefore, as obesity trends increase across the Americas 5 interventions to improve diet and increase physical activity among children have a great potential to reduce the cancer burden across the Americas.…”

Section: Introductionmentioning

confidence: 99%

Diet, physical activity, obesity and related cancer risk: strategies to reduce cancer burden in the Americas

et al. 2019

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“…17 This discrepancy may represent increased surveillance in the population of patients with colon SMNs because they had a prior malignancy or because they have an underlying genetic syndrome, whereas primary CCs would have been detected when patients presented with symptoms rather than from screening. 17 This discrepancy may represent increased surveillance in the population of patients with colon SMNs because they had a prior malignancy or because they have an underlying genetic syndrome, whereas primary CCs would have been detected when patients presented with symptoms rather than from screening.…”

Section: Discussionmentioning

confidence: 99%

“…Colon SMNs were diagnosed at an earlier stage and were more likely to be located on the right side, which is in contrast to primary CCs in the young adult population, which tend to be diagnosed at a later stage and more commonly are found in the distal colon. 17 This discrepancy may represent increased surveillance in the population of patients with colon SMNs because they had a prior malignancy or because they have an underlying genetic syndrome, whereas primary CCs would have been detected when patients presented with symptoms rather than from screening. Alternatively, there may be underlying genomic differences between primary CCs and colon SMNs that have yet to be defined.…”

Section: Discussionmentioning

confidence: 99%

Colon cancer as a subsequent malignant neoplasm in young adults

Teng

Nelson

Dehal

et al. 2019

Cancer

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BACKGROUND: The incidence of colon cancer (CC) is rising in younger adults and can occur de novo or in patients previously treated for another cancer. To the authors' knowledge, the impact on survival of CC occurring as a subsequent malignant neoplasm (SMN) has not been described for younger patients, which the authors anticipate to be lower with SMNs than that of primary CC. METHODS: Patients aged <50 years with CC in the 2004 through 2014 National Cancer Data Base were identified. Patients were stratified by primary or subsequent occurrence. The impact of SMN status on overall survival (OS) was evaluated. RESULTS: Of 41,915 patients, 2852 (6.8%) had colon SMNs. More patients with colon SMNs were aged 40 to 49 years compared with patients with primary CC (83% vs 77%; P < .001). Patients with colon SMNs presented with earlier clinical and pathological T, N, and M classifications (all P < .001). Colon SMNs more commonly occurred in the right colon, whereas primary CC was found to have a higher prevalence in the sigmoid colon (P < .001). Patients with colon SMNs more frequently underwent total colectomy (17% vs 5%; P < .001), but received less chemotherapy (53% vs 65%; P < .001). When adjusted for demographic, tumor, and treatment characteristics, SMN status was associated with a 23% decreased OS compared with primary CC (95% CI, 1.14-1.31; P < .001). Chemotherapy offered a 33% improvement in OS (95% CI, 0.56-0.8; P < .001). CONCLUSIONS: Colon SMNs in younger patients present at an earlier stage and are treated more aggressively surgically compared with primary CCs. Patients with SMNs of the colon have decreased survival, although chemotherapy offers a survival advantage. Further investigation is warranted to determine whether these disparities are due to the effects of cancer treatment or differences in tumor biology. Cancer 2019;125:3749-3754.

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Patterns and outcomes of colorectal cancer in adolescents and young adults

Cited by 51 publications

References 43 publications

Age-related rates of colorectal cancer and the factors associated with overall survival

Age-related rates of colorectal cancer and the factors associated with overall survival

Diet, physical activity, obesity and related cancer risk: strategies to reduce cancer burden in the Americas

Colon cancer as a subsequent malignant neoplasm in young adults

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