Risk factors and clinical characteristics of early-onset colorectal cancer vs. late-onset colorectal cancer: a case-case study

Abstract

Background and objectives Early-onset colorectal cancer (eoCRC), defined as colorectal cancer (CRC) before the age of 50 is increasing in incidence. We evaluated exogenous and endogenous risk factors, and clinical features of eoCRC, compared to late-onset CRC (loCRC). Methods In this retrospective case-case study, patients were prospectively enrolled from 2015 to 2018. We collected clinical features (age, sex, time from symptom onset to diagnosis, symptoms, family history, smoking and alcohol habits, diabetes, BMI, and genetic analysis) and tumor characteristics. Independent risk factors for eoCRC and odds ratios (ORs) were identified. Results Fifty-four eoCRCs and 494 loCRCs were enrolled. Patients with eoCRC experienced longer delay time from symptom onset to diagnosis: 40.7% were diagnosed within 6 months from symptoms onset, compared to 85.6% of patients with loCRC (P < 0.0001). They differed for sex, presence of symptoms, family history, smoking habit, alcohol intake, and BMI. Rectal localization was more closely associated with eoCRC (64.8%) than loCRC (34.5%, P < 0.0001). Family history of CRC was associated with eoCRC (OR = 8.8). When family history occurred with hereditary cancer syndromes, the OR for eoCRC increased to 21. Conclusion In young adults with alarming symptoms, CRC must be suspected to avoid delay time from symptom onset to diagnosis and genetic risk assessment has to be evaluated. Smoking habits, alcohol intake, and BMI are not associated with eoCRC.

The Role of Diet and Lifestyle in Early-Onset Colorectal Cancer: A Systematic Review

“…A total of 375 eoHRAs were found during colonoscopy surveillance, with the highest quintile of Western diet consumption as eoHRA risk factor (OR 1.67) and the highest quintile of prudent diet as a protective factor (OR 0.69) (Figure 2). Moreover, the Western diet was associated with advanced adenomas of the distal colon and rectum (OR 1.65), consistent with the typical eoCRC localization in the left colon and rectum [10,11]. These two dietary patterns have been described as exogenous factors associated with the prevention or predisposition of loCRC, too: respectively, the 'healthy' pattern (high in fruits, vegetables, and whole grains or legumes, fish, and low-fat milk or dairy products) and the 'unhealthy' or 'Western dietary' pattern (high in red and processed meat, sugary drinks, refined grains, desserts) [60].…”

“…eoCRC has a distinct epidemiology, anatomical localization, histopathology, and clinical presentation compared to loCRC [ 9 ]. eoCRCs are typically located in the left colon (rectum, sigmoid colon, and descending colon) [ 10 , 11 ] and present more frequently at stage III–IV upon first diagnosis. They also tend to display a higher percentage of signet ring and mucinous histology as well as poor differentiation [ 2 , 10 , 12 ].…”

Clinical Characteristics and Outcomes of Colorectal Cancer in the ColoCare Study: Differences by Age of Onset

“…Zisman et al observed that smokers were on average 5.2 years (95% CI: 4.9-5.5. years) younger at their colorectal cancer diagnosis than non-smokers. Two studies have investigated smoking as a driver for early-onset colorectal cancer [10,31]. While one study did not observe differences in smoking behavior, a more recent study supports our findings of early-onset patients being less likely to be smokers [10,31].…”

“…Two studies have investigated smoking as a driver for early-onset colorectal cancer [10,31]. While one study did not observe differences in smoking behavior, a more recent study supports our findings of early-onset patients being less likely to be smokers [10,31]. Taken together, our results suggest that the traditional risk factors for CRC such as BMI and smoking may not explain the recent increase in early-onset cancers, demonstrating the need to identify other risk factors that may explain this increasing trend of early-onset cancers.…”

Risk of Colorectal Cancer in Patients With Irritable Bowel Syndrome: A Meta-Analysis of Population-Based Observational Studies

“…Early-onset CRC has attracted increasing attention from researchers in recent years, and reports from different regions around the world confirmed that the proportion of early-onset CRC is continuing to rise ( 34 – 38 ). Patients with early-onset CRC have a longer delay from symptom onset to diagnosis and are diagnosed at a higher rate of advanced stages than older patients ( 39 , 40 ). CRC is relatively slow to develop, and aggressive screening may reduce the incidence and allow for diagnosis before it progresses to an incurable stage, thereby reducing mortality and prolonging life ( 41 , 42 ).…”