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Rates of Colorectal Cancer Diagnosis in Adults Younger Than Age 50

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Key Points

  • The proportion of patients diagnosed with colorectal cancer under the age of 50 rose from 10% in 2004 to 12.2% in 2015.
  • Nearly 52% of younger adults were diagnosed with more advanced stages of cancer (stage III/IV) vs 40% in those older than 50 years.

A new study published by Virostko et al in Cancer found that the proportion of adults diagnosed with colorectal cancer under age 50 in the United States has continued to increase over the past decade, and younger adults are diagnosed with more advanced disease.

To determine recent trends in colorectal cancer rates, Boone Goodgame, MD, of The University of Texas at Austin, and his colleagues examined information from the National Cancer Database registry. From 2004 to 2015 (the most recent year included in the database), 130,165 patients under age 50 and 1,055,598 patients over age 50 were diagnosed with colorectal cancer.

Findings

Researchers found the proportion of patients diagnosed with colorectal cancer under the age of 50 rose from 10% in 2004 to 12.2% in 2015. The proportion of young-onset disease was higher in African American and Hispanic populations vs in non-Hispanic white populations throughout 2004 to 2015. Nearly 52% of younger adults were diagnosed with more advanced stages of cancer (stage III/IV) vs 40% in those older than 50 years.

Diagnoses in men under the age of 50 years rose only in non-Hispanic whites, whereas women, Hispanic, and non-Hispanic whites had an increase in younger diagnoses over time. Rates of colorectal cancer diagnosis in young adults increased over time, regardless of income level. The highest proportion of young adult diagnoses occurred in the top income category. The proportion of colorectal cancers diagnosed in younger individuals rose in urban areas, but not in rural areas.

"Several studies have shown that the rates of colorectal cancer in younger adults have risen slowly in the United States since the 1970s, but for practicing physicians, it feels like we are seeing more and more young people with colorectal cancer now than we were even 10 years ago," said Dr. Goodgame in a press release. "Until just last year, guidelines recommended colon cancer screening beginning at 50. Now many guidelines do recommend screening at age 45, but most physicians and patients don't appear to be following those recommendations."

Dr. Goodgame noted that the cause of increasing rates of colorectal cancer in younger patients is unclear.

Commentary

In an accompanying editorial, Chyke Doubeni, MD, MPH, of the University of Pennsylvania, pointed to the need for additional research. "Because the number of colorectal cancer cases from inherited causes are much higher in younger individuals, it is unknown whether screening for sporadic cases in a group with such low disease rate can result in a favorable balance of harms and benefits," he wrote.

"It is therefore imperative that the various hypotheses for increasing colorectal cancer incidence among people younger than 50 be rigorously tested to determine if changing the current screening age in people who are not at increased familial risk represents the most appropriate public health response," he added.

Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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