Colorectal Cancer in 18- to 49-Year-Olds

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To evaluate CRC detection rates in a large, integrated healthcare system to assess treatment outcomes in younger CRC patients and to determine factors that could aid in identifying these individuals, confirmed cases of CRC were analyzed using a cancer database spanning from 1985 to 2017, from a large, integrated healthcare system composed of 15 hospitals, 150 outpatient clinics and 20 outpatient oncology clinics. Three cohorts were evaluated (18-44 years, 45-49 years and greater than 50 years). 

Significant increases in CRC detection were seen in the cohort aged 18-44 (annual change 2.7%), and the cohort age 45-49 (annual percentage change 4.15%). The higher proportion of AfricanAmericans, Hispanic and obese subjects were seen in the younger cohorts. A family history of CRC was found in 49% of the patients aged 18-44 and 38% of patients aged 45-50. Patients younger than age 50 were more likely to have metastases at diagnosis (6.8%) vs. the cohort over 50 (4.15%).

Survival was better in younger cohorts and they were more likely to receive multimodality treatment (surgery with chemotherapy or radiation). Survival probability was similar in different ethnic groups.

It was concluded that CRC is increasing at similar rates in young people aged 18-44 and 4549, and that they are more likely to present with advanced disease needing multimodality treatment. A family history identifies some patients less than 50 years of age. Young patients presented with changes in bowel habit, rectal bleeding, anemia, and weight loss should include colonoscopy in evaluation. Rectal and anal symptoms should prompt careful physical and endoscopic evaluation.

Vakil, N., Ciezki, K., Singh, M. “Colorectal Cancer in 18- to 49-year-olds: Rising Rates, Presentation, and Outcome in a Large Integrated Health System.”  Gastrointestinal Endoscopy; Vol. 94, No. 3, 2021; pp. 618-626.

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