In patients at intermediate risk for colorectal cancer, colonoscopy is recommended by most European and American organizations as a screening examination starting at age 50 at intervals not exceeding 10 years. But how do patients outside the screening population, i.e. younger affected individuals, fare? Although cancer cases are increasing in this group, outcomes are currently poorly understood. A recently published cohort study provides new insights.
The US study from the setting of the renowned Mayo Clinic had a population-based retrospective cohort design. The sample was registry data (SEER database, 1998-2011) from a total of 258 024 colorectal cancer patients, 15% of whom were under 50 years of age (mean age 42.5).
The younger patients were more likely to have advanced tumors at the time of diagnosis. The relative risk for regional extension was significantly increased by 30% compared with older patients, and that for distant metastases by as much as 50%. Despite these poor outcomes, younger sufferers survived the disease longer than older sufferers (significant risk reduction for disease-specific death by 23%; HR 0.77; p<0.001). Radiation was used significantly more often in younger patients (53% vs. 48% probability), and surgery was performed more often on the primary tumor for distant metastases in them (72% vs. 63%; p<0.001).
Young patients not forgotten
Patients who develop colorectal cancer under the age of 50 are more likely to present with advanced disease, but are treated more aggressively and subsequently survive longer than their older counterparts, the study concluded. The key question now is: Should colorectal cancer screening start earlier? In any case, more attention needs to be paid to the increasing number of patients under 50 years of age. Warning symptoms such as change in bowel function and blood in the stool should be taken more seriously to prevent the common delay in diagnosis at a young age, according to the authors.
Currently, colorectal cancer is predominantly considered a disease of the elderly. Although earlier screening is already recommended for certain risk factors and family history, many physicians still do not comply with this recommendation, according to the authors.
Source: Abdelsattar ZM, et al: Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer 2016 Jan 25. doi: 10.1002/cncr.29716 [Epub ahead of print].
InFo ONCOLOGY & HEMATOLOGY 2016; 4(4): 3.
