Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersIn the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.
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The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action
Mayo Clin Proc 2014 Jan 03;[EPub Ahead of Print], DJ Ahnen, SW Wade, WF Jones, R Sifri, J Mendoza Silveiras, J Greenamyer, S Guiffre, J Axilbund, A Spiegel, YN YouFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The incidence and mortality of young-onset (< 50 years) colorectal cancer (CRC) unfortunately is rising in the United States. The reasons for this increase are not clear, but hypotheses propose higher obesity rates, sedentary lifestyles, and comorbid conditions such as diabetes mellitus may be contributing. Tools are available to help primary care physicians determine which patients are at higher risk and who should be screened for CRC (http://www.hhs.gov/familyhistory and http://www.cancer.org/acs/groups/content/documents/document/acspc-024588.pdf ). Additionally, primary care physicians need to be aware of the concerning symptoms that could be related to CRC and warrant an expedited diagnostic work-up. These include a suggestive family history and/or rectal bleeding, anemia, abdominal pain, and change in bowel habits. Most young-onset CRC occurs in the rectum, rectosigmoid, and distal colon, with approximately 86% of patients with young-onset CRC being symptomatic at diagnosis. Primary care physicians play a crucial role in screening and early detection and can help facilitate appropriate referrals for endoscopic work-up in these patients.