Diagnosis of colorectal cancer in young adults

Important points

• Young adults with colon cancer are usually diagnosed with a more aggressive form of the disease at a later stage. There are also racial and ethnic disparities, including significantly higher rates of colon cancer among non-Hispanic black adults.

• Obesity, family history, inflammatory bowel disease, and symptoms such as abdominal pain and rectal bleeding are factors strongly associated with colon cancer in young people.

• Important concerns for young adults diagnosed with colorectal cancer include fertility, family planning, career aspirations, and financial security.

Young adults with colon cancer tend to be diagnosed at a later stage and have more aggressive tumors. Furthermore, two studies presented at the American College of Surgeons (ACS) Clinical Meeting found that younger patients living with colorectal cancer have a different long-term impact on their lives than the disease* has on older people. It was found that it had a negative impact. 2024, San Francisco, California.

Sociodemographic and patient characteristics associated with colon cancer in adults younger than 45 years

Colon cancer is the leading cause of cancer-related death in the United States and is typically associated with older adults. “We know that over the past 20 years, the rate of colon cancer diagnosis among patients aged 66 and older has decreased by 20%. However, the incidence of this cancer among those aged 18 to 44 has decreased by 15% over the same period. ,” said study lead author Kelly Chan, M.D., a clinical scholar in the ACS Cancer Program and a fourth-year general surgeon. Resident at Loyola University Medical Center in Chicago.

To understand why colon cancer is affecting more young adults, researchers examined sociodemographic factors and tumor biology in young adults associated with colon cancer. Using the National Cancer Database, a large, hospital-based database that captures approximately three-quarters of all cancers diagnosed in the United States, researchers studied two groups: young people diagnosed (18 ~44 years) and older adults (45 years and older). I had colon cancer between 2015 and 2021.

Research results

From 2015 to 2021, there were 318,951 new cases of colon cancer diagnosed at Commission on Cancer (CoC) hospitals. Of these, 16,974 (5.6%) were young (18-44 years old) and 301,977 (94.4%) were elderly. Comparing age groups, researchers found that a higher proportion of young adults had late-stage disease with more aggressive tumors. Additionally, a higher proportion of young non-Hispanic black Americans (16.9%) had colon cancer compared to the proportion of non-Hispanic black Americans who make up the general U.S. population (12.1%).

“These findings highlight disparities in colon cancer incidence in this population, following previous studies showing that early-onset colon cancer diagnoses are highest in non-Hispanic black patients compared to other groups. “This is consistent with research,” Dr. Chan said.

After adjusting for sociodemographic factors and other serious health conditions, the disease in young adults is strongly associated with obesity, family history of colon cancer, inflammatory bowel disease, and symptoms such as abdominal pain and rectal bleeding. Researchers have discovered something.

“Other studies have demonstrated that colon cancer in young adults has more aggressive molecular and genetic features. Therefore, taken together, our findings demonstrate that colon cancer in young adults has more aggressive molecular and genetic features. “This study highlights the need for further research to understand the development of colon cancer in patients and to revise risk assessments to improve prevention and screening before these cancers progress to later stages,” said Dr. Chan. said. .

In terms of limitations, approximately one-quarter of the U.S. cancer population is treated at non-CoC accredited hospitals and was not included in this study. This means that some differences based on region, race, and ethnicity may not have been taken into account.

A new population perspective: investigating colorectal cancer in adults under 50 years of age

For young adults, a cancer diagnosis has many far-reaching effects that are not fully explained. “Colorectal cancer is increasing in young adults, but it comes with many unique circumstances,” said lead study author Samantha Savich, M.D., a fourth-year general surgery resident at the University of Michigan in Ann Arbor. said. “We need to recognize that colorectal cancer affects young people at this developmental stage in their lives and find more holistic ways to address their concerns.”

To better understand the experiences of young people with colorectal cancer, the research team conducted interviews with 35 patients diagnosed with colorectal cancer before the age of 50. Participants were recruited from three academic medical centers receiving cancer treatment. Participants were asked open-ended questions about the impact of their cancer diagnosis on their lives, their daily challenges, and concerns about the future.

Patients were most concerned about four areas of health and well-being: physical health, mental health, family planning, and career. Specifically, their responses revealed that infertility, anxiety, uncertainty about diagnosis and long-term survival, and the inability to accumulate assets, pursue higher education, or establish job security were most important. I did. Moreover, these concerns were not gender-specific. Career, physical health, financial security, mental health, fertility, and family planning were equally important to both men and women.

The study authors believe that this understanding of patient concerns can lead to further conversations about the comprehensive needs of young patients and develop programs that address patients' unique challenges, such as infertility counseling, financial support, and mental health counseling. We hope that interest in creating this will increase.

“These aspects of cancer treatment are rarely discussed, leaving patients concerned about fertility, family planning, career aspirations, wealth creation, and all the other things they have to put on hold because of a cancer diagnosis. It's important to recognize that,” Dr. Savich said. . “This is not just colorectal cancer. Cancer is increasing in younger patients overall. There are many patients who are experiencing similar challenges. Further research is needed to better understand these issues in patients with cancer and ultimately restructure comprehensive cancer programs to ensure they are treating patients. It's just a disease.”

The main limitation of this study is that results can be biased in this type of study, called convenience sampling.

Co-authors of the study on sociodemographic and patient characteristics associated with colon cancer are Brian Paris, MA; Dr. Joseph Kotler. Xuan Zhu, MPH; Anani Hegnifio, MS; and Clifford Y. Ko, MD, FACS.

Dr. Kelly Chan is supported through an American College of Surgeons Clinical Fellowship.

Co-authors of the Emerging Population Perspectives in Colorectal Cancer study are Sarah Bradley, Ph.D., MPH, CPH; Mede Marzogi, Bachelor of Science; Clare Ashmead Mears, MA; Crystal A. Vitas, MA, MPH; Pasithorn A. Suwanabol, MD, MS, FACS.

This research was supported by the Rogel Cancer Center at the University of Michigan, Ann Arbor.

*Note: “Colon cancer” refers to cancer of the colon, and “colorectal cancer” includes both colon cancer and rectal cancer. Dr. Chan's study analyzed colon cancer, and Dr. Sabich's study analyzed colorectal cancer.

Quote:

• Zhang K et al. Sociodemographic and patient characteristics associated with colon cancer in young adults under 45 years of age, Scientific Forum, American College of Surgeons (ACS) Clinical Meeting 2024.

• Savich S. et al. Emerging Population Perspectives: Exploring Colorectal Cancer in Adults under 50, Scientific Forum, American College of Surgeons (ACS) Clinical Congress 2024.

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