Mortality rates from early-onset colorectal cancer have increased significantly

Philadelphia — Early-onset mortality rate colorectal cancer (EO-CRC) has increased significantly across the United States over the past 20 years, with the impact most pronounced among people ages 20 to 44, according to a new analysis of two major U.S. mortality databases. Understood.

Data from the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and Surveillance, Epidemiology, and End Results (SEER) databases. Increased prevalence of EO-CRCThis is defined as a diagnosis of CRC in a patient younger than 50 years.

Additionally, the researchers reported that increased mortality occurred in all patients in the study (ages 20 to 54), regardless of tumor stage at diagnosis.

These findings “promote further efforts to increase awareness of colorectal cancer symptoms and keep clinical suspicion low in young patients presenting with colorectal cancer symptoms.” anemiagastrointestinal bleeding, or changes in bowel habits,” said Yazan Aboud, MD, PGY-3, Internal Medicine, associate chief resident and resident research director at Rutgers New Jersey Medical School. Medscape Medical News.

Mr. Abboud presented the findings (Abstract P3865) here American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting.

Analysis of NCHS and SEER

Due to rising EO-CRC rates, the American Medical Association had recommended lowering the screening age to 45 years. U.S. Preventive Services Task Force was officially withdrawn In 2021, to this era. This change supported by real-world evidenceThis shows that early screening significantly reduces the risk of colorectal cancer. However, as colorectal cancer cases among older adults are decreasing overall; considerable interest Our aim is to determine why young people are experiencing a paradoxical increase in EO-CRC and how this impacts associated mortality.

Abboud et al. collected age-adjusted mortality rates for EO-CRC from 2000 to 2022 from the NCHS database. In addition, stage-specific incidence-based mortality rates from 2004 to 2020 were obtained from the SEER 22 database. The NCHS database covers approximately 100% of the U.S. population, while the SEER 22 database included in the NCHS covers 42%.

The researchers divided patients into two cohorts based on age (20 to 44 years and 45 to 54 years) and tumor stage at diagnosis (early stage and late stage), and calculated annual percentage change (APC) and mean APC. compared. 2 groups. They also assessed trends across the patient cohort aged 20 to 54 years.

In the NCHS database, there were a total of 147,026 deaths attributable to EO-CRC across all ages studied, of which 27% (39,746) were between 20 and 44 years of age. Associated mortality decreased from 2000 to 2005 (APC = -1.56) but increased from 2005 to 2022 (APC = 0.87) for all age groups studied.

For the 45-54 year old cohort, mortality decreased from 2000 to 2005 and then increased, whereas for the 20-44 year old cohort, mortality increased steadily over the entire follow-up period from 2000 to 2022. (APC = 0.93). Comparison of age cohorts confirmed a larger increase in mortality for people aged 20–44 years (mean APC = 0.85; mean APC = 0.85; mean APC = 0.85; mean APC = 0.85; P < .001).

In the SEER 22 database, there were 4,652 deaths among patients with early-stage tumors across all age groups studied (mean APC = 12.17). Mortality was increased in patients aged 45 to 54 years with early-stage tumors (mean APC = 11.52), but there were insufficient numbers of patients aged 20 to 44 years to judge this outcome.

In the SEER 22 database, the number of deaths among patients with terminal tumors across all age groups was 42,120 (mean APC = 10.05). And increased mortality was observed in patients with late-stage tumors in both age cohorts of 45-54 years (mean APC = 9.58) and 20-44 years (mean APC = 11.06).

“When we evaluated the SEER database and stratified tumors by stage at diagnosis, we found that early-onset colorectal cancer mortality increased on average over the study period for both early-stage and late-stage tumors. It has been proven that the Medscape Medical News.

Identifying patients at risk

Leave a comment Medscape Medical NewsDavid A. Johnson, M.D., professor of medicine and chief of gastroenterology at Eastern Virginia Medical University in Norfolk, said the study's findings call for evidence-based tools to identify young people at increased risk for EO-CRC. He said that it tells the story.

“We suspect that in many young patients with bowel cancer, the onset and diagnostic tests were delayed, so it was discovered when the cancer was more advanced,” said Professor Johnson, who was not involved in the study. Ta.

However, it would be interesting to assess whether the cancers in the 20-44 year old cohort are biologically more aggressive, or whether these patients are ignoring early signs and symptoms, he said. said.

Johnson said younger patients may ignore the “alert” feature that indicates a colon cancer test. “Particularly in these younger cohorts, evaluation should focus on frank bleeding and iron deficiency.”

“Future studies are needed to investigate the role of neoadjuvant chemotherapy in young patients with early-stage colorectal cancer and assess patient outcomes,” Aboud added.

This study received no specific funding. Mr. Aboud reported no relevant financial relationships. Mr. Johnson reported that he serves as an advisor to ISOTHRIVE. He is also a member of the editorial board of Medscape Gastroenterology.

John Watson is a freelance writer living in Philadelphia.