Researchers identify higher rates of young-onset CRC mortality in Midwest, Great Lakes regions
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Researchers have discovered geographic patterns of mortality rates among patients with young-onset colorectal cancer in the United States, according to findings published in Gastroenterology.
Using CRC-specific mortality data from 3,036 U.S. counties from 1999 to 2019, researchers at the Lerner Research Institute and the Center for Young-Onset Colorectal Cancer at Cleveland Clinic categorized patients by age at diagnosis and adjusted for young-onset CRC risk factors and prognostic indicators. They identified new young-onset CRC mortality hot spots in the Midwest and northeastern Great Lakes region and cold spots in western and southwestern counties, which have a lower risk for young-onset CRC mortality.
In an interview with Healio, Blake Buchalter, PhD, MPH, study author and postdoctoral fellow in the department of quantitative health sciences and Genomic Medicine Institute at Cleveland Clinic Lerner Research Institute, highlighted key takeaways from the study and detailed future research directives.
Healio: What was the main driver behind your team’s decision to explore this topic?
Buchalter: Incidence and mortality of colorectal cancer among those diagnosed under the age of 50 have been rising in the United States since the mid-1990s with poorly understood geographic patterns and causes.
We aimed to build upon and clarify the existing geospatial literature by identifying geographic hot and cold spots showing where young-onset colorectal cancer (yoCRC) mortality is significantly more or less common than expected.
Healio: How was the study designed?
Buchalter: We utilized 1999-2019 CDC WONDER Underlying Cause of Death data and geographic information system spatial clustering methods to retrospectively identify geographic hot and cold spots of yoCRC in U.S. counties. Unlike previous work, we directly adjusted for risk factors and prognostic indicators, such as smoking and obesity, when identifying hot and cold spots and stratified yoCRC into younger (< 35 years) and older (35-49 years) age categories to examine how clustering patterns might differ between these populations.
Healio: What were the main takeaways?
Buchalter: Geographic hot spots of yoCRC mortality among older patients (35-49 years) more closely matched the southern U.S. patterns seen for average-onset CRC, while mortality hot spots among the youngest yoCRC patients (< 35 years) have distinct hot spot patterns in the Midwest and Great Lakes region. There were also vast yoCRC mortality cold spots across the western U.S. for all age categories.
Healio: How will these results inform patient care going forward?
Buchalter: These are aggregated ecological results, so patient care should not be adjusted from these results alone. These findings should serve as a baseline for further in-depth study to both confirm the hot and cold spots we identified and also consider applying more granular patient-level data within the sub-region hot spots we found.
Healio: What additional research is needed?
Buchalter: More descriptive and associative epidemiological work is needed, particularly spatiotemporal studies in order to improve understanding of when and where the rise in yoCRC incidence/mortality began. More research utilizing large cohorts and cancer registry data may help to elucidate the underlying drivers and causes of the rise.
I think it is important to emphasize again that these are findings from county-aggregated data and should be viewed as a starting place for further study. Also, these data are from before the U.S. Preventive Services Task Force changed their recommendations for beginning colorectal cancer screening at 45 years old.
References:
- Buchalter BR, et al. Gastroenterology. 2022;doi:10.1053/j.gastro.2022.06.044.
- Cleveland Clinic Lerner Research Institute. Researchers discover young-onset colorectal cancer mortality hot and cold spots. Available at: https://www.lerner.ccf.org/news/details/?Researchers+Discover+Young-Onset+Colorectal+Cancer+Mortality+Hot+and+Cold+Spots. Accessed: July 18, 2022.
Perspective
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The alarming rise in CRC among people aged younger than 50 years has been garnering increased attention from physicians, researchers and the lay population. Key questions that still need to be answered are which young individuals are at increased risk for CRC and which environmental factors are responsible.
In this study, we utilized CDC data to determine geographic hot and cold spots for mortality from yoCRC. These areas, based on county-level data, were adjusted for other known risk factors for CRC. Interestingly, we found that when looking specifically at the youngest cohort of patients (< 35 years), the geographic pattern for CRC mortality was significantly different from the one seen in average age-onset patients.
These findings lay the groundwork for further in-depth research that could help elucidate which environmental exposures are more common among young people living in hot spots vs. those in cold spots and thereby uncover novel risk factors that may be contributing to the alarming rise in yoCRC. These risk factors could then help guide risk-based screening and inform preventative measures with the potential of stemming the tide of yoCRC.
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