1 in 6 early-onset colorectal cancer survivors diagnosed with subsequent cancer
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CHICAGO — Among those who survived early-onset colorectal cancer, approximately 16% developed a second cancer, with higher risk reported among men, according to a population-based study presented at Digestive Disease Week.
“The number of cancer survivors is increasing and is projected to grow to 26 million by 2040 in the United States,” Aniruddha Rathod, PhD, MBBS, MPH, a postdoctoral researcher at Peter O’Donnell Jr. School of Public Health at University of Texas Southwestern Medical Center, told Healio. “These survivors are at an increased risk of developing another cancer in future.
“Early-onset colorectal cancer incidence rates have been rising in the United States and around the world. There is a lack of knowledge regarding the specific needs of this expanding group, and our investigation contributes to better inform screening and surveillance recommendations among early-onset colorectal cancer survivors.”
Using data from the Nation Cancer Institute’s Surveillance, Epidemiology and End Results Program, Rathod and colleagues investigated the risk for subsequent cancers among 7,041 survivors (52.4% men, 60.5% non-Hispanic white, 72.6% aged 40-49 years) diagnosed with early-onset CRC (stage 0-III) between 1992 and 1999. Researchers also identified risk factors related to individual patients, type of tumors and treatment, and stratified all analyses by sex.
Overall, 16.2% of patients developed a second cancer, which included 337 second CRC diagnoses. Further, 25-year cumulative incidence of a subsequent cancer was 18.5% (95% CI, 17-20) among men and 16.8% (95% CI, 15-18) among women, and 6.4% (95% CI, 5-7) and 4.4% (95% CI, 4-5), respectively, for a second CRC diagnosis.
By age 70 years, cumulative incidence for any cancer was 19.7% (95% CI, 18-21) in men and 18.4% (95% CI, 17-20) in women, and 6.6% (95% CI, 6-8) and 4.5% (95% CI, 4-5) for CRC.
“Among those developing future cancer, the four most common types of future cancers were colorectal, breast, prostate and lung cancer,” Rathod noted.
Factors associated with an increased risk for cancer of any type among men included lower county-level median household income (< 70,000 vs. > 70,000; HR = 1.3; 95% CI, 1-1.5), higher tumor grade (4 vs. 1; HR = 3.9; 95% CI, 1.8-8.4) and histology (mucinous adenocarcinoma vs. non-adenocarcinoma; HR = 4.6; 95% CI, 1.6-12.9). For women, factors included higher stage (II vs. 0-I; HR = 0.75; 95% CI, 0.59-0.97; III vs. 0-I; HR = 0.51, 95% CI, 0.39-0.66) and tumor location (distal vs. proximal colon; HR = 0.75; 95% CI, 0.6-0.95; rectum vs. proximal colon; HR = 0.5; 95% CI, 0.38-0.65).
“Our findings suggest that one in six persons diagnosed with stage 0 to III early-onset colorectal cancer between 1992 to 1999 was diagnosed with a future cancer in a U.S. based population cohort,” Rathod said.
“There are no known guidelines available specifically tailored for early-onset colorectal cancer survivors related to testing for future cancers,” he continued. “The recommendations from professional societies are for CRC only and vary widely. Given available screening and early detection tests for these cancers, there may be opportunity to refine screening and surveillance strategies for early-onset colorectal cancer survivors given the prevalence of these future cancer types.”
Perspective
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Joshua Sommovilla, MD
With increasing focus on diagnosing and treating the increasing number of younger individuals with colorectal cancer, the survivorship needs of this patient population should not be overlooked. This article focuses on an important aspect of colorectal cancer survivorship: the future risk for developing subsequent cancers.
We know from studies done at our institution and others that young patients with colorectal cancer are more likely to be impacted by hereditary cancer syndromes than older individuals. This likely explains some of the elevated cancer risk, highlighting the importance of genetic counselling and testing for these patients. It does not, however, offer a full explanation of the elevated risk, as these syndromes still only impact a minority of patients.
The subsequent cancers found in the study include colon and rectal cancers, as well as lung, breast and prostate cancer. The screening tests used for each of these cancers vary in their effectiveness, risks and downsides in both average-risk and high-risk populations. This study’s findings suggest that a history of colorectal cancer at a young age may be yet another factor in determining how to best employ screening tests for colorectal as well as other common cancers.
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Rathod A, et al. Abstract 114: Risk of second cancers in a population-based sample of 7,000 survivors of early-onset colorectal cancer. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid).
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