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Colorectal cancer resection rates increased in patients aged younger than 50 years
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SAN DIEGO — Colorectal cancer resection rates were observed to increase in patients aged younger than 50 years, while the opposite trend was observed in the colorectal cancer resection rates for patients aged oler than 50 years, according to data presented at the 2012 Digestive Disease Week Annual Meeting.
According to the researchers, colorectal cancer resection rates closely estimate colorectal cancer incidence rates as most patients with colorectal cancer undergo resection. National colorectal cancer resection rates in patients aged less than 50 years have increased steadily from 1993 to 2009, while the opposite trend was observed in older persons.
To determine whether environmental risk factors or increased colorectal screening were responsible for the increase in colorectal cancer resection, researchers analyzed national trends in colorectal cancer resection rates using the Nationwide Inpatient Sample.
“We were seeing an alarming increase of younger people with advanced colorectal cancer, who would not have met our screening guidelines as they were under the age of 50,” Parvathi Myer, MD, MHS, a fellow in the Division of Gastroenterology and Hepatology at Stanford University Medical Center told HemOnc Today. “Using data from the National Input Sample, we used colorectal cancer resection as our outcome measure — which is actually the unique thing about this study is that this was our proxy for incidence, the assumption being that most people with colon cancer have surgery, and they only have it done once.”
Researchers identified all cases of colorectal cancer resection from 1993-2009, defined as hospitalizations including an ICD-9 CM procedure code for colorectal resection and a diagnostic code for colon/rectal cancer. Proximal and distal colorectal cancers were defined by a combination of procedure and diagnosis codes — proximal colorectal cancer was defined by resection proximal to the splenic flexure, and distal colorectal cancer by resection of, or distal to, the splenic flexure.
According to study results, the colorectal cancer resection rate for patients aged 18-39 increased from 2.5 (2.1-2.9) in 1993 to 3.1 (2.7-3.5) in 2009 with an increase of 2.4% per year (1.7-3.1%). For patients aged 40-49, colorectal cancer resection rates increased from 16.0 (14.0-17.9) in 1993 to 18.9 (16.8-21.0) in 2009.
“Overall, in patients aged 18-39 there was an increase in colorectal cancer over the time period of the study, with a 2.4% increase per year, which is not necessarily an enormous increase, but it is significant,” Myer said. “When we looked at the statistics in patients aged 40-49, we saw an increase of approximately 1.3% per year, which again, is not a huge increase, but evidence that a significant increase is occurring.”
In contrast, colorectal cancer resection rates for patients aged 50-75 decreased from 128.8 (119.5-138.0) in 1993 to 87.5 (80.0-94.3) in 2009, and colorectal cancer resection rates for ages >75 decreased from 384.3 (359.4-409.2) in 1993 to 216.4 (199.2-233.6) in 2009.
“Essentially, we are trying to figure out the next step in this process: why is this happening?” Myer said. “Hereditary cancer syndromes are a very small proportion of the population so the next step of the study would be to look at whether there are changing environmental factors in younger patients. Common factors would include obesity, BMI, decreased physical activity, and dietary changes.”
Reference:
- Myer P. #1783: Rising Incidence of Colorectal Cancer in Young Adults in the US: Similar Trends Among Men and Women Under Age 50. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, 2012; San Diego.
Disclosures:
- The researchers report consulting relationships with GeneNews, Abbott Laboratories, and Epigenomics, as well as grant/research support from Abbott Laboratories and Epigenomics.