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Researchers target delays in diagnosis, rising incidence of young-onset colorectal cancer
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Data presented at this year’s American Association for Cancer Research Annual Meeting suggest young-onset colorectal cancer often is misdiagnosed and identified at later stages.
Additionally, nearly 70% of patients younger than 50 years reported having to see at least two physicians before being diagnosed with colorectal cancer.
These results are concerning but should be taken with a grain of salt, according to Hisham Hussan, MD, physician in the division of gastroenterology at The Ohio State University Wexner Medical Center.
“The study is consistent with prior reports showing a delay in colon cancer diagnosis among younger adults,” Hussan told HemOnc Today. “However, there may be some bias here, since the researchers only used social media to contact patients — they did not contact patients without social media. Therefore, the data may not be a complete representation of the entire population of early-onset colorectal cancer.”
HemOnc Today spoke with Hussan, a member of the international working group investigating early-onset colorectal cancer, about why the results are important, what factors need to be considered regarding this trend and what future research on this topic should entail.
Question: What does the most recent research on early-onset colorectal cancer suggest ?
Answer : The data suggest there has been a doubling of cases of colorectal cancer among patients younger than 50 years since the early 1990s, especially for rectal cancer. We believe there is an increased risk for early-onset colorectal cancer in this younger population, and prior reports show that there is a delay in diagnosis. People who are older than 50 years usually undergo colonoscopy screening. Because of this, they are diagnosed with colon cancer in the early stages. Patients younger than 50 years who develop colon cancer usually are diagnosed at later stages because they do not undergo screening and only present once they experience symptoms, such as bleeding, weight loss and changes in bowel habits.
Q: What factors need to be taken into consideration regarding this trend?
A: My colleagues and I presented an abstract at American College of Gastroenterology Annual Meeting that showed obesity was associated with early-onset colorectal cancer. We hypothesize that obesity plays a huge role in early-onset colorectal cancer in combination with an animal-based diet and lack of exercise. On the other hand, a plant-based diet, exercise and weight loss can reduce the risk for colon cancer. We think these risk factors are also present among those aged older than 50 years but, because we are performing colonoscopy in this older population, we are not seeing the same increase in colon cancer that we are seeing in the younger population.
Q: What should future research on this entail?
A: We are conducting prospective studies looking at risk factors for colon cancer among adults younger than 50 years. Future research should focus on diet, exercise and impact of the microbiome. This will be the future of the research on this topic — what is the cause and how do we prevent it?
Q: Is there anything else that you would like to mention?
A: The rate of colon cancer is increasing among young individuals. Medical providers must keep this in mind when they evaluate rectal bleeding, weight loss or changes in bowel habits among this young population of patients to reduce delays in diagnosis. – by Jennifer Southall
References:
Dozois EJ, et al. Medicine. 2008;doi:10.1097/MD.0b013e3181881354.
Dwyer AJ, et al. Gastroenterology. 2019;doi:10.1053/j.gastro.2019.04.049.
Järvinen HJ, et al. Scand J Gastroenterol. 1984;19:634-638.
O’Connell JB, et al. Am J Surg. 2004;doi:10.1007/s00268-004-7306-7.
Yarden R, et al. Abstract 3347/13. Presented at: AACR Annual Meeting; March 29-April 3, 2019; Atlanta.
For more information:
Hisham Hussan, MD, can be reached at The Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, OH 43210; email: hisham.hussan@osumc.edu.
Disclosure : Hussan reports no relevant financial disclosures.