Zaid Abdelsattar and Samantha Hendren had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Zaid Abdelsattar and Samantha Hendren were responsible for the conception and design of the study. Zaid Abdelsattar was responsible for data acquisition. All authors contributed to the data analysis and interpretation, and all authors drafted the article. All authors provided final approval of the article.
Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening
Version of Record online: 25 JAN 2016
© 2016 American Cancer Society
Volume 122, Issue 6, pages 929–934, March 15, 2016
How to Cite
Abdelsattar, Z. M., Wong, S. L., Regenbogen, S. E., Jomaa, D. M., Hardiman, K. M. and Hendren, S. (2016), Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer, 122: 929–934. doi: 10.1002/cncr.29716
Presented in part as a poster presentation at the 2015 American Society of Colon and Rectal Surgeons Annual Scientific Meeting; May 30-June 3, 2015; Boston, MA.
- Issue online: 3 MAR 2016
- Version of Record online: 25 JAN 2016
- Manuscript Accepted: 28 AUG 2015
- Manuscript Revised: 22 AUG 2015
- Manuscript Received: 11 JUN 2015
- Zaid M. Abdelsattar is supported by Agency for Healthcare Research and Quality. Grant Number: T32 HS000053-23
- Sandra L. Wong is supported by Agency for Healthcare Research and Quality. Grant Number: 1K08 HS20937-01
- American Cancer Society. Grant Number: RSG-12-269-01-CPHPS
- Scott E. Regenbogen is supported by the American Society of Colon and Rectal Surgeons Research Foundation
- Samantha Hendren is supported by National Institutes of Health/National Cancer Institute. Grant Number: 1K07 CA163665-22
- American Society of Colon and Rectal Surgeons Research Foundation
- colorectal cancer;
- young onset
Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown.
The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis.
Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease.
Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults. Cancer 2016;122:929–34. © 2016 American Cancer Society.