Evaluating the age distribution of patients with colorectal cancer: are the United States Preventative Services Task Force guidelines for colorectal cancer screening appropriate?

Abstract

Purpose: Evaluate the appropriateness of the 2008 United States Preventative Services Task Force screening recommendations for colorectal cancer.

Methods: Ages at diagnosis data were collected on patients with colorectal cancer from the William Beaumont Tumor Registry. The database identified 6,925 patients treated for colorectal cancer between January 1973 and December 2007. Patients were divided into 3 age groups at diagnosis categories (younger than 50 years old, those 50 to 75 years old, and those older than 75 years old) to evaluate whether there were changes in the age distribution, pathologic stage, or tumor location during the 35-year period.

Results: The percent of patients with colorectal cancer older than age 75 years increased from 29% to 40% (P < .0001). The combined percentage of patients younger than age 50 years and older than age 75 years has increased from 36% (1973-1978) to 49% (2003-2007). The combined percentages of stage III and IV disease in patients younger than 50 years and older than 75 years were 51% and 34%, respectively (P < .0001). Rectal or left-sided lesions occurred in 68%, 64%, and 50% of patients younger than 50 years old, those 50 to 75 years old, and those older than 75 years old, respectively (P < .0001). Right-sided lesions occurred in 22%, 25%, and 37% of those younger than 50 years old, those 50 to 75 years old, and those older than 75 years old, respectively (P < .0001).

Conclusions: There has been a significant increase in the percentage of colorectal cancer patients older than age 75 years. Failing to screen patients younger than 50 years and older than the age of 75 years would miss 49% of patients treated at our institution from 2003 to 2007.