Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: colorectal cancer; outcomes; screening; treatment; young onset.

Figure 1

Adjusted proportion of patients presenting with localized, regional or distant disease by age group at diagnosis. The multinomial regression model adjusted for sex, race, marital status, tumor location, and year of diagnosis. p<0.001 for all pairwise comparisons.

Figure 2

Adjusted 5-year cancer-specific survival for patients too young for average-risk screening and those 50 years or older, stratified by stage at presentation. The Weibull survival model adjusted for sex, race/ethnicity, marital status, tumor location, stage at diagnosis, receipt of cancer-directed surgery or radiation, and the year of diagnosis.