Red Flag Signs and Symptoms for Early Diagnosis of Early-Onset Colorectal Cancer Summary Background Early detection of colorectal cancer before the age of 50 (early-onset CRC) is a clinical priority due to its alarming increase. Methods We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18 to 64 years) with ≥2 years of continuous enrollment (2006-2015) to identify red flag signs/symptoms 3 months to 2 years before the index date among 17 prespecified signs/symptoms. We evaluated diagnostic intervals based on the presence of these signs/symptoms before and within 3 months of diagnosis. Results Between 3 months and 2 years before the index date, four red flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with ORs ranging between 1.34 and 5.13. Having 1, 2, or ≥ 3 of these signs/symptoms was associated with a risk of 1.94 (95% CI, 1.76 to 2.14), 3.59 (2.89 to 4.44), and 6 .52 (3.78 to 11.23) times (P trend < .001), with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Fheterogenity=0.012). The number of different signs/symptoms was predictive of early-onset CRC that began 18 months before diagnosis. About 19.3% of cases had their first sign/symptom between 3 months and 2 years before diagnosis (median diagnostic interval: 8.7 months), and about 49.3% had the first sign/symptom within within 3 months after diagnosis (median diagnostic interval: 0.53). Conclusions Early recognition of warning signs and symptoms (abdominal pain, rectal bleeding, diarrhea, or iron deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC. |
Comments
Researchers at Washington University School of Medicine in St. Louis have identified four important signs and symptoms that indicate an elevated risk of early-onset colorectal cancer. These warning signs may be key to earlier detection and diagnosis of early-onset colorectal cancer among younger adults. The number of young adults with colorectal cancer has nearly doubled in recent years.
By studying anonymized health insurance data from more than 5,000 patients with early-onset colorectal cancer (cancer that occurs before a person turns 50), researchers found that in the period between three months and two years before diagnosis, Abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia indicate a higher risk in people under 50 years of age. They found that having just one of the symptoms nearly doubled the risk; having two symptoms increased the risk by more than 3.5 times; and having three or more increased the risk by more than 6.5 times.
The study is published in the Journal of the National Cancer Institute .
“Colorectal cancer is not simply a disease that affects older people; “We want younger adults to be aware of these potentially very telling signs and symptoms and act accordingly, especially since people under 50 are considered low risk and do not undergo routine colorectal cancer screening.” said principal investigator Yin Cao, ScD, associate professor of surgery in the Division of Public Health Sciences and research fellow at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.
“Raising awareness among primary care physicians, gastroenterologists and emergency physicians is also crucial,” Cao said. "To date, many early-onset colorectal cancers are detected in emergency rooms and there are often significant delays in the diagnosis of this cancer."
Cao said two symptoms in particular, rectal bleeding and iron deficiency anemia , a condition in which there are not enough healthy red blood cells to carry oxygen, point to the need for timely endoscopy and follow-up.
In this study, Cao, with first author Cassandra DL Fritz, MD, assistant professor of medicine in the Division of Gastroenterology, and co-senior author Ebunoluwa Otegbeye, MD, general surgery resident, analyzed early-onset colorectal cancer cases and controls combined using the commercial IBM MarketScan database, a big data tool that provides longitudinal, de-identified information based on health insurance claims data from approximately 113 million insured adults ages 18 to 64.
“It typically takes about three months to get a diagnosis from the time a person first goes to the doctor with one or more of the red flag signs and symptoms we have identified,” Fritz said. “But in this analysis, we found that some young adults had symptoms up to two years before their diagnosis. "That may be part of the reason why many of these younger patients had more advanced disease at the time of diagnosis than we typically see in older people who are screened regularly."
People born in 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared to young adults born in 1950. That trend has led the National Cancer Institute, the American Cancer Society, the American Gastroenterological Association and other professional societies to prioritize research into identifying risk factors and improving early detection. In 2021, the US Preventive Services Task Force lowered the recommended age for colorectal cancer screening from 50 to 45 years.
Cao, also an associate professor of medicine, leads a research group focused on identifying risk factors and molecular variations in early-onset colorectal cancer. His group is among the first to report that obesity, prolonged sitting, metabolic syndrome, diabetes, sugary drinks and other risk factors may contribute to the increased incidence of early-onset colorectal cancer.
According to the American Cancer Society, although the death rate from colorectal cancer has been declining for several decades in older adults due to regular colonoscopies and improved treatment, more younger people are being diagnosed with the disease in advanced stages and many They die from the disease. .
Such a change suggests the urgency of recognizing symptoms as soon as possible.
“Since most cases of early-onset colorectal cancer have been and will continue to be diagnosed after the presentation of symptoms, it is crucial to recognize these warning signs and symptoms immediately and make a diagnosis as soon as possible,” Cao said. . “By doing so, we can diagnose the disease earlier, which in turn can reduce the need for more aggressive treatment and improve patients’ quality of life and survival rates.”
