TY - JOUR
T1 - The increasing incidence of young-onset colorectal cancer
T2 - A call to action
AU - Ahnen, Dennis J.
AU - Wade, Sally W.
AU - Jones, Whitney F.
AU - Sifri, Randa
AU - Silveiras, Jose Mendoza
AU - Greenamyer, Jasmine
AU - Guiffre, Stephanie
AU - Axilbund, Jennifer
AU - Spiegel, Andrew
AU - You, Y. Nancy
N1 - Funding Information:
Grant Support: This work was supported by the Colon Cancer Alliance and partially supported by the University of Texas MD Anderson Cancer Center G. S. Hogan Gastrointestinal Cancer Research Fund (Y.N.Y.).
Funding Information:
Potential Competing Interests: Dr Ahnen serves on the scientific advisory boards of EXACT Sciences and CM&L Pharma. Dr Jones is a member of the Salix Pharmaceuticals speaker’s bureau and a partner in Premier Surgical Center, Louisville, KY. Dr You receives funding from the University of Texas MD Anderson Cancer Center G. S. Hogan Gastrointestinal Cancer Research Fund. Ms Guiffre, Dr Mendoza Silveiras, Mr Spiegel, and Ms Greenamyer are employees of the Colon Cancer Alliance, and Ms Wade serves as a consultant to the Colon Cancer Alliance. Dr Sifri and Ms Axilbund have no conflicts of interest to disclose.
Funding Information:
Population-based CRC screening for asymptomatic, average-risk individuals starting at 50 years of age is supported by the US Preventive Services Task Force, the Agency for Healthcare Policy and Research, the US Multi-Society Task Force, and various specialty organizations. 46,47,64-66 From 1975 to 2000, screening has been credited with approximately half of the 22% decrease in CRC incidence and the 26% reduction in CRC mortality, with treatment and risk factor reductions accounting for the remaining gains. 5
PY - 2014/2
Y1 - 2014/2
N2 - In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.
AB - In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.
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U2 - 10.1016/j.mayocp.2013.09.006
DO - 10.1016/j.mayocp.2013.09.006
M3 - Review article
C2 - 24393412
AN - SCOPUS:84897575984
SN - 0025-6196
VL - 89
SP - 216
EP - 224
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 2
ER -