NEW YORK (Reuters Health) – New research suggests a small survival benefit for people with early-onset colorectal cancer (CRC), particularly those aged 35 to 39 years, compared with diagnosis at later ages.
The findings “reinforce the importance of early CRC detection in the younger population,” Dr. En Cheng of the Yale School of Public Health in New Haven, Connecticut, and colleagues write in JAMA Network Open.
The researchers characterized overall survival for early-onset CRC (before age 50) compared with later-onset CRC (ages 51 to 55 years, reference group) using data from the National Cancer Database.
Among more than 769,000 individuals with CRC, 46% died during a median follow-up of 2.9 years, including 13.3% of those with early-onset CRC and 10.2% with later-onset CRC.
Compared with the later-onset group, the early-onset group had a lower 10-year survival rate in an unadjusted analysis (53.6% vs. 54.3%) in the unadjusted analysis.
However, after adjusting for other factors associated with mortality, most notably disease stage, individuals with early-onset CRC had a lower risk of dying during follow-up than those with later-onset CRC (adjusted hazard ratio, 0.95; 95% confidence interval: 0.93 to 0.96; P<0.001).
The survival advantage was greatest for people diagnosed with CRC between aged 35 and 39 years and stages I and II and was absent among those diagnosed before age 25 and stages III through IV.
“This study’s finding that younger individuals with CRC had increased mortality in unadjusted analyses, which was associated with being diagnosed at later stages of illness, suggests that more attention in screening given to younger individuals may reduce their mortality if their diseases can be detected at earlier stage,” Dr. Cheng and colleagues write.
They say the finding of a survival advantage associated with early-onset CRC among younger individuals “should be interpreted cautiously, given that the advantage had a small magnitude and was heterogeneous by age and stage. Further study is needed to understand the underlying heterogeneity of survival by age and stage among individuals with early-onset CRC.”
Updated recommendations from the U.S. Preventive Services Task Force (USPSTF) advise CRC screening in people as young as age 45 (https://bit.ly/35suAub).
The authors of an invited commentary say given the fairly low incidence of CRC before age 45, “there has been little to no evidence to support screening asymptomatic patients younger than 45 years. However, a full diagnostic evaluation is warranted for patients of any age who present with signs and symptoms concerning for CRC, which is reiterated by the results of the study by Cheng et al.”
Dr. Kirbi Yelorda and co-authors with Stanford University in California say CRC screening for patients 50 years and older has been “well studied and proven effective in lowering the overall observed incidence of CRC.”
“While CRC diagnoses and CRC-related deaths have been trending up in patients aged 50 years and younger, one would expect this trend to slow as the new screening age of 45 years or older is implemented,” they note.
“CRC diagnoses in patients younger than 45 years continue to represent a small percentage of all CRC diagnoses, but the findings by Cheng et al provide optimism about treatment outcomes in these patients. More information is needed to understand how the updated USPSTF CRC screening recommendations could impact mortality in patients screened between the ages of 45 and 50 years,” they conclude.
The study was supported in part by the National Institutes of Health and Stand Up To Cancer.
SOURCE: https://bit.ly/3qgKgut and https://bit.ly/3zBF1JO JAMA Network Open, online June 16, 2021.