Young Colorectal Cancer Patients Are Going Undiagnosed

Patients under the age of 50 are more likely to initially experience non-specific symptoms of colorectal cancer (CRC) before referral to cancer specialists, according to the findings of a study published in the journal Colorectal Disease.

CRC occurrences are on the rise in young patients, and by 2030 it is estimated that one in 10 colon cancers and one four rectal cancers will be diagnosed in this age group. Contributing factors that explain this trend might be decreasing physical activity and heightened levels of obesity.

In this national population‐based study, researchers assessed 10,463 patients with colorectal cancer whose data were provided by the Clinical Practice Research Datalink (CPRD), a primary-care based dataset which comprises approximately 8-10% of the population in England. The CPRD provided linked data for any patients with a CRC diagnosis in the cancer registry between 2006 and 2013. Of the total number of patients, 7% were younger than 50 years of age, 16% were aged 50-59, 31.4% were aged 60-69, and 45.7% were aged 70-79. Any patients over the age of 80 years old were excluded as they were more likely to be diagnosed as an emergency.  All symptoms, diagnoses, and investigations were recorded by the general practitioner (GP) into an electronic database based on Read codes, which translated into numerical ‘medcodes’ which were supplied to the researchers. The researchers compared odds ratios (ORs) for presenting with a specific symptom for an age group, and appraised data adjusted for patient demographics, and emergency diagnosis. The researchers compared categorical data utilizing the chi-square test with generalized estimating equation modeling used for regression analysis.

Missed Opportunities

The study results revealed that young patients were more likely to present with abdominal pain and via an emergency showed the lowest percentage of early stage cancer. These patients experienced a longer interval between referral and diagnosis (12.5 days) juxtaposed to those aged 60–69, reflecting the higher proportion of referrals via nonurgent visits. “Compared with older patients also presenting with nonspecific symptoms, younger patients were more likely to be diagnosed as an emergency,” the study authors wrote. However, there was no difference in the risk of an emergency presentation if the presenting consultation included a red‐flag.”

They added that for CRC patients diagnosed as a nonemergency “there was no significant delay in referral between the age groups. However, young patients experienced a significantly longer interval from referral to diagnosis compared with all other ages, reflecting the higher proportion of nonurgent referrals.”

The study authors continued by writing that “our study suggests that young patients experience missed opportunities for a nonemergency diagnosis.”