Introduction

The incidence of early-onset colorectal cancer (EOCRC, <45 years) is on the rise among adults, including African Americans (AA).

Aims & Methods

Aim: To investigate differences between EOCRC and late-onset colorectal cancer (LOCRC, >45 years) in AA patients and understand the trend patterns in the last decade, particularly during the COVID era.
Methods: We conducted a retrospective review of patient records at Howard University Hospital from 2011 to 2022. Our analysis included demographics, clinical presentations, pathology reports, and colonoscopy records. A three-year interval analyses were performed, with a specific focus on the COVID-19 period (2020-2022) and compared it with preceding years to discern temporal trends. Our cohort consisted of 23 EOCRC individuals, and 192 LOCRC.

Results

The majority (80%) of our cohort consisted of AA. A high proportion of males were diagnosed with colorectal cancer (CRC) during the COVID-19 period (2020-2022), with rates of 87.5% in EOCRC versus 75% in LOCRC, in contrast to a nearly equal gender distribution in preceding years. The incidence of CRC fluctuated over the study period, with a higher observed incidence between 2011-2013 that gradually declined until 2019, followed by a notable spike during the COVID era (2020-2022), particularly in EOCRC patients probably due to an increase in smoking, alcohol consumption, and obesity in both LOCRC and EOCRC groups.
The predominant initial symptom for EOCRC patients persisted as abdominal pain. However, our temporal analysis uncovered a noteworthy rise in the incidence of altered bowel habits (75% vs. 50%) and hematochezia (75% vs. 52%), especially in the recent COVID era in EOCRC patients compared to LOCRC patients. Importantly, these shifts were noted to be the primary indications for colonoscopy among EOCRC patients (p=0.044). In the COVID era, EOCRC patients exhibited a predominant left-side occurrence (p=0.040), unlike the balanced distribution in 2017-2019. Overall, LOCRC patients mostly had cancers on their right side. Analysis of cancer stage revealed a significant shift in EOCRC patients presenting in stage 4 during 2011-2016 to stage 2 in the COVID era (p=0.042), suggesting increased awareness or a more symptomatic presentation that led to early diagnostic evaluation. There was no statistically significant difference in cancer type between the groups, with adenocarcinoma being the most common. due to decreased screening.

Conclusion

In our study, we found a notable increase in CRC during the COVID-19 era, especially among young AA males. Shifts in lifestyle and clinical presentations highlight the necessity for addressing the healthcare strategies in this group. EOCRC patients showed left-sided cancer predominance and a shift from stage 4 to stage 2, suggesting potential improvements in awareness and early detection.

Disclosure

None

Introduction

Colorectal cancer’s (CRC) incidence above 50 years old has been decreasing globally in the last decades, but its incidence in patients below 50 years old (early-onset colorectal cancer, EO-CRC) has been increasing, for reasons not yet fully understood.

Aims & Methods

A unicentric cohort study was conducted in a tertiary centre, including all patients admitted for a first diagnosis of CRC and evaluated by the Multidisciplinary Colorectal Cancer Group from 01.01.2017 until 31.12.2018. Patients with a previous diagnosis of a Hereditary Colorectal Cancer Syndrome were excluded.

Results

A total of 438 patients were included, 58.2% males, with a mean age at diagnosis of 67.7±11.1 years old. Mean follow-up time was 41.49 months. There were 25 EO-CRC patients (5.7%), 17 males (68%), mean age 43.1±6.0 years old.
Globally, 32.4% of the patients were current or past smokers, 18.5% had previous non-colorectal cancer, 7.5% and 3.4% were previously exposed to immunosuppressive drugs or abdominal/pelvic radiotherapy, respectively. The majority presented with normal(29.7%) to high Body Max Index (39.7%), median 25.6 (IQR:22.6-28.4) Kg/m². The most common CRC location was the rectum (42.9%) and 56.1% were stage I or II (AJCC 8^th edition).
In the univariate analysis, a significant association was found between EO-CRC and: smoking status (past or current smokers 52% in EO-CRC vs. 31.2% in older cases p=0.009); lymphovascular invasion (40.0% in EO-CRC vs. 17.4% in over 50, p=0.018) No significant differences were found for histological subtype (p=0.447), perineural invasion (p=0.474), or tumor stage at diagnosis, although a relevant proportion of the younger patients had metastatic disease at diagnosis (28.0% vs. 12.8%, p=0.064).
Immunohistochemistry for mismatch-repair proteins showed loss of expression of at least one protein in 1/18 EO-CRC patients and 22/179 of older patients (p=0.728).
From the EO-CRC patients, 16 were evaluated in the Familial Cancer Clinic and 14 underwent germline mutation analysis: 13 patients had inconclusive results, one of them presented a MUTYH heterozygote mutation and another was diagnosed with MUTYH-associated Polyposis (composed heterozygote mutation).

Conclusion

Colorectal cancer showed distinctive features in the younger population, with a higher prevalence of lymphovascular invasion and, possibly, a higher incidence of metastatic disease at diagnosis. Smoking had a significant association with CRC, especially in this younger population. Whether this means there is a biological difference is not yet clear. More evidence is needed in order to clarify EO-CRC aetiology and to develop screening and improve management strategies.

References

Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-14. doi: 10.1200/EDBK_279901. PMID: 32315236

Introduction

Colorectal cancer (CRC) is a global health problem with high incidence and mortality rates. Although the incidence has decreased with the use of screening tests, the mortality rate is approximately 1,6 – 2,0 % per year. Recent studies have shown a steady increase in the incidence of early onset (<50 years) CRC compared to that of patients >50 years of age. Early-onset CRC cancer is reported to have a more progressive course and may have a genetic and epigenetic background. In this study, we aimed to investigate the disease characteristics and risk factors for colorectal cancer in patients <50 years old and compare with patients over 50 years of age.

Aims & Methods

Patients younger than 50 years, diagnosed with colorectal adenocarcinoma and followed in our hospitals' gastroenterology, oncology, or general surgery departments between January/2009 and June/2022 were included in this retrospective study. A total of 6102 patients’ files were examined. Among these, 1166 were under the age of 50, whilst 4936 were 50 years and older. Patients younger than 18 years, who had a previous history of CRC, a known familial CRC syndrome, who had synchronous tumors at the time of diagnosis or had in situ CRC were not included in the study. After applying the exclusion criteria, 989 patients were included in the under-50 age group. The comparison group consisted of 1009 patients randomly selected from a group of 4000 patients aged 50 years or older. Patients were divided into Group A (<50 years) and Group B (≥ 50 years) according to the age at diagnosis. Patients’ demographic characteristics, body mass index, history of cigarette smoking and alcohol use, presenting symptoms, history of H. pylori infection, co-morbidities and medications were recorded from the files. Tumour characteristics, localization, size, TNM stage, and treatment methods were also analyzed and the relationship with each other was examined comparatively.

Results

The results of 1998 patients included in the study are shown in Table 1. TNM stages and the duration of symptoms before the diagnosis were similar between the groups but the rate of stage 1 disease was higher in group B. The rates of metastatic disease and rectal cancer were higher in Group A, but statistically non-significant. Abdominal pain was significantly more frequent in Group A, while anemia was significantly more common in Group B. Patients in Group A had higher rates of IBD, family history of CRC, mucinous adenocarcinoma, poorly differentiated tumor, higher histological grade and higher microsatellite instability (MSI-H). Although perineural and lymphatic invasion rates were similar, vascular invasion was higher in group B.

Table1. Comparison of Patients in Group A and Group B

Conclusion

Our study revealed that Early-onset CRC is more frequently diagnosed at the metastatic stage, is characterized by a more common presence of mucinous cells, poorly differentiated histology, and microsatellite instability.

Introduction

The incidence of early-onset colorectal cancer has been increasing worldwide, and action is urgently needed to address this problem. Although we have previously reported age-related changes with respect to molecular pathology, the vast majority remains unknown regarding the clinicopathologic characteristics of early-onset colorectal cancers and adenomas, especially those resected by endoscopic approaches. In this study, we defined early-onset colorectal tumors as adenoma and carcinoma diagnosed age at 40 or under. The aim of this study was to examine the clinicopathologic characteristics of endoscopically resected early-onset colorectal tumors compared with later-onset colorectal tumors diagnosed at age 40 or older.

Aims & Methods

We examined the clinicopathological characteristics of endoscopically resected colorectal adenomas and carcinomas in 1,005 patients with 2,367 lesions including early-onset colorectal carcinoma/adenoma (159 lesions in 96 consecutive cases from January 2010 to December 2020), late-onset colorectal carcinoma (183 lesions in 90 cases from January 2010 to December 2020), and late-onset adenoma (2,025 lesions in 819 consecutive cases from January 2020 to July 2020) endoscopically resected at the Nippon Medical School Hospital. The chi-square test was used to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables.

Results

Median age (quartiles) and sex (female/male) of cases were 37 (34-38), 34 (35%) / 62 (65%) in the early-onset tumor group; and 55 (46-72), 277 (30%) / 632 (70%) in the late-onset tumor group, respectively. The distribution rate of tumor location was 49 cases (31%) for proximal colon, 97 (61%) for distal colon, 13 (8.2%) for rectum in the early-onset group; and 1085 (49%), 899 (41%), 83 (10%) in the later-onset group, respectively. Macroscopic types were classified into Ip for 46 cases (29%), Is and Isp for 100 (63%), II for 13 (8.2%) in the early-onset group; and 278 (13%), 1574 (71%), 356 (16%) in the late-onset group, respectively. Histological types were classified into tubular adenocarcinoma or papillary carcinoma for 14 cases (8.8%), high-grade tubular adenoma (TA) for 36 (23%), low-grade TA for 97 (61%), sessile serrated lesion or traditional serrated adenoma for 12 (7.5%) in the early-onset tumor group; and 183 (8.3%), 281 (13%), 1655 (75%), 89(4%), respectively. Compared with the later-onset colorectal tumors, a higher rate of left-sided tumor location and macroscopic type Ip was observed in the early-onset colorectal tumor (p <0.001, respectively). When limited to adenoma lesions, the rate of high-grade was significantly higher in the early-onset colorectal adenomas than those in the later-onset colorectal adenomas.

Conclusion

Regarding tumor location and macroscopic type, unique clinicopathological features were observed in early-onset colorectal tumors compared with later-onset colorectal tumors. Further studies are needed to investigate the association between early-onset colorectal cancer and adenomas stratified by the method by tumor resection.

Introduction

The incidence of early-onset colorectal cancer (eoCRC), defined as colorectal cancer occurring in young adults under the age of 50, is increasing globally. Questionable eoCRCs' exogenous risk factors are represented by diet and lifestyle, even though a scant literature is available to date. The DEMETRA study is being conducted to assess diet and lifestyle as potential risk factors for eoCRC in various European and non-European countries with populations characterized by large variations in dietary/drinking habits and eoCRC incidence.

Aims & Methods

Therefore, our aims were to (i) develop a unique and shared semi-quantitative food frequency questionnaire (SQFFQ) able to accurately describe dietary and drinking habits of eoCRCs and healthy age-matched controls of different countries at global level that will be involved in the DEMETRA study; (ii) validate the SQFFQ.
We designed an ad-hoc, shared, online SQFFQ to investigate the usual consumption of 329 foods over the past year. These foods were classified in groups and subgroups using the same criteria as the EPIC Italy study [1]. In addition to frequency of consumption, the tool investigates the portions habitually consumed using validated photographs, household measures, and standard units, as well as types of seasoning and methods of cooking and storage. A special software was then developed to analyze responses and link them to food composition tables in order to provide a nutritional breakdown of individual and collective diets. The SQFFQ was then validated for repeatability by administering it twice, 3 weeks apart, to a sample of 30 young adults under 50 years (mean age 35.1 y ± sd 7.71; 63,3% females, 33.3% males, 3% preferred not to answer). To evaluate repeatability, the measurement error for each food group was estimated as the percentage change between the estimates of food consumption for the same individual. Afterwards, the agreement between the two measurements for each food group was measured with Cohen's kappa coefficient.

Results

For 40 out of 65 food groups, the difference between the two SFFQs was less than 20%. The greatest percentage differences were found, as expected, for food groups with sporadic consumption (snacks, barbecue sauces, ketchup, mayonnaise) or consumed in minimal quantities (spices). Agreement levels, represented by the calculation of Cohen's kappa coefficient, were as follows: 12 food groups showed fair/sufficient agreement (Cohen's kappa 20-40), 23 foods exhibited good/moderate agreement (Cohen's kappa >40-60), and 22 food groups demonstrated high substantial agreement (Cohen's kappa >60). Insufficient agreement, with Cohen's Kappa values < 0.21, was observed for only three food groups (snacks, sauces, mayonnaises).

Conclusion

The ad hoc designed SQFFQ provides a reasonably repeatable measure of dietary intake and can be used to assess the dietary and drinking habits of volunteers in this age group. Indeed, most staple foods in the Italian diet, including pasta, fruit, vegetables, legumes, eggs, meat, coffee, and tea, are well estimated by the SQFFQ. However, as yet described in literature, challenges persist in estimating the consumption of foods assumed sporadically (such as snacks) or in small quantities such as spices. Definitive conclusions will be drawn after the completion of the external validation, in which the SQFFQ will be validated against the gold standard, represented by the completion of a 4-day food diary followed by a dietary recall.

References

1. Pala V, Sieri S, Palli D, Salvini S, Berrino F, Bellegotti M, et al. Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori. 2003;89: 594–607.