Meeting NewsPerspective

Colorectal cancer in young patients often misdiagnosed, identified at late stage

Ronit Yarden, PhD, MHSA
Ronit Yarden

Almost 70% of patients aged younger than 50 years had to see at least two physicians before being diagnosed with colorectal cancer, according to results of a survey scheduled for presentation at American Association for Cancer Research Annual Meeting.

These previous misdiagnoses often led to colorectal cancer being diagnosed at a later stage, results showed.

“Colorectal cancer is one of the most preventable [cancers], and early detection could cure most patients,” Ronit Yarden, PhD, MHSA, director of medical affairs at Colorectal Cancer Alliance, said during a press cast. “Traditionally colorectal cancer has been associated with aging, which is why guidelines call for initiating screening for [this disease] at the age of 50 [years]. It is estimated that about one in 10 new cases of colorectal cancer are in a patient younger than 50-years-old.”

Colorectal cancer is the third most common cancer in the United States among both men and women. It is also the second deadliest.

Previous studies have shown patients diagnosed with colorectal cancer when aged younger than 50 years often have later stages of the disease.

Yarden and colleagues evaluated data from 1,195 surveys completed by patients and survivors of colorectal cancer.

Fifty-seven percent of the cohort was diagnosed when aged 40 to 49 years, 33% when aged 30 to 39 years, and 10% when aged younger than 30 years.

About 30% of all the patients reported having a family history of colorectal cancer, and 8% were diagnosed with Lynch syndrome.

Results showed 71% of patients were diagnosed at stage 3 or stage 4 of the disease.

Further, 67% of patients saw at least two physicians before being diagnosed with colorectal cancer, and 63% of patients waited 3 to 12 months before deciding to see a physician.

Many patients reported that they did not recognize the symptoms of colorectal cancer, leading to the delayed visit to the doctor.

Thirty-three percent patients saw only one physician, and 17% these patients said they were initially misdiagnosed.

Researchers distributed the survey via social media and the Colorectal Cancer Alliance website, which meant that it was limited to people who had access to those platforms.

“As we all know, early detection is critical to successful treatment and cure of colorectal cancer,” Yarden said. “This survey shows that most young adults were diagnosed with advanced stages of colorectal cancer after it had spread both regionally to lymph nodes and to distant organs, such as the liver and lungs.

“Both the medical community and the general population should be aware that colorectal cancer — which is one of the most preventable diseases — can happen in young adults,” Yarden added. “Symptoms should not be dismissed at any age, and screening should be extended if we want to beat this disease.” – by John DeRosier

Reference:

Yarden R, et al. Abstract 3347/13. Scheduled for presentation at: AACR Annual Meeting; March 29-April 3, 2019; Atlanta.

Disclosures: This study was funded by the Colorectal Cancer Alliance. The study authors report no relevant financial disclosures.

 

Ronit Yarden, PhD, MHSA
Ronit Yarden

Almost 70% of patients aged younger than 50 years had to see at least two physicians before being diagnosed with colorectal cancer, according to results of a survey scheduled for presentation at American Association for Cancer Research Annual Meeting.

These previous misdiagnoses often led to colorectal cancer being diagnosed at a later stage, results showed.

“Colorectal cancer is one of the most preventable [cancers], and early detection could cure most patients,” Ronit Yarden, PhD, MHSA, director of medical affairs at Colorectal Cancer Alliance, said during a press cast. “Traditionally colorectal cancer has been associated with aging, which is why guidelines call for initiating screening for [this disease] at the age of 50 [years]. It is estimated that about one in 10 new cases of colorectal cancer are in a patient younger than 50-years-old.”

Colorectal cancer is the third most common cancer in the United States among both men and women. It is also the second deadliest.

Previous studies have shown patients diagnosed with colorectal cancer when aged younger than 50 years often have later stages of the disease.

Yarden and colleagues evaluated data from 1,195 surveys completed by patients and survivors of colorectal cancer.

Fifty-seven percent of the cohort was diagnosed when aged 40 to 49 years, 33% when aged 30 to 39 years, and 10% when aged younger than 30 years.

About 30% of all the patients reported having a family history of colorectal cancer, and 8% were diagnosed with Lynch syndrome.

Results showed 71% of patients were diagnosed at stage 3 or stage 4 of the disease.

Further, 67% of patients saw at least two physicians before being diagnosed with colorectal cancer, and 63% of patients waited 3 to 12 months before deciding to see a physician.

Many patients reported that they did not recognize the symptoms of colorectal cancer, leading to the delayed visit to the doctor.

Thirty-three percent patients saw only one physician, and 17% these patients said they were initially misdiagnosed.

Researchers distributed the survey via social media and the Colorectal Cancer Alliance website, which meant that it was limited to people who had access to those platforms.

“As we all know, early detection is critical to successful treatment and cure of colorectal cancer,” Yarden said. “This survey shows that most young adults were diagnosed with advanced stages of colorectal cancer after it had spread both regionally to lymph nodes and to distant organs, such as the liver and lungs.

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“Both the medical community and the general population should be aware that colorectal cancer — which is one of the most preventable diseases — can happen in young adults,” Yarden added. “Symptoms should not be dismissed at any age, and screening should be extended if we want to beat this disease.” – by John DeRosier

Reference:

Yarden R, et al. Abstract 3347/13. Scheduled for presentation at: AACR Annual Meeting; March 29-April 3, 2019; Atlanta.

Disclosures: This study was funded by the Colorectal Cancer Alliance. The study authors report no relevant financial disclosures.

 

    Perspective
    Afsaneh M. Barzi

    Afsaneh M. Barzi

    The study by Yarden and colleagues highlights the significance of delays in diagnosis for younger vs. older patients with colorectal cancer. This information is valuable and provides impetus to promote educational programs for providers in the field as well as patients.

    It is important to note that younger adults with colorectal cancer may have different tumor biology that results in tumor spread sooner than for older individuals, and diagnostic delays may not be the only explanation for more advanced stage at diagnosis.

    That said, the rising incidence of colorectal cancer in younger individuals is well-recognized in the oncology community. Yet, the primary care community — including internists, family physicians and ER physicians — may not be aware of this shift in epidemiology. Patients with symptoms of colon and rectal cancers are initially seen and evaluated by the primary care workforce;thus, raising awareness about the changing trends in age of presentation of colorectal cancer can improve the timeliness of diagnosis.

    However, the results of this study should be interpreted with caution. The survey respondents are those who are diagnosed with colorectal cancer and not the broader population with nonspecific symptoms of abdominal pain, hemorrhoids and constipation. For the population with nonspecific symptoms, several other issues, including poor dietary habits and hemorrhoids, remain more common than colorectal cancer. Therefore, not everyone with nonspecific symptoms needs a colonoscopy upon their first presentation. In these patients,appropriate referral for colonoscopy is necessary if their symptoms continue beyond a few weeks.

    Having an established physician, rather than receiving episodic care in the ER, is critical to timeliness of diagnosis in patients with persistent symptoms, including those with colorectal cancer.

    • Afsaneh M. Barzi, MD
    • University of Southern California

    Disclosures: Barzi reports no relevant financial disclosures.

    Perspective
    John D. Carpten

    John D. Carpten

    There are a number of really important aspects to this research.

    One of the most important is the significant policy implications, as many of the current screening recommendations for colorectal cancer are around age 50 years. For those individuals who are diagnosed with colorectal cancer in their 30s or 40s, this raises a potentially significant problem.

    Additional studies need to be done to identify the factors influencing these early-onset cancers, and hopefully that will improve our ability to detect these cancers earlier and identify the most appropriate and effective ways to treat them, particularly given the fact that they tend to be diagnosed at more advanced stages.

    Lastly, as cancers arise in younger individuals, we definitely need to work toward ways to ensure access to appropriate care, particularly for individuals in their 20s or 30s who may be diagnosed with early forms of cancer. We know that disparities can be described in different ways — whether they are racial, ethnic, urban vs. rural, or financial — and we know that adolescents and young adults represent a new disparity group that can get lost in the system. We need to find better ways to detect these cancers earlier so we can manage them better.

    • John D. Carpten, PhD
    • University of Southern California

    Disclosures: Carpten reports no relevant financial disclosures.

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