Disclosures: Karlitz reports personal fees from Exact Sciences and other support from Gastro Girl/GI On Demand outside the submitted work. Please see the study for all other authors' relevant financial disclosures.
January 26, 2022
3 min read

Increase in distant-stage early colorectal cancer highest among younger age groups

Disclosures: Karlitz reports personal fees from Exact Sciences and other support from Gastro Girl/GI On Demand outside the submitted work. Please see the study for all other authors' relevant financial disclosures.
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Individuals aged between 20 and 39 years had the greatest burden of distant early-onset colorectal adenocarcinoma, according to a retrospective study published in Cancer Epidemiology, Biomarkers & Prevention.

Investigators found the highest proportions of distant-stage disease among non-Hispanic Black and Hispanic subgroups.

Quote from Jordan J. Karlitz, MD.

"The results of our manuscript can motivate people to go out and get screened on time at age 45 [years] to prevent the development of cancer altogether and prevent diagnoses of distant-stage disease if cancer is already present," Jordan J. Karlitz, MD, chief of the gastrointestinal division at Denver Health Medical Center and associate professor at the University of Colorado School of Medicine, told Healio.Our results underscore the importance of understanding that patients under age 45 [years], who will not be eligible for average-risk screening, are risk-stratified for earlier testing based on symptoms and cancer family history.”

Background and methodology

Studies have shown rising rates of early-onset colorectal cancer in the U.S., including increases in distant-stage disease in young patients, researchers wrote. But with previous work often grouping together colorectal adenocarcinomas and carcinoid tumors, results may have been skewed toward less aggressive-stage disease.

“Prior studies on colorectal cancer staging combined all histologic subtypes, whereas our analysis focused specifically on adenocarcinomas, which is the histologic subtype that is the focus of screening and prevention,” Karlitz said. “Our primary motivation was to examine adenocarcinomas specifically in order to obtain a better assessment of colorectal cancer staging in young patients.”

Karlitz and colleagues evaluated annual incidence data from the SEER database on 103,975 patients aged 20 to 54 years (54% men; 61.3% non-Hispanic white; 14.2% Black; 13.9% Hispanic) with colorectal adenocarcinoma between 2000 to 2016. They stratified patients by age, disease stage, subsite (colorectal, rectal-only, colon-only) and race, and calculated 3-year average annual incidence rate changes (pooled 2000-2002 rates compared with 2014-2016) and cancer stage proportions.

Key findings

Distant-stage cancers showed the steepest percent increase among all stages between 2000-2002 and 2014-2016.

Among those with colon-only disease, distant adenocarcinoma increased the most (49% between 2000-2016) among patients aged 30 to 39 years. For those with rectal-only disease, the greatest increase in distant-stage incidence between 2000 and 2016 occurred among those aged 20 to 29 years (133%), followed by those aged 30 to 39 years (97%) and those 40 to 49 years (48%), researchers reported. Additionally, they observed corresponding decreases in incidence of early-stage disease among these subgroups.

The analysis also revealed an association between younger age and increased risk for distant-stage disease: patients aged 20 to 29 years had a 29% likelihood of presenting with distant disease compared with 20% for those aged 50 to 54-years.

“When we initiated our data collection, we expected to see that colorectal cancer would be more aggressive in younger patients; however, the degree to which aggressivity increases as patients get younger was very concerning,” Karlitz said.

When Karlitz and colleagues stratified the data by race and ethnicity, they found the largest increases in distant-stage rectal adenocarcinoma proportions from the 2000-2002 to 2014-2016 periods among non-Hispanic Black individuals aged 20 to 29 years (0%-46%), Hispanic individuals aged 20 to 29 years (28%-41%) and non-Hispanic Black individuals aged 30 to 39 years (21%-33%). For distant-stage colon adenocarcinoma, the largest proportion increase occurred among non-Hispanic Black individuals aged 20 to 29 years, from 20% to 34%.

Next steps

Further research must be conducted to identify factors that may lead to aggressive presentations of colorectal cancer in younger patients, Karlitz said. This would involve assessing risk factors and understanding why younger patients have delayed diagnoses.

“We also need to place additional focus, both from a clinical and research perspective, on racial subgroups that have an increased tendency to present with distant-stage disease, including the youngest non-Hispanic Black and Hispanic subgroups, to better understand why these trends exist and intervene to reverse them,” Karlitz said.


Montminy EM, et al. Cancer Epidemiol Biomarkers Prev. 2022;doi:10.1158/1055-9965.EPI-21-0611.
Younger individuals may have the highest risk of presenting with distant-stage colorectal cancer. https://www.aacr.org/about-the-aacr/newsroom/news-releases/. Published Jan. 26, 2022. Accessed Jan. 26, 2022.

For more information:

Jordan J. Karlitz, MD, can be reached at Denver Health Medical Center, 777 Bannock St., Denver, CO 80204; email: jordan.karlitz@dhha.org.