Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;18(12):2752-2759.e2.
doi: 10.1016/j.cgh.2019.10.009. Epub 2019 Oct 14.

Risk Factors Associated With Early-Onset Colorectal Cancer

Valerie Gausman  1 , David Dornblaser  1 , Sanya Anand  1 , Richard B Hayes  2 , Kelli O'Connell  3 , Mengmeng Du  3 , Peter S Liang  4
Affiliations

Risk Factors Associated With Early-Onset Colorectal Cancer

Valerie Gausman et al. Clin Gastroenterol Hepatol. 2020 Nov.

Abstract

Background & aims: The incidence of colorectal cancer (CRC) is increasing in individuals younger than 50 years, who do not usually undergo screening if they are of average risk. We sought to identify risk factors for CRC in this population.

Methods: We compared sociodemographic and medical characteristics of patients who received a diagnosis of CRC at an age of 18-49 years (early-onset) with patients who received a diagnosis of CRC at an age of 50 years or older (late-onset) and with age-matched, cancer-free individuals (controls) at a tertiary academic hospital. We collected data from all adult patients with a diagnosis of CRC from January 1, 2011 through April 3, 2017 from electronic health records. Associations with risk factors were assessed using univariable and multivariable logistic regression models.

Results: We identified 269 patients with early-onset CRC, 2802 with late-onset CRC, and 1122 controls. Compared with controls, patients with early-onset CRC were more likely to be male (odds ratio [OR], 1.87; 95% CI, 1.39-2.51), have inflammatory bowel disease (IBD) (3% vs 0.4% for controls; univariable P < .01), and have a family history of CRC (OR, 8.61; CI, 4.83-15.75). Prevalence values of well-established modifiable CRC risk factors, including obesity, smoking, and diabetes, were similar. Compared to patients with late-onset CRC, patients with early-onset CRC were more likely to be male (OR, 1.44; 95% CI, 1.11-1.87), black (OR, 1.73; 95% CI, 1.08-2.65) or Asian (OR, 2.60; 95% CI, 1.57-4.15), and have IBD (OR, 2.97; 95% CI, 1.16-6.63) or a family history of CRC (OR, 2.87; 95% CI, 1.89-4.25). Sensitivity analyses excluding IBD and family history of CRC showed comparable results. Early-onset CRC was more likely than late-onset disease to be detected in the left colon or rectum (75% vs 59%, P = .02) and at a late stage of tumor development (77% vs 62%, P = .01).

Conclusions: In a retrospective study of patients with early-onset CRC vs late-onset CRC or no cancer, we identified non-modifiable risk factors, including sex, race, IBD, and family history of CRC, to be associated with early-onset CRC.

Keywords: BMI; Colon Cancer; Screening; Young Onset.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Statement: There are no conflicts to declare for all authors.

Figures

Figure 1:
Figure 1:. Study cohort flow chart
Abbreviations: CRC, colorectal cancer
See this image and copyright information in PMC

Comment in

  • Who Is at Risk for Early-Onset Colorectal Cancer?
    Maratt JK, Kahi CJ. Maratt JK, et al. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2686-2688. doi: 10.1016/j.cgh.2019.12.034. Epub 2020 Jan 8. Clin Gastroenterol Hepatol. 2020. PMID: 31926337 No abstract available.

References

    1. Siegel RL, Miller KD, and Jemal A, Cancer statistics, 2018. CA Cancer J Clin, 2018. 68(1): p. 7–30. - PubMed
    1. Siegel RL, Ward EM, and Jemal A, Trends in colorectal cancer incidence rates in the United States by tumor location and stage, 1992–2008. Cancer Epidemiol Biomarkers Prev, 2012. 21(3): p. 411–6. - PubMed
    1. Bailey CE, et al., Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg, 2015. 150(1): p. 17–22. - PMC - PubMed
    1. Rex DK, et al., Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol, 2017. 112(7): p. 1016–1030. - PubMed
    1. American Society for Gastrointestinal Endoscopy Standards of Practice, C., et al., The role of endoscopy in inflammatory bowel diseas0e. Gastrointest Endosc, 2015. 81(5): p. 1101–21 e1–13. - PubMed

Publication types