The growing incidence of early-onset colorectal cancer (EO-CRC) in the US, which caused the recommended age for first screening to decrease to age 45, prompted a comparative analysis of EO-CRC mortality between age cohorts in different stages of diagnosis, according to research presented at the American College of Gastroenterology.

Yazan Abboud, MD, from Rutgers New Jersey Medical School in Newark, New Jersey, presented the research on behalf of his team.

The investigators conducted a comparative analysis of EO-CRC mortality between age cohorts of 20-44 and 45-54 years in different stages of diagnosis. Age-adjusted mortality rates for EO-CRC between 2000-2022 were collected from the CDC’s National Center of Health Statistics (NCHS) database, which covers virtually the entire US population. The SEER 22 database, which covers about 42% of the US population, was the source for stage-specific incidence-based mortality (IBM) rates between 2004-2020.

In situ and localized stages were classified as early while regional and distant were classified as late-stage.  Joinpoint regression and weighted Bayesian Information Criteria were utilized to generate annual percentage change (APC) and average APC (AAPC). Pairwise comparison between the age cohorts was conducted using the tests of coincidence and parallelism (P< 0.05)

The NCHS database analysis resulted in 147,026 attributed to EO-CRC between 2000-2022. While mortality rates decreased between 2000 and 2005, rates increased between 2005 and 2022 (APC= 0.87). Among patients aged 45-54 years there were 107,280 deaths; mortality decreased between 2000-2005 and increased afterward (APC=0.87). Among patients aged 20-44 years the investigators noted 39,746 deaths, with mortality steadily increasing between 2000 and 2022 (APC=0.93). Comparison of the age cohorts revealed that patients aged 20-44 years had a greater increase in mortality compared to those aged 45-54 years (AAPC= 0.85) with nonidentical nonparallel data and AAPC-difference of 0.85 (P-values< 0.01).

Among patients whose deaths were attributed to early-stage tumors (4026), mortality increased (AAPC=12.37) among patients aged 45-54 years; the sample size was insufficient for those aged 20-44). For late-stage tumors, which resulted in 37,875 deaths, mortality increased (AAPC=10.56) in both cohorts: 45-54 years (AAPC=11.17) and 20-44 years (AAPC= 13.87).

These findings reinforce the need for increased advocacy for CRC screening in younger patients aiming to improve outcomes, the investigators concluded.

Abboud Y, Shah A, Hajifathalian K, Gaglio P,  Al-Khazraji A. P3865 - Rising mortality of early-onset colorectal cancer particularly in patients younger. Presented at: American College of Gastroenterology. October 29, 2024. Philadelphia, Pennsylvania.