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The Biologically Distinct Threat of Early-Onset CRC
Chicago, Illinois—At the 2019 Great Debates & Updates in GI Malignancies meeting, Mark A. Lewis, MD, Director, Gastrointestinal Oncology, Intermountain Healthcare, Salt Lake City, Utah, provided an update on the biologically distinct threat of early-onset colorectal cancer (CRC).
Citing numerous news articles reporting on the rising rate of colon and rectal cancers among younger patients, Dr Lewis spoke about the alarming trend of colon cancer deaths and diagnoses in this population.
“Since 2000, there has been a 22% increase in the incidence and a 13% increase in the mortality of colorectal cancer in patients under age 50,” he said. Of note, individuals born in 1990 have twice and four times the risk for colon and rectal cancers, respectively, than those born in 1950 faced at a comparable age.
With the increased risk for colon cancer being attributed to numerous genetic and lifestyle factors, Dr Lewis posited the question, “Why don’t we screen for CRC earlier?”
Possible reasons for why screening is recommended for later in life (eg, age 50 years) include increased volume and cost, complication rates tied to colonoscopies, and lack of benefit per life-years-gained modeling.
However, as Dr Lewis pointed out, starting screening earlier (ie, at age 45), regardless of strategy, increases the number of prevented cancers, and appears to be cost-effective within the current standard of willingness to pay.
“The rate of early-onset CRC is increasing and it appears to be biologically distinct from cancers occurring in patients aged 50 and older,” Dr Lewis said, adding that a better understanding of etiologies is needed, along with risk stratification and increased preventive efforts.
“Screening initiation at age 45 could be considered in the average-risk population,” he suggested before concluding that there should be a low clinical threshold for considering CRC in young patients who present with complaints of GI bleeding among primary care providers.—Hina Porcelli
