Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1011-1020
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1011
Old vs new: Risk factors predicting early onset colorectal cancer
Aslam R Syed, Payal Thakkar, Zachary D Horne, Heitham Abdul-Baki, Gursimran Kochhar, Katie Farah, Shyam Thakkar
Aslam R Syed, Heitham Abdul-Baki, Gursimran Kochhar, Katie Farah, Shyam Thakkar, Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA 15212, United States
Payal Thakkar, Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
Zachary D Horne, Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, United States
Author contributions: Syed AR, Farah K, Thakkar S performed the research; Abdul-Baki H, Horne ZD analyzed the data; Syed A, Thakkar P, Thakkar S wrote the paper and Thakkar P, Kochhar G, Thakkar S critically revised the manuscript for important intellectual content.
Institutional review board statement: Clinical research in this study was supported by the Allegheny Research Singer Institute, and was exempt from full review, and was approved for a quality improvement study.
Informed consent statement: Research described here did not involve humans, and only reported de-identified patient information. All analyzed data was omitted or anonymized.
Conflict-of-interest statement: This article and all authors declare no conflicts of interests.
Data sharing statement: The original anonymous dataset is available on request from the first author at aslam.syed@ahn.org.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shyam Thakkar, MD, Professor, Division of Gastroenterology and Hepatology, Allegheny Health Network, 1307 Federal Street, Suite 301, Pittsburgh, PA 15212, United States. shyam.thakkar@ahn.org
Telephone: +1-412-3598061 Fax: +1-412-4422158
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: June 4, 2019
Revised: August 1, 2019
Accepted: October 3, 2019
Article in press: October 3, 2019
Published online: November 15, 2019
Abstract
BACKGROUND

Colorectal cancer (CRC) is the second leading cause of all cancer related deaths in the United States and Europe. Although the incidence has been decreasing for individuals’ ≥ 50, it has been on the rise for individuals < 50.

AIM

To identify potential risk factors for early-onset CRC.

METHODS

A population-based cohort analysis using a national database, Explorys, screened all patients with an active electronic medical record from January 2012 to December 2016 with a diagnosis of CRC. Subgroups were stratified based on age (25 – 49 years vs ≥ 50 years). Demographics, comorbidities, and symptom profiles were recorded and compared between both age groups. Furthermore, the younger group was also compared with a control group consisting of individuals aged 25-49 years within the same timeframe without a diagnosis of CRC. Twenty-data points for CRC related factors were analyzed to identify potential risk factors specific to early-onset CRC.

RESULTS

A total of 68860 patients were identified with CRC, of which 5710 (8.3%) were younger than 50 years old, with 4140 (73%) between 40-49 years of age. Multivariable analysis was reported using odds ratio (OR) with 95%CI and demonstrated that several factors were associated with an increased risk of CRC in the early-onset group versus the later-onset group. These factors included: African-American race (OR 1.18, 95%CI: 1.09-1.27, P < 0.001), presenting symptoms of abdominal pain (OR 1.82, 95%CI: 1.72-1.92, P <0.001), rectal pain (OR 1.50, 95%CI: 1.28-1.77, P < 0.001), altered bowel function (OR 1.12, 95%CI: 1.05-1.19, P = 0.0005), having a family history of any cancer (OR 1.78, 95%CI: 1.67-1.90, P < 0.001), gastrointestinal (GI) malignancy (OR 2.36, 95%CI: 2.18-2.55, P < 0.001), polyps (OR 1.41, 95%CI: 1.08-1.20, P < 0.001), and obesity (OR 1.14, 95%CI: 1.08-1.20, P < 0.001). Comparing the early-onset cohort versus the control group, factors that were associated with an increased risk of CRC were: male gender (OR 1.34, 95%CI: 1.27-1.41), P < 0.001), Caucasian (OR 1.48, 95%CI: 1.40-1.57, P < 0.001) and African-American race (OR 1.25, 95%CI: 1.17-1.35, P < 0.001), presenting symptoms of abdominal pain (OR 4.73, 95%CI: 4.49-4.98, P < 0.001), rectal pain (OR 7.48, 95%CI: 6.42-8.72, P < 0.001), altered bowel function (OR 5.51, 95%CI: 5.19-5.85, P < 0.001), rectal bleeding (OR 9.83, 95%CI: 9.12-10.6, P < 0.001), weight loss (OR 7.43, 95%CI: 6.77-8.15, P < 0.001), having a family history of cancer (OR 11.66, 95%CI: 10.97-12.39, P < 0.001), GI malignancy (OR 28.67, 95%CI: 26.64-30.86, P < 0.001), polyps (OR 8.15, 95%CI: 6.31-10.52, P < 0.001), tobacco use (OR 2.46, 95%CI: 2.33-2.59, P < 0.001), alcohol use (OR 1.71, 95%CI: 1.62-1.80, P < 0.001), presence of colitis (OR 4.10, 95%CI: 3.79-4.43, P < 0.001), and obesity (OR 2.88, 95%CI: 2.74-3.04, P < 0.001).

CONCLUSION

Pending further investigation, these potential risk factors should lower the threshold of suspicion for early CRC and potentially be used to optimize guidelines for early screening.

Keywords: Colorectal cancer, Early-onset colorectal cancer, Colorectal cancer screening, Epidemiology analysis, Colorectal neoplasm, Average-risk screening

Core tip: Colorectal cancer (CRC) is the second leading cause of all cancer related deaths in the United States. Unfortunately, the incidence of patients with CRC under age 50 is on the rise, reported on average between 8%-10% of all CRC diagnosis. Given the recent guideline modification from the American Cancer Society to propose screening to start at age 45, clinicians need a better understanding on which populations to screen earlier. Our manuscript uniquely outlines potential risk factors for early-onset CRC by comparing diagnosed patients with non-CRC patients, which has not been reported in prior literature.