Misdiagnosis of young-onset colorectal cancer common

By Megan Brooks

NEW YORK (Reuters Health) - 7/3/2019

Many patients younger than age 50 who develop colorectal cancer are initially misdiagnosed, leading to a more advanced stage of disease when it is detected, according to a new study.

"Despite declining incidence in older adults, there has been a rapid and alarming rise in colorectal cancer incidence among young adults in recent decades. We do not yet know the cause of the rising incidence in younger patients, and there is little awareness of this trend among health care providers," Dr. Ronit Yarden, director of medical affairs at the Colorectal Cancer Alliance, a patient advocacy organization based in Washington, D.C., said in a statement.

Dr. Yarden presented her group's research at a preview media briefing February 27, ahead of presentation at the upcoming American Association for Cancer Research (AACR) annual meeting.

The researchers conducted an online survey of 1,195 individuals with young-onset CRC. More than half (57%) were diagnosed between ages 40 and 49, a third between age 30 and 39 and about 10% before age 30.

About 30% had a family history of CRC, and 8% had been diagnosed with Lynch syndrome, a genetic syndrome associated with a higher risk of CRC.

Most respondents (71%) were diagnosed with stage III or stage IV disease, in contrast to patients over age 50 who typically are diagnosed at stage I or II disease, Dr. Yarden told the briefing. "As we know, early detection is critical to the treatment and potential cure of colorectal cancer," she said.

Nearly two-thirds of respondents waited three to 12 months to see a doctor after symptoms began, often because they didn't recognize their symptoms as signs of CRC. Nearly one in four waited more than a year to get checked out.

Two-thirds of respondents saw two or more physicians before receiving a diagnosis of CRC, and some saw as many as four doctors. Common misdiagnoses were hemorrhoids, irritable bowel syndrome, anemia and diverticulitis.

"Both the medical community and the general population should be aware that colorectal cancer, which is one of the most preventable diseases, could happen in young adults. Symptoms should not be dismissed at any age," Dr. Yarden said at the briefing.

"There are a number of really important aspects related to this research," added Dr. John Carpten, briefing moderator and program chair for the AACR annual meeting.

"One of the most important is that there are significant policy implications, as many of the current screening recommendations for colorectal cancer are around age 50 years. For those individuals who are diagnosed with colon cancer in their 30s or 40s, this raises a potentially significant problem," said Dr. Carpten.

"Additional studies need to be done to actually identify the factors influencing these early-onset cancers. Hopefully that will improve our ability to detect these cancers earlier and to identify the most appropriate and effective ways to treat these cancers, particularly given the fact that they tend to be diagnosed at more advanced stages," he added.

"Lastly, as cancers arise in younger individuals, we definitely need to work toward ways to ensure access to appropriate care, particularly for individuals in their 20s or 30s who may be diagnosed with early forms of cancer. We know that disparities can be described in different ways - whether they are racial, ethnic, urban vs. rural, or financial - and we know that adolescents and young adults represent a new disparity group that can get lost in the system. We need to find better ways to detect these cancers earlier so we can manage them better," said Dr. Carpten.

The study was funded by the Colorectal Cancer Alliance. Dr. Yarden and Dr. Carpten reported no relevant conflicts of interest.

SOURCE: http://bit.ly/2VzL5O8

AACR 2019 Annual Meeting.

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