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Colorectal cancer outcomes and treatment patterns in patients too young for average‐risk screening
Author(s) -
Abdelsattar Zaid M.,
Wong Sandra L.,
Regenbogen Scott E.,
Jomaa Diana M.,
Hardiman Karin M.,
Hendren Samantha
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29716
Subject(s) - medicine , proportional hazards model , epidemiology , cancer registry , cancer , colorectal cancer , population , retrospective cohort study , disease , cohort , hazard ratio , radiation therapy , relative risk , confidence interval , environmental health
BACKGROUND Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. METHODS The current study was a population‐based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease‐specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. RESULTS Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P <.001) or distant (relative risk ratio, 1.5; P <.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P <.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P <.001). Patients younger than the recommended screening age had better overall disease‐specific survival (hazards ratio, 0.77; P <.001), despite a larger percentage of these individuals presenting with advanced disease. CONCLUSIONS Patients with CRC diagnosed at age <50 years are more likely to present with advanced‐stage disease. However, they receive more aggressive therapy and achieve longer disease‐specific survival, despite the greater percentage of patients with advanced‐stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults. Cancer 2016;122:929–34 . © 2016 American Cancer Society .