Background Prompt detection of colorectal cancer under age 50 (early-onset CRC) is a clinical priority due to its alarming rise. Methods We conducted a matched case-control study of 5075 incident early-onset CRC among U.S. commercial insurance beneficiaries (113 million adults aged 18-64) with ≥2 years of continuous enrollment (2006-2015) to identify red-flag signs/symptoms between 3 months to 2 years before the index date among 17 pre-specified signs/symptoms. We assessed diagnostic intervals according to the presence of these signs/symptoms before and within 3 months of diagnosis. Results Between 3 months to 2 years before the index date, four red-flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with ORs ranging from 1.34 to 5.13. Having 1, 2, or ≥ 3 of these signs/symptoms were associated with a 1.94 (95% CI, 1.76 to 2.14), 3.59 (2.89 to 4.44), and 6.52 (3.78 to 11.23)-fold risk (Ptrend < .001), with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity=0.012). The number of different signs/symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. About 19.3% of cases had their first sign/symptom occur between 3 months to 2 years before diagnosis (median diagnostic interval: 8.7 months), and around 49.3% had the first sign/symptom within 3 months of diagnosis (median diagnostic interval: 0.53 month). Conclusions Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, or iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
Background Racial/ethnic minority children and adolescents are more likely to have an advanced cancer diagnosis compared with non‐Hispanic Whites, which may relate to the lack of consistent health care access. This study aims to describe racial/ethnic disparities in cancer diagnosis stage among children and adolescents and assess whether health insurance mediates these disparities. Methods Data on individuals ≤19 years of age diagnosed with primary cancers from 2007 to 2016 were obtained from the Surveillance, Epidemiology, and End Results 18 database. Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between race/ethnicity and cancer diagnosis stage were calculated using Poisson regression. Analyses addressing health insurance as a potential mediator were also performed. Results Compared with non‐Hispanic Whites, racial/ethnic minorities had a higher prevalence of a distant cancer diagnosis, with PRs of 1.31 (95% CI, 1.23–1.40) for non‐Hispanic Blacks, 1.14 (95% CI, 1.04–1.24) for non‐Hispanic Asian/Pacific Islanders, and 1.15 (95% CI, 1.09–1.21) for Hispanics. These associations were attenuated when adjusting for health insurance, with PRs of 1.24 (95% CI, 1.16–1.33) for non‐Hispanic Blacks, 1.11 (95% CI, 1.02–1.21) for non‐Hispanic Asian/Pacific Islanders, and 1.07 (95% CI, 1.01–1.13) for Hispanics. Any Medicaid or no insurance at diagnosis mediated 49%, 22%, and 9% of the observed association with distant stage in Hispanics, non‐Hispanic Blacks, and non‐Hispanic Asian/Pacific Islanders, respectively. Conclusions Disparities in cancer diagnosis stage in racial/ethnic minority children and adolescents may be partially explained by health insurance coverage. Further research is needed to understand the mechanisms.
ImportanceAlcohol consumption is associated with adverse oncologic and treatment outcomes among individuals with a diagnosis of cancer. As a key modifiable behavioral factor, alcohol consumption patterns among cancer survivors, especially during treatment, remain underexplored in the United States.ObjectiveTo comprehensively characterize alcohol consumption patterns among US cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from May 6, 2018, to January 1, 2022, from the National Institutes of Health All of Us Research Program, a diverse US cohort with electronic health record (EHR) linkage, and included 15 199 participants who reported a cancer diagnosis and 1839 patients among a subset with EHR data who underwent treatment within the past year of the baseline survey. Data analysis was performed from October 1, 2022, to January 31, 2023.Main Outcomes and MeasuresPrevalence of current drinking and of risky drinking behaviors, including exceeding moderate drinking (&gt;2 drinks on a typical drinking day), binge drinking (≥6 drinks on 1 occasion), and hazardous drinking (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C] score ≥3 for women or ≥4 for men).ResultsThis study included 15 199 adults (mean [SD] age at baseline, 63.1 [13.0] years; 9508 women [62.6%]) with a cancer diagnosis. Overall, 11 815 cancer survivors (77.7%) were current drinkers. Among current drinkers, 1541 (13.0%) exceeded moderate drinking, 2812 (23.8%) reported binge drinking, and 4527 (38.3%) engaged in hazardous drinking. After multivariable adjustment, survivors who were younger than 65 years, men, or of Hispanic ethnicity or who received a diagnosis before 18 years of age or ever smoked were more likely to exceed moderate drinking (aged &lt;50 years: odds ratio [OR], 2.90 [95% CI, 2.41-3.48]; aged 50-64 years: OR, 1.84 [95% CI, 1.58-2.15]; men: OR, 2.38 [95% CI, 2.09-2.72]; Hispanic ethnicity: OR, 1.31 [95% CI, 1.04-1.64]; aged &lt;18 years at diagnosis: OR, 1.52 [95% CI, 1.04-2.24]; former smokers: OR, 2.46 [95% CI, 2.16-2.79]; current smokers: OR, 4.14 [95% CI, 3.40-5.04]) or binge drink (aged &lt;50 years: OR, 4.46 [95% CI, 3.85-5.15]; aged 50-64 years: OR, 2.15 [95% CI, 1.90-2.43]; men: OR, 2.10 [95% CI, 1.89-2.34]; Hispanic ethnicity: OR, 1.31 [95% CI, 1.09-1.58]; aged &lt;18 years at diagnosis: OR, 1.71 [95% CI, 1.24-2.35]; former smokers: OR, 1.69 [95% CI, 1.53-1.87]; current smokers: OR, 2.27 [95% CI, 1.91-2.71]). Survivors with cancer diagnosed before 18 years of age or who ever smoked were more likely to be hazardous drinkers (aged &lt;18 years at diagnosis: OR, 1.52 [95% CI, 1.11-2.08]; former smokers: OR, 1.83 [95% CI, 1.68-1.99]; current smokers: OR, 2.13 [95% CI, 1.79-2.53]). Of 1839 survivors receiving treatment as captured in the EHR, 1405 (76.4%) were current drinkers, and among these, 170 (12.1%) exceeded moderate drinking, 329 (23.4%) reported binge drinking, and 540 (38.4%) engaged in hazardous drinking, with similar prevalence across different types of cancer treatment.Conclusions and RelevanceThis cross-sectional study of a diverse US cohort suggests that alcohol consumption and risky drinking behaviors were common among cancer survivors, even among individuals receiving treatment. Given the adverse treatment and oncologic outcomes associated with alcohol consumption, additional research and implementation studies are critical in addressing this emerging concern among cancer survivors.
Early-onset colorectal cancer (CRC) is increasing in the United States and globally. Compared to CRC diagnosed at older ages, patients with early-onset CRC experienced significant diagnostic delays, with tumors of advanced clinicopathological features and unknown etiology. While screening recommendations have been recently lowered to age 45 in the United States, about half of early-onset CRC cases are diagnosed before age 45, thus will not be detected via screening. This presentation will review emerging risk factors of early-onset CRC throughout the life course, as well as clinical signs and symptoms associated with early-onset CRC. Citation Format: Yin Cao. Early-onset colorectal cancer: Emerging risk factors and early detection [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr IA013.
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