A positive family history of cancer or lifestyle factors may not explain the high incidence of early-onset colorectal cancer in India

Ratheesh, Raman; Kotapalli, Viswakalyan; Vamsy, Mohana; Patnaik, Sujit Chyau; Srinivasulu, Mukta; Bashyam, Murali D.

doi:10.2217/crc.14.31

Cited by 3 publications

(18 citation statements)

References 33 publications

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“…Of the 12 859 unique articles retrieved, 699 full texts were reviewed, and 81 studies were included (Figure 1 and Table). There were 76 cross-sectional studies, 4 case-control studies, and 1 cohort study .…”

Section: Resultsmentioning

confidence: 99%

“…36 Studies were performed in Africa (5 studies), 31,41,54,65,84 Asia or the Middle East (26 studies), 18, 35, 37, 42, 48, 49, 51-53, 56, 62, 66, 67, 71, 77, 78, 80, 82, 85, 96, 99-104 Europe (19 studies), 28,29,40,43,45,46,50,55,57,58,60,63,64,72,73,75,87,91,93 North America (23 studies), 12, 27, 32-34, 36, 39, 44, 47, 59, 61, 68-70, 74, 81, 86, 88, 92, 94, 95, 97, 98 South America (5 studies), 30,38,83,89,90 and Oceania (2 studies). 76,79 There were 67 studies 12, 13, 27, 28, 30, 32-34, 36, 38-40, 44, 45, 47, 48, 51-77, 79, 81, 83, 84, 86-102, 104 deemed to have low risk of bias, 10 studies 18,29,31,35,37,46,50,80,85,103 with moderate risk of bias, and 4 studies 41,49,…”

Section: Search Strategy and Study Characteristicsmentioning

confidence: 99%

“…There were 78 studies 12,13,18,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] that reported on 17 signs and symptoms at presentation, based on claims or medical records (66 studies), 12, 13, 27, 28, 30, 32-34, 38-40, 42-45, 47, 48, 51-77, 79, 81, 83, 84, 86-92, 94-104 patient report (6 studies), 18,29,37,46,80,82 or other (7 studies). 31,35,41,49,50,78,85 (Figure 2; eFigure 1 in Supplement 1).…”

Section: Presenting Signs and Symptomsmentioning

confidence: 99%

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Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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ImportanceEarly-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes.ObjectiveTo report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation.Data SourcesPubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023.Study SelectionStudies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included.Data Extraction and SynthesisData extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model.Main Outcomes and MeasuresOutcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis.ResultsOf the 12 859 unique articles initially retrieved, 81 studies with 24 908 126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies).Conclusions and RelevanceIn this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

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Section: Resultsmentioning

confidence: 99%

Section: Search Strategy and Study Characteristicsmentioning

confidence: 99%

Section: Presenting Signs and Symptomsmentioning

confidence: 99%

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Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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“…Such trends of early onset of disease in Indians are not exclusively limited to brain cancers but have also been noted for colorectal cancer, renal cell carcinoma, and breast cancer. 18 19 20 The late occurrence of tumors in international population in contrast to Indians could be due to the better wellness programs in United States leading to longer average life expectancy (both sexes combined) of 79 years as compared with 66 years in India. 21 In our cohort, median age at diagnosis for pineal tumors was seen to be later than Indian data but corroborating with US data.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Profiling and Trends of Primary Intracranial Tumors: A Hospital-Based Brain Tumor Registry from a Tertiary Care Center

Meel

Choudhary

Kumar

et al. 2021

JNRP

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Background and Objectives Hospital-based cancer registry is an essential tool for augmentation of the standard of care, administration motive, and resource for population-based cancer registries. Here, we presented hospital-based brain tumor registry (HBBTR) to outline a comprehensive epidemiological data, both clinical and histopathological, as well as trends of central nervous system tumors. In addition, we compare this data with national brain tumor data as well as an international brain tumor registry. Materials and Methods For the generation of this 7-year HBBTR data of all primary intracranial tumors operated, diagnosed, and registered at the Department of Pathology, Sawai ManSingh, between January 1, 2013 and December 31, 2019, was collected, analyzed, and compared with Tata Memorial Hospital, National Institute of Mental Health and Neurosciences, and Central Brain Tumor Registry of the United States. Results A total of 3,526 patients were of primary intracranial tumors. Out of which, male patients were 1,982 (56.2%), while 1,544 (43.8%) were female patients. Maximum proportion of tumors was in fifth decade. Overall, pediatric and adult patients constituted of 15.5 and 84.5% of the cases, respectively. Among all primary intracranial tumors, meningiomas (20%) were most common followed by glioblastoma multiformat (18%) and least common were germ cell tumors (0.1%) followed by pineal tumors (0.3%). In pediatric cohort astrocytic tumors (30.1%) are most common followed by embryonal tumors (20.8%), while in adults meningiomas (23.1%) were most common followed by glioblastomas (20.3%). Our registry showed similar trends of tumors with national data as compared with international data in median age of presentation. Conclusion This HBBTRs provide prevalence of primary intracranial tumors at a tertiary care center and could be a part of population-based registry.

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“…Nevertheless, the study is expected to have a significant impact on cancer prevention strategies in India. Firstly, revised Bethesda guidelines cannot be applied to select suspected LS samples for mutation screening given the high proportion of CRC patients aged below 50 yr [34]. More importantly, IHC based analysis of MLH1 and MSH2 may not be ideal to identify possible LS cases.…”

Section: Discussionmentioning

confidence: 99%

Evidence for presence of mismatch repair gene expression positive Lynch syndrome cases in India

Bashyam

Kotapalli

Ratheesh

et al. 2014

Molecular Carcinogenesis

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Lynch syndrome (LS), the most common form of familial CRC predisposition that causes tumor onset at a young age, is characterized by the presence of microsatellite instability (MSI) in tumors due to germline inactivation of mismatch repair (MMR) system. Two MMR genes namely MLH1 and MSH2 account for majority of LS cases while MSH6 and PMS2 may account for a minor proportion. In order to identify MMR genes causing LS in India, we analyzed MSI and determined expression status of the four MMR genes in forty eight suspected LS patient colorectal tumor samples. Though a majority exhibited MSI, only 58% exhibited loss of MMR expression, a significantly low proportion compared to reports from other populations. PCR-DNA sequencing and MLPA-based mutation and exonic deletion/duplication screening respectively, revealed genetic lesions in samples with and without MMR gene expression. Interestingly, tumor samples with and without MMR expression exhibited significant differences with respect to histological (mucin content) and molecular (instability exhibited by mononucleotide microsatellites) features. The study has revealed for the first time a significant proportion of LS tumors not exhibiting loss of MMR expression.

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A positive family history of cancer or lifestyle factors may not explain the high incidence of early-onset colorectal cancer in India

Cited by 3 publications

References 33 publications

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Epidemiological Profiling and Trends of Primary Intracranial Tumors: A Hospital-Based Brain Tumor Registry from a Tertiary Care Center

Evidence for presence of mismatch repair gene expression positive Lynch syndrome cases in India

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