Colorectal cancer in Egyptian patients under 40 years of age

Abstract

Although colorectal cancer is not a common cancer in Egypt, the age distribution of the disease shows that a high proportion occurs in children and adults under 40 years of age. We reviewed the records of 1,608 colorectal cancer patients treated in 4 cancer hospitals in Egypt during a period of 3 to 10 years. The hospitals in which about 85% of all colorectal cancer cases in Egypt were seen included Egypt's 2 major cancer centers, The National Cancer Institute (NCI) in Cairo and Tanta Cancer Center (TCC) in the mid-Nile Delta region, and 2 major university hospitals, Assiut University in South Egypt and Ain Shams University in Cairo. Our review showed that patients younger than 40 years represented 35.6% of all patients in the 4 cancer hospitals, and that these rates were similar among the hospitals and for the years reviewed. The male-to-female ratio increased from 1.0 to 1.7 for the age groups ranging from 0-9 and 30-39 years, and increased from 1.0 to 1.5 for the age groups ranging from 40-49 to over 60 years. More than half of all the patients had rectal tumors, and about 90% of the cancers were adenocarcinomas; 30.6% of patients younger than 40 years, compared with 13.8% of older patients, had mucin-producing tumors. This study confirmed the occurrence of a high colorectal cancer rate in young Egyptians, and it opens the door to future epidemiologic studies to identify causes and risk factors of this disease pattern in Egypt. Int.

Distinct Genetic and Epigenetic Signatures of Colorectal Cancers According to Ethnic Origin

“…More than one third of Egyptian colorectal carcinomas affect young people before 40 years and 60% affect people younger than 50 years, whereas only 15% of patients were older than 60 years in a multicenter study in Egypt (4). A comparison of the age-specific colorectal cancer incidence rates of a representative sample from Egypt with the data from the Surveillance, Epidemiology and End Results (SEER) of the National Cancer Institute, Bethesda, MD, showed higher rates of colorectal cancer among Egyptians than in North Americans until age 30 to 34, followed by constant rates in Egyptians (<20 of 100,000) and a marked increase in North Americans (>100 of 100,000) in 60þ age groups (3). This high prevalence in the young could not be explained by Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) as few, if any, of the young patients fulfilled the Amsterdam criteria nor could it be explained by other known hereditary syndromes including familial adenomatous polyposis.…”

“…Cancers in the Eastern and Middle Eastern countries appear to include novel clinical and molecular categories as implied by different incidence rates, familial clustering, and/or younger age at onset compared with the West (1, 2). In particular, colon cancer is a surprisingly young-age disease and has a more unfavorable outcome in Egypt (3). More than one third of Egyptian colorectal carcinomas affect young people before 40 years and 60% affect people younger than 50 years, whereas only 15% of patients were older than 60 years in a multicenter study in Egypt (4).…”

Differing DNA Methylation Patterns and Gene Mutation Frequencies in Colorectal Carcinomas from Middle Eastern Countries

“…We reported previously that colorectal carcinoma in Egypt is characterized by young age of onset, frequent rectal cancer, and poor differentiation, and by distinctive genetic alterations, including a low frequency of K-ras mutation in the tumors of young patients (4,20). We proposed that cultural influences and environmental exposures, such as pesticides, parasitic infestations, or dietary habits, may contribute to the nonWestern disease pattern (21).…”

Rising rates of colorectal cancer among younger Iranians: is diet to blame?

“…If their hypothesis is accepted, a cohort effect should soon be evident (that is, within the next 10 years), with the crc rate in the Iranian population 45-54 years of age also becoming close to the U.S. rate (35 per 100,000 population annually) 12 . In Egypt, where the proportion of young people with crc is exceptionally high (36%) 63 , a genetic predisposition is more possible 64 . A similar unique genetic pattern in the Iranian population cannot be ruled out.…”