Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer

Fritz, Cassandra; Otegbeye, Ebunoluwa; Zong, Xiaoyu; Demb, Joshua; Nickel, Katelin B.; Olsen, Margaret A.; Mutch, Matthew G.; Davidson, Nicholas O.; Gupta, Samir; Cao, Yin

doi:10.1093/jnci/djad068

Cited by 18 publications

(25 citation statements)

References 38 publications

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“…18,19 For example, the widespread adoption of colonoscopy screening has significantly decreased colon cancer mortality. 20,21 Of note, while there has been an increase in colon cancer being diagnosed in younger people, 22 resulting in a change to recommend colon cancer screening at an earlier age, 23 that increase in colon cancer incidence among younger adults has not translated into higher colon cancer mortality rates. Evidence suggests that sigmoidoscopies reduce CRC incidence and mortality more in men than women due to women having more frequent proximal lesions that cannot be seen with a sigmoidoscope.…”

Section: Discussionmentioning

confidence: 99%

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020)

Ali,

Ishtiaq,

Tedder

et al. 2024

JGH Open

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Background and AimThis study investigates temporal trends in gastrointestinal cancer‐related mortality in the United States between 1999 and 2020, focusing on differences by sex, age, and race.MethodsWe investigated the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research multiple causes of death database (Years 1999–2020) for gastrointestinal cancer‐related mortality with a focus on the underlying cause of death.ResultsA total of 3 115 243 gastrointestinal cancer‐related deaths occurred from 1999 to 2020. The overall age‐adjusted mortality rate decreased from 46.7 per 100 000 in 1999 to 38.4 per 100 000 in 2020. The average annual percent change (AAPC) for the study period was −0.9% (95% CI: −1.0%, −0.9%, P < 0.001), with no significant difference in AAPC between the sexes but some difference between races and related to individual cancers. African Americans and Asian Americans, and Pacific Islanders experienced a greater decrease in mortality compared with Whites. Mortality rates for American Indian and Alaskan Native populations also decreased significantly from 1999 to 2020 (P < 0.001). There were significant declines in esophageal, stomach, colon, rectal, and gallbladder cancer‐related mortality but increases in the small bowel, anal, pancreatic, and hepatic cancer‐related mortality (P < 0.001), with variation across different sexes and racial groups.ConclusionWhile overall gastrointestinal cancer‐related mortality declined significantly in the United States from 1999 to 2020, mortality from some cancers increased. Furthermore, differences between sexes and racial groups underscore crucial differences in gastrointestinal cancer mortality, highlighting areas for future research.

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Section: Discussionmentioning

confidence: 99%

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020)

Ali,

Ishtiaq,

Tedder

et al. 2024

JGH Open

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“…Of the 12 859 unique articles retrieved, 699 full texts were reviewed, and 81 studies 12,13,18, were included (Figure 1 and Table ). There were 76 cross-sectional studies, 12, 13, 18, 27-35, 37-43, 45, 46, 48-92, 94, 96-104 4 case-control studies, 44,47,93,95 and 1 cohort study. 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).…”

Section: Search Strategy and Study Characteristicsmentioning

confidence: 99%

“…There were 5 studies 36,44,47,93,95 examining the association of EOCRC risk with abdominal pain, anemia, constipation, diarrhea, hematochezia, and nausea or vomiting (Figure 3). Hematochezia…”

Section: Associations Of Signs and Symptoms With Eocrc Riskmentioning

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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“…Additionally, risk prediction models with a web interface exist that can support individualised risk prediction conditional on specific symptoms [13]. Currently available evidence chiefly pertains to sources of electronic health records data that do not include information on genetic risk [2,[14][15][16][17][18]. The UK Biobank is one of the largest data sources where information from electronic health records and genetic risk are integrated.…”

Section: Introductionmentioning

confidence: 99%

Phenotypes and rates of cancer-relevant symptoms and tests in the year before cancer diagnosis in UK Biobank and CPRD Gold

Barclay,

Renzi,

Antoniou

et al. 2023

PLOS Digit Health

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Early diagnosis of cancer relies on accurate assessment of cancer risk in patients presenting with symptoms, when screening is not appropriate. But recorded symptoms in cancer patients pre-diagnosis may vary between different sources of electronic health records (EHRs), either genuinely or due to differential completeness of symptom recording. To assess possible differences, we analysed primary care EHRs in the year pre-diagnosis of cancer in UK Biobank and Clinical Practice Research Datalink (CPRD) populations linked to cancer registry data. We developed harmonised phenotypes in Read v2 and CTV3 coding systems for 21 symptoms and eight blood tests relevant to cancer diagnosis. Among 22,601 CPRD and 11,594 UK Biobank cancer patients, 54% and 36%, respectively, had at least one consultation for possible cancer symptoms recorded in the year before their diagnosis. Adjusted comparisons between datasets were made using multivariable Poisson models, comparing rates of symptoms/tests in CPRD against expected rates if cancer site-age-sex-deprivation associations were the same as in UK Biobank. UK Biobank cancer patients compared with those in CPRD had lower rates of consultation for possible cancer symptoms [RR: 0.61 (0.59–0.63)], and lower rates for any primary care consultation [RR: 0.86 (95%CI 0.85–0.87)]. Differences were larger for ‘non-alarm’ symptoms [RR: 0.54 (0.52–0.56)], and smaller for ‘alarm’ symptoms [RR: 0.80 (0.76–0.84)] and blood tests [RR: 0.93 (0.90–0.95)]. In the CPRD cohort, approximately representative of the UK population, half of cancer patients had recorded symptoms in the year before diagnosis. The frequency of non-specific presenting symptoms recorded in the year pre-diagnosis of cancer was substantially lower among UK Biobank participants. The degree to which results based on highly selected biobank cohorts are generalisable needs to be examined in disease-specific contexts.

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Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer

Cited by 18 publications

References 38 publications

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020)

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020)

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

Phenotypes and rates of cancer-relevant symptoms and tests in the year before cancer diagnosis in UK Biobank and CPRD Gold

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