Young-Onset Colorectal Cancer in the North East of Scotland: Survival, Clinico-Pathological Features and Genetics

Abstract

Background Colorectal cancer (CRC) in patients aged under 55 years is on the rise, constituting approximately 10% of cases. Our aim was to determine the survival and clinico-pathological details of young-onset CRC (yCRC), as well as audit the referral rate to genetic services and thus establish the incidence of microsatellite instability (MSI). Methods A retrospective case note review was conducted for patients aged under 55 years who were diagnosed with CRC between 2005-2015 in the North East of Scotland. Cases were identified by pathology records and data was obtained from patient notes then crosschecked with the NHS Grampian genetics electronic case records. Analysis was performed using SPSS version 25 (IBM, New York, USA) to produce Kaplan-Meier survival estimates, descriptive statistics and markers predictive for genetic referral. Results Data from 345 patients (age range 22-54 years) were analysed. The one year, five year and overall survival rates were found to be 89%, 63% and 55%, respectively. A majority of patients (61%) presented with advanced Dukes’ C or D disease. Of 201 patients that met criteria for genetic referral, only 93 (46%) were referred to genetics services. MSI was identified in 14% of those referred. Conclusions Survival in yCRC was found to be better than that in later onset disease, despite higher rates of advanced disease. Patients were under-referred to genetic services, where a significant proportion were found to be MSI positive.

Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry

“…Furthermore, we found that more than 39% of our cases were first diagnosed with CRC when still under 50 years. We also found that the mean age for early-onset CRCs was 40 years and that the highest number of cases were in the final decade of the age range investigated (40-50 years of age), which is in accordance with other studies [9,11,16,48]. However, this pattern is more pronounced in Asia than in the Western countries [38,[49][50][51][52][53][54][55].…”

“…In the last 10 years, a large number of research projects around the world have focused on early-onset CRC. The sample size of these studies ranged between 49 and 64,068 cases [5, 7-18, 48, 56-58] and the mean age of study subjects ranged between 37 and 47 years [5,[7][8][9][10][11][12][14][15][16][17][18]. In contrast to our study, the frequency of earlyonset CRC is generally reported to be higher in men than in women [5,7,10,11,[13][14][15][16][17]48], but various studies have yielded conflicting results [10,28,47,59].…”

“…According to several studies, the incidence early-onset CRC (affecting those < 50 years of age) varies between different parts of the world with nearly 20% of the cases found in Asia including the Middle East (where the disease is not unusual in < 40-year olds) as compared to 2-8% reported in the U.S. [7,8]. The mean age of earlyonset CRC ranges between 37 and 47 years around the world [5,[7][8][9][10][11][12][13][14][15][16][17][18] and 41-69% of these cases are men. Compared to Western World (Europe and the U.S.), the incidence of CRC is currently very low in the older Iranian population, while young Iranians are showing a rising trend [19].…”

Oral antibiotic use and early-onset colorectal cancer: findings from a case-control study using a national clinical database

“…However, the relationship is not particularly specific; with around 67 million courses of antibiotics prescribed each year in the USA to children aged less than 19 [18], exposure to antibiotics among the young is incredibly common. It is therefore hard to judge how many of these exposed individuals will potentially be diagnosed with earlyonset CRC-a relatively rare disease outcome [9].…”

“…This pattern may be related; antibiotic consumption has been associated with CRC genesis in adults of all ages [4][5][6][7][8]. In contrast to declining incidence amongst older populations [5,9], CRC incidence among adults aged 20-29 years in Europe is increasing by ~8% each year [1]. In the USA, CRC is the second most common incident cancer and third leading cause of cancer death in adult males less than 50 years old [10].…”