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From the JAMA Network
August 11, 2015

Young Age and Aggressive Treatment in Colon Cancer

Author Affiliations
  • 1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
  • 2Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
  • 3Department of Medicine–Hematology/Oncology, Northwestern University, Chicago, Illinois
  • 4Department of Surgery, Mayo Clinic, Rochester, Minnesota
JAMA. 2015;314(6):613-614. doi:10.1001/jama.2015.9379

The downward trend in colorectal cancer (CRC) incidence and mortality over the past several decades1 has not held true for young patients. Currently, CRC incidence in patients younger than 50 years continues to increase, most markedly among those younger than 35 years by approximately 2% per year. This trend was identified in a recent analysis that estimated patients younger than screening age (ie, age 50 years) will comprise 10.9% of colon and 22.9% of rectal cancers by 2030, compared with 4.8% and 9.5% in 2010, respectively.2 Young-onset CRC is characterized by more advanced stages, poor tumor differentiation, mucinous carcinoma, more distal location, and even a particular profile of biomarkers.3 Although more aggressive disease usually results in worse outcomes, disease-specific and overall survival for patients with young-onset CRC consistently matches or surpasses that of older patients, stage-for-stage.3 Given this seemingly conflicting information, optimal treatment for these young patients remains unclear.

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