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June 30, 2021

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review

REACCT Collaborative
JAMA Surg. 2021;156(9):865-874. doi:10.1001/jamasurg.2021.2380

Importance  The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.

Observations  Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.

Conclusions and Relevance  The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.

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1 Comment for this article
EOCRC, further investigation
Daniel Krell, M.D. | Retired PCP
In reports of EOCRC, I have not seen breakdowns of incidence by gender; HPV vaccination status; evidence of HPV infection (genital, anal, rectal, tumor); age of onset of sexual activity; number of partners; or receptive anal intercourse. Such breakdowns established cervical cancer as an STD, resulting in appropriate diagnostics and treatments. Increased incidence of EOCRC is a global phenomenon and, certainly, multifactorial. This should not diminish the value of a deeper dive into the HPV issue.