Conference Coverage

Survey: CRC diagnosis often delayed or initially missed in patients under age 50


The incidence of colorectal cancer in patients aged 20-49 years is increasing, but the diagnosis is often delayed in this age group because of a failure by both patients and physicians to recognize the symptoms as related to CRC, a survey suggests.

Dr. Ronit Yarden

Dr. Ronit I. Yarden

Of 1,195 colorectal cancer (CRC) patients or survivors aged under 50 years who responded to the web-based survey, 63% waited between 3 and 12 months before visiting their doctor after experiencing symptoms, including bloating, constipation, rectal bleeding, blood in stool, abdominal pain, flatulence, fatigue, or nausea and vomiting, Ronit I. Yarden, PhD, reported during a press conference highlighting data to be presented at the upcoming American Association for Cancer Research (AACR) annual meeting in Atlanta.

More than half of the respondents (56%) had at least three symptoms and still waited at least 3 months before visiting a doctor.

“And almost one in four waited at least a year to visit their doctor or other provider,” said Dr. Yarden, director of medical affairs for the Colorectal Cancer Alliance in Washington, D.C., which conducted the survey.

When patients did seek medical care, they often were initially misdiagnosed. In fact, 67% of the respondents reported having seen at least two physicians, with some seeing more than four physicians, before being diagnosed correctly with CRC, she said, noting that among the most common misdiagnoses were hemorrhoids and inflammatory bowel disease.

The delays in treatment and correct diagnoses have life-threatening implications; data show that, while the overall incidence of CRC is declining, the incidence in younger adults has increased. According to the American Cancer Society, most CRC patients over the age of 50 years are diagnosed in the early stages of disease, whereas 71% of the young-onset survey respondents were diagnosed at stage III or IV, Dr. Yarden said.

This is important, because 5-year survival is only 70% for stage III disease, and is less than 50% for stage IV disease. One in four survey respondents was diagnosed at stage IV, she said.

The survey included young-onset patients and survivors and was administered over social media to track the self-reported clinical, psychosocial, financial, and quality of life experiences of “this often-overlooked group,” she said.

The majority of participants (57%) were diagnosed between the ages of 40 and 49 years, a third were diagnosed between the ages of 30 and 39, and about 10% were diagnosed before the age of 30.

The findings underscore the need for greater awareness that “colorectal cancer, which is one of the most preventable diseases, can happen in younger adults,” Dr. Yarden said, also noting that extended screening is needed “if we want to beat this disease.”

John D. Carpten, PhD, the AACR meeting program chair and press conference comoderator, agreed that the findings could have significant policy implications, as many screening recommendations for CRC call for screening beginning at age 50 years.

“So for those individuals who are diagnosed with colon cancer in their 30s or 40s, this raises a potentially significant problem,” he said. “Additional studies need to be done to actually identify the factors influencing these early onset cancers. ... Hopefully that will improve our ability to detect these cancers earlier and to identify the most appropriate and effective ways to treat these cancers – particularly given that they tend to be diagnosed at more advanced stages.”

Work is also needed to help ensure access to the most appropriate care for younger patients – a concern related to disparities in health care access, he said, noting that the AACR meeting with “have a strong emphasis on disparities.”

Disparities can be related to race/ethnicity, rural versus urban setting, and socioeconomic factors, but they can also be related to age – which might be a particular problem in the case of early-onset CRC, he said.

Adolescent and young adult patients, in particular, represent “sort of a new disparity group,” and “can sometimes get lost in the system,” said Dr. Carpten, professor and chair of translational genomics and director of the Institute of Translational Genomics at the University of Southern California, Los Angeles.

“So we need to find better ways to detect these cancers earlier so we can manage these better,” he said.

This study was funded by the Colorectal Cancer Alliance. Dr. Yarden reported having no conflicts of interest.

SOURCE: Yarden R et al. AACR 2019, Abstract preview.

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