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Khan MMM, Munir MM, Woldesenbet S, Endo Y, Khalil M, Tsilimigras D, Harzman A, Huang E, Kalady M, Pawlik TM. Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race/Ethnicity and Social Vulnerability. Ann Surg Oncol 2024; 31:3222-3232. [PMID: 38361094 PMCID: PMC10997707 DOI: 10.1245/s10434-024-15029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted health care delivery, including cancer screening practices. This study sought to determine the impact of the COVID-19 pandemic lockdown on colorectal cancer (CRC) screening relative to social vulnerability. METHODS Using the Medicare Standard Analytic File, individuals 65 years old or older who were eligible for guideline-concordant CRC screening between 2019 and 2021 were identified. These data were merged with the Center for Disease Control Social Vulnerability Index (SVI) dataset. Changes in county-level monthly screening volumes relative to the start of the COVID-19 pandemic (March 2020) and easing of restrictions (March 2021) were assessed relative to SVI. RESULTS Among 10,503,180 individuals continuously enrolled in Medicare with no prior diagnosis of CRC, 1,362,457 (12.97%) underwent CRC screening between 2019 and 2021. With the COVID-19 pandemic, CRC screening decreased markedly across the United States (median monthly screening: pre-pandemic [n = 76,444] vs pandemic era [n = 60,826]; median Δn = 15,618; p < 0.001). The 1-year post-pandemic overall CRC screening utilization generally rebounded to pre-COVID-19 levels (monthly median screening volumes: pandemic era [n = 60,826] vs post-pandemic [n = 74,170]; median Δn = 13,344; p < 0.001). Individuals residing in counties with the highest SVI experienced a larger decline in CRC screening odds than individuals residing in low-SVI counties (reference, low SVI: pre-pandemic high SVI [OR, 0.85] vs pandemic high SVI [OR, 0.81] vs post-pandemic high SVI [OR, 0.85]; all p < 0.001). CONCLUSIONS The COVID-19 pandemic was associated with a decrease in CRC screening volumes. Patients who resided in high social vulnerability areas experienced the greatest pandemic-related decline.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Alan Harzman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Emily Huang
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Matthew Kalady
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Gökmen İ, Taştekin E, Demir N, Özcan E, Akgül F, Hacıoğlu MB, Erdoğan B, Topaloğlu S, Çiçin İ. Molecular Pattern and Clinical Implications of KRAS/NRAS and BRAF Mutations in Colorectal Cancer. Curr Issues Mol Biol 2023; 45:7803-7812. [PMID: 37886935 PMCID: PMC10605734 DOI: 10.3390/cimb45100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of our study was to evaluate the incidence of KRAS/NRAS and BRAF mutations, analyze molecular patterns, and investigate associations with clinical parameters of these mutations in CRC KRAS/NRAS and BRAF mutations analyzed by next-generation sequencing. The detection rates of these mutations and patients' demographics were recorded and the relationship between them was evaluated using the chi-square test. KRAS mutation was detected in 332 of 694 patients, while the mutation rates in KRAS exons 2/3 and 4 were 39.6%/3.2% and 5%, respectively. The most common mutation pattern was KRAS G12D. Five atypical variants were detected: V14I in KRAS exon 2, A18D, Q22K and T50I in exon 3, and T148P in exon 4. NRAS mutation was detected in 29 (4.5%) patients. One atypical variant L80W was detected in NRAS exon 3. BRAF mutation was seen in 37 (5.3%) patients, with BRAFV600E (83.8%) being the most common mutation pattern. NRAS mutation was significantly more frequent in patients > 64 years of age, BRAF mutation in women, and NRAS/BRAF mutations in right colon tumors. Grouping BRAF mutations into BRAFV600E and BRAFnon-V600E and their analysis according to specific tumor localizations showed that all four BRAFnon-V600E mutations originated in the rectum. In our study, KRAS exon 2 and other RAS mutation rates were higher than in the literature, while the BRAF v.600E mutation rate was similar. NRAS and BRAF mutations were significantly more frequent in the right colon. BRAF mutation was more common in women and in the right colon.
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Affiliation(s)
- İvo Gökmen
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - Ebru Taştekin
- Department of Pathology, Trakya University School of Medicine, Edirne 22030, Turkey;
| | - Nazan Demir
- Department of Medical Oncology, Sultan I. Murat Public Hospital, Edirne 22030, Turkey;
| | - Erkan Özcan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - Fahri Akgül
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - Muhammed Bekir Hacıoğlu
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - Bülent Erdoğan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - Sernaz Topaloğlu
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
| | - İrfan Çiçin
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22030, Turkey; (E.Ö.); (F.A.); (M.B.H.); (S.T.); (İ.Ç.)
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Wang W, Jin J, Zhou Z, Wang Y, Min K, Zuo X, Jiang J, Zhou Y, Shi J. Snail inhibits metastasis via regulation of E‑cadherin and is associated with prognosis in colorectal cancer. Oncol Lett 2023; 25:271. [PMID: 37216162 PMCID: PMC10193364 DOI: 10.3892/ol.2023.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/28/2023] [Indexed: 05/24/2023] Open
Abstract
The overall survival (OS) rate of patients with colorectal cancer (CRC) remains low due to the lack of clear prognostic markers. Therefore, the identification of valuable prognostic markers is urgently required. Snail and E-Cadherin (E-Cad) are important protein molecules in the EMT process and play a crucial role in tumor invasion and metastasis. The present study investigated the clinical significance of Snail and E-cad expression in CRC. Compared with those in adjacent tissue, the expression levels of Snail and E-cad were significantly increased and decreased, respectively, in CRC. Moreover, low Snail and high E-cad expression were associated with clinicopathological features and longer OS time. Furthermore, Snail and E-cad could predict the prognosis of patients with CRC. Reverse transcription-qPCR, Western blotting, Wound scratch assay, High content cell migration experiment, which showed that low Snail or high E-cad expression inhibited invasion and metastasis of CRC. In conclusion, Snail can promote CRC invasion and metastasis by regulating E-cad. Snail and E-cad expression constitute a novel prognostic marker for CRC, and the present study revealed a greater combined effect of Snail and E-cad as effective prognostic markers in CRC for the first time.
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Affiliation(s)
- Weimin Wang
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Jun Jin
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
| | - Zhen Zhou
- Department of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Yunfan Wang
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
| | - Ke Min
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
| | - Xin Zuo
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
| | - Jiaping Jiang
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
| | - Yan Zhou
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yixing, Jiangsu 214200, P.R. China
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Jun Shi
- Department of General Surgery, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Yixing, Jiangsu 214200, P.R. China
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Liu A, Zheng Y, Yang P, Chu H, Hou X. Change in onset age of first primary colorectal cancer in the USA. Int J Colorectal Dis 2023; 38:45. [PMID: 36795178 DOI: 10.1007/s00384-023-04336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Identifying the onset age of cancer is essential for its early intervention. The aim of this study was to characterize the features and investigate the variation tendency of first primary colorectal cancer (CRC) onset age in the USA. METHODS For this retrospective population-based cohort analysis, data on patients diagnosed with first primary CRC (n = 330,977) between 1992 and 2017 were obtained from the Surveillance, Epidemiology, and End Results dataset. Annual percent changes (APC) and average APCs were calculated to examine the changes in average age at CRC diagnosis using the Joinpoint Regression Program. RESULTS From 1992 to 2017, the average age at CRC diagnosis decreased from 67.0 to 61.2 years, declining by 0.22% and 0.45% annually before and after 2000. The age at diagnosis was lower in the distal than in the proximal CRC cases and the age has the downward trends in all subgroups of sex, race, and stage. Over one-fifth of CRC patients were initially diagnosed with distantly metastatic CRC, with the age lower than that in localized CRC cases (63.5 vs 64.8 years). CONCLUSIONS The first primary CRC onset age has decreased significantly in the USA over the last 25 years and the modern lifestyle may be responsible for the decline. Specifically, the age of proximal CRC is invariably higher than that of distal CRC. Moreover, the age of advanced stage is lower than that of the early stage. Clinicians should adopt earlier screening age and more effective screening techniques for CRC.
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Affiliation(s)
- Ao Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yongqiang Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Pengcheng Yang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huikuan Chu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. Statistical methods for measuring trends in colorectal cancer incidence in registries: A systematic review. Front Oncol 2022; 12:1049486. [DOI: 10.3389/fonc.2022.1049486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundMonitoring cancer trends in a population is essential for tracking the disease’s burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends.MethodsWe performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used.ResultsThis review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used.ConclusionThis review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.
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Significant Rise of Colorectal Cancer Incidence in Younger Adults and Strong Determinants: 30 Years Longitudinal Differences between under and over 50s. Cancers (Basel) 2022; 14:cancers14194799. [PMID: 36230718 PMCID: PMC9563745 DOI: 10.3390/cancers14194799] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There is evidence in the recent literature that the incidence patterns of colorectal cancer (CRC) have changed considerably over the years, tending to rise rapidly in individuals under 50 years old compared with those over 50 years. The current study aimed to assess the incidence of CRC in Crete from 1992−2021 and compare them among younger and older adults. (2) Methods: Data on malignant neoplasms of colon, rectosigmoid junction, and rectum have been extracted from the database of the Regional Cancer Registry of Crete. (3) Results: The number of these cases for the period 1992−2021 was 3857 (n = 2895 colon and n = 962 rectum). The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1−9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2−153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20−34 years and further increase is expected from 2022−2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012−2021. (4) Conclusions: We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. The observed trends clearly indicate that starting CRC screening at an earlier age may be essential.
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. A systematic review of methods to estimate colorectal cancer incidence using population-based cancer registries. BMC Med Res Methodol 2022; 22:144. [PMID: 35590277 PMCID: PMC9118801 DOI: 10.1186/s12874-022-01632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. Methods We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. Results This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. Conclusion This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01632-7.
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Affiliation(s)
- Norah Alsadhan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Alaa Almaiman
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mar Pujades-Rodriguez
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cathy Brennan
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sultana A Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Robert M West
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Increased Risk of Advanced Colonic Adenomas and Timing of Surveillance Colonoscopy Following Solid Organ Transplantation. Dig Dis Sci 2022; 67:1858-1868. [PMID: 33973084 DOI: 10.1007/s10620-021-06987-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Detection and removal of colonic adenomatous polyps (CAP) decreases colorectal cancer (CRC) development, particularly with more or larger polyps or polyps with advanced villous/dysplastic histology. Immunosuppression following solid organ transplantation (SOT) may accelerate CAP development and progression compared to average-risk population but the benefit of earlier colonoscopic surveillance is unclear. AIMS Study the impact of maintenance immunosuppression post-SOT on developmental timing, multiplicity and pathological features of CAP, by measuring incidence of advanced CAP (villous histology, size ≥ 10 mm, ≥ 3 polyps, presence of dysplasia) post-SOT and the incidence of newly diagnosed CRC compared to average-risk age-matched population. METHODS Single-center retrospective cohort study of SOT recipients. RESULTS 295 SOT recipients were included and were compared with 291 age-matched average-risk controls. The mean interval between screening and surveillance colonoscopies between SOT and control groups was 6.3 years vs 5.9 years (p = 0.13). Post-SOT maintenance immunosuppression mean duration averaged 59.9 months at surveillance colonoscopy. On surveillance examinations, SOT recipients exhibited more advanced (≥ 10 mm) adenomas compared to matched controls (9.2% vs. 3.8%, p = 0.034; adjusted OR 2.38; 95% CI 1.07-5.30). CONCLUSION SOT recipients appear at higher risk for developing advanced CAP, suggesting that earlier surveillance should be considered.
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Ranasinghe R, Mathai M, Zulli A. A synopsis of modern - day colorectal cancer: Where we stand. Biochim Biophys Acta Rev Cancer 2022; 1877:188699. [DOI: 10.1016/j.bbcan.2022.188699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
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Panteris V, Karantanos P, Vasilakis N, Vgenopoulou S, Lymperopoulou G, Feretzakis G, Dalainas I, Kouroumalis E. New considerations for colorectal cancer screening based on the demographic profile of colorectal cancer in a Greek population. Mol Clin Oncol 2022; 16:57. [PMID: 35111323 PMCID: PMC8771310 DOI: 10.3892/mco.2022.2490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vasileios Panteris
- Gastroenterology Department, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Panagiotis Karantanos
- Gastroenterology Department, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Nikolaos Vasilakis
- Gastroenterology Department, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Stephanie Vgenopoulou
- Histopathology Department, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Georgia Lymperopoulou
- Gastroenterology Department, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Georgios Feretzakis
- Department of Quality Control, Research and Continuing Education, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
| | - Ilias Dalainas
- General Manager, Sismanogleio‑Amalia Fleming General Hospital, 15126 Athens, Greece
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Lewandowska A, Rudzki G, Lewandowski T, Stryjkowska-Góra A, Rudzki S. Risk Factors for the Diagnosis of Colorectal Cancer. Cancer Control 2022; 29:10732748211056692. [PMID: 35000418 PMCID: PMC8753079 DOI: 10.1177/10732748211056692] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Colorectal cancer defined as cancer of the colon or rectum, is the third most frequently diagnosed cancer in men and the second in women, and, according to the World Health Organization database GLOBOCAN, it accounts for nearly 1.4 million new cases annually worldwide. The occurrence of colorectal cancer is associated with nonmodifiable risk factors, including age and hereditary factors, as well as with modifiable environmental and lifestyle factors. METHODS The study included 800 patients, 400 diagnosed with colorectal cancer and 400 within the control group, who gave their written informed consent to participate in the study. Patients with cancer other than colorectal cancer were randomly selected for control group I, and patients with no cancer diagnosis were selected for control group II. The method used was a case-control study - an observational and analytical study with a control group, conducted among patients of the Clinical Oncology Centre and the Provincial Hospital in the years 2019-2020. The study comparing the exposure was carried out in a group of people who developed the endpoint, that is colorectal cancer, with the exposure in a well-matched group of controls who did not reach the endpoint. Assessment of activity and BMI was used according to WHO recommendations, as well as the expert system. The data were tested for the distribution and the homogeneity of variance was validated before applying the parameter tests. Comparison of quantitative variables between groups was performed using ANOVA. RESULTS The mean age of the patients was 64.53 ± 8.86 years, of the control group I - 59.64 ± 9.33 and the control group II - 57.5 (7.83). There was a strong positive association between the incidence of ulcerative colitis and the risk of colorectal cancer (P < .01). Among obese subjects, the risk of developing colorectal cancer was 1.27 (95% CI, 1.06-1.53) compared with nonobese subjects. A strong positive relationship was found between low physical activity converted to metabolic equivalent of MET effort per week and the risk of colorectal cancer (P < .001). The relative risk for current smokers was 2.17 (95% CI 1.79-2.66). There was an association between higher fat consumption and higher red meat consumption and the risk of developing colorectal cancer (P < .01). CONCLUSIONS Obesity, low physical activity, active and passive smoking and high salt and red meat consumption have been associated with an increased risk of colorectal cancer. These findings provide further evidence of the importance of maintaining a healthy lifestyle.
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Affiliation(s)
- Anna Lewandowska
- Institute of Healthcare, State School of Technology and Economics in Jaroslaw, Jaroslaw, Poland
| | - Grzegorz Rudzki
- Chair and Department of Endocrinology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Lewandowski
- Institute of Technical Engineering, State School of Technology and Economics in Jaroslaw, Jaroslaw, Poland
| | | | - Sławomir Rudzki
- I Chair and Department of General and Transplant Surgery and Nutritional, Medical University of Lublin, Lublin, Poland
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McClelland PHT, Liu T, Ozuner G. Early-Onset Colorectal Cancer in Patients under 50 Years of Age: Demographics, Disease Characteristics, and Survival. Clin Colorectal Cancer 2021; 21:e135-e144. [PMID: 34972664 DOI: 10.1016/j.clcc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/05/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Incidence of early-onset colorectal cancer (EO-CRC) is increasing in younger demographics. This study analyzes disease-specific survival in individuals under 50 years of age. METHODS Patients with colorectal malignancy were identified in the Surveillance Epidemiology and End Results (SEER) database from 2004 to 2015. Cases were categorized into typically screened (age 50-79 years) and non-typically screened (age 20-49 years) cohorts, as well as by decade. Kaplan-Meier curves and Cox proportional hazard models were used to study survival. RESULTS A total of 240,772 patients with colorectal cancer were analyzed. Average annual percent change in incidence was -0.24% among typically screened patients and +1.12% among patients with EO-CRC. Patients with EO-CRC more frequently presented with distal tumors (70.6% vs. 57.6%, P < .001) and advanced tumor stage (61.3% vs. 48.6%, P < .001). Patients aged 50 and over had comparable 5 year disease-specific survival to younger patients (68.2% vs. 66.4%, P = .31); however, patients in the 3rd, 4th, and 8th decade of life had particularly low survival rates (59.0% vs. 65.8% vs. 65.8%, logrank P < .001). Patients aged 20-29 years had the most increased risk of cause-specific mortality on univariable Cox regression analysis [HR 1.43, 95% CI 1.31-1.56; P < .001], although this was not significant on multivariable analysis [HR 1.06, 95% CI 0.97-1.15; P = .201]. Male sex, older age, advanced stage, rectal and/or cecal primary, and earlier year of diagnosis were independently associated with increased mortality. CONCLUSION Patients with EO-CRC are diagnosed at a later stage and have lower disease-specific survival than those in typically screened cohorts. Additional studies on tumor biology and surveillance strategies are needed to improve outcomes in this population.
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Affiliation(s)
| | - Tianming Liu
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Gokhan Ozuner
- Department of Surgery, Hackensack Meridian Health, North Bergen, NJ
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Gheju A, Jurescu A, Tăban S, Al-Jobory D, Lazăr F, Dema A. Different disease characteristics in young patients with colorectal cancer: a large retrospective study in a city in Romania. J Int Med Res 2021; 49:3000605211016630. [PMID: 34034541 PMCID: PMC8161876 DOI: 10.1177/03000605211016630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE In 2018, colorectal cancer (CRC) was the second most frequent malignancy in Romania after lung cancer. Although CRC is typically encountered in patients >50 years old, CRC's global incidence among younger adults has been increasing. We aimed to compare the disease characteristics of patients with CRC aged ≤50 years with those >50 years old. METHODS We retrospectively evaluated data from patients with CRC who underwent standard surgery at "Pius Brinzeu" Emergency County Hospital, Timisoara, Romania. Patients were divided into two groups: Group 1 (patients ≤50 years old) and Group 2 (patients >50 years old). Six parameters were analyzed (sex, residence location, age, tumor localization, microscopic findings, pathological staging). RESULTS Data on age-related CRC were available for 1380 patients treated from January 2012 to December 2018. Group 1 included 120 patients while group 2 included 1260 patients. Significantly more Group 1 patients presented with advanced CRC compared with Group 2 patients (94.2% vs. 87.4%). Furthermore, CRC in younger adults was more likely to be diagnosed at an advanced stage. CONCLUSIONS Monitoring the CRC incidence in younger adults is essential to assess whether screening practices require changes and to raise awareness among clinicians of the increasing CRC incidence among younger patients.
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Affiliation(s)
- Adelina Gheju
- Department of Pathology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Aura Jurescu
- Department of Pathology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorina Tăban
- Department of Pathology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pathology, Emergency Clinical County Hospital "Pius Brinzeu", Timisoara, Romania
| | - Diana Al-Jobory
- Department of Surgery II, Emergency Clinical County Hospital "Pius Brinzeu", Timisoara, Romania
| | - Fulger Lazăr
- Department of Surgery II, Emergency Clinical County Hospital "Pius Brinzeu", Timisoara, Romania.,Department of Surgery II, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Alis Dema
- Department of Pathology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pathology, Emergency Clinical County Hospital "Pius Brinzeu", Timisoara, Romania
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Wong SW, Ling DY, Yeow RQ, Chong RW, Aziz MRA, Aziz NA, Poh KS, Roslani AC. Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study. Singapore Med J 2021; 62:636-641. [PMID: 34005846 DOI: 10.11622/smedj.2021051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to investigate the clinicopathological patterns and survival outcomes of young-onset colorectal cancer (CRC) in Malaysia. METHODS The study consisted of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,921 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002-2016. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009-2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients. RESULTS The overall proportion of young-onset CRC was 10.7%. Mean age for young-onset CRC was 39.5 ± 7.4 years, with male-to-female ratio of 1.2:1.0. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRC were diagnosed at advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and treatment modality were independent prognostic factors. CONCLUSION The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, prognosis between both groups were equivalent.
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Affiliation(s)
- Sui-Weng Wong
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Dao-Yao Ling
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ri-Qi Yeow
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ro-Wan Chong
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Nora Abdul Aziz
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Keat-Seong Poh
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Abstract
With the changing lifestyle and the acceleration of aging in the Chinese population, the incidence and mortality of colorectal cancer (CRC) have risen in the last decades. On the contrary, the incidence and mortality of CRC have continued to decline in the USA since the 1980s, which is mainly attributed to early screening and standardized diagnosis and treatment. Rectal cancer accounts for the largest proportion of CRC in China, and its treatment regimens are complex. At present, surgical treatment is still the most important treatment for rectal cancer. Since the first Chinese guideline for diagnosis and treatment of CRC was issued in 2010, the fourth version has been revised in 2020. These guidelines have greatly promoted the standardization and internationalization of CRC diagnosis and treatment in China. And with the development of comprehensive treatment methods such as neoadjuvant chemoradiotherapy, targeted therapy, and immunotherapy, the post-operative quality of life and prognosis of patients with rectal cancer have improved. We believe that the inflection point of the rising incidence and mortality of rectal cancer will appear in the near future in China. This article reviewed the current status and research progress on surgical therapy of rectal cancer in China.
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Bett ZK. Aneurysmal dilatation of colon: A rare imaging presentation of colon cancer. Radiol Case Rep 2020; 15:2259-2261. [PMID: 32963665 PMCID: PMC7490976 DOI: 10.1016/j.radcr.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022] Open
Abstract
Aneurysmal dilatation of colon is a rare imaging feature of colon adenocarcinoma. Two cases with massive aneurysmal dilatation of the colon secondary to moderately differentiated adenocarcinomas are described. The 2 cases presented with asymmetric and progressive abdominal distension with no obstructive symptoms. Contrast-enhanced computed tomography of the abdomen and pelvis demonstrated marked aneurysmal dilatation of the involved segments of the colon and circumferential mural thickening. Colonoscopy found markedly dilated lumen in the involved segment of the colon. Histology of the biopsy specimens taken during colonoscopy revealed moderately differentiated adenocarcinoma with extensive infiltration of colon wall and damage of myenteric nerve plexus.
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An Autophagy-Related Long Noncoding RNA Signature Contributes to Poor Prognosis in Colorectal Cancer. JOURNAL OF ONCOLOGY 2020; 2020:4728947. [PMID: 33149738 PMCID: PMC7603611 DOI: 10.1155/2020/4728947] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022]
Abstract
Purpose Colorectal cancer is one of the most common malignant primary tumors, prone to metastasis, and associated with a poor prognosis. As autophagy is closely related to the development and treatment of colorectal cancer, we investigated the potential prognostic value of long noncoding RNA (lncRNA) associated with autophagy in colorectal cancer. Methods In this study, we acquired information on the expression of lncRNAs in colorectal cancer from the Cancer Genome Atlas (TCGA) database and found that 860 lncRNAs were associated with autophagy-related genes. Subsequently, univariate Cox regression analysis was used to investigate 32 autophagy-related lncRNAs linked to colon cancer prognosis. Subsequently, eight of the 32 autophagy-related lncRNAs (i.e., long intergenic nonprotein coding RNA 1503 [LINC01503], ZEB1 antisense RNA 1 [ZEB1-AS1], AC087481.3, AC008760.1, AC073896.3, AL138756.1, AL022323.1, and TNFRSF10A-AS1) were selected through multivariate Cox regression analysis. Based on these autophagy-related lncRNAs, a risk signature was constructed, and the patients were divided into high- and low-risk groups. Results The high-risk group's overall survival time was significantly shorter than that of the low-risk group (p < 0.0001). Receiver operating characteristic curve analysis was performed to further confirm the validity of the model (area under the curve: 0.689). Moreover, multivariate regression suggested that the risk score was a significant prognostic risk factor in colorectal cancer. Gene set enrichment analysis showed that these gene sets are significantly enriched in cancer-related pathways, such as Kirsten rat sarcoma viral oncogene homolog (KRAS) signaling. Conclusion The risk signature of eight autophagy-related lncRNAs has prognostic potential for colorectal cancer. These autophagy-related lncRNAs may play a vital role in the biology of colorectal cancer.
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Jiang D, Shu C, Lei C, Wan Y, Sun L. Early-onset colorectal cancer: A distinct entity with unique genetic features. Oncol Lett 2020; 20:33. [PMID: 32774506 PMCID: PMC7406876 DOI: 10.3892/ol.2020.11894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/26/2020] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to elucidate the genetic features of early-onset colorectal cancer (CRC), particularly the genetic mutations that may be regarded as prognostic and/or predictive markers in CRC and other malignancies. In total, 40 patients with non-polyposis CRC aged 35 or younger were selected. The formalin-fixed, paraffin-embedded tumors acquired were subjected to mismatch repair (MMR) protein immunochemical staining and gene analysis with next-generation sequencing (44 exons, 17 genes; Ion Torrent Sequencing Platform). A total of 11 (27.5%) tumors presented with MMR protein deficiency (dMMR) and 26 (65%) tumors harbored one or more genetic mutations, including K-RAS proto-oncogene (35%), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA; 20%), B-Raf proto-oncogene (5%), erb-b2 receptor tyrosine kinase 2 (5%), discoidin domain receptor tyrosine kinase 2 (5%), N-RAS proto-oncogene (2.5%), KIT proto-oncogene (2.5%), TSC complex subunit 1 (2.5%), DNA methyltransferase 3 alpha (2.5%) and ABL proto-oncogene 1 (2.5%). Of the dMMR tumors, 81.8% (9/11) of cases presented with mutations in the tested genes, while only 58.6% (17/29) of the MMR-proficient (pMMR) tumors presented with these (P=0.158). PI3KCA was frequently mutated in dMMR tumors compared to pMMR tumors (P=0.025). In a subgroup with a family history of CRC, the dMMR status (P<0.001) and PIK3CA genetic mutation status (P=0.01) were more frequently observed compared to the other two groups (with a family history of other cancer types or no malignancy). Almost all patients who had relatives with CRC presented with both dMMR and other genetic mutations, while this was not observed in the patients who had relatives with other types of carcinoma. Certain genetic mutations that are rarely reported in CRC were only identified in those patients with a family history of carcinoma. In conclusion, non-polyposis CRC in young adults presents as a distinct entity with a unique set of genetic features. However, investigation of more cases in further studies is required to verify the present results.
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Affiliation(s)
- Dan Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Chang Shu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Chengdu, Sichuan 610041, P.R. China
| | - Chuanfen Lei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ying Wan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Linyong Sun
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Symptoms and demographic factors associated with early-onset colorectal neoplasia among individuals undergoing diagnostic colonoscopy. Eur J Gastroenterol Hepatol 2020; 32:821-826. [PMID: 32243343 DOI: 10.1097/meg.0000000000001720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The incidence and mortality of colorectal cancer (CRC) are increasing in adults under 50 years. Risk factors associated with early-onset colorectal neoplasia (CRN) are uncertain. We aimed to identify clinical predictors associated with the presence of CRN detected by diagnostic colonoscopy in symptomatic individuals under 50 years of age. METHODS We used a single-center endoscopy database to identify symptomatic patients 18-49 years of age who underwent ambulatory colonoscopy between 2007 and 2017. Pathology reports identified CRN as adenomas, advanced adenomas (based on size or histology), or adenocarcinomas. Multivariable analysis was used to determine factors associated with CRN. RESULTS We identified 4333 eligible patients of whom 363 (8.4%) had any CRN and 48 (1.1%) had advanced neoplasia (advanced adenoma or adenocarcinoma). Factors associated with any CRN on multivariable analysis included male sex [odds ratio (OR) 1.50 (1.19-1.88)], older age group [compared to 18-29 years, OR for 30-39: 3.12 (1.93-5.04); OR for 40-49: 4.68 (2.97-7.36)], obesity [OR for BMI 30-34.9 compared to 18-24.9: 1.44 (1.04-2.01)], and any tobacco use [OR 1.63 (1.18-2.23)]. Anemia was associated with advanced neoplasia [OR 3.11 (1.32-7.34)]. Of the advanced neoplastic lesions, 38 of 48 (79.2%) were located in the distal colon. CONCLUSIONS In the largest study to date of symptomatic individuals under 50 years of age undergoing colonoscopy in the USA, advanced CRN was most often detected in the distal colon and was associated with anemia, but not with abnormal bowel habits or abdominal pain. We also found that patients with CRN under 50 years of age were more likely to be male, smokers, and obese. These findings should prompt further investigation of these risk factors alone and in combination.
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Ohri A, Robinson A, Liu B, Bhuket T, Wong R. Updated Assessment of Colorectal Cancer Incidence in the U.S. by Age, Sex, and Race/Ethnicity. Dig Dis Sci 2020; 65:1838-1849. [PMID: 31701261 DOI: 10.1007/s10620-019-05913-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/19/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Whether recent updates to colon cancer screening guidelines benefit men and women or all race/ethnic groups equally is not clear. AIMS The aim of this study is to evaluate age-, sex-, and race/ethnicity-specific trends in CRC incidence and disease burden among adults. METHODS Using 2000-2014 surveillance, epidemiology, and end results database, annual CRC incidence (per 100,000 persons/year) among U.S. adults was categorized by age (using 10-year age intervals) and stratified by sex and race/ethnicity. Comparison of incidence between groups utilized the z-statistic with p < 0.05 indicating statistical significance. RESULTS Overall, CRC incidence was the highest among patients aged ≥ 80 years (330.8 per 100,000 persons/year), which was significantly higher in men versus women (377.2 vs. 304.3 per 100,000 persons/year, p < 0.001). CRC incidence in younger individuals was 22.8 per 100,000 persons/year (age 40-49) and 6.8 per 100,000 persons/year (age 30-39). CRC incidence was significantly higher in African Americans compared to non-Hispanic whites. From 2000 to 2014, CRC incidence declined in all age groups over age 60, remained stable in age 50-59, and demonstrated proportional increases in among age 20-49 years. While CRC incidence in all race/ethnic groups aged ≥ 60 years declined, Hispanics aged 50-59 increased 21.9%, but remained stable in other race/ethnic groups. Race/ethnicity-specific disparities in CRC incidence in patients aged 20-49 were also observed. CONCLUSIONS While CRC incidence has declined among U.S. adults aged ≥ 60, increasing incidence among patients aged < 50 is concerning. Identifying risk factors among "average-risk" patients is needed to better implement targeted screening of individuals not currently meeting CRC screening criteria.
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Affiliation(s)
- Ajay Ohri
- Department of Internal Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA
| | - Ann Robinson
- Department of Internal Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
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Lumsdaine CT, Liu-Smith F, Li X, Zell JA, Lu Y. Increased incidence of early onset colorectal adenocarcinoma is accompanied by an increased incidence of rectal neuroendocrine tumors. Am J Cancer Res 2020; 10:1888-1899. [PMID: 32642298 PMCID: PMC7339271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023] Open
Abstract
Recent studies have reported an increasing incidence of early onset colorectal cancer (CRC). Few studies compared the changing incidence of CRC by the major histological type, adenocarcinoma and neuroendocrine tumors (NETs). Using data from the Surveillance, Epidemiology, and End Results Program (SEER), we identified CRC from 1992 to 2015 with site and histological codes. Standardized incidence rates of CRC by anatomical locations (proximal, distal and rectal colon) and histological types (adenocarcinoma, NETs and others) were calculated over calendar years. Annual percent changes (APC) and joint-point regression were further computed. A significant increase of cancers in the distal colon and rectum was observed in young populations (20-44 and 45-54 years) but not in the proximal colon. Further analyses found that the highest rise of rectal NETs was in the 45-54 years which contributed 53.47% to the total increase of rectal cancer. The APCs for NETs in the rectum were 2.9 (95% CI: -0.1, 6.0) and 6.1 (95% CI: 3.8-8.4) for 20-44 years or 45-54 years respectively. The increase of NETs in the rectum was still significant in the older than 55 years (APC=3.7, 95% CI: 2.8-4.7), although the total CRC in this group was decreasing. Incidence of NETs in the distal colon is not apparently changing. The increase of CRC incidence among young populations (age < 55) is mainly due to the increased incidence in the rectum and distal colon. Moreover, the increase of early onset cancer in the rectum could be ascribed to increased incidence of adenocarcinoma and NETs.
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Affiliation(s)
- Cory Tyler Lumsdaine
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of CaliforniaIrvine, CA, USA
| | - Feng Liu-Smith
- Department of Epidemiology, Susan and Henry Samueli College of Health Sciences, University of CaliforniaIrvine, CA, USA
| | - Xiaodong Li
- Department of Pathology, School of Medicine, University of CaliforniaIrvine, CA, USA
| | - Jason A Zell
- Department of Medicine, School of Medicine, University of CaliforniaIrvine, CA, USA
- Chao Family Comprehensive Cancer Center, University of CaliforniaIrvine, CA, USA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of CaliforniaIrvine, CA, USA
- Department of Epidemiology, Susan and Henry Samueli College of Health Sciences, University of CaliforniaIrvine, CA, USA
- Chao Family Comprehensive Cancer Center, University of CaliforniaIrvine, CA, USA
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Saad El Din K, Loree JM, Sayre EC, Gill S, Brown CJ, Dau H, De Vera MA. Trends in the epidemiology of young-onset colorectal cancer: a worldwide systematic review. BMC Cancer 2020; 20:288. [PMID: 32252672 PMCID: PMC7137305 DOI: 10.1186/s12885-020-06766-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent data suggest that the risk of young-onset colorectal cancer (yCRC), in adults less than 50 years of age, is increasing. To confirm findings and identify contemporary trends worldwide, we conducted a systematic review of studies examining population-level trends in yCRC epidemiology. METHODS We searched MEDLINE (1946-2018), EMBASE (1974-2018), CINAHL (1982-2018), and Cochrane Database of Systematic Reviews (2005-2018) for studies that used an epidemiologic design, assessed trends in yCRC incidence or prevalence, and published in English. Extracted information included country, age cut-off for yCRC, and reported trends in incidence or prevalence (e.g. annual percent change [APC]). We pooled similarly reported trend estimates using random effects models. RESULTS Our search yielded 8695 articles and after applying our inclusion criteria, we identified 40 studies from 12 countries across five continents. One study assessed yCRC prevalence trends reporting an APCp of + 2.6 and + 1.8 among 20-39 and 40-49 year olds, respectively. 39 studies assessed trends in yCRC incidence but with substantial variability in reporting. Meta-analysis of the most commonly reported trend estimate yielded a pooled overall APCi of + 1.33 (95% CI, 0.97 to 1.68; p < 0.0001) that is largely driven by findings from North America and Australia. Also contributing to these trends is the increasing risk of rectal cancer as among 14 studies assessing cancer site, nine showed an increased risk of rectal cancer in adults less than 50 years with APCi up to + 4.03 (p < 0.001). CONCLUSIONS Our systematic review highlights increasing yCRC risk in North America and Australia driven by rising rectal cancers in younger adults over the past two decades.
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Affiliation(s)
- Khalid Saad El Din
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada
| | - Jonathan M Loree
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
- BC Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 No 3 Rd, Richmond, BC, V6X 2C7, Canada
| | - Sharlene Gill
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
- BC Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Carl J Brown
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
- St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Hallie Dau
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada.
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC Canada, V6T 1Z3, Canada.
- Arthritis Research Canada, 5591 No 3 Rd, Richmond, BC, V6X 2C7, Canada.
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Ahmed M. Colon Cancer: A Clinician's Perspective in 2019. Gastroenterology Res 2020; 13:1-10. [PMID: 32095167 PMCID: PMC7011914 DOI: 10.14740/gr1239] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
Colon cancer is a common preventable cancer. With the adoption of widespread colon cancer screening in the developed countries, the incidence and mortality of colon cancer have decreased in the targeted population. But unfortunately, the incidence and mortality of colorectal cancer (CRC) have been increasing over the last 25 years in the young adults below the age of 50. There is disparity in benefit, i.e. reduction in risk of death between right-sided and left-sided colon cancer by screening colonoscopy. The reason could be multifactorial and various measures have been taken to decrease this disparity. Although most of the screened populations are average risk individuals, a minority of the population have various risk factors for developing colon cancer and need to follow specific colon cancer screening guidelines. Gene mutations (adenomatous polyposis coli (APC), deleted in colon cancer (DCC), K-ras, p53, B-Raf proto-oncogene serine/threonine kinase (BRAF), mismatch repair genes) and microsatellite instability lead to the development of colon cancer. Although various non-invasive methods of colon cancer screening are now available, colonoscopy remains the gold standard of colon cancer screening and adenoma detection rate is now being used as the quality metrics in screening colonoscopy. Although Multi-Society Task Force (MSTF) and American College of Physicians (ACP) recommend initiating screening colonoscopy at age 50 years in all individuals except African Americans who should begin screening colonoscopy at age 45 years, the American Cancer Society (ACS) recommends initiating screening colonoscopy at age 45 years in all individuals irrespective of race and ethnicity. Low-volume split-dose prep has been found to be as effective as high-volume split-dose prep and more tolerable to patients with increased compliance. Boston bowel preparation scale is recommended to measure the quality of colon cleansing. CRC is curative if it is diagnosed at an early stage but various palliative treatment options (endoscopic, oncologic and surgical) are available in advanced stages of this cancer. Adequate number of lymph node assessment during surgery is essential in accurate staging of CRC. Checkpoint inhibitors have been found to have dramatic response and durable clinical benefit in dMMR/MSI-H metastatic CRC. Different genetic and immune-oncologic research trials are ongoing for early detection and better management of CRC.
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Affiliation(s)
- Monjur Ahmed
- 132 South 10th Street, Main Building, Suite 468, Philadelphia, PA 19107, USA.
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Christodoulides N, Lami M, Malietzis G, Rasheed S, Tekkis P, Kontovounisios C. Sporadic colorectal cancer in adolescents and young adults: a scoping review of a growing healthcare concern. Int J Colorectal Dis 2020; 35:1413-1421. [PMID: 32556652 PMCID: PMC7340664 DOI: 10.1007/s00384-020-03660-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sporadic colorectal cancer (CRC) amongst adolescents and young adults (AYA) is increasing in incidence. The reasons for this trend are not well understood. Current guidelines do not specifically address this patient cohort. A scoping review was performed to summarise the range of available evidence and identify key areas that need to be addressed in current guidelines. METHODS A systematic literature search was conducted adhering to the PRISMA statement. All potentially eligible studies were screened, and data extraction was performed by two reviewers independently. The studies were then divided into 5 broad subgroups: (1) risk factors, (2) screening, (3) clinicopathological and molecular features, (4) presentation and (5) management. Descriptive statistics were used for data analysis. RESULTS A total of 17 studies were included from 2010 to 2019. Overall, young adults with CRC tend to present with non-specific symptoms. The majority of these patients have a delayed diagnosis and more advanced disease at presentation, with a rise in prevalence of distal colon and rectal cancers. AYAs tend to have poorly differentiated tumours and are managed more aggressively. Overall 5-year survival varies between studies. CONCLUSION This is, to our knowledge, the first scoping review presenting the range of available evidence on CRC in AYAs. Although the rise in incidence is recognised by specialist bodies, recommendations are limited by the sparsity of available data. We seek to highlight the need for further research, define the role of earlier screening and raise awareness to promote thorough assessment of young patients.
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Affiliation(s)
- Natasha Christodoulides
- grid.439369.20000 0004 0392 0021Chelsea and Westminster Hospital, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College, South Kensington Campus, London, SW7 2AZ UK
| | - Mariam Lami
- grid.439369.20000 0004 0392 0021Chelsea and Westminster Hospital, London, UK
| | - George Malietzis
- grid.439369.20000 0004 0392 0021Chelsea and Westminster Hospital, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College, South Kensington Campus, London, SW7 2AZ UK ,grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, London, UK
| | | | - Paris Tekkis
- grid.439369.20000 0004 0392 0021Chelsea and Westminster Hospital, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College, South Kensington Campus, London, SW7 2AZ UK ,grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- grid.439369.20000 0004 0392 0021Chelsea and Westminster Hospital, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College, South Kensington Campus, London, SW7 2AZ UK ,grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, London, UK
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Bakarman MA, AlGarni AM. Colorectal cancer patients in western Saudi Arabia. Outcomes and predictors for survival over a 10-years period (2002-2014). Saudi Med J 2019; 40:1227-1234. [PMID: 31828274 PMCID: PMC6969635 DOI: 10.15537/smj.2019.12.24699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives: To determine the survival outcomes and to describe the epidemiological characteristics of patients with colorectal cancer (CRC) in western Saudi Arabia. Methods: Our study is a retrospective analysis of patients with CRC diagnosed between 2002 and 2014. We recruited 279 patients who were selected randomly and followed until the end of July 2017. A Kaplan-Meier curve was used to estimate the survival rate for CRC patients according to gender, histopathological pattern, tumor site, and mutation type, taking into consideration time factor, dropouts, and loss to follow-up. Results: The mean age of CRC patients was 57±13 years, and most of them were Saudi (87.5%). Regarding tumor epidemiology, 32.4% of the patients at Best American Joint Committee on Cancer (Best AJCC) stage 4; 28.9% were at stage 3; and 1.2% were at stage zero. The most frequent pathological variant was adenocarcinoma (77.4%); the most affected site was the rectum (40.5%). By Cox regression analysis, age at diagnosis, tumor stage, Kirsten Ras (KRAS) mutation, and lymphovascular invasion were significant prognostic factors for survival in CRC patients. Conclusion: Colorectal cancer patients presented to the hospital late in the disease course. This may call for lowering the screening age, increasing awareness programs, and establishing a national screening program.
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Affiliation(s)
- Marwan A Bakarman
- Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Exarchakou A, Donaldson LJ, Girardi F, Coleman MP. Colorectal cancer incidence among young adults in England: Trends by anatomical sub-site and deprivation. PLoS One 2019; 14:e0225547. [PMID: 31805076 PMCID: PMC6894790 DOI: 10.1371/journal.pone.0225547] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Colorectal cancer incidence in the UK and other high-income countries has been increasing rapidly among young adults. This is the first analysis of colorectal cancer incidence trends by sub-site and socioeconomic deprivation in young adults in a European country. METHODS We examined age-specific national trends in colorectal cancer incidence among all adults (20-99 years) diagnosed during 1971-2014, using Joinpoint regression to analyse data from the population-based cancer registry for England. We fitted a generalised linear model to the incidence rates, with a maximum of two knots. We present the annual percentage change in incidence rates in up to three successive calendar periods, by sex, age, deprivation and anatomical sub-site. RESULTS Annual incidence rates among the youngest adults (20-39 years) fell slightly between 1971 and the early 1990s, but increased rapidly from then onwards. Incidence Rates (IR) among adults 20-29 years rose from 0.8 per 100,000 in 1993 to 2.8 per 100,000 in 2014, an average annual increase of 8%. An annual increase of 8.1% was observed for adults aged 30-39 years during 2005-2014. Among the two youngest age groups (20-39 years), the average annual increase for the right colon was 5.2% between 1991 and 2010, rising to 19.4% per year between 2010 (IR = 1.2) and 2014 (IR = 2.5). The large increase in incidence rates for cancers of the right colon since 2010 were more marked among the most affluent young adults. Smaller but substantial increases were observed for cancers of the left colon and rectum. Incidence rates in those aged 50 years and older remained stable or decreased over the same periods. CONCLUSIONS Despite the overall stabilising trend of colorectal cancer incidence in England, incidence rates have increased rapidly among young adults (aged 20-39 years). Changes in the prevalence of obesity and other risk factors may have affected the young population but more research is needed on the cause of the observed birth cohort effect. Extension of mass screening may not be justifiable due to the low number of newly diagnosed cases but clinicians should be alert to this trend.
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Affiliation(s)
- Aimilia Exarchakou
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam J. Donaldson
- Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fabio Girardi
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Glover M, Mansoor E, Panhwar M, Parasa S, Cooper GS. Epidemiology of Colorectal Cancer in Average Risk Adults 20-39 Years of Age: A Population-Based National Study. Dig Dis Sci 2019; 64:3602-3609. [PMID: 31175493 PMCID: PMC6858534 DOI: 10.1007/s10620-019-05690-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS While overall rates of colorectal cancer (CRC) have declined in individuals aged above 50 years of age, this decline has not been seen in younger individuals who do not benefit from current screening guidelines. We sought to describe the prevalence of CRC in adults 20-39 years of age without family history of CRC or inflammatory bowel disease as early-onset CRC (EoCRC), evaluate associated signs and symptoms and medical comorbidities in EoCRC, and compare them with individuals aged 20-39 years without CRC (NoCRC). Our secondary aim was to compare EoCRC with individuals aged 40 years and above with CRC (LoCRC). METHODS Utilizing a commercial database (Explorys Inc, Cleveland, OH), we identified a cohort of patients aged 20-39 years with first ever diagnosis of CRC between 2013 and 2018 based on the Systematized Nomenclature of Medicine-Clinical Terms. We calculated the overall prevalence rate of EoCRC, described age, race, and gender-based prevalence rates of EoCRC, and identified associated symptoms and medical comorbidities associated with EoCRC. RESULTS The overall rate of EoCRC was 18.9/100,000. Compared to NoCRC, EoCRC patients were more likely to be Caucasian and female, with predominant symptoms of hematochezia, anemia, and decreased appetite. EoCRC group had higher prevalence rates of medical comorbidities such as diabetes, smoking, and obesity. Compared to LoCRC, EoCRC group presented more frequently with left-sided CRC and rectal cancers. CONCLUSION This is one of the largest studies to date to describe the epidemiology of EoCRC in USA. We found EoCRC to occur predominantly in the Caucasian and female population. EoCRC presented more frequently with left-sided and rectal CRC. We also identified signs/symptoms as well as comorbidities associated with EoCRC. Patients with these features may benefit from earlier screening.
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Affiliation(s)
- Michael Glover
- MS-4, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, Ohio 44106
| | - Emad Mansoor
- Department of Internal Medicine and Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Cleveland OH USA
| | - Muhammed Panhwar
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland OH USA
| | - Sravanthi Parasa
- Department of Internal Medicine and Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Cleveland OH USA; Current address: Swedish Medical Center, Seattle WA USA
| | - Gregory S. Cooper
- Department of Internal Medicine and Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, Ohio 44106, Wearn 244
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Zhu J, Zhao L, Luo B, Sheng W. Shikonin regulates invasion and autophagy of cultured colon cancer cells by inhibiting yes-associated protein. Oncol Lett 2019; 18:6117-6125. [PMID: 31788086 PMCID: PMC6865637 DOI: 10.3892/ol.2019.10980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/06/2019] [Indexed: 01/14/2023] Open
Abstract
Colon cancer is a common malignancy, and its morbidity and mortality have been increasing in recent years in China. Shikonin (Shi), a naturally occurring naphthoquinone, exhibits anticancer activity. However, the mechanisms of action of Shi remain unclear. The aim of the present study was to investigate the antitumor mechanism of Shi in colon cancer cells. The effects of different Shi concentrations on the viability of colon cancer cells using MTT, colony formation and wound-healing assays were assessed. Western blot analysis was performed to detect the expression of LC3-II, p62. Shi effectively suppressed viability and cell migration, and induced autophagy in colon cancer cells. Yes-associated protein (YAP) increases cell viability, and inhibits cell apoptosis and cell contact. Expression of YAP is downregulated by Shi. The cytotoxic effects of Shi were further investigated on YAP overexpression and on YAP knockout cell lines. The findings revealed that Shi suppressed the viability and induced autophagy of colon cancer cells. Additionally, YAP expression reversed the effects of Shi. The results of the present study suggest that Shi may be a promising anticancer treatment for colon cancer, and YAP may be a potential diagnostic marker for colon cancer.
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Affiliation(s)
- Jing Zhu
- Laboratory of Cancer, College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, P.R. China.,Department of Basic Medical Sciences, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Lei Zhao
- Reproductive Medicine Centre, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Bin Luo
- Department of Basic Medical Sciences, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Wang Sheng
- Laboratory of Cancer, College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, P.R. China
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Holford TR, Chen HS, Annett D, Krapcho M, Dorogaeva A, Feuer EJ. CP*Trends: An Online Tool for Comparing Cohort and Period Trends Across Cancer Sites. Am J Epidemiol 2019; 188:1361-1370. [PMID: 30989187 DOI: 10.1093/aje/kwz089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Cohort or period components of trends can provide a rationale for new research or point to clues on the effectiveness of control strategies. Graphical display of trends guides models that quantify the experience of a population. In this paper, a method for smoothing rates by single year of age and year is developed and displayed to show the contributions of period and cohort to trends. The magnitude of the contribution of period and/or cohort in a model for trends may be assessed by the percentage of deviance explained and the relative contributions of cohort (C) and period (P) individually, known as the C-P score. The method is illustrated using Surveillance, Epidemiology, and End Results data (1975-2014) on lung and bronchial cancer mortality in females and prostate and colorectal cancer incidence in males. Smoothed age-period and age-cohort rates provide a useful first step in studies of etiology and the impact of disease control without imposing a restrictive model. We found that, in this data set, cohort predominates for female lung and bronchial cancer and period predominates for male prostate cancer. However, the effects change with age for male colorectal cancer incidence, indicating an age shift in relevant exposures. These methods are applied on an interactive website for both incidence and mortality at over 20 cancer sites in the United States.
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Affiliation(s)
- Theodore R Holford
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Huann-Sheng Chen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - David Annett
- Information Management Services, Calverton, Maryland
| | | | | | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Differences in biological behaviors between young and elderly patients with colorectal cancer. PLoS One 2019; 14:e0218604. [PMID: 31211804 PMCID: PMC6581287 DOI: 10.1371/journal.pone.0218604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background We investigated the differences in biological behaviors of sporadic colorectal cancer (CRC) between young and elderly patients. CRC is a common cancer, with a mean age at onset of > 65 years. However, recent reports indicate increasing rates in younger populations. The biological behaviors of sporadic CRC in elderly patients could differ from those in young patients. Methods Between September 2007 and August 2012, we selected 723 CRC patients from our institution. The patients were divided into Group Y (n = 127, aged ≤50 years) and Group O (n = 596, aged >50 years). The clinicopathologic and oncologic outcomes in the two groups were compared. Results Group Y tumors were characterized by higher incidences of mucin production (13.4% vs. 6.7%; P = 0.017), high microsatellite instability (MSI-H) (19.8% vs. 5.2%; P < 0.001), and N2 stage (32.3% vs. 22.1%; P = 0.020) than those in Group O. The recurrence rates were similar in both groups (14.9% vs. 17.3%; P = 0.665). The 5-year overall survival and disease-free survival did not differ. Multivariate analysis indicated that cellular differentiation and pathologic stage were significant prognostic factors for 5-year overall survival. Conclusion Although age was not a prognostic factor for overall survival and young patients did not show a worse prognosis, there were differences in mucin production, MSI-H, and N2 stage between the two groups. Further studies are needed to clarify the clinical and biological characteristics of CRC, improve its treatment strategies, and promote better outcomes in young patients.
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Mannucci A, Zuppardo RA, Rosati R, Leo MD, Perea J, Cavestro GM. Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis. World J Gastroenterol 2019; 25:2565-2580. [PMID: 31210710 PMCID: PMC6558439 DOI: 10.3748/wjg.v25.i21.2565] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.
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Affiliation(s)
- Alessandro Mannucci
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Riccardo Rosati
- Department of Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Department of Biomedical Science, Humanitas University, Milan 20090, Italy
| | - José Perea
- Surgery Department, “Fundación Jiménez Díaz” University Hospital, Madrid 28040, Spain
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Madrid 28040, Spain
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
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Olivo R, Ratnayake S. Colorectal cancer in young patients: a retrospective cohort study in a single institution. ANZ J Surg 2019; 89:905-907. [PMID: 31083813 DOI: 10.1111/ans.15241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Young onset colorectal cancer is on the rise, with a disproportionate increase in incidence among young people, both in Australia and internationally. Current national guidelines for bowel cancer screening in average risk individuals include only patients greater than 50 years of age. It is well recognized that colorectal cancer is a highly treatable malignancy when detected at an early stage, and timely diagnosis yields a greater than 90% chance of cure and survival. The aims of this study were to define the clinical presentations leading to colonoscopy in young patients and assess the incidence of malignancy in this group. METHODS This is a retrospective cohort study including all patients ≤35 years of age without any baseline indication for early bowel cancer surveillance that underwent colonoscopy at Caboolture Hospital from January 2017 to April 2018. RESULTS A total of 224 patients underwent colonoscopy in the study period. A total of 210 (93.8%) had symptoms including rectal bleeding (51.7%), altered bowel habit (25.9%), abdominal pain (10.3%) and symptomatic anaemia (6.7%) prior to colonoscopy. Two cases of invasive adenocarcinoma were identified (0.89%, P < 0.01), both of which were symptomatic and were defined as stage IIIB disease on histopathology. CONCLUSION In a theoretically low-risk population, the incidence of malignancy was nearly 1%. More advanced disease at diagnosis may be due to a delay in investigating these patients due to an overall low suspicion of cancer in young individuals. As such, investigation should be offered early to young patients presenting with any warning symptoms.
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Affiliation(s)
- Rebecca Olivo
- Department of Surgery, Caboolture Hospital, Brisbane, Queensland, Australia
| | - Sujith Ratnayake
- Department of Surgery, Caboolture Hospital, Brisbane, Queensland, Australia
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Fiedler B, Fiedler L, DeDonno MA, Anago K, Cruz LDL, Luck GR, Hennekens CH. Lack of reliability of self-reports by patients with advanced colorectal polyps. Intest Res 2019; 17:278-280. [PMID: 30541225 PMCID: PMC6505098 DOI: 10.5217/ir.2018.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/05/2018] [Indexed: 11/05/2022] Open
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Chernyavskiy P, Kennerley VM, Jemal A, Little MP, Rosenberg PS. Heterogeneity of colon and rectum cancer incidence across 612 SEER counties, 2000-2014. Int J Cancer 2019; 144:1786-1795. [PMID: 30152110 PMCID: PMC10667616 DOI: 10.1002/ijc.31776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/13/2018] [Accepted: 07/18/2018] [Indexed: 01/04/2023]
Abstract
Recent analyses have suggested decreases over time in colorectal cancer incidence at older ages (≥55 years) but increases at younger ages (20-54 years). Understanding the geographic heterogeneity of incidence facilitates resource allocation for potential interventions and advances our knowledge of differential etiologies for these cancers. We performed age-period-cohort analysis using 2000-2014 county-level incidence from the Surveillance, Epidemiology, and End Results (SEER) database, estimating relative risk (RR) and age-adjusted annual percent change (Net Drifts) simultaneously for 612 counties via a hierarchical model, separately for colon and rectum cancer, stratified by age group (20-54 vs. 55-84). We also studied correlates of RR and Net Drift with various county-level characteristics. In all SEER counties, colon and rectum cancer incidence rates increased at ages 20-54, whereas rates decreased at ages 55-84. There was marked heterogeneity in both RR and Net Drift among states and counties for both cancer types. Maps of county RR and Net Drift revealed localized clusters in several states. For both cancer types, counties with high RR and unfavorable Net Drift tended to have higher prevalence of obesity and diabetes and to be of a lower socioeconomic status. Counties with higher overall screening rates tended to have lower Net Drifts for both cancer types. Increasing colorectal cancer incidence in the younger age group is geographically widespread, although there is significant heterogeneity in temporal trends and risk both within and between states. These geographic patterns correlate with different county-level characteristics depending on cancer type and age group.
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Affiliation(s)
- Pavel Chernyavskiy
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
- Radiation Epidemiology Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
- University of Wyoming, Department of Mathematics and Statistics, Laramie, Wyoming, USA
| | - Victoria M. Kennerley
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
| | - Philip S. Rosenberg
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
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Wang W, Chen W, Lin J, Shen Q, Zhou X, Lin C. Incidence and characteristics of young-onset colorectal cancer in the United States: An analysis of SEER data collected from 1988 to 2013. Clin Res Hepatol Gastroenterol 2019; 43:208-215. [PMID: 30686691 DOI: 10.1016/j.clinre.2018.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/27/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) has significantly increased in adults < 50 years old who are below the screening age. OBJECTIVES The primary objective was to evaluate the age-standardized incidence (ASI) of young-onset CRC from 1988 to 2013. The secondary objective was to assess factors associated with cancer-specific death (CSD). METHODS We accessed data of 64,854 CRC patients (20-49 years old) from the United States Surveillance, Epidemiology, and End Results Program (SEER) database. RESULTS A gradual increase in the ASI of CRC in the study population was found: from 3.59/100,000 males in 1988 to 5.21/100,000 males in 2013, and from 3.15/100,000 females in 1988 to 4.45/100,000 females in 2013. ASI adjusted by race revealed a relatively pronounced increase in the white population compared to African American and other races, with an increase from 3.07/100,000 persons in 1988 to 4.79/100,000 persons in 2013. Males had a 19% higher likelihood of CRC-related death compared to females [hazard ratio (HR) = 1.19, 95% confidence interval (CI): 1.16-1.23], and African American had a 1.34-fold higher likelihood of CRC-related death compared to whites (95% CI: 1.28-1.39). CRC-related death was significantly higher in patients with signet ring-cell histology (HR = 1.56, 95% CI: 1.45-1.68), compared to patients with adenocarcinoma. Male gender, and advanced stage predicted a higher likelihood of CRC-related death in African Americans compared to the whole population. Signet ring-cell histology, advanced stage, and advanced grade were significantly associated with CRC-related death in African-American patients. CONCLUSION This study corroborates emerging data that the (ASI) of young-onset CRC is increasing. It also identified factors associated with cancer-specific death in this population that may aid in targeting screening strategies for adults < 50 years old.
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Affiliation(s)
- Weibing Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China
| | - Wenbin Chen
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China
| | - Jianjiang Lin
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China
| | - Qinsong Shen
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China
| | - Xile Zhou
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China
| | - Caizhao Lin
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79, Qingchun road, 310003 Hangzhou, Zhejiang, PR China.
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Yin J, Bai Z, Zhang J, Zheng Z, Yao H, Ye P, Li J, Gao X, Zhang Z. Burden of colorectal cancer in China, 1990 -2017: Findings from the Global Burden of Disease Study 2017. Chin J Cancer Res 2019; 31:489-498. [PMID: 31354218 PMCID: PMC6613508 DOI: 10.21147/j.issn.1000-9604.2019.03.11] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective Our goal is to analyze the trend of colorectal cancer (CRC) regarding the death, incidence and prevalence rates over time, and to provide epidemiological knowledge basis for health policy revision by comparing data about fatal outcomes of CRC in 2017 to those data in 1990, which was extracted from the Global Burden of Disease (GBD). Methods The time trend and changes of CRC burden from 1990 to 2017 were measured by using the methods and results from the Institute for Health Metrics and Evaluation (IHME) GBD 2017, based on the rates of death, incidence and prevalence. Results The death rate of CRC is 13.24/100,000, accounting for 1.79% of total deaths in China in 2017. In 1990, CRC ranked 21st in all causes of death in China compared to its 11th ranking in 2017. The death, incidence and prevalence rate of CRC were standardized by the age scale of the global population in 2010, the change of standardized death rate of CRC was not significant, from 9.33/100,000 in 1990 to 10.10/100,000 in 2017. The standardized incidence rate of CRC significantly increased from 12.18/100,000 in 1990 to 22.42/100,000 in 2017. The standardized prevalence rate of CRC significantly increased from 44.55/100,000 in 1990 to 118.40/100,000 in 2017. The trend of the prevalence rate in both genders grow higher in 2017 compared to the 1990, resulting in 141.6%, 209.8% and 189.0% for the studied three age groups (15−49, 50−69 and 70+ years old), respectively. The death rate increased in the age groups of 50−69 and 70+ years in both genders (8.6% and 31.0% respectively), in contrast to a decrease of death rate in the age group of 15−49 years old (−10.8%). Conclusions China experienced a stunning increase in terms of incidence and prevalence rate of CRC from 1990 to 2017. To decrease the burden of CRC, prevention and management of known risk factors should be promoted through national polices.
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Affiliation(s)
- Jie Yin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Zhigang Bai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Jun Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Pengpeng Ye
- National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), Chinese Center for Disease Control and Prevention (CDC), Beijing 100050, China
| | - Jun Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Xin Gao
- National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), Chinese Center for Disease Control and Prevention (CDC), Beijing 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
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Colorectal cancer in young African Americans: clinical characteristics and presentations. Eur J Gastroenterol Hepatol 2018; 30:1137-1142. [PMID: 30020112 DOI: 10.1097/meg.0000000000001205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Colorectal cancer (CRC) is the third most common cancer in the USA, and the incidence in young adults has been increasing over the past decade. We studied the clinical characteristics and presentations of CRC in young African American (AA) adults because available data on how age and ethnicity influence its pattern of presentation is limited. PATIENTS AND METHODS We conducted a retrospective study of 109 young adults (75 African Americans) below 50 years, who were diagnosed with CRC between 1 January 1997 and 31 December 2016. Proximal CRC was defined as lesions proximal to the splenic flexure. Independent t-tests and χ-test or Fisher's exact test were performed where appropriate to determine the differences between AA and non-AA patients. RESULTS The mean age at diagnosis was 42 years (range: 20-49 years). Compared with non-AAs, AAs had more frequent proximal CRC (38.7 vs. 14.7%, P=0.003), lower hemoglobin (10.5 vs. 12.7 g/dl, P<0.001), and more frequent weight loss (21.3 vs. 2.9% P=0.014). Non-AAs presented more frequently with rectal bleeding (52.9 vs. 32.0% P=0.037). There was no statistically significant difference in histology, stage, grade, tumor size, and carcinoembryonic antigen level between groups. When we stratified between proximal and distal disease among patients with CRC, we found larger tumor size in distal disease, which presented more with rectal bleeding and bowel habit changes. Proximal disease presented more as abdominal pain and weight loss. CONCLUSION There should be a higher index of suspicion for CRC in young AA adults presenting with anemia, abdominal pain, and weight loss. Early screening colonoscopy should be advocated in AAs because of the predominance of proximal disease.
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Ellis L, Abrahão R, McKinley M, Yang J, Somsouk M, Marchand LL, Cheng I, Gomez SL, Shariff-Marco S. Colorectal Cancer Incidence Trends by Age, Stage, and Racial/Ethnic Group in California, 1990–2014. Cancer Epidemiol Biomarkers Prev 2018; 27:1011-1018. [DOI: 10.1158/1055-9965.epi-18-0030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/06/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022] Open
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Peterse EFP, Meester RGS, Siegel RL, Chen JC, Dwyer A, Ahnen DJ, Smith RA, Zauber AG, Lansdorp-Vogelaar I. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer 2018; 124:2964-2973. [PMID: 29846933 PMCID: PMC6033623 DOI: 10.1002/cncr.31543] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2016, the Microsimulation Screening Analysis‐Colon (MISCAN‐Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re‐evaluated the optimal screening strategies in light of the increase in CRC diagnosed in young adults. METHODS The authors adjusted the MISCAN‐Colon model to reflect the higher CRC incidence in young adults, who were assumed to carry forward escalated disease risk as they age. Life‐years gained (LYG; benefit), the number of colonoscopies (COL; burden) and the ratios of incremental burden to benefit (efficiency ratio [ER] = ΔCOL/ΔLYG) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start (40 years, 45 years, and 50 years) and ages to stop (75 years, 80 years, and 85 years) screening, and screening intervals (depending on screening modality). The authors then determined the model‐recommended strategies in a similar way as was done for the US Preventive Services Task Force, using ER thresholds in accordance with the previously accepted ER of 39. RESULTS Because of the higher CRC incidence, model‐predicted LYG from screening increased compared with the previous analyses. Consequently, the balance of burden to benefit of screening improved and now 10‐yearly colonoscopy screening starting at age 45 years resulted in an ER of 32. Other recommended strategies included fecal immunochemical testing annually, flexible sigmoidoscopy screening every 5 years, and computed tomographic colonography every 5 years. CONCLUSIONS This decision‐analysis suggests that in light of the increase in CRC incidence among young adults, screening may be offered earlier than has previously been recommended. Cancer 2018;124:2964‐73. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. Colorectal cancer incidence has been increasing since the mid‐1990s in adults aged <50 years. A well‐established decision‐analytic modeling approach suggests that in light of this increasing incidence, the optimal age to start colorectal cancer screening is 45 years. See also pages 2974‐85.
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Affiliation(s)
| | - Reinier G S Meester
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.,Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California
| | - Rebecca L Siegel
- Surveillance Information Services, American Cancer Society, Atlanta, Georgia
| | - Jennifer C Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea Dwyer
- University of Colorado Cancer Center, Denver, Colorado.,Fight Colorectal Cancer, Springfield, Missouri
| | - Dennis J Ahnen
- University of Colorado Cancer Center and Gastroenterology of the Rockies, Denver, Colorado
| | - Robert A Smith
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Sheneman DW, Finch JL, Messersmith WA, Leong S, Goodman KA, Davis SL, Purcell WT, McCarter M, Gajdos C, Vogel J, Eckhardt SG, Lieu CH. The impact of young adult colorectal cancer: incidence and trends in Colorado. COLORECTAL CANCER 2017. [DOI: 10.2217/crc-2017-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: Far less is known about colorectal cancer (CRC) incidence in individuals under the age of 50. This study examined CRC incidence in order to better understand the changing CRC population. Methods: This study analyzed 39,525 CRC cases from the Colorado Central Cancer Registry from 1992 through 2013. Age-adjusted incidence, observed and relative 5-year survival, and estimated annual percentage change was analyzed. Results: Age-adjusted rates averaging 1.7% per year were observed in the under-50 population, while falling on average 4.3% per year (p < 0.05) in the over-50 population. Average-adjusted incidence rose in males under 50 by 2.7% per year (p < 0.05). Conclusion: The absolute incidence of CRC continues to fall in Colorado, however incidence is rising in individuals under 50, particularly males.
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Affiliation(s)
- David W Sheneman
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jack L Finch
- Colorado Department of Public Health & Environment, Colorado Central Cancer Registry, Denver, CO, USA
| | - Wells A Messersmith
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Stephen Leong
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Karyn A Goodman
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - S Lindsey Davis
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - William T Purcell
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Martin McCarter
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Csaba Gajdos
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jon Vogel
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - S Gail Eckhardt
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - Christopher H Lieu
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
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Abstract
OPINION STATEMENT Colorectal cancer (CRC) is the third most common cancer worldwide. CRC has been thought to be less common in Asia compared to Western countries. However, the incidence rates of CRC in Asia are high and there is an increasing trend in the Asian population. Furthermore, colorectal cancer accounts for the greatest number of all incidences of CRC in Asia. The increasing adoption of a Western lifestyle, particularly in dietary habits, is likely the most important factor contributing to the rapid increase in colon cancer incidence; it is noteworthy that trends for rectal cancer were flat. The etiology of colon and rectal cancer is a bit different. The risks of distal colon and rectal cancers are more likely to be related to environmental factors, such as polluted surface water sources, alcohol consumption, and habitual smoking. The lack of great change in the incidence of rectal cancer might be due to weaker associations with such lifestyle factors. Therefore, it has been hypothesized that proximal and distal sections of the colon and rectum are two different organs in terms of function and genetic background. It may mean differences in differential sensitivities and exposures to carcinogens. However, despite the decrease in whole incidence, the CRC incidence in young adults in Western countries are reversely increasing, especially in rectal cancer, due to reasons largely unknown. Although the treatment algorithm is different between Asia and western countries, globally, the survival rate for patients with rectal cancer has risen during the past 10 years. Screening contributes a great deal to reducing the incidence and improving survival. Most countries in Asia, such as China, need nationwide registration and screening systems to provide better data.
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Affiliation(s)
- Yanhong Deng
- Department of Medical Oncology, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University , 26 Yuancun Er Heng Road, Guangzhou, 510655, China.
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Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, Jemal A. Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst 2017; 109:3053481. [PMID: 28376186 DOI: 10.1093/jnci/djw322] [Citation(s) in RCA: 753] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/05/2016] [Indexed: 12/14/2022] Open
Abstract
Background Colorectal cancer (CRC) incidence in the United States is declining rapidly overall but, curiously, is increasing among young adults. Age-specific and birth cohort patterns can provide etiologic clues, but have not been recently examined. Methods CRC incidence trends in Surveillance, Epidemiology, and End Results areas from 1974 to 2013 (n = 490 305) were analyzed by five-year age group and birth cohort using incidence rate ratios (IRRs) and age-period-cohort modeling. Results After decreasing in the previous decade, colon cancer incidence rates increased by 1.0% to 2.4% annually since the mid-1980s in adults age 20 to 39 years and by 0.5% to 1.3% since the mid-1990s in adults age 40 to 54 years; rectal cancer incidence rates have been increasing longer and faster (eg, 3.2% annually from 1974-2013 in adults age 20-29 years). In adults age 55 years and older, incidence rates generally declined since the mid-1980s for colon cancer and since 1974 for rectal cancer. From 1989-1990 to 2012-2013, rectal cancer incidence rates in adults age 50 to 54 years went from half those in adults age 55 to 59 to equivalent (24.7 vs 24.5 per 100 000 persons: IRR = 1.01, 95% confidence interval [CI] = 0.92 to 1.10), and the proportion of rectal cancer diagnosed in adults younger than age 55 years doubled from 14.6% (95% CI = 14.0% to 15.2%) to 29.2% (95% CI = 28.5% to 29.9%). Age-specific relative risk by birth cohort declined from circa 1890 until 1950, but continuously increased through 1990. Consequently, compared with adults born circa 1950, those born circa 1990 have double the risk of colon cancer (IRR = 2.40, 95% CI = 1.11 to 5.19) and quadruple the risk of rectal cancer (IRR = 4.32, 95% CI = 2.19 to 8.51). Conclusions Age-specific CRC risk has escalated back to the level of those born circa 1890 for contemporary birth cohorts, underscoring the need for increased awareness among clinicians and the general public, as well as etiologic research to elucidate causes for the trend. Further, as nearly one-third of rectal cancer patients are younger than age 55 years, screening initiation before age 50 years should be considered.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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Abstract
OBJECTIVE Post-colonoscopy colorectal cancer (PCCRC), a cancer occurring within a short interval of a colonoscopy, might be partly explained as missed or incompletely resected lesions. Associated risk factors are age, sex, comorbidity, cancer location, and colonoscopy volume. There is a gap in the knowledge of prevalence of PCCRC and the impact of different risk factors in Sweden. METHODS This is a retrospective population-based observational cohort study of the colonoscopies performed on adults during the years 2001-2010 that were identified from Swedish health registers. The rate of PCCRC (diagnosed 6-36 months after the first colonoscopy) was defined as the number of PCCRCs divided by the number of colorectal cancers (CRC) in the interval of 0-36 months. Univariate and multivariate Poisson regression analyses examined associations with PCCRC. RESULTS There were 289 729 colonoscopies performed on 249 079 individuals included in the study. There were 16 319 individuals with a colorectal cancer diagnosis 0-36 months after a colonoscopy. Of these, 1286 (7.9%) were PCCRCs. In the multivariate analysis, young age (18-30 years) and former polyp diagnosis had the highest risks [relative risk (RR)=3.3; 95% confidence interval: 2.1-5.2 and RR=3.1; 95% confidence interval: 2.7-3.6]. The impact of other risk factors, such as female sex, comorbidity, right sided colorectal cancer location, and time period, was consistent with the finding in other studies. CONCLUSION The prevalence of PCCRC in Sweden seems to be relatively high, indicating that there is room for improvement in colonoscopy quality. The high RR of PCCRC in the youngest age group, even though there were only a few cases, has not been described in other studies.
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The Rising Incidence of Younger Patients With Colorectal Cancer: Questions About Screening, Biology, and Treatment. Curr Treat Options Oncol 2017; 18:23. [DOI: 10.1007/s11864-017-0463-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sarakarn P, Suwanrungruang K, Vatanasapt P, Wiangnon S, Promthet S, Jenwitheesuk K, Koonmee S, Tipsunthonsak N, Chen SLS, Yen AMF, Chen THH. Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen, Thailand (1989 – 2012). Asian Pac J Cancer Prev 2017; 18:1039-1043. [PMID: 28547938 PMCID: PMC5494213 DOI: 10.22034/apjcp.2017.18.4.1039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen,
Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon
Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups
for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an
overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual
percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed
and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those
aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis,
the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group
AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45
years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC
have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.
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Affiliation(s)
- Pongdech Sarakarn
- Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taiwan.
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Comparing Clinical Characteristics and Outcomes of Young-onset and Late-onset Colorectal Cancer: An International Collaborative Study. Clin Colorectal Cancer 2017; 16:334-342. [PMID: 28462853 DOI: 10.1016/j.clcc.2017.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 01/26/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared with the general population, the incidence of young-onset (YO) colorectal cancer (CRC) is increasing. However, a significant knowledge gap exists in the clinical characteristics, treatment patterns, and outcomes for these patients. MATERIALS AND METHODS Six international tertiary cancer centers conducted a retrospective study. Patients with YO CRC (aged 18-44 years) and LO CRC (aged > 44 years) diagnosed with histologically proven colorectal adenocarcinoma from June 2003 to June 2014 were enrolled. Patients were randomly chosen from each center's database, and the patient demographics and treatment information were collected. The data were then centralized, and the final analysis was performed at a single institution. Cox proportional hazards models were used to estimate the crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for progression-free survival and mortality, and YO was compared with LO. Site-specific HRs were pooled using a random-effects meta-analysis. RESULTS Overall, 498 patients, including 224 with YO (129 men; mean age, 37 ± 5.5 years) and 274 with LO (167 men; mean age, 64.8 ± 9.5 years) CRC, were included. At the diagnosis, 137 patients (61.2%) and 122 patients (44.5%) with YO and LO CRC had metastatic disease, respectively. For both cohorts, the 3 most common presenting symptoms were pain, hematochezia, and weight loss. Surgery was performed in 141 YO (63.0%) and 219 LO (79.9%) patients. The longitudinal noncurative treatment patterns were similar, but more biologic therapy was used for these YO patients. The pooled progression-free survival analysis results for first-line noncurative treatment favored LO (HR, 1.96; 95% CI, 1.04-3.68). The mortality analysis showed no significant differences between the 2 groups (YO: HR, 1.53; 95% CI, 0.91-2.58). CONCLUSION Despite similar treatment patterns and survival outcomes, YO disease might be clinically more aggressive.
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Douaiher J, Ravipati A, Grams B, Chowdhury S, Alatise O, Are C. Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol 2017; 115:619-630. [PMID: 28194798 DOI: 10.1002/jso.24578] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study is to describe the trends and variations in the global burden of colorectal cancer (CRC). METHODS Data (2012-2030) relating to CRC was extracted from GLOBOCAN 2012 database and analyzed. RESULTS The results of our study demonstrate a rising global burden of colorectal cancer which persists until the year 2035 and likely beyond. The rise in the global burden is not uniform with significant variations influenced by geographic location, socio-economic status, age, and gender. Although the EURO region has the highest burden, Asia as a continent continues to bear the heaviest brunt of the disease. Although the burden of disease is higher in more developed regions, mortality is considerably higher in less developed regions and this gap widens over the next two decades. The disease predominantly affects the male gender across all regions of the world. Age has a complex relation with the burden of CRC and is affected by the cross-influences relating to socio-economic status. CONCLUSIONS The results of our study demonstrate a rising global burden of CRC with some unique variations. Knowledge of this data can increase awareness and help strategic targeting of efforts and resources.
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Affiliation(s)
- Jeffrey Douaiher
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
| | | | - Benjamin Grams
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Chandrakanth Are
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
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Dhir M, Ramalingam L, Shuai Y, Pakrafter S, Jones HL, Hogg ME, Zureikat AH, Holtzman MP, Ahrendt SA, Bahary N, Pingpank JF, Zeh HJ, Bartlett DL, Choudry HA. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases. Ann Surg Oncol 2016; 24:875-883. [DOI: 10.1245/s10434-016-5689-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 11/18/2022]
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Bhandari A, Woodhouse M, Gupta S. Colorectal cancer is a leading cause of cancer incidence and mortality among adults younger than 50 years in the USA: a SEER-based analysis with comparison to other young-onset cancers. J Investig Med 2016; 65:311-315. [PMID: 27864324 DOI: 10.1136/jim-2016-000229] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 01/06/2023]
Abstract
Colorectal cancer (CRC) incidence and mortality are rising among young adults. Our aim was to contrast the relative incidence and mortality of CRC to other common cancers among young adults in the USA. We used Surveillance, Epidemiology, and End Results registry data to compare cancer site-specific and age-specific mortality and incident rates for adults younger than age 50. We summarized extracted data, both overall, and stratified by sex. We found CRC was the third leading cause of cancer death among adults younger than age 50, after breast and lung cancer (1.67 cases per 100,000). Among young women, CRC was the fourth leading cause of cancer death (1.51 per 100,000). Among young men, CRC was the second leading cause of cancer death (1.82 cases per 100,000). CRC was the second most incident cancer among young adults for men and women combined. Among men, CRC was the second most incident cancer after age 30, with 4.9, 9.0, 16.4, and 30.8 cases per 100,000 for ages 30-34, 35-39, 40-44, and 45-49 years, respectively. Among women, CRC incidence was similar with 4.2, 7.6, 15.3, and 25.9 cases per 100,000 for ages 30-34, 35-39, 40-44, and 45-49 years, respectively. These results show that CRC is a leading cause of cancer incidence and mortality among young adults in the USA, relative to other cancers. Given trends toward increasing rates of CRC among young adults, strategies for identifying individuals at risk for young-onset CRC who might benefit from early age of screening initiation merit investigation.
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Affiliation(s)
- Abhishek Bhandari
- Department of Hospital Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Melissa Woodhouse
- Beckman Research Institute of the City of Hope, Duarte, California, USA
| | - Samir Gupta
- Department of Medicine, Division of Gastroenterology, Veterans Affairs San Diego Health Care System, and the Moores Cancer Center, University of California, San Diego, California, USA
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Lee DY, Teng A, Pedersen RC, Tavangari FR, Attaluri V, McLemore EC, Stern SL, Bilchik AJ, Goldfarb MR. Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II-III Rectal Cancer. Ann Surg Oncol 2016; 24:311-318. [PMID: 27766558 DOI: 10.1245/s10434-016-5626-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Stage II-III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15-39 years) often do not receive optimal cancer therapy. METHODS Overall, 3295 AYAs with clinical stage II-III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined. RESULTS The majority of patients were non-Hispanic White (72.0 %), male (57.5 %), and without comorbidities (93.8 %). A greater proportion of Black and Hispanic patients did not receive radiation (24.5 and 27.1 %, respectively, vs. 16.5 % for non-Hispanic White patients), surgery (22.4 % and 21.6 vs. 12.3 %), or chemotherapy (21.5 % and 24.1 vs. 14.7 %) compared with non-Hispanic White patients (all p < 0.05). After controlling for competing factors, Black (odds ratio [OR] 0.7, 95 % confidence interval [CI] 0.5-0.9) and Hispanic patients (OR 0.6, 95 % CI 0.4-0.9) were less likely to receive neoadjuvant chemoradiation compared with non-Hispanic White patients. Females, the uninsured, and those treated at a community cancer center were also less likely to receive neoadjuvant therapy. Having government insurance (OR 0.22, 95 % CI 010-0.49) was a predictor for not receiving surgery. Although 5-year OS was lower (p < 0.05) in Black (59.8 %) and Hispanic patients (65.9 %) compared with non-Hispanic White patients (74.9 %), on multivariate analysis race did not impact mortality. Not having surgery (hazard ratio [HR] 7.1, 95 % CI 2.8-18.2) had the greatest influence on mortality, followed by poorly differentiated histology (HR 3.0, 95 % CI 1.3-6.5), nodal positivity (HR 2.6, 95 % CI 1.9-3.6), no chemotherapy (HR 1.9, 95 % CI 1.03-3.6), no insurance (HR 1.7, 95 % CI 1.1-2.7), and male sex (HR 1.5, 95 % CI 1.1-2.0). CONCLUSION There are racial and socioeconomic disparities in the treatment of stage II-III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.
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Affiliation(s)
- David Y Lee
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Annabelle Teng
- Department of Surgery, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | - Rose C Pedersen
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Farees R Tavangari
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vikram Attaluri
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Elisabeth C McLemore
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stacey L Stern
- Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Anton J Bilchik
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Melanie R Goldfarb
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
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