BACKGROUND AND PURPOSE:

• Rate of early-onset colorectal cancer (EOCRC; defined as diagnosis <50 years) is increasing
• Demb et al. (JAMA Network Open, 2024) sought to determine the frequency of presenting red flag signs and symptoms among individuals with EOCRC

METHODS:

• Systematic review and meta-analysis
• Study inclusion criteria
  • Patients <50 years diagnosed with nonhereditary CRC
  • Reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis 
• Study design
  • Quality of the included studies and risk of bias was measured
  • Data on frequency of signs and symptoms were pooled using a random-effects model
• Primary outcomes
  • Pooled proportions of signs and symptoms in patients with EOCRC
  • Estimates for association of signs and symptoms with EOCRC risk
  • Time from sign or symptom presentation to EOCRC diagnosis

RESULTS:

• 81 studies | 24,908,126 patients <50
• Most common presenting signs and symptoms (78 studies)
  • Hematochezia: pooled prevalence 45% (95% CI, 40 to 50)
  • Abdominal pain: pooled prevalence 40% (95% CI, 35 to 45)
  • Altered bowel habits: pooled prevalence 27% (95% CI, 22 to 33)
• The signs and symptoms with the greatest association with EOCRC likelihood were
  • Hematochezia: estimate range 5.2 to 54.0
  • Abdominal pain: estimate range 1.3 to 6.0
  • Anemia: estimate range 2.1 to 10.8
• Time from signs and symptoms presentation to EOCRC diagnosis
  • Mean 6.4 (range 1.8 to 13.7) months | 23 studies
  • Median 4 (range 2.0 to 8.7) months | 16 studies

CONCLUSION:

• For patients with early onset colorectal cancer, the most common signs and symptoms were hematochezia and abdominal pain (nearly half of all patients) and altered bowel habits (over a quarter of all patients)
• Hematochezia was associated with the highest risk of EOCRC
• Delays in diagnosis were common, and were generally on the order of 4 to 6 months
• The authors state

These findings and the increasing risk of CRC in individuals younger than 50 years highlight the urgent need to educate clinicians and patients about these signs and symptoms to ensure that diagnostic workup and resolution are not delayed

Adapting current clinical practice to identify and address these signs and symptoms through careful clinical triage and follow-up could help limit morbidity and mortality associated with EOCRC

Learn More – Primary Sources:

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis