Highlights
- •Out of 1778 patients <50 years old undergoing colonoscopy, 27 (1.5%) had colorectal cancer
- •13/27 (48%) colorectal cancer patients had a metastatic disease at the time of diagnosis
- •Patients aged 40-50 years old had a greater risk compared to those aged <40
- •The presence of alarm symptoms was associated with a diagnosis of colorectal cancer (OR 3.7; p=0.005)
Abstract
Background: Colorectal cancer (CRC) diagnosed before the age of 50, known as early-onset CRC
(eoCRC), is considered uncommon. We aimed at analysing the incidence of preneoplastic
and neoplastic lesions of the colon and rectum in patients under 50 years old and
to identify possible predictors
Methods: We retrospectively collected data from 1778 patients under 50 years old (mean age
39.9±7.8) referred for colonoscopy between 2015-2018. Cumulative incidence of adenomas
and eoCRC was assessed. Multivariable regression models were fitted
Results: The cumulative incidence for adenomas was 11.0% (95% CI 9-12), while it was 1.5%
(95% CI 1-2) for eoCRC (metastatic disease in 13/27 patients). Age as a continuous
variable was associated with the presence of adenomas (incidence rate ratio 1.06;
95% CI 1.03-1.09; p<0.001). EoCRC arose in most cases in the rectum (13/27, 48.1%).
Age ≥40 was the main risk factor (OR 2.25; 95% CI 1.35-3.73; p=0.002) for both adenomas
(160/196 patients, 81.6%) and eoCRC (20/27 patients, 74.1%), while smoking seemed
to have no role (p=0.772). The presence of alarm symptoms was statistically significant
at bivariable analysis for eoCRC only (OR 3.70; 95% CI 1.49-9.22; p=0.005), as well
as having multiple gastrointestinal symptoms (OR 19.85; 95% CI 2.64-149.42; p=0.004).
Only 3/27 (11.1%) patients with eoCRC had a family history for CRC
Conclusions: A high cumulative incidence rate of both adenomas and eoCRC was found, this latter
occurring more common in patients aged 40-49, without apparent risk factors. The presence
of alarm symptoms or multiple gastrointestinal symptoms led to a late diagnosis.
Keywords
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Article info
Publication history
Published online: February 17, 2021
Accepted:
February 8,
2021
Received in revised form:
January 30,
2021
Received:
March 25,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
