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Younger persons who developed colorectal cancer (CRC) were more and more likely to present with distant-stage disease in recent years, researchers found.

From 2000 to 2016, people in their 20s and 30s experienced the sharpest increases in distant-stage early-onset colorectal adenocarcinomas out of various age groups -- with young Black and Hispanic patients disproportionately affected, reported Jordan Karlitz, MD, of University of Colorado School of Medicine, Denver, and colleagues.

"Optimizing earlier screening initiatives and risk-stratifying younger patients by symptoms and family history are critical to counteract rising distant stage disease," they wrote in .

The results "support the benefits of shifting the average-risk screening age from 50 to 45 for all patients and assuring that real-world screening rates are optimized," they said. "Furthermore, the results underscore that in patients younger than screening age, vigilant attention to concerning symptoms must be paid so that earlier diagnostic testing can be undertaken and ... comprehensive family history assessments must take place so that earlier screening can be offered."

For their study, Karlitz' group analyzed data on 103,975 patients with CRC who were included in the U.S. Surveillance Epidemiology and End Results 18 cancer registry. In situ adenocarcinomas decreased in most age groups and sites from 2000-2002 to 2014-2016.

But over this time period, distant-stage cancers rose significantly, both when looking at colorectal tumors and colon- or rectal-only adenocarcinomas:

• Colorectal: up 57% for the 20-29 age group, up 66% for 30-39, up 41% for 40-49, and up 15% for ages 50-54
• Rectal-only: up 133%, 97%, 48%, and 33%, respectively
• Colon-only: up 19%, 49%, 38%, and 7%, respectively

Distant-stage disease comprised an increasing proportion of CRCs from 2000-2002 to 2014-2016, with the steepest increases observed in the rectal subsite. For example, the burden of distant-stage cancers in patients 20-29 years old presenting with rectal-only adenocarcinoma increased from 18% to 31% between the two time periods, while it increased from 20% to 29% in those 30-39 years old.

In rectal-only adenocarcinoma, non-Hispanic Blacks (0% to 46%) and Hispanics (28% to 41%) in the 20-29 year age group had the greatest rise in distant-stage disease. Non-Hispanic Blacks ages 20-29 also had a substantial jump in distant-stage colon-only adenocarcinoma (20% to 34%).

Study authors cautioned that their work was limited by its observational nature and said that more research is needed to determine why younger patients are increasingly presenting with distant-stage colorectal adenocarcinoma.

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