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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Early and late-onset colorectal cancer in African Americans during COVID-19
Lakshmi G Chirumamilla, Hassan Brim, Suryanarayana R Challa, Gholamreza Oskrochi, Mrinalini Deverapalli, Rumaisa Rashid, Mudasir Rashid, Farshad Aduli, Angesom Kibreab, Adeyinka Laiyemo, Zaki A Sherif, Nader Shayegh, Babak Shokrani, Rabia Zafar, John M Carethers, Hassan Ashktorab
Lakshmi G Chirumamilla, Suryanarayana R Challa, Farshad Aduli, Angesom Kibreab, Adeyinka Laiyemo, Babak Shokrani, Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
Hassan Brim, Rabia Zafar, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
Gholamreza Oskrochi, College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait
Mrinalini Deverapalli, Rumaisa Rashid, Mudasir Rashid, Nader Shayegh, Hassan Ashktorab, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
Zaki A Sherif, Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC 20060, United States
John M Carethers, Department of Medicine, Moores Cancer Center, and Wertheim School of Public Health and Human Longevity, University of California San Diego, California, CA 92093, United States
Author contributions: Chirumamilla LG, Devarapalli M, Rashid R, Rashid M, Shayegh N, and Zafar R performed the research; Oskrochi G contributed new reagents and analytic tools; Chirumamilla LG, Brim H, Challa SR, and Ashktorab H analyzed the data and wrote the manuscript; Brim H, Challa SR, and Ashktorab H designed the research study; and all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Howard University Internal Review Board, approval No. IRB-12-CMED-76.
Informed consent statement: No consent form was required since chart review with de-identified data was used for the study and adhered to the principles of the Declaration of Helsinki.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data collected for the study, including de-identified participant data, will be made available to others at publication via a signed data access agreement and at the discretion of the investigators’ approval of the proposed use of such data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hassan Ashktorab, Professor, Department of Medicine and Cancer Center, Howard University College of Medicine, 520 W Street NW, Washington, DC 20060, United States.
hashktorab@howard.edu
Received: February 12, 2025
Revised: May 16, 2025
Accepted: November 7, 2025
Published online: December 15, 2025
Processing time: 302 Days and 15.7 Hours
BACKGROUND
The incidence of early-onset colorectal cancer (EOCRC, < 45 years of age at onset) is on the rise among adults, including African Americans (AA).
AIM
To examine differences between EOCRC and late-onset colorectal cancer (LOCRC) among AA patients and any effect during coronavirus disease (COVID) by comparing data during pre-COVID (2015-2019) and the COVID era (2020-2023).
METHODS
We conducted a retrospective review of Howard University Hospital records from 2015 to 2023 for colorectal cancer patients that included demographics, clinicals, pathology, and colonoscopy records. A three-year interval analysis was performed to compare post-COVID era (2020-2023) to preceding years to discern temporal trends.
RESULTS
The study included 138 LOCRC and 13 EOCRC cases of which > 80% of patients were AA. Compared to pre-COVID, LOCRC cases increased in number from 55 to 83, and EOCRC cases increased from 6 to 7 during COVID. There was no change in mean age for LOCRC (64.7 years vs 65.3 years) but mean age increased for EOCRC (37.3 years vs 41.5 years). Males predominated in both groups particularly during the pandemic. More than 65% of LOCRC patient colonoscopies were for diagnostic purposes. Gastrointestinal bleeding as a colonoscopy indication and reduced bowel preparation quality were increased during the pandemic. EOCRC patients showed a shift from stage 4 (49.2%) to stage 2 (30%) and LOCRC patients staging trends changed from stage 4 (40%) to stage 3 (28.6%).
CONCLUSION
We report increase in colorectal cancer cases during the COVID-19 era, especially among young AA males. EOCRC and LOCRC patients showed distal location predominance, most commonly in recto-sigmoid region. The decrease in staging or metastasis, which might be due to growing awareness and earlier detection among patients.
Core Tip: The incidence of early-onset colorectal cancer (CRC) is rising, especially in African Americans, who face higher CRC rates and mortality. The coronavirus disease 2019 pandemic disrupted screenings, leading to increased early-onset colorectal cancer and late-onset CRC cases. This study highlights how the pandemic worsened racial disparities in CRC outcomes, emphasizing the need for targeted public health interventions. Lower metastasis rates may reflect early detection or stage 4 patients avoiding care and dying outside hospitals. Addressing these inequities is crucial to improving CRC outcomes, particularly among African Americans disproportionately affected by delayed screenings and healthcare disruptions during the pandemic.
