Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1011-1020
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1011
Old vs new: Risk factors predicting early onset colorectal cancer
Aslam R Syed, Payal Thakkar, Zachary D Horne, Heitham Abdul-Baki, Gursimran Kochhar, Katie Farah, Shyam Thakkar
Aslam R Syed, Heitham Abdul-Baki, Gursimran Kochhar, Katie Farah, Shyam Thakkar, Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA 15212, United States
Payal Thakkar, Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
Zachary D Horne, Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, United States
Author contributions: Syed AR, Farah K, Thakkar S performed the research; Abdul-Baki H, Horne ZD analyzed the data; Syed A, Thakkar P, Thakkar S wrote the paper and Thakkar P, Kochhar G, Thakkar S critically revised the manuscript for important intellectual content.
Institutional review board statement: Clinical research in this study was supported by the Allegheny Research Singer Institute, and was exempt from full review, and was approved for a quality improvement study.
Informed consent statement: Research described here did not involve humans, and only reported de-identified patient information. All analyzed data was omitted or anonymized.
Conflict-of-interest statement: This article and all authors declare no conflicts of interests.
Data sharing statement: The original anonymous dataset is available on request from the first author at aslam.syed@ahn.org.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shyam Thakkar, MD, Professor, Division of Gastroenterology and Hepatology, Allegheny Health Network, 1307 Federal Street, Suite 301, Pittsburgh, PA 15212, United States. shyam.thakkar@ahn.org
Telephone: +1-412-3598061 Fax: +1-412-4422158
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: June 4, 2019
Revised: August 1, 2019
Accepted: October 3, 2019
Article in press: October 3, 2019
Published online: November 15, 2019
Processing time: 261 Days and 5.9 Hours
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer (CRC) is the second leading cause of all cancer related deaths in the United States. Unfortunately, incidence in the younger population is on the rise. Several studies have outlined the importance of screening, and potential risk-factors to help identify a higher than average-risk population.

Research motivation

Identifying potential risk factors in the younger population for colorectal cancer may effectively lower the incidence rate for early-onset CRC. Prior studies have reported risk-factors; however a comparison analysis between a young, healthy, cancer-free cohort and patients with early-onset CRC has not been reported.

Research objectives

This study mainly investigated the factors related to early-onset colorectal cancer incidence and compared them to a control cohort to help identify potential risk-factors.

Research methods

This population-based cohort analysis utilized a national database to determine potential risk-factors of early-onset colorectal cancer. Twenty factors were compared to a control population without prior or current diagnosis of early-onset CRC as well as a later-onset CRC group. Analysis was performed using odds ratio with 95% confidence intervals, followed by normalization by conversion to Cohen’s d coefficient.

Research results

Having a family history of gastrointestinal malignancy and/or any cancer resulted in the most significant risk of early-onset CRC vs the control cohort and the later-onset CRC cohort. Identifiable symptoms found to be potential risk-factors included rectal bleeding, rectal pain, weight loss, abdominal pain, altered bowel function, colitis, obesity, hypertension, tobacco use, and hyperlipidemia.

Research conclusions

Young adults who have risk factors for development of early-onset CRC may need to be considered for earlier-onset screening protocols. These risk factors include having a family history of gastrointestinal malignancy, family history of any malignancy, family or personal history of polyps, and rectal bleeding.

Research perspectives

Clinicians should be aware of the rise of incidence of early-onset CRC. Vigilance to screen for CRC in this population should be based on potential risk-factors outlined in our study. Further prospective, long-term studies are necessary to elucidate the rising incidence of early-onset CRC.