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Alagoz O, May FP, Doubeni CA, Fendrick AM, Vahdat V, Estes C, Ellis T, Limburg PJ, Brooks D. Impact of racial disparities in follow-up and quality of colonoscopy on colorectal cancer outcomes. J Natl Cancer Inst 2024; 116:1807-1816. [PMID: 39044335 PMCID: PMC11542987 DOI: 10.1093/jnci/djae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The benefits of colorectal cancer (CRC) screening programs rely on completing follow-up colonoscopy when a noncolonoscopy test is abnormal and on quality of colonoscopy screening as measured by the endoscopists' adenoma detection rate. Existing data demonstrate substantially lower follow-up colonoscopy rates and adenoma detection rate for Black Americans than White Americans. However, the contributions of racial differences in follow-up colonoscopy and adenoma detection rate on CRC outcomes have not been rigorously evaluated. METHODS We used established and validated CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report lower follow-up colonoscopy rates and adenoma detection rate in Black adults compared with White adults (15% and 10% lower, respectively). We simulated screening with annual fecal immunochemical test, triennial multitarget stool DNA, and colonoscopy every 10 years between ages 45 and 75 years using real-world utilization of the screening modalities vs no screening. We reported lifetime outcomes per 1000 Black adults. RESULTS Elimination of Black-White disparities in follow-up colonoscopy rates would reduce CRC incidence and mortality by 5.2% and 9.3%, respectively, and improve life-years gained with screening by 3.4%. Elimination of Black-White disparities in endoscopists' adenoma detection rate would reduce CRC incidence and mortality by 9.4% and improve life-years gained by 3.7%. Elimination of both disparities would reduce CRC incidence and mortality by 14.6% and 18.7%, respectively, and improve life-years gained by 7.1%. CONCLUSIONS This modeling study predicts eliminating racial differences in follow-up colonoscopy rates, and quality of screening colonoscopy would substantially reduce Black-White disparities in CRC incidence and mortality.
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Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Folasade P May
- Department of Medicine, University of California Los Angeles (UCLA) Health and UCLA Kaiser Permanente Center for Health Equity, Los Angeles, CA, USA
| | - Chyke A Doubeni
- Department of Family and Community Medicine, College of Medicine, Comprehensive Cancer Center, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - A Mark Fendrick
- Department of Internal Medicine and Department of Health Management and Policy, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | | | - Chris Estes
- Exact Sciences Corporation, Madison, WI, USA
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Chiu LS, Huang KZ, Xu X, Heeren T, Haque R, Schroy PS. Initial Stage of Disease Similar for White and Black Patients With Early-Onset Colorectal Cancer at a Safety-Net Hospital. J Clin Gastroenterol 2024; 58:162-168. [PMID: 36806090 DOI: 10.1097/mcg.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Non-Hispanic Black (NHB) patients with early-onset colorectal cancer (EOCRC) are more likely to present with advanced-stage disease than their Non-Hispanic White (NHW) counterparts. To further elucidate whether differences in tumor biology or disparities in access to care may be responsible, we examined the association between race/ethnicity and initial stage of disease, time to diagnosis, and tumor characteristics among NHW and NHB patients with EOCRC cared for in a safety-net health care setting. METHODS We performed a retrospective cohort study of NHW and NHB patients diagnosed with primary EOCRC who received care at Boston Medical Center between January 2000 and May 2020. We compared demographics, risk factors, presenting signs/symptoms, time to diagnosis, health care utilization, and tumor characteristics (stage, grade, location, and mutational status). RESULTS We identified 103 patients (mean age 41.5±7.2 y, 53.4% men), including 40 NHWs and 63 NHBs, with EOCRC. NHB and NHW patients were similar with respect to demographics, presenting signs/symptoms, and risk factor distribution. There were also no significant differences between NHWs and NHBs with respect to the advanced stage of disease at presentation (45.0% vs. 42.9%, P =0.83), the median time to diagnosis [152 d (IQR, 40 to 341) vs. 160 d (IQR, 61 to 312), P =0.79] or tumor characteristics, except for a predilection for proximal disease among NHBs (30.2% vs. 15.0%). CONCLUSIONS NHB patients were no more likely than NHW patients to present with advanced-stage disease, aggressive tumor histology, or experience delays in diagnosis within a safety-net health care system.
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Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kevin Z Huang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Xixi Xu
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Rubiya Haque
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul S Schroy
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Luo J, He MW, Luo T, Lv GQ. Identification of multiple risk factors for colorectal cancer relapse after laparoscopic radical resection. World J Gastrointest Surg 2023; 15:2211-2221. [PMID: 37969700 PMCID: PMC10642461 DOI: 10.4240/wjgs.v15.i10.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a common life-threatening disease that often requires surgical intervention, such as laparoscopic radical resection. However, despite successful surgeries, some patients experience disease relapse. Identifying the risk factors for CRC relapse can help guide clinical interventions and improve patient outcomes. AIM To determine the risk factors that may lead to CRC relapse after laparoscopic radical resection. METHODS We performed a retrospective analysis using the baseline data of 140 patients with CRC admitted to our hospital between January 2018 and January 2020. All included participants were followed up until death or for 3 years. The baseline data and laboratory indicators were compared between the patients who experienced relapse and those who did not experienced relapse. RESULTS Among the 140 patients with CRC, 30 experienced relapse within 3 years after laparoscopic radical resection and 110 did not experience relapse. The relapse group had a higher frequency of rectal tumors with low differentiation and lymphatic vessel invasion than that of the non-relapse group. The expression of serum markers and the prognostic nutritional index were lower, whereas the neutrophil-to-lymphocyte ratio, expression of cytokeratin 19 fragment antigen 21-1, vascular endothelial growth factor, and Chitinase-3-like protein 1 were significantly higher in the relapse group than those in the non-relapse group. The groups did not differ significantly based on other parameters. Logistic regression analysis revealed that all the above significantly altered factors were independent risk factors for CRC relapse. CONCLUSION We identified multiple risk factors for CRC relapse following surgery, which can be considered for the clinical monitoring of patients to reduce disease recurrence and improve patient survival.
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Affiliation(s)
- Jun Luo
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Mei-Wen He
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Ting Luo
- Department of Operating Room, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Guo-Qing Lv
- Department of Gastrointestinal Surgery, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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4
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. Statistical methods for measuring trends in colorectal cancer incidence in registries: A systematic review. Front Oncol 2022; 12:1049486. [DOI: 10.3389/fonc.2022.1049486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundMonitoring cancer trends in a population is essential for tracking the disease’s burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends.MethodsWe performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used.ResultsThis review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used.ConclusionThis review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.
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Bi JH, Yuan HY, Jiang Y, Zhang Y, Zheng WW, Zhang L, Li ZY, Li HL, Tan YT, Zhao WS, Xiang YB. Incidence, Mortality Features and Lifetime Risk Estimation of Digestive Tract Cancers in an Urban District of Shanghai, China. J Epidemiol Glob Health 2022; 12:248-257. [PMID: 35751747 PMCID: PMC9470802 DOI: 10.1007/s44197-022-00047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/05/2022] [Indexed: 10/28/2022] Open
Abstract
Digestive tract cancers are the common cause of cancer deaths in both China and worldwide. This study aimed to describe the burden, recent trends and lifetime risks in the incidence and mortality of digestive tract cancers in an urban district of Shanghai, China. Our study extracted data on stomach, colon, rectum and liver cancers diagnosed in Changning District between 2010 and 2019 from the Shanghai Cancer Registry. We calculated age-standardized incidence and mortality rates, the risks of developing and dying from cancer, and the estimated annual percent changes. Between 2010 and 2019, 8619 new cases and 5775 deaths were registered with digestive tract cancers in the district. The age-standardized incidence rates (ASIRs) of liver cancer decreased steadily, whereas the ASIRs of stomach, colon and rectum cancers remained stable from 2010 to 2019. The age-standardized mortality rates (ASMRs) of stomach and liver cancers showed significant declining changes from 2010 to 2019 in both sexes, but that of colon and rectum cancers remained stable during the entire period. The risks of developing and dying from digestive tract cancers were substantially higher in men than women. The burden of digestive tract cancer and its disparities between sex and age group remain major public health challenges in urban Shanghai. To reduce the burden of digestive tract cancers, the government and researchers should develop and promote a healthy diet, organize a screening, and reduce the prevalence of smoking, alcohol drinking, and hepatitis B virus and hepatitis C virus infections.
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Affiliation(s)
- Jing-Hao Bi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Hui-Yun Yuan
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Yu Jiang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Yun Zhang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Wen-Wei Zheng
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Lei Zhang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Zhuo-Ying Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Hong-Lan Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Yu-Ting Tan
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Wen-Sui Zhao
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China.
| | - Yong-Bing Xiang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China.
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. A systematic review of methods to estimate colorectal cancer incidence using population-based cancer registries. BMC Med Res Methodol 2022; 22:144. [PMID: 35590277 PMCID: PMC9118801 DOI: 10.1186/s12874-022-01632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. Methods We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. Results This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. Conclusion This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01632-7.
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Affiliation(s)
- Norah Alsadhan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Alaa Almaiman
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mar Pujades-Rodriguez
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cathy Brennan
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sultana A Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Robert M West
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Incidence trends for twelve cancers in younger adults-a rapid review. Br J Cancer 2022; 126:1374-1386. [PMID: 35132237 PMCID: PMC9090760 DOI: 10.1038/s41416-022-01704-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Many cancer referral guidelines use patient’s age as a key criterium to decide who should be referred urgently. A recent rise in the incidence of colorectal cancer in younger adults has been described in high-income countries worldwide. Information on other cancers is more limited. The aim of this rapid review was to determine whether other cancers are also increasing in younger age groups, as this may have important implications for prioritising patients for investigation and referral. We searched MEDLINE, Embase and Web of Science for studies describing age-related incidence trends for colorectal, bladder, lung, oesophagus, pancreas, stomach, breast, ovarian, uterine, kidney and laryngeal cancer and myeloma. ‘Younger’ patients were defined based on NICE guidelines for cancer referral. Ninety-eight studies met the inclusion criteria. Findings show that the incidence of colorectal, breast, kidney, pancreas, uterine cancer is increasing in younger age groups, whilst the incidence of lung, laryngeal and bladder cancer is decreasing. Data for oesophageal, stomach, ovarian cancer and myeloma were inconclusive. Overall, this review provides evidence that some cancers are increasingly being diagnosed in younger age groups, although the mechanisms remain unclear. Cancer investigation and referral guidelines may need updating in light of these trends.
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Lee JK, Merchant SA, Jensen CD, Murphy CC, Udaltsova N, Corley DA. Rising Early-onset Colorectal Cancer Incidence Is Not an Artifact of Increased Screening Colonoscopy Use in a Large, Diverse Healthcare System. Gastroenterology 2022; 162:325-327.e3. [PMID: 34555382 PMCID: PMC8678196 DOI: 10.1053/j.gastro.2021.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sophie A. Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Thompson CA, Begi T, Parada H. Alarming recent rises in early-onset colorectal cancer. Cancer 2021; 128:230-233. [PMID: 34529834 DOI: 10.1002/cncr.33919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Talia Begi
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California.,Moores Cancer Center, University of California San Diego, La Jolla, California.,Department of Radiation Medicine and Applied Science, University of California San Diego, La Jolla, California
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Dairi O, Anderson JC, Butterly LF. Why is colorectal cancer increasing in younger age groups in the United States? Expert Rev Gastroenterol Hepatol 2021; 15:623-632. [PMID: 33480301 DOI: 10.1080/17474124.2021.1876561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: While colorectal cancer (CRC) incidence and mortality have decreased for older adults, the rates are increasing in adults younger than 50 years of age in the United States as well as globally. In response to strong epidemiologic evidence as well as sophisticated models, the American Cancer Society (ACS) has recommended screening adults for CRC starting at age 45. Understanding the factors associated with the rise of incidence in adults younger than age 50 may help to identify those adults who may be at greatest risk.Areas covered: In this review, we provide an overview of the recent literature and discuss possible explanations for the increase in CRC in young adults including obesity and other recognized CRC risk factors, delay in diagnosis of symptomatic patients (<50 years of age), and review perspectives on the current and future status of the field.Expert opinion: Currently there are little data regarding risk factors for CRC in average risk young adults who are asymptomatic. With potential endorsement of screening at 45 years of age by US Preventive Services Task Force, more data regarding clinical and molecular risk factors associated with CRC in young adults will be available.
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Affiliation(s)
- Obaida Dairi
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, USA.,New Hampshire Colonoscopy Registry, Lebanon, NH, USA
| | - Lynn F Butterly
- New Hampshire Colonoscopy Registry, Lebanon, NH, USA.,Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Bähler C, Brüngger B, Ulyte A, Schwenkglenks M, von Wyl V, Dressel H, Gruebner O, Wei W, Blozik E. Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study. BMC Public Health 2021; 21:23. [PMID: 33402140 PMCID: PMC7786957 DOI: 10.1186/s12889-020-10079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. Methods The study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression. Results Overall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization. Conclusions Variation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10079-8.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland. .,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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Holowatyj AN, Langston ME, Han Y, Viskochil R, Perea J, Cao Y, Rogers CR, Lieu CH, Moore JX. Community Health Behaviors and Geographic Variation in Early-Onset Colorectal Cancer Survival Among Women. Clin Transl Gastroenterol 2020; 11:e00266. [PMID: 33512797 PMCID: PMC7678794 DOI: 10.14309/ctg.0000000000000266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/12/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Despite overall reductions in colorectal cancer (CRC) morbidity and mortality, survival disparities by sex persist among young patients (age <50 years). Our study sought to quantify variance in early-onset CRC survival accounted for by individual/community-level characteristics among a population-based cohort of US women. METHODS Geographic hot spots-counties with high early-onset CRC mortality rates among women-were derived using 3 geospatial autocorrelation approaches with Centers for Disease Control and Prevention national mortality data. We identified women (age: 15-49 years) diagnosed with CRC from 1999 to 2016 in the National Institutes of Health/National Cancer Institute's Surveillance, Epidemiology, and End Results program. Patterns of community health behaviors by hot spot classification were assessed by Spearman correlation (ρ). Generalized R values were used to evaluate variance in survival attributed to individual/community-level features. RESULTS Approximately 1 in every 16 contiguous US counties identified as hot spots (191 of 3,108), and 52.9% of hot spot counties (n = 101) were located in the South. Among 28,790 women with early-onset CRC, 13.7% of cases (n = 3,954) resided in hot spot counties. Physical inactivity and fertility were community health behaviors that modestly correlated with hot spot residence among women with early-onset CRC (ρ = 0.21 and ρ = -0.23, respectively; P < 0.01). Together, individual/community-level features accounted for distinct variance patterns in early-onset CRC survival among women (hot spot counties: 33.8%; non-hot spot counties: 34.1%). DISCUSSION Individual/community-level features accounted for approximately one-third of variation in early-onset CRC survival among women and differed between hot spot vs non-hot spot counties. Understanding the impact of community health behaviors-particularly in regions with high early-onset CRC mortality rates-is critical for tailoring strategies to reduce early-onset CRC disparities.
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Affiliation(s)
- Andreana N. Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marvin E. Langston
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Richard Viskochil
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jose Perea
- Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Alvin J. Siteman Cancer Center, St. Louis, Missouri, USA
| | - Charles R. Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher H. Lieu
- Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado, USA
| | - Justin X. Moore
- Division of Epidemiology, Augusta University at the Medical College of Georgia, Augusta, Georgia, USA
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13
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Zahnd WE, Gomez SL, Steck SE, Brown MJ, Ganai S, Zhang J, Arp Adams S, Berger FG, Eberth JM. Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer. Cancer 2020; 127:239-248. [PMID: 33112412 DOI: 10.1002/cncr.33256] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. METHODS Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. RESULTS EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. CONCLUSIONS EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J Brown
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Office of the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Franklin G Berger
- Colorectal Cancer Prevention Network, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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14
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Boardman LA, Vilar E, You YN, Samadder J. AGA Clinical Practice Update on Young Adult-Onset Colorectal Cancer Diagnosis and Management: Expert Review. Clin Gastroenterol Hepatol 2020; 18:2415-2424. [PMID: 32525015 DOI: 10.1016/j.cgh.2020.05.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
DESCRIPTION The objectives of this expert review are: (1) to prepare clinicians to recognize the presentation and evidence-based risk factors for young adult-onset colorectal cancer (CRC), defined as CRC diagnosed in individuals 18 - <50 years of age; (2) to improve management for patients with young onset CRC. This review will focus on the following topics relevant to young adult-onset CRC: epidemiology and risk factors; clinical presentation; diagnostic and therapeutic management including options for colorectal and extra-colonic surgical intervention, chemotherapy and immune-oncology therapies; genetic testing and its potential impact on preimplantation genetics; fertility preservation; and cancer surveillance recommendations for these individuals and their family members. METHODS The evidence reviewed in this manuscript is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. BEST PRACTICE ADVICE 1: With the rising incidence of people developing CRC before 50 years of age, diagnostic evaluation of the colon and rectum is encouraged for all patients, irrespective of age, who present with symptoms that may be consistent with CRC, including but not limited to: rectal bleeding, weight loss, change in bowel habit, abdominal pain, iron deficiency anemia. BEST PRACTICE ADVICE 2: Clinicians should obtain family history of colorectal and other cancers in first and second degree relatives of patients with young adult-onset CRC and discuss genetic evaluation with germline genetic testing either in targeted genes based on phenotypic presentation or in multiplex gene panels regardless of family history. BEST PRACTICE ADVICE 3: Clinicians should present the role of fertility preservation prior to cancer-directed therapy including surgery, pelvic radiation, or chemotherapy BEST PRACTICE ADVICE 4: Clinicians should counsel patients on the benefit of germline genetic testing and familial cancer panel testing in the pre-surgical period to inform which surgical options may be available to the patient with young adult-onset CRC BEST PRACTICE ADVICE 5: Clinicians should consider utilizing germline and somatic genetic testing results to inform chemotherapeutic strategies BEST PRACTICE ADVICE 6: Clinicians should offer hereditary CRC syndrome specific screening for CRC and extra-colonic cancers only to young adult-onset CRC patients who have a genetically or clinically diagnosed hereditary CRC syndrome. For patients with sporadic young adult-onset CRC, extra-colonic screening and CRC surveillance intervals are the same as for patients with older adult-onset CRC.
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Affiliation(s)
- Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Eduardo Vilar
- Division of Cancer Prevention and Population Sciences, Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Nancy You
- Division of Surgery, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jewel Samadder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
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15
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Barzi A, Weipert CM, Espenschied CR, Lenz HJ. Novel Genomic Differences in Cell-Free Circulating DNA Profiles of Young- Versus Older-Onset Colorectal Cancer. J Adolesc Young Adult Oncol 2020; 10:336-341. [PMID: 32915106 DOI: 10.1089/jayao.2020.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We present the first analysis examining molecular alterations detected utilizing a clinically available cell-free circulating tumor DNA (cfDNA) assay in a cohort of patients with advanced colorectal cancer (aCRC) diagnosed <50 versus ≥50 years of age. Patient characteristics and mutation frequencies were compared using cfDNA tests from 5873 patients. Patients <50 had more sequence alterations in APC, CTNNB1, and SMAD4, as well as a higher frequency of focal BRAF and ERBB2(HER2) amplifications. Our study adds further evidence suggesting that young- versus older-onset CRC may have distinct molecular underpinnings, with prognostic and therapeutic implications.
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Affiliation(s)
- Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California, USA
| | - Caroline M Weipert
- Department of Medical Oncology and Therapeutics Research, Guardant Health, Redwood City, California, USA
| | - Carin R Espenschied
- Department of Medical Oncology and Therapeutics Research, Guardant Health, Redwood City, California, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
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16
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Lowery JT, Weber TK, Ahnen DJ, Schroy III PC, Levell CL, Smith RA. An action plan to address the rising burden of colorectal cancer in younger adults. COLORECTAL CANCER 2020. [DOI: 10.2217/crc-2020-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim: The National Colorectal Cancer Roundtable convened a national Summit to discuss the causes of early-onset colorectal cancer and clinical challenges to mitigating burden of this disease. Materials & methods: Information presented was synthesized through scientific consensus building to determine priorities for new research and practice change. Results: Research priorities include evaluating role of novel risk factors, understanding natural history and identifying ways to implement evidenced-based practices for identifying and managing at-risk persons. Practice change should focus on adoption of guidelines for collecting family history, screening in young adults at risk, provider and population awareness about risk and symptoms, and universal tumor testing. Conclusion: Successful implementation of strategies to address research and practice change will require collaboration from multiple partners.
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Affiliation(s)
- Jan T Lowery
- Center for Personalized Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Thomas K Weber
- Northwell Health, Professor of Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 10028, USA
| | - Dennis J Ahnen
- Gastroenterology of the Rockies, University of Colorado School of Medicine & Director of Genetics Program, Aurora, CO 80045, USA
| | - Paul C Schroy III
- Boston University School of Medicine, Section of Gastroenterology, Boston, MA 02118, USA
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17
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NRAS mutant E132K identified in young-onset sporadic colorectal cancer and the canonical mutants G12D and Q61K affect distinct oncogenic phenotypes. Sci Rep 2020; 10:11028. [PMID: 32620824 PMCID: PMC7334206 DOI: 10.1038/s41598-020-67796-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
Recent data show a global increase in colorectal cancer (CRC) cases among younger demographics, which portends poorer prognosis. The cause of rising incidence is uncertain, and its mutational landscape remains largely unexplored, including those in genes of the epidermal growth factor receptor pathway. Among these are NRAS mutants where there is paucity of functional studies compared to KRAS. Here, the novel NRAS mutant E132K, identified in three tumor samples from Filipino young-onset, sporadic colorectal cancer patients, was investigated for its effects on different cancer hallmarks, alongside the NRAS canonical mutants G12D and Q61K which are yet poorly characterized in the context of CRC. The novel NRAS mutant E132K and the canonical G12D and Q61K mutants show resistance to apoptosis, cytoskeletal reorganization, and loss of adhesion. In contrast to activating KRAS mutations, including the analogous KRAS G12D and Q61K mutations, all three NRAS mutants have no apparent effect on cell proliferation and motility. The results highlight the need to characterize isoform- and mutation-specific oncogenic phenotypes which can have repercussions in disease management and choice of therapeutic intervention. Further analyses of young-onset versus late-onset CRC datasets are necessary to qualify NRAS E132K as a biomarker for the young-onset subtype.
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18
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Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2020. CA Cancer J Clin 2020; 70:145-164. [PMID: 32133645 DOI: 10.3322/caac.21601] [Citation(s) in RCA: 3214] [Impact Index Per Article: 642.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steepest among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Lynn F Butterly
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joseph C Anderson
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert A Smith
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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19
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Anderson JC, Robinson C, Butterly LF. Young adults and metachronous neoplasia: risks for future advanced adenomas and large serrated polyps compared with older adults. Gastrointest Endosc 2020; 91:669-675. [PMID: 31759925 PMCID: PMC7039748 DOI: 10.1016/j.gie.2019.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recent increases in colorectal cancer (CRC) incidence in adults younger than 50 years of age have led to more colonoscopies in this age group. As a result, there may be an increasing number of adults <50 years old with polyps detected. There is concern that younger adults may require closer follow-up. Our goal was to use data from the New Hampshire Colonoscopy Registry (NHCR) to examine the risk for metachronous advanced adenomas (AAs) and large (>1 cm) serrated polyps in younger versus older adults who return for a follow-up colonoscopy. METHODS Our cohort consisted of NHCR participants with at least 1 polyp on index examination and a follow-up colonoscopy at least 1 year after the index examination. Outcomes were the risks for metachronous AAs (adenomas ≥1 cm, with villous elements or high-grade dysplasia, or CRC) and large (≥1 cm) serrated polyps. We present absolute risk and adjusted risks from a logistic regression model stratified by age at index colonoscopy (<40, 40-49, 50-59, and 60+ [reference]). Covariates included index findings, endoscopist adenoma detection rates, sex, smoking, body mass index, follow-up time (months), bowel preparation quality, and family history of CRC. RESULTS In our sample of 12,380 adults, absolute risk for metachronous AA was lower for younger patients than for patients aged ≥60. After adjusting for covariates, when comparing with the 60+ group (reference), the lowest risk was observed in those younger than 40 years (odds ratio, .19; 95% confidence interval, .05-.80). Of note, similar risks were observed in the 40 to 49 age group (odds ratio, .61; 95% confidence interval, .41-.92) and 50 to 59 age group (odds ratio, .71; 95% confidence interval, .58-.86). The risk for large metachronous serrated polyps was not associated with age. CONCLUSIONS Younger adults aged <40 with index adenomas had a lower risk for metachronous AAs than those aged ≥60. The 40- to 49-year age group was found to have metachronous risk similar to the 50- to 59-year age group, with both less than the ≥60 age group. These data suggest that current surveillance interval guidelines for patients aged ≥50 years may appropriately be used with younger adults.
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Affiliation(s)
- Joseph C. Anderson
- Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- New Hampshire Colonoscopy Registry, Lebanon, NH, United States
| | | | - Lynn F. Butterly
- Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- New Hampshire Colonoscopy Registry, Lebanon, NH, United States
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20
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Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book 2020; 40:1-14. [PMID: 32315236 DOI: 10.1200/edbk_279901] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.
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Affiliation(s)
| | | | | | | | - Nilofer S Azad
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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21
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Piscitello A, Edwards DK. Estimating the Screening-Eligible Population Size, Ages 45-74, at Average Risk to Develop Colorectal Cancer in the United States. Cancer Prev Res (Phila) 2020; 13:443-448. [PMID: 32029430 DOI: 10.1158/1940-6207.capr-19-0527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Colorectal cancer is a growing burden in adults less than 50 years old. In 2018, the American Cancer Society published a guideline update recommending a reduction in the colorectal cancer screening start age for average-risk individuals from 50 to 45. Implementing these recommendations would have important implications for public health. However, the approximate number of people impacted by this change, the average-risk population ages 45-49, is not well-described in the literature. Here, we provide methodology to conservatively estimate the average-risk and screening-eligible population in the United States, including those who would be impacted by a lowered colorectal cancer screening start age. Using multiple data sources, we estimated the current average-risk population by subtracting individuals with symptomatic colorectal cancer, with a family history of colorectal cancer, and with inflammatory bowel disease and hereditary nonpolyposis colorectal cancer from the total population. Within this population, we estimated the number of screening-eligible individuals by subtracting those with previous colorectal cancer screening (45- to 49-year-old) or up to date with colorectal cancer screening (50- to 74-year-old). The total average-risk population is estimated between 102.1 and 106.5 million people, of whom 43.4-45.2 million people are eligible for colorectal cancer screening. Lowering the screening age would add roughly 19 million people to the average-risk population and increase the current number of screening-eligible individuals on immediate implementation by over 60% (from 27 to 44 million). Estimating the population size impacted by lowering the recommended colorectal cancer screening start age enables more accurate decision-making for policymakers and epidemiologists focused on cancer prevention.
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