Younger Patients With CRC Misdiagnosed, Diagnosed at Later Stages

Ronit Yarden, PhD, MHSA

Many younger patients see more than one doctor and face misdiagnoses before being given a diagnosis of colorectal cancer (CRC), according to recent research presented during a webcast ahead of the 2019 AACR Annual Meeting.

“Traditionally, colorectal cancers have been associated with aging, which is why guidelines called for initiating colorectal cancer screening at the age of 50. As a consequence, both incidence and mortality from colorectal cancer are declining in the elderly,” Ronit Yarden, PhD, MHSA, researcher on the study and director of medical affairs at the Colorectal Cancer Alliance said during the webcast.

“On the contrary … there is a rise in incidence in young-onset colorectal cancer,” Yarden said, mentioning for every 10 CRC diagnoses in the United States, 1 will be in a patient who is under the age of 50.

Both the United States Preventive Services Task Force (USPSTF) and the American Cancer Society recently updated their CRC screening guidelines, urging for regular screenings to begin at the age of 45 instead of 50. Yarden also mentioned that if individuals have a family history of CRC, they should start screenings even earlier, at the age of 40.

Researchers reviewed 1195 online surveys completed by individuals who were diagnosed with CRC before the age of 50 and found that 57% were diagnosed between the ages of 40 and 49; 33% were diagnosed between 30 and 39; and 10% were diagnosed before the age of 30. Thirty percent had a family history of CRC and 8% were diagnosed with Lynch syndrome, which can be a genetic predisposition to the disease.

One-fourth of the diagnoses were rectal cancer, and the rest were colon cancer.

The majority of patients (70%) were diagnosed with stage III or stage IV disease — a contrast to their older counterparts, who are more likely to be diagnosed at stage I or II disease, according to the researchers.

“As we know, early detection is critical to the treatment and potential cure of colorectal cancer,” Yarden said.

Investigators also found that 63% of survey responders waited 3 to 12 months to see a doctor after symptoms began, namely because they did not recognize that they were experiencing signs of cancer. Instead, patients were commonly diagnosed with issues such as hemorrhoids, irritable bowel syndrome, and anemia.

“Most of the patients waited at least 3 months to reach out to their doctors, and almost 1 in 4 waited more than a year to visit their doctor or other provider.”

Further, 67% of participants stated that they saw 2 or more physicians before receiving a diagnosis of CRC. Only one-third (33%) were diagnosed after seeing 1 doctor; 40% were diagnosed after seeing 2 doctors; 16% after seeing 3; and 11% after seeing 4 doctors.

“Both the medical community and the general population should be aware that colorectal cancer, which is one of the most preventable diseases, could happen in young adults,” Yarden said. “Symptoms should not be dismissed at any age, and screening should be extended if you want to beat the disease.”

Yarden RI, Newcomer KL; Never Too Young Advisory Board, Colorectal Cancer Alliance. Young onset colorectal cancer patients are diagnosed with advanced disease after multiple misdiagnoses. Presented ahead of the 2019 AACR Annual Meeting; March 29-April 3, 2019; Atlanta, GA.

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