Increasing Incidence of Left-Sided Colorectal Cancer in the Young: Age Is Not the Only Factor
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SSAT QUICK SHOT PRESENTATION
Increasing Incidence of Left-Sided Colorectal Cancer in the Young: Age Is Not the Only Factor David E. Kearney 1 & Christy E. Cauley 1 & Alexandra Aiello 1 & Matthew F. Kalady 1 & James M. Church 1 & Scott R. Steele 1 & Michael A. Valente 1 Received: 11 August 2019 / Accepted: 18 May 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Recent single-institution studies have shown that colorectal cancer (CRC) in patients < 50 is predominantly leftsided. The aims of this study were to 1 compare the incidence of left-sided CRC in patients under and over 50, 2 investigate this trend over time, and 3 examine whether racial differences exist in the anatomical distribution of CRC. Methods We used the Nationwide Inpatient Sample to identify all patients with colon or rectal cancer who underwent a resection from 2000 to 2014. Logistic regression models were used to determine the odds of a patient having a left-sided CRC based on age and race. Results A total of 1,547,589 patients underwent resection, with a mean age of 68.6. Overall, 65.1% of patients < 50 had a leftsided CRC compared with 47.2% of patients ≥ 50 (OR = 2.1; 95% CI 2.0, 2.1). The difference was greater as patients became older with 39.9% of patients > 70 having a left-sided CRC (< 50 vs ≥ 70; OR = 2.8; 95% CI 2.7, 2.9). The incidence of CRC in those under 50 increased over the study period due to an increase in left-sided tumors. The distribution of CRC varied with race, with African-Americans having a lower odds for left-sided CRC (OR = 0.89; 95% CI 0.87, 0.91) and Asians/Pacific Islanders having a higher odds (OR = 1.8; 95% CI 1.7, 1.9). Conclusion In the < 50 age group, the incidence of CRC is increasing, with majority of these tumors left-sided. Tumor location varies with both age and race. Keywords Colorectal cancer . Race . Age . Anatomical distribution
Introduction The incidence of colorectal cancer (CRC) has been decreasing in the USA with the exception of patients under 50 years old. This trend of increasing CRC in the young has also been observed globally.1–4 The decreasing incidence of CRC in the USA in patients over 50 years is thought to be due to the removal of colorectal polyps as a result of screening. 2,3 Young patients who present with CRC do not undergo screening and often present with advanced tumors after delayed diagnosis.4 In response to these findings, the American Presented at the SSAT section of Digestive Disease Week in San Diego on May 21, 2019 * David E. Kearney [email protected] 1
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
Cancer Society recently modified its guidelines and now recommends colorectal cancer screening to start at 45 years of age for average-risk individuals.5 The anatomical location of CRC has previously been reported to be affected by both patient age and race. CRC in the young appears to have a left-sided predominance.4,6 A previous publication from our institution by S
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