Early-onset colorectal cancer: more than one side to the story

Figures & data

Table 1. Characteristics of 650,382 people diagnosed with colorectal cancer by age at diagnosis (±50 years), Surveillance, Epidemiology and End Results 18, 2000–2016.

Variables	Age 18–49 years (n = 66,186)		Age ≥50 years (n = 584,196)		p-value
	n	%	n	%
Median age (interquartile range)	44 (39–47)		71 (61–80)
Sex					<0.01
– Male	34,833	52.6	300,243	51.4
– Female	31,353	47.4	283,953	48.5
Race/ethnicity					<0.01
– Non-Hispanic white	38,955	59.4	420,647	72.4
– Non-Hispanic black	9451	14.4	65,422	11.3
– Hispanic	10,439	15.9	50,804	8.7
– Other	6738	10.3	44,490	7.7
– Missing	603		2833
Year of diagnosis					<0.01
– 2000–2003	13,852	20.9	144,092	24.7
– 2004–2007	15,058	22.8	138,421	23.7
– 2008–2011	15,926	24.1	135,341	23.2
– 2012–2016	21,350	32.3	166,342	28.5
Stage at diagnosis					<0.01
– Local	17,494	34.7	177,183	42.8
– Regional	19,666	39.0	151,134	36.6
– Distant	13,292	26.4	85,233	20.6
– Missing	15,734		170,646
Tumor location					<0.01
– Appendix	3810	5.8	8360	1.4
– Cecum	5911	8.9	94,596	16.2
– Ascending colon	4867	7.4	80,268	13.7
– Hepatic flexure	1576	2.4	21,177	3.6
– Transverse colon	3182	4.8	39,258	6.7
– Splenic flexure	1438	2.2	13,648	2.3
– Descending colon	3100	4.7	24,591	4.2
– Sigmoid colon	14,225	21.5	112,992	19.3
– Rectosigmoid junction	6246	9.4	42,816	7.3
– Rectum	19,826	30.0	119,597	20.5
– Large intestine, not specified	2005	3.0	26,893	4.6

Note: Missing values not included in Chi-square tests.

Table 2. Crude and adjusted hazard ratios demonstrating association between age at diagnosis and all-cause mortality, by tumor side, Surveillance, Epidemiology and End Results 18, 2000–2006.

Age at diagnosis	Right colon (n = 262,713)		Left colon (n = 169,830)		Rectum (n = 187,726)
	Crude HR (95% CI)	Adjusted HR ^† (95% CI)	Crude HR (95% CI)	Adjusted HR ^† (95% CI)	Crude HR (95% CI)	Adjusted HR ^† (95% CI)
18–29 years	0.63 (0.56, 0.70)	0.72 (0.63, 0.82)	1.39 (1.24, 1.56)	1.18 (1.03, 1.34)	1.11 (1.01, 1.22)	1.05 (0.94, 1.18)
30–39 years	0.77 (0.73, 0.82)	0.76 (0.71, 0.81)	1.12 (1.06, 1.19)	0.98 (0.91, 1.05)	0.96 (0.91, 1.01)	0.89 (0.84, 0.95)
40–49 years	0.94 (0.91, 0.97)	0.88 (0.85, 0.92)	1.07 (1.04, 1.11)	0.96 (0.92, 1.00)	0.99 (0.96, 1.02)	0.91 (0.88, 0.94)
50–59 years	1.00	1.00	1.00	1.00	1.00	1.00
60–69 years	1.16 (1.13, 1.18)	1.24 (1.21, 1.27)	1.38 (1.35, 1.41)	1.36 (1.32, 1.40)	1.44 (1.40, 1.47)	1.39 (1.35, 1.53)
≥70 years	2.17 (2.13, 2.21)	2.61 (2.56, 2.67)	2.86 (2.80, 2.92)	3.10 (3.02, 3.18)	2.98 (2.92, 3.03)	3.05 (2.98, 3.12)

Note: Adjusted hazard ratios adjusted for sex, race/ethnicity, stage and year of diagnosis; right colon includes appendix, cecum, ascending colon, hepatic flexure and transverse colon; left colon includes splenic flexure, descending colon and sigmoid colon; and rectum includes rectosigmoid junction and rectum.

† Observations with missing data were dropped from adjusted models; these models comprised samples of 193,222 (right colon), 120,861 (left colon) and 133,907 (rectum). Akaike information criterion for adjusted models as follows: 2126667.0 (right colon), 1137598.5 (left colon) and 1220860.7 (rectum).

CI: Confidence interval; HR: Hazard ratio.

Figure 1. Association between age at diagnosis and all-cause mortality by tumor side.

Adjusted hazard ratios demonstrating association between age at diagnosis and all-cause mortality for right colon (A), left colon (B), and rectal (C) cancer, SEER 18, 2000–2016.

HR: Hazard ratio; SEER: Surveillance, Epidemiology and End Result.

Table 3. Five-year risk (95% CI) of all-cause mortality by age at diagnosis and tumor side.

Age at diagnosis	Right colon (n = 262,713)	Left colon (n = 169,830)	Rectum (n = 187,726)
18–29 years	0.27 (0.24, 0.29)	0.42 (0.38, 0.46)	0.34 (0.32, 0.35)
30–39 years	0.32 (0.31, 0.34)	0.35 (0.33, 0.37)	0.31 (0.30, 0.33)
40–49 years	0.37 (0.36, 0.38)	0.33 (0.32, 0.34)	0.31 (0.30, 0.32)
50–59 years	0.38 (0.37, 0.38)	0.30 (0.29, 0.30)	0.30 (0.30, 0.31)
60–69 years	0.40 (0.39, 0.40)	0.36 (0.35, 0.36)	0.38 (0.38, 0.39)
≥70 years	0.57 (0.57, 0.58)	0.57 (0.57, 0.58)	0.61 (0.61, 0.62)

CI: Confidence interval.

Figure 2. Cumulative incidence of all-cause mortality by age at diagnosis and tumor side.

Cumulative incidence of all-cause mortality by age at diagnosis for right colon (A), left colon (B) and rectal (C) cancer, SEER 18, 2000–2016.

SEER: Surveillance, Epidemiology and End Result.

Table 4. Summary of risk factors for right colon, left colon and rectal cancer.

Variables	Right colon	Left colon	Rectum	Ref.
Obesity in adulthood	↑↑↑	↑↑↑↑	↑↑	[43,44]
Obesity in childhood	↑↑	↑↑	–	[45]
Adult height	↑↑	↑	–	[36,39]
Western diet	–	↑↑↑↑↑	↑↑↑↑	[42]
Healthy diet	↓↓	↓↓	↓↓	[42]
Cigarette smoking	↑↑↑	–	↑	[40,41]
Alcohol intake	–	↑↑	↑↑	[46]
Physical activity	↓↓↓	↓↓↓	–	[36,43]

Each arrow corresponds to an incremental increase or decrease from the null by approximately 0.1.

↑: Increases risk; –: No association; ↓: Decreases risk.

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