Different Presentation Leads to Later Colorectal-Cancer Diagnosis in People Under 50

By Will Boggs MD

August 17, 2019

NEW YORK (Reuters Health) - Presentation with nonspecific symptoms contributes to delays in the diagnosis of colorectal cancer in patients younger than 50, researchers in the U.K. report.

"One of the ideas we had in mind was that young patients were simply 'ignoring' their symptoms, until they were too severe or acute, requiring an emergency presentation," Dr. Chanpreet S. Arhi from Imperial College London told Reuters Health by email. "Instead we found young patients were actually seeing their GPs, albeit with nonspecific symptoms."

An estimated 6% of colorectal cancer cases in England are diagnosed in people under 50, and according to projections, more than one in 10 colon cancers and one in four rectal cancers will be diagnosed in this age group by 2030. Current U.K. referral guidelines concentrate on diagnosing colorectal cancer in patients over 50.

Dr. Arhi's team used data from England's Clinical Practice Research Datalink to compare the interval from presentation to diagnosis and the odds of an emergency diagnosis of colorectal cancer for those under the age of 50 versus older patients.

Significantly more patients in the under-50 age group (29.1%) than in any other age group (19.9% of 50- to 59-year-olds, 20.8% of 60- to 69-year-olds, and 22.7% of 70- to 79-year-olds) were diagnosed as emergencies, the researchers report in Colorectal Disease, online August 6.

Among all age groups, early-stage diagnosis was least common in the under-50 group (31.5% vs. an overall rate of 37.3%).

The under-50 age group presented most commonly with abdominal pain and had the lowest percentage of red-flag symptoms (rectal bleeding, anemia, change in bowel habits, diarrhea and abdominal mass) and the highest percentage of consultations with nonspecific symptoms of all age groups (28.5% and 32.1%, respectively).

Young patients were more likely than older patients to present to their GP in the year leading up to diagnosis.

The interval from referral to diagnosis was significantly longer in the under-50 age group (median, 59 days) than in any other age group (overall median, 49 days).

Physicians should "be aware that young patients with cancer will not necessarily present with the typical 'red-flag' symptoms," Dr. Arhi said. "Instead, recurrent attendances by a young patient with nonspecific symptoms should alert the physician to the possibility of cancer."

"The latest NICE guidance (2015) has changed to include a younger age group," he said. "We await to see if this will make a difference in the number of consultations or the likelihood for an emergency diagnosis for young patients."

SOURCE: https://bit.ly/2KN8pnR

Colorectal Dis 2019.