Faculty Bibliography

BACKGROUND:Young adults diagnosed with colorectal cancer (CRC) comprise a growing, yet understudied, patient population. We estimated 5-year relative survival of early-onset CRC and examined disparities in survival by race-ethnicity in a population-based sample. METHODS:We used the National Cancer Institute's Surveillance, Epidemiology, and End Results program of cancer registries to identify patients diagnosed with early-onset CRC (20-49 years of age) between January 1, 1992, and December 31, 2013. For each racial-ethnic group, we estimated 5-year relative survival, overall and by sex, tumor site, and stage at diagnosis. To illustrate temporal trends, we compared 5-year relative survival in 1992-2002 vs 2003-2013. We also used Cox proportional hazards regression models to examine the association of race-ethnicity and all-cause mortality, adjusting for age at diagnosis, sex, county type (urban vs rural), county-level median household income, tumor site, and stage at diagnosis. RESULTS:We identified 33,777 patients diagnosed with early-onset CRC (58.5% White, 14.0% Black, 13.0% Asian, 14.5% Hispanic). Five-year relative survival ranged from 57.6% (Black patients) to 69.1% (White patients). Relative survival improved from 1992-2002 to 2003-2013 for White patients only; there was no improvement for Black, Asian, or Hispanic patients. This pattern was similar by sex, tumor site, and stage at diagnosis. In adjusted analysis, Black (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.36-1.49), Asian (aHR, 1.06; 95% CI, 1.01-1.12), and Hispanic (aHR, 1.16; 95% CI, 1.10-1.21) race-ethnicity were associated with all-cause mortality. CONCLUSION/CONCLUSIONS:Our study adds to the well-documented disparities in CRC in older adults by demonstrating persistent racial-ethnic disparities in relative survival and all-cause mortality in patients with early-onset CRC.

Introduction: Incidence rates of colorectal cancer (CRC) are increasing among younger adults (age , 50 years) in the U.S., and more recently, rates have increased in persons age 50-54 years. To better understand the corresponding changes in mortality, we examined trends in CRC mortality rates by age over a 27-year time period.
Method(s): We used population-based data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program of cancer registries to estimate age-specific (30-84 years, by 5-year age group) mortality rates per 100,000 persons during the period 1992-2019. We used joinpoint regression analysis to quantify changes in the direction and magnitude of mortality rates; the slope of the best-fit line between joinpoints corresponds to the annual percent change (APC) in mortality, with p< 0.05 indicating a statistically significant difference from a slope of zero.
Result(s): Between 1992 and 2019, CRC mortality rates steadily increased by about 1% per year for ages 30-34 and 35-39 years. For ages 40-44 and 45-49 years, rates decreased by , 1% per year from 1992 until the mid 2000s and subsequently increased from 2004 to 2019 (APC 1.1, p< 0.05) and 2006 to 2019 (APC 1.3, p< 0.05), respectively (Table). For age groups 50-54 to 60-64 years, mortality rates decreased by about 2% per year from 1992 until the mid 2000s; however, after 2006, rates increased for age 50-54 years (APC 0.5, p< 0.05) and decreased more slowly for ages 55-59 (APC -0.4, p< 0.05) and 60-64 (APC -1.5, p< 0.05) years. Mortality rates also decreased at a lower rate for age 65-69 years, beginning in 2011 (APC for 2011-2019: -1.7, p< 0.05 vs. APC for 2001-2010: -3.9, p< 0.05). For age groups 70-74 to 80-84 years, mortality rates steadily decreased by about 3% per year from 2000 to 2019.
Conclusion(s): Age-specific CRC mortality rates mirror the well-described trends in CRC incidence rates, with increasing rates in every age group up to 50-54 years and slowing rates at age 55-59 years. Our findings suggest that CRC diagnoses and deaths are increasingly common in middle-aged adults, despite the availability of screening and improved treatment options. Future efforts should identify factors contributing to increasing CRC mortality rates, as well as implement strategies to improve screening participation in these age groups

BACKGROUND:The COVID-19 pandemic significantly impacted the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening. We aimed to determine the effect of the pandemic on CRC screening at a safety-net hospital and a private health system based in New York City. METHODS:We identified individuals eligible for CRC screening aged 50 to 75 years presenting for outpatient care at a safety-net public hospital and private health system in April through September of 2019 and 2020. The primary outcome was the proportion of screening-eligible patients seen in primary care who underwent CRC screening. RESULTS:The safety-net hospital had 516 (6.1% of screening-eligible individuals) and 269 (4.3%) screening tests completed in 2019 and 2020, respectively (p < 0.01). Fecal immunochemical tests (FIT) accounted for 69.6% of screening in 2019 and 88.1% in 2020. Colonoscopy accounted for 20.3% of screening in 2019 and 11.9% in 2020. The private health system had 39 (0.7%) and 21 (0.6%) screening tests completed in 2019 and 2020, respectively (p = 0.48). FIT accounted for 61.9% of screening in 2019 and 57.1% in 2020. Colonoscopy accounted for 38.1% of screening in 2019 and 42.9% in 2020. CONCLUSION/CONCLUSIONS:Absolute numbers of screening tests decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening uptake and increase in proportional FIT use in the safety-net hospital but no change in the private health system.

BACKGROUND/UNASSIGNED:In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years. METHODS/UNASSIGNED:We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50-54, 55-59, 60-64, 65-69, and 70-75 years). RESULTS/UNASSIGNED:Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1-25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%-37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance. CONCLUSIONS/UNASSIGNED:Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years. IMPACT/UNASSIGNED:As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years.

BACKGROUND:Several US organizations now recommend starting average-risk colorectal cancer (CRC) screening at age 45 years, but the prevalence of colonic neoplasia in individuals younger than 50 years has not been well characterized. We used a national endoscopic registry to calculate age-stratified prevalence and predictors of colorectal neoplasia. METHODS:Outpatient screening colonoscopies performed during 2010-2020 in the GIQuIC registry were analyzed. We measured the prevalence of advanced neoplasia and adenomas by age, sex, and race/ethnicity, as well as the prevalence ratio (PR) of neoplasia compared to the reference group of 50-54 year-olds. Multivariable logistic regression models were used to identify predictors of neoplasia. RESULTS:We identified 3,928,727 screening colonoscopies, of which 129,736 (3.3%) were performed on average-risk individuals younger than 50 years. The prevalence of advanced neoplasia was 6.2% for 50-54 year-olds and 5.0% (PR 0.81, 95% CI 0.78-0.83) for average-risk 45-49 year-olds. Men had higher prevalence of neoplasia than women for all age groups. White individuals had higher prevalence of advanced neoplasia than persons of other racial/ethnic groups in most age groups, which was partially driven by serrated lesions. On multivariable regression, White individuals had higher odds of advanced neoplasia than Black, Hispanic, and Asian individuals in both younger and older age groups. CONCLUSIONS:In a large US endoscopy registry, the prevalence of advanced neoplasia in 45-49 year-olds was substantial and supports beginning screening at age 45 years. White individuals had higher risk of advanced neoplasia than Black, Hispanic, and Asian individuals across the age spectrum. These findings may inform adenoma detection benchmarks and risk-based screening strategies.