Early-Onset Colorectal Cancer: Prevalence, Risk Factors, and Clinical Features among Commercially Insured Adults in the United States

Abstract

Abstract Background The incidence of colorectal cancer in patients younger than 50 has been rising in the last 30 years, accounting for up to 25% of total cases. Despite the screening age recently being lowered to 45, a significant proportion of cases would still arise at younger ages prior to screening. Nonfamilial early onset colorectal cancer remain a particular concern. Identification of risk factors and clinical features in this age group is needed to improve detection. Methods In this retrospective cohort analysis using claims data from the Truven Health MarketScan insurance database from 2007–2017, patients were identified with colon and rectal cancer, compared across three age groups (ages 18–40, 40–50 and > 50), and analyzed for risk factors and clinical features. Results Females sex was more prevalent in the younger age group compared to age > 50 (54% and 51.9% vs 49.6%), with little change noted between rectal cancer age groups by sex. A higher percentage of younger patients were in the obese age groups compared with older groups for colon cancer, particularly the morbidly obese with BMI > 40 (24.94%, 25.75%, and 21.34% in the three age groups). Abdominal pain was a common presenting symptom identified in the age groups < 50 compared with age > 50 (25% and 19% vs 14%) along with hematochezia, weight loss, and anemia. Conclusions Morbid obesity and female sex may be important risk factors among patients with early onset CRC. The presence of abdominal pain was more common among the early onset CRC cohort.