P3866 - Are We Screening Young Enough? The Younger the Cohort the Greater the Increase in Colorectal Cancer Incidence

Yazan Abboud, MD¹, Eric Montminy, MD², Anand Shah, MD³, Chun-Wei Pan, MD⁴, Kaveh Hajifathalian, MD¹, Paul Gaglio, MD⁵, Ahmed Al-Khazraji, MD^1
1Rutgers New Jersey Medical School, Newark, NJ; ²Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, IL; ³Rutgers New Jersey Medical School, Harrison, NJ; ⁴John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ⁵Rutgers NJ Medical School, Newark, NJ

Introduction: Prior studies showed variations in colorectal cancer (CRC) incidence based on tumor anatomical locations. There is limited data on early-onset CRC (EO-CRC) incidence per anatomical location. Despite initiating CRC screening at age 45, its incidence is still increasing in the younger cohorts. Therefore, we conducted a comprehensive comparative analysis of EO-CRC incidence between young and younger cohorts in different anatomical locations.

Methods: EO-CRC age-adjusted incidence rates between 2001-2020 were collected from the US Cancer Statistics database (covers ~98% of US population). Age cohorts were: 20-44 and 45-54 years. Anatomical locations were 1: cecum, ascending colon, and hepatic flexure, 2: transverse colon, 3: splenic flexure and descending colon, and 4: sigmoid colon, rectosigmoid junction, and rectum. Using joinpoint regression and the weighted Bayesian Information Criteria, time-trends were estimated as annual percentage change (APC) and average APC (AAPC) (P< 0.05).

Results: EO-CRC incidence rates in adults aged 20-44 years (142,362 patients) were increasing (AAPC= 1.42, P< 0.001) at a greater pace compared to adults aged 45-54 years (372,513 patients) who had a stable trend (AAPC= 0.48, P=0.06), with non-identical and non-parallel data and absolute AAPC difference of 0.93 (P=0.003) (Table and Figure).

For cecum, ascending colon, and hepatic flexure, incidence decreased in adults aged 45-54 years (AAPC= -0.31, P=0.01) but not in those aged 20-44 years (AAPC= -0.35, P=0.49).

For transverse colon, incidence increased in adults aged 20-44 years at a greater rate compared to adults aged 45-54 years who had a stable trend (AAPC= 1.25 vs 0.49; AAPC-difference=0.76, P=0.02).

For splenic flexure and descending colon, incidence increased in adults aged 20-44 years at a greater rate compared to adults aged 45-54 years who had a stable trend (AAPC= 1.13 vs 0.08; AAPC-difference=1.06, P=0.01).

Lastly, for sigmoid colon, rectosigmoid, and rectum tumors, the rates increased in both age cohorts, with faster pace in adults aged 20-44 (AAPC= 1.93 vs 1.07; AAPC-difference= 0.86, P=0.002).

Discussion: Twenty-year analysis of more than half a million patients diagnosed with EO-CRC shows increasing incidence in adults aged 20-44 years at a greater rate compared to those aged 45-54 years. This was seen across all anatomical locations, mostly notably in left-sided tumors. Our findings hold important healthcare implications advocating for screening patients at a younger age to prevent CRC.



Disclosures:


Yazan Abboud, MD¹, Eric Montminy, MD², Anand Shah, MD³, Chun-Wei Pan, MD⁴, Kaveh Hajifathalian, MD¹, Paul Gaglio, MD⁵, Ahmed Al-Khazraji, MD¹. P3866 - Are We Screening Young Enough? The Younger the Cohort the Greater the Increase in Colorectal Cancer Incidence, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.