Jul 2026· Cancer Causes and Control· Vol 37· 0 citations· 35 references
Medicine
TL;DR
Obesity was more prevalent in EOCRC patients than in LOCRC patients and hence these differences should be considered in development of age-stratified screening and prevention strategies.
Abstract
Early-onset colorectal cancer (EOCRC, < 50 years) is rising in the United States, whereas late-onset CRC (LOCRC, ≥ 50 years) is declining. Fewer studies have examined association between risk factors and age at colorectal (CRC) diagnosis by race. Hence, we investigated whether associations between lifestyle and clinical risk factors and age at CRC diagnosis differed by race. Retrospective study conducted between 2010 and 2023 using data from a tertiary medical center in Alabama. Exposure included lifestyle factors—smoking status, and body mass index; clinical factors—type 2 diabetes (T2D), hypertension, and hyperlipidemia. Outcome was age at CRC diagnosis categorized as LOCRC and EOCRC. Multivariable logistic regression was used to examine association between lifestyle and clinical risk factors with age at CRC diagnosis after controlling for race, sex, and marital status. Race-stratified analyses were conducted. Among 3,209 CRC patients, 54.1% were male, 71.4% White, and 55.8% were married. LOCRC was diagnosed in 81.2%. Patients who were former smokers (OR: 1.89; 95% CI: 1.50, 2.39), had T2D (OR: 1.92; 95% CI: 1.44, 2.57), hypertension (OR: 2.46; 95% CI: 1.65, 3.66), and hyperlipidemia (OR: 3.32; 95% CI: 2.35, 4.70) had higher odds of LOCRC, whereas obesity (OR: 0.61; 95% CI: 0.48, 0.77) had lower odds of LOCRC compared to EOCRC. Hypertension showed significant association with LOCRC in White patients. Hyperlipidemia showed stronger association with LOCRC in Black patients. Obesity was more prevalent in EOCRC patients and hence these differences should be considered in development of age-stratified screening and prevention strategies.
Traditional environmental risk factors and established common genetic variants are not associated with the rising incidence of early-onset colorectal cancer, and drivers of early-onset disease might include novel environmental exposures or early-life factors beyond traditional risk assessment.
Anmol Nigam, Chidiebere Onongaya, Pravin Meshram et al.· Diseases of the Colon & Rect...· 0 citations
Background The incidence of early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is rising despite declining overall colorectal cancer (CRC) rates. EOCRC presents distinct clinical challenges, with emerging associations to obesity and sociodemographic disparities. This study compares hospitalization trends, inpatient outcomes, and sociodemographics in EOCRC vs. late-onset CRC (LOCRC). Methods Using the National Inpatient Sample (NIS) (2016–2020), we identified hospitalizations with a primary diagnosis of CRC. Patients were categorized from a hospital-based classification of EOCRC (<50 years) or LOCRC (≥50 years). Multivariate logistic regression assessed associations between body mass index (BMI), demographics, and outcomes including inpatient mortality, length of stay (LOS), and chemotherapy use. Results Among 246,231 CRC hospitalizations, 13.7% (n=33,662) were EOCRC. Compared to LOCRC, EOCRC patients were more likely to be female [odds ratio (OR): 1.09], Black (OR: 1.17), Hispanic (OR: 1.56), or Asian (OR: 1.29), and more often covered by Medicaid, private insurance, or have no coverage. EOCRC patients had higher rates of tobacco use disorder (OR: 1.26) and depression (OR: 1.13), but lower prevalence of diabetes, coronary artery disease (CAD), and alcohol use disorder. EOCRC hospitalizations had lower inpatient mortality (OR: 0.649). Inpatient chemotherapy was more common in EOCRC (OR: 1.78). Obesity was positively associated with EOCRC for BMI 30–39 (OR: 1.07) and BMI ≥40 (OR: 1.50), while LOCRC showed inverse associations for the same BMI groups. Conclusions EOCRC is associated with unique demographic and clinical profiles when compared to LOCRC, highlighting disparities by race, insurance status, and comorbidities. The higher rate of inpatient chemotherapy use in EOCRC warrants further study to evaluate its clinical necessity and outcomes. These findings reinforce the need for targeted screening and inpatient care strategies for younger and underserved patient populations.
Manali Shah, Ravi Upadhyay, Lawanya Singh et al.· Journal of Gastrointestinal...· 0 citations
Background: The incidence of early-onset colorectal cancer (eoCRC), diagnosed at age <50 years, is increasing in the United States. Prior studies using national and state cancer databases have observed higher eoCRC mortality after diagnosis among non-Hispanic Black (NHB) patients. These studies, however, often did not account for insurance status, access to care, and comorbidity burden, which may contribute to the observed disparities. We examined the associations between race and ethnicity and neighborhood-level socioeconomic status [measured by the neighborhood deprivation index (NDI)] and survival among persons with eoCRC in a large integrated healthcare delivery system whose racially/ethnically diverse members have standardized access to care. Methods: We included Kaiser Permanente Southern California (KPSC) members diagnosed with eoCRC (age 15-49 years) between 2009-2020 and followed them through 12/31/2023. Patients with <12 months of prior KPSC membership, an unspecific CRC site, or other/unknown race/ethnicity were excluded. Bivariate and multivariable Cox models were used to estimate hazard ratios (HRs) for the associations between race/ethnicity and NDI and all-cause and CRC-specific mortality. Multivariable models were adjusted for age at diagnosis, sex, Charlson comorbidity score, obesity, stage at diagnosis, cancer site, and histologic subtype. Subgroup analyses were conducted by stage at diagnosis (localized vs. advanced). Results: Of 1,695 eoCRC cases included, we observed 465 deaths (among those with known cause, 417 (90.3%) were CRC-specific). The mean follow-up time was 6.8 years. In the adjusted models, NHB and non-Hispanic Asian/Pacific Islander (NH API) patients, but not Hispanic patients, had significantly higher all-cause mortality [HR=1.62, 95% CI: 1.14-2.29; HR=1.44 (1.08-1.93), respectively] compared with non-Hispanic White (NHW) patients. In the subgroup analyses, race and ethnicity were not associated with all-cause mortality among patients with localized disease. However, among patients diagnosed with advanced disease, NHB patients had a significantly higher risk of all-cause mortality compared with NHW patients (HR=1.54, 95% CI: 1.07-2.22, p=0.02). Similar findings were observed for CRC-specific mortality, overall and by cancer stage. NDI was not significantly associated with all-cause or CRC-specific mortality. Conclusions: In this insured population, NHB race and ethnicity were associated with increased risk of CRC-specific mortality among those diagnosed with advanced stage eoCRC. However, the number of NHB patients diagnosed at distant stages was small. Therefore, future research is needed to confirm these findings and better understand potential survival disparities.
T. Habeshian, Lan-Fang Xu, K. Cannavale et al.· Journal of Colon and Rectal...· 0 citations
The global EOPC burden among WCBA and its links to core metabolic determinants are delineated, providing an evidence base to guide targeted interventions in this priority population and support progress toward international development goals.
Jiaxing Li, Jing Luo, Qi-Hui Hu et al.· PLoS ONE· 0 citations
Pancreatic cancer is a highly lethal malignancy, and its incidence is increasing among younger individuals. Although smoking, alcohol use, and unhealthy diet are established risk factors, the cumulative impact of multiple lifestyle exposures on age at diagnosis remains unclear. This study aimed to estimate the combined burden of lifestyle and environmental risks associated with the timing of pancreatic cancer diagnosis.
We conducted a hospital-based retrospective case-only study including 134 patients diagnosed with pancreatic cancer between 2020 and 2025. Data on family history of pancreatic cancer, cigarette smoking, alcohol consumption, dietary patterns, exercise, and occupational chemical exposure were collected through structured interviews and medical record reviews. Cox proportional hazards models using age at diagnosis as the time scale were used to evaluate associations between exposures and earlier diagnosis. Lifestyle factors were integrated into a cumulative exposure index and analyzed using Cox models with adjustment for the remaining covariates.
The mean age at diagnosis was 64.8 years. A significant difference in age at diagnosis was observed across smoking categories, with current smokers having the youngest mean age, whereas no significant difference was observed across alcohol consumption categories. Patients with triple exposure had the youngest mean age at diagnosis (55.5 years), followed by those with double (63.5 years), single (64.8 years), and no (69.0 years) exposures. Compared with no exposure, single, double, and triple exposures were associated with progressively higher hazards of earlier diagnosis (HR = 1.79, 95% CI: 1.14–2.81,
p
= 0.011; HR = 2.97, 95% CI: 1.67–5.28,
p
< 0.001; and HR = 6.66, 95% CI: 3.35–13.22,
p
< 0.001, respectively).
Our findings indicate a significant association between a higher combined exposure index and earlier age at pancreatic cancer diagnosis. This exposure–response gradient suggests that a greater accumulation of adverse lifestyle exposures corresponds to earlier age at diagnosis among affected patients.
Not applicable.
Fu-Jen Lee, L. Chien, Jaw-Town Lin et al.· BMC Gastroenterology· 0 citations
Simple Summary Colorectal cancer diagnosed before age 50 is becoming more common in many countries, although the reasons remain uncertain. This review examined 75 publications on lifestyle, metabolic, clinical, medication-related, and social factors associated with early-onset disease. The clearest associations involved excess body weight and poor metabolic health. Physical inactivity, smoking, alcohol consumption, and dietary patterns showed less consistent associations, while inflammatory bowel disease emerged as a clinical risk condition. Evidence on medications and social conditions was limited. Many of these factors influence colorectal cancer at older ages; their relevance to earlier-onset disease may depend on when exposure begins, its duration, and how exposures interact over time. The findings support prevention throughout the life course with healthier food and activity environments, tobacco control, reduced harmful alcohol use, and better metabolic health. However, observational evidence does not establish that any single factor causes early-onset colorectal cancer or should independently determine screening eligibility.
A. Alegre-Martínez, L. Cabañas-Alite, I. Fernández-Benet et al.· Cancers· 1 citation
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