title: Diagnosis of colon cancer differs in younger versus older patients despite similar complaints.
abstract: BACKGROUND
  Colon cancer is common, affecting mostly older people. Since age is a risk factor, young patients might not be given the same attention as older ones regarding symptoms that could imply the presence of colon cancer.
  
  
  OBJECTIVE
  To investigate whether young patients, i.e., under age 50, complain of symptoms for longer than older patients until the diagnosis of colon cancer is established.
  
  
  METHODS
  In this retrospective cohort study, patients were divided into two groups: < 50 years old (group 1) and > or = 50 (group 2). All had undergone surgery for left or right-colon cancer during the 10 year period of the study from January 2000 through December 2009 at one medical center. Rectal and sigmoid cancers were excluded. Data collected included age, geander, quantity and quality of complaints, duration of complaints, in-hospital versus community diagnosis, pathological staging, the side of colon involved, and overall mortality. The primary outcome was the quality and duration of complaints. Secondary outcomes were the pathological stage at presentation and the mortality rate.
  
  
  RESULTS
  The study group comprised 236 patients: 31 (13.1%) were < 50 years old and 205 (86.9%) were > or = 50. No significant difference was found in the quantity and quality of complaints between the two groups. Patients in group 1 (< 50 years) complained for a longer period, 5.3 vs.2.4 months (P= 0.002). More younger patients were diagnosed with stage IV disease (38.7% vs. 21.5%, P= 0.035) and fewer had stage I disease (3.2% vs. 15.6%, P= 0.06); the mortality rates were similar (41.9% vs. 39%). Applying a stepwise logistic regression model, the duration of complaints was found to be a predictor of mortality (P= 0.03, OR 1.6, 95% CI 1-3.6), independently of age (P= 0.003) and stage (P< 0.001).
  
  
  CONCLUSIONS
  Younger patients are more often diagnosed with colon cancer later, at a more advanced stage. Alertness to patients' complaints, together with evaluation regardless of age but according to symptoms and clinical presentation are crucial. Large-scale population-based studies are needed to confirm this trend.
authors.affiliation: Department of General Surgery, Rambam Health Care Campus, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel. o_ben-ishay@Rambam.health.gov.il
authors.forename: Offir
authors.initials: O
authors.lastname: Ben-Ishay
authors.forename: Eran
authors.initials: E
authors.lastname: Brauner
authors.forename: Zvi
authors.initials: Z
authors.lastname: Peled
authors.forename: Amira
authors.initials: A
authors.lastname: Othman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Person
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D003106:Colon / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000706:statistics & numerical data*