title: The conundrum of the young colon cancer patient.
abstract: BACKGROUND
  Colonoscopy has had a major impact on the incidence and survival of colon cancer for patients who are screened, usually beginning at the age of 50. Meanwhile, the incidence rate of colon cancer is actually increasing in the patients younger than 50 while no routine screening is implemented for this age group.
  
  
  METHODS
  All patients surgically treated for colon cancer (2004-2011) without preexisting high-risk characteristics (hereditary nonpolyposis colorectal cancer, inflammatory bowel disease) were included (n = 1,015). Age-related disparities in baseline disease and outcomes were reviewed.
  
  
  RESULTS
  Patients younger than 50 years of age (n = 108; 10.6%) had the greatest baseline rates of metastatic (20.4% vs 8.0%; P < .001), node-positive disease (54.6% vs 39.4%; P = .002), and greater rates of extramural vascular invasion (38.9 vs 29.4%; P = .043). Cancer-related mortality also was greatest in this group (28.7 vs 18.4%; P = .011). Multivariable Cox regression shows that patients younger than 50 are still at significantly greater risk of mortality after adjustment for effects of age, baseline AJCC staging, smoking, and comorbidity (hazard ratio: 1.57, 95% confidence interval 1.01-2.45; P = .049).
  
  
  CONCLUSIONS
  Patients younger than 50 present with the most advanced and aggressive disease, giving them the worst stage-independent prognosis of all age groups. Potential causes include age-related differences in tumor biology and underdetection by current screening efforts. This raises the question of how to address the conundrum of the young colon cancer patient, who often is the proverbial needle in a haystack of young patients, with nonspecific gastrointestinal symptoms but who would benefit considerably from early detection.
authors: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors: Ramzi
authors: R
authors: Amri
authors: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors: Liliana G
authors: LG
authors: Bordeianou
authors: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: dberger@mgh.harvard.edu.
authors: David L
authors: DL
authors: Berger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003107:Colorectal Surgery; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome