title: Rectal cancer in patients under the age of 50 years: the delayed diagnosis.
abstract: BACKGROUND
  The incidence of rectal cancer in younger patients continues to increase. Because most of these patients do not meet criteria for routine colorectal cancer screening, diagnosis may be delayed, potentially resulting in adverse outcomes. The aim of this study was to determine whether patients under the age of 50 years with rectal cancer have a delay in diagnosis and treatment leading to a worse overall prognosis.
  
  
  METHODS
  A case control study of patients diagnosed with rectal adenocarcinoma in an academic medical center from 1997 to 2007 under 50 years of age were matched 1:1 to randomly selected patients over the age of 50 years by sex and date of diagnosis. Time to diagnosis, time to treatment, staging of the American Joint Committee on Cancer, and 5-year overall survival were compared.
  
  
  RESULTS
  The overall time to treatment from symptom onset was 217 days for patients under the age of 50 years versus 29.5 days if over 50 years of age (P < .0001). The primary delay occurred between the onset of symptoms and presentation to the initial physician. There was no difference in stage at the time of diagnosis or 5-year survival (64% vs 71%, P = .39 and P = .54, respectively).
  
  
  CONCLUSIONS
  Patients with rectal cancer under the age of 50 years have symptoms for a considerable period of time before seeking medical care and are referred in less timely manner to specialists. However, the delay in diagnosis did not adversely impact stage on presentation or 5-year survival.
authors.affiliation: Department of Surgery, Western Connecticut Health Network Danbury Hospital, Danbury, CT, USA.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Scott
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Lynsey E
authors.initials: LE
authors.lastname: Rangel
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Turner M
authors.initials: TM
authors.lastname: Osler
authors.affiliation: Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 5095, Chicago, IL 60637, USA. Electronic address: nhyman@surgery.bsd.uchicago.edu.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Hyman
mesh_terms: D000046:Academic Medical Centers; D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis
keywords: Delay; Rectal cancer; Symptoms; Young age