title: Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
abstract: BACKGROUND
  Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown.
  
  
  METHODS
  The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis.
  
  
  RESULTS
  Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease.
  
  
  CONCLUSIONS
  Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.|Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Zaid M
authors.initials: ZM
authors.lastname: Abdelsattar
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.affiliation: College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Jomaa
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Hardiman
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: colorectal cancer; outcomes; screening; treatment; young onset