Researchers from the University of Arizona have echoed the call for better understanding of molecular and genetic causes of early-onset rectal cancer in younger patients, to improve the care of this population. New data on characteristics of patients who develop early-onset disease, they emphasize, may help to improve prevention programs.
Odinaka Mogor, from the University of Arizona, Tucson, and colleagues presented a poster at the Society for Surgery of the Alimentary Tract Annual Meeting in which they noted that, while the majority of patients with rectal cancer are over 50 years of age, there are variations in presentation, demographics, and comorbidities when evaluating attributes of older patients versus younger patients (those under age 50).
Similar to other studies in this setting, Mogor and colleagues noted that younger patients with rectal cancer have more aggressive disease but lower mortality overall, and that, while multiple factors have led to a decline in the overall incidence of rectal cancer in recent years, this malignancy has been increasing among adults under age 50.
The researchers used data from the National Inpatient Sample (NIS) database (2010–2012) to investigate potential factors associated with rectal cancer among younger patients. They evaluated the patients based on age, demographics, comorbidities, procedures performed, and hospital outcomes.
In this study, there were 68,699 patients with rectal cancer, and the mean patient age was 65.3 years. Only 4% were under the age of 50. Mogor et al found that the incidence of rectal cancer in this younger group increased over the study period (2.8% vs 3%). They also learned that the majority of these younger patients were white females.
The most common presentation among the younger patients was bleeding, and they were more likely to have a family history of rectal cancer. Perhaps not surprisingly, younger patients were more likely to undergo elective surgery and laparoscopic surgery. The investigators controlled for host factors in a regression model, and found that younger patients had lower complication rates, shorter hospital length of stay, and lower mortality rates compared with their older counterparts.
Younger patients were more likely to use alcohol and to be obese. However, the researchers found no differences in other comorbidities when comparing the two groups. “Knowing this is important,” said gastrointestinal malignancy specialist Syed Kazmi, MD, an assistant professor of medicine at UT Southwestern Medical Center, Dallas, Texas. Kazmi added that these new findings may lead to more tailored prevention programs. “You need to know the reasons why younger patients are getting more rectal cancer. What are the risk factors? It is definitely an important question. It can help with prevention,” he said in an interview with Cancer Network.