BOSTONSurgeons at the University of TexasSouthwestern
Medical Center (UT-SW), Dallas, have documented a rising incidence of
colorectal cancer among people aged 40 to 49. They presented the
results of the retrospective study at the American Society of Colon
and Rectal Surgeons (ASCRS) annual meeting.
The results have led the investigators to question whether the
current recommendation to start colorectal cancer screening at age 50
is out of date and to suggest that moving the start of routine
screening back to age 40 should be considered.
The researchers identified 1,128 patients diagnosed with colorectal
cancer from 1978 to 1998 at Parkland Memorial Hospital, Dallas. They
then compared the incidence with respect to age for the first 5 years
of the study with the last 5 years to see whether there had been a
From 1978 to 1982, people in their 40s accounted for 8.1% (14) of 173
patients diagnosed with colorectal cancer. From 1994 to 1998, the
total number of colorectal cancer cases was 340 patients, of which
14.4% (49) were in their 40s.
We need other institutions to verify our findings, senior
author Sharon G. Gregorcyk, MD, told ONI in a postcon-ference
interview. If we can find a nationwide trend, that would
definitely indicate to us that something is going on, and we should
probably change routine screening guidelines.
An assistant professor of surgery at UT-SW, Dr. Gregorcyk is director
both of Parkland Surgical Clinics at Parkland Memorial Hospital and
of the University of Texas-Parkland Anorectal Physiology Laboratory.
She said she proposed the study after seeing a 17-year-old colon
cancer patient and several others in their 30s. This led her to
suspect that colon cancer patients were being diagnosed at a younger
age. A lot of us had the feeling that we were seeing colon
cancer in younger and younger patients, she said. It was
hard to know, is that a true fact, or is it just that those cases
stand out in our minds?
Indeed, the review showed only a modest increase among patients under
age 40: from 8.1% of the 1978 to 1982 group to 9.7% of the patients
diagnosed from 1994 to 1998. Dr. Gregorcyk said she has no
explanation for why the incidence increased significantly among
patients in their 40s.
Studies done from 1966 to 1994 are the basis of the current
recommendation that routine screening begin at age 50. Issued in
1997, the recommendation has been endorsed by the American Cancer
Society, American College of Gastroenterology, American
Gastroenterological Association, American Society of Colon and Rectal
Surgeons, American Society for Gastrointestinal Endoscopy,
Crohns and Colitis Foundation of America, Oncology Nursing
Society, and Society of American Gastrointestinal Surgeons.
Dr. Gregorcyk called on surgeons at other cancer centers to do
similar studies to be sure that the growing number of younger
patients at the Dallas hospital is not an isolated event. Meanwhile,
she said she plans to continue tracking the incidence of colorectal
cancer at Parkland.