Early-Onset Colorectal Study Shows Better Overall Survival for Patients Under 50

Individuals with an early-onset colorectal cancer diagnosis had a survival benefit versus those at later ages, especially for patients younger than 50 years old.

Findings from a cohort study of patients with primary colorectal cancer (CRC) revealed that a young onset of disease was associated with better survival compared with later-life occurrence when adjusting for tumor stage at diagnosis, according to findings published in JAMA Network Open.

This study used data collected from the National Cancer Database (NCDB) and included individuals up to 90 years of age, with those who were diagnosed between ages 51 and 55 selected as the later-onset reference group. Early-onset disease was defined as occurring at any age younger than 50 years.

“In this cohort study using a large US database, we observed an increase in incident CRC diagnoses at age 50 years, with an increased proportion of individuals with earlier-stage disease and a transient decrease in mortality,” wrote the study investigators.

Investigators studied 769,871 patients with CRC, of whom 102,168 (13.3%) had early-onset CRC and 78,812 (10.2%) had later-onset CRC. Patients diagnosed with early-onset CRC were more likely to be female, at 47.3% vs 43.8% of the later-onset group (P < .001). Those with early-onset disease were also more likely to be diagnosed with stage IV (27.8%) vs later onset (24.1%); P < .001).

Individuals diagnosed with early-onset CRC experienced inferior overall survival, with a lower 10-year rate of 53.6% (95% CI, 53.2%-54.0%) vs 54.3% (95% CI, 53.8%-54.8%) in those with later-onset disease (P < .001). However, those with early-onset CRC had higher survival rates across all years of follow-up when survival was stratified by stage. Individuals with early-onset CRC also had a reduction in mortality by a progressive multivariable adjustment analysis (HR, 0.95; 95% CI, 0.93-0.96; P < .001).

Looking at a subgroup of patients receiving a diagnosis from 35 to 39 years, showed the greatest mortality reduction (adjusted HR, 0.88; 95% CI, 0.84-0.92; P < .001). This compared favorably with the subgroups of patients ages 20 to 24 years (adjusted HR, 1.04; 95% CI, 0.88-1.22; P = .66) and younger than 20 years (HR, 1.04; 95% CI, 0.88-1.22; P = .66).

One limitation noted was the gap in cancer screenings from ages 49 to 50 years resulted in higher rates of diagnosis in the latter group. In addition, the NCDB did not make data available regarding causes of death, meaning investigators could not specify CRC-specific mortality.

“Our findings may have policy implications and may inform the current debate on whether to decrease the age of initial CRC screening,” wrote the study authors.

Investigators conclude that more attention should be given to younger patients to detect the disease at an early stage. These findings should be interpreted cautiously because further studies are needed to understand the heterogeneity of survival by age for patients with early-onset CRC.


Cheng E, Blackburn HN, Ng K, et al. Analysis of survival among adults with early-onset colorectal cancer in the national cancer database. JAMA Netw Open. 2021;4(6):e2112539. doi:10.1001/jamanetworkopen.2021.12539