Advanced-stage colon cancer prior to the screening age: Association with age, race, and insurance status.

Abstract

377 Background: Stage-at-diagnosis is a major determinant of outcome in colon cancer. Population-based screening is currently only recommended after age 50, but the number of colon cancers diagnosed before 50 is increasing. We aimed to identify risk factors associated with advanced-stage disease (stage III or IV) among colon cancers diagnosed before 50. Methods: Between 2003 and 2007, 248,716 colon adenocarcinomas (25,383 diagnosed before age 50) were reported to the National Cancer Database. Patients with familial adenomatous polyposis were excluded. Among the cases diagnosed before 50, independent predictors for presenting at advanced stages (stage III or IV) were identified using multivariate logistic regression. Results: 10.2% of all colon cancers occur prior to age 50. Stage III or IV disease accounted for 62.2% of the cases before age 50, and 46.9% of those diagnosed at or after age 50 (p<0.001). Among colon cancers diagnosed before 50, independent risk factors for advanced-stage disease included: very young age groups (age 18-30 and age 30-40 vs. age 40-50), African American race (vs. Caucasian), and having Medicaid, non-Medicare government insurance or no insurance (vs. private insurance), after adjusting for gender, tumor location, geographic region, and treatment facility type (Table). Conclusions: In the unscreened population of patients before age 50, disparities in age, race, and insurance are associated with the stage at presentation. The risk factors identified help alert the treating clinicians toward patients most vulnerable to delays in their cancer diagnosis. [Table: see text] No significant financial relationships to disclose.