Colorectal Cancer in Young African Americans: The Clinical Characteristics and Presentations

Abstract

Introduction: Colorectal cancer (CRC) is considered a major public health problem in the United States. It is the third most common cancer in the country and the incidence in young adults has been increasing over the past decade.(1) Age and ethnicity may influence the pattern of clinical presentations. Available data is limited in young adults especially African Americans (AA). Methods: We conducted a retrospective study in young adults (age <50) who were diagnosed with CRC and were admitted in our hospital between January 1, 1997 and December 31, 2016. The following parameters were collected; age at diagnosis, sex, race, comorbidities, BMI, smoking status, alcohol use, histology, location, stage, grade, primary tumor size, presenting symptoms, duration of symptoms, hemoglobin, creatinine, and CEA. Proximal CRC were defined as lesions proximal to splenic flexure. The data were analyzed according to ethnicity (AA vs non-AA). Independent t-test and chi square test were performed and P-value of <.05 was considered statistically significant. Results: During the study period, 109 young adults with CRC were included, of which 75 (68.8%) were AA. The mean age at diagnosis was 42.2 years (range, 20-49). Compared to non-AA, AA had more frequent proximal CRC (38.7% vs 14.7%, P=.012), lower hemoglobin (10.5 vs 12.7 g/dL, p <.001), and more frequent weight loss (21.3% vs 2.9% P=.014). Non-AA presented more frequently with rectal bleeding (52.9% vs 32.0% P=.037). There was no statistically significant difference in histology, stage, grade, tumor size and CEA level between groups.Table: Table. Demographic Data, Comorbidities, and Lab Values in Young AA and Non-AATable: Table. Symptoms at Presentation and Method of DiagnosisConclusion: Our study revealed the epidemiological data of CRC in young adults and showed different characteristics between ethnicity. The incidence of proximal CRC is higher in AA compared to non-AA. Although young AA present with anemia and weight loss more than non-AA, they have lower incidence of hematochezia. There should be a higher index of suspicion for CRC in young AA presenting with anemia. Early colonoscopy should be encouraged in this population. Reference: 1. Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA surgery. 2015;150(1):17-22.