Abstract
Advanced stage presentation of colorectal cancer is associated with poorer survival outcomes, particularly among young adults. This study aimed to determine whether demographic risk factors for advanced stage presentation differed between young and older adults. Individual-level data on all incident colorectal cancers in people aged 20years and above were extracted from the National Cancer Registration and Analysis Service database for the years 2012 to 2015. Patients were divided into two cohorts: young-onset colorectal cancer (YOCC) if aged 20-49years and older-onset colorectal cancer (OOCC) if aged 50years and above. Logistic regression was used to identify risk factors for advanced stage presentation, defined as TNM Stage III or IV, in each cohort. There were 7075 (5.2%) patients in the YOCC cohort and 128345 (94.8%) patients in the OOCC cohort. Tumours in the YOCC cohort were more likely to be at an advanced stage (67.2% vs 55.3%, P<0.001) and located distally (63.7% vs 55.4%, P<0.001). No demographic factor was consistently associated with advanced stage presentation in the YOCC cohort. Among the OOCC cohort, increased social deprivation [OR (Index of Multiple Deprivation quintile 5 vs 1)=1.11 (95% CI 1.07-1.16), P<0.001], Black/Black British ethnicity [OR (baseline White) = 1.25 (95% CI 1.11-1.40), P<0.001] and residence in the East Midlands [OR (baseline London)=1.11 (95% CI 1.04-1.17), P=0.001] were associated with advanced stage presentation. Demographic factors associated with advanced disease were influenced by age. The effects of social deprivation and ethnicity were only observed in older adults and mirror trends in screening uptake. Targeted interventions for high-risk groups are warranted.
Highlights
In England, colorectal cancer (CRC) is the third most common cancer in men and women and accounts for 35 000 new diagnoses each year [1]
What does this paper add to the literature? Demographic risk factors for advanced stage presentation of colorectal cancer are not well described in the UK
Population-based studies in other nations with a high human development index (HDI) have shown that younger age, social deprivation and Black ethnicity are associated with advanced stage CRC [21,22,23,24,25], but demographic risk factors have not been explored in detail and it is unknown whether these risk factors differ between young and older adults
Summary
In England, colorectal cancer (CRC) is the third most common cancer in men and women and accounts for 35 000 new diagnoses each year [1]. Population-based studies in other nations with a high HDI have shown that younger age, social deprivation and Black ethnicity are associated with advanced stage CRC [21,22,23,24,25], but demographic risk factors have not been explored in detail and it is unknown whether these risk factors differ between young and older adults. In the UK, there is scant evidence regarding the association between demographic factors, such as socioeconomic status (SES) and ethnicity, and advanced stage presentation due to a lack of complete data in nationally curated cancer registries until recently [26]. Take-up of the Bowel Cancer Screening Programme (BCSP) in England is known to be reduced in men, more deprived socioeconomic groups and areas of increased ethnic diversity [27], but how these trends are reflected in the stage at presentation of the screening age population has yet to be demonstrated. Identifying the demographic factors associated with advanced stage presentation is of critical importance as it would help guide targeted interventions at a population level
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