Increasing Colorectal Cancer Burden Among Young US Hispanics: Is It Time to Change Current Screening Guidelines?

Abstract

The disease burden for colorectal cancer (CRC) varies considerably according to race and ethnicity. A variety of factors, including adherence to CRC screening, are thought to contribute to the racial/ethnic differences in CRC incidence and mortality [1]. In the US, African Americans (A–A) have the highest incidence CRC and the lowest survival rates compared with other racial groups; Hispanics are diagnosed at a later stage and have worse survival compared to with non-Hispanic whites (NHW) [2, 3]. Since Hispanics, compared with NHW and A–A have lower CRC screening rates, they are less likely to be diagnosed at early stages, reducing survival rates [4]. Moreover, since CRC is ranked as one of the top-three causes of cancer-related deaths in US Hispanics, it is a major cause of mortality in this population [5]. Recent epidemiological studies have reported an increase in the incidence of sporadic early onset (\50 years old) CRC despite a decrease in the incidence of CRC in older individuals, probably due to routine screening [6, 7]. Tumors from early onset CRC patients are characteristically microsatellite stable, are located in the distal colon, and have advanced histological features and more advanced staging compared to late-onset tumors, contributing to a higher mortality rate [8–10]. Furthermore, early onset CRC is more often complicated by metastasis either at presentation or during the disease course compared with CRC patients[50 years old [10]. The population aged\50 thus presents an epidemiologic challenge since they are not covered by current screening guidelines, which currently target individuals C50 years old, with the exception of the A–A population (C45 years old) or those individuals with family history of CRC [11].