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COLON CANCER DEADLIER IN THE YOUNG?  A SHIFTING PARADIGM
C Fonseca, P Ali, A Heidenreich, R Ruthberg, A Damadi
Ascension Providence Hospital

Background
In the United States, colorectal cancer (CRC) is the third most common cancer among adults and the third leading cause of cancer related deaths. There has been an increase in the incidence of CRC in patients under the age of 50. The American Cancer Society now has a qualified recommendation that CRC screening should start at age 45 for adults with an average risk. This study aimed to compare factors associated with CRC in patients younger than 50 and in those 50 and older, that required surgical resection due to malignancy or premalignant conditions. With more information, recommendation guidelines may change to mitigate the burden of CRC related surgical resection in this at-risk population between 45 and 50 years old (5).

Methods
A retrospective chart review was conducted looking at 933 patients over ten years who had bowel resection due to CRC or premalignant polyps; individuals found to have hereditary tumors and inflammatory bowel disease were excluded. Data was analyzed with chi square test of association comparing proportions of patients in the two age groups.

Results
Of the 933 patients, 595 had CRC and 338 with premalignant polyps. 89% of patients were older than 50. 72.5% of patients were overweight or obese. A higher proportion of the < 50 population was obese (p=0.66). 51% of all the tumors were in the ascending colon. 24.5% and 17.5% of the tumors in the < 50 population were in the sigmoid and rectum respectively. A significantly higher proportion of the younger population had advanced stages (Stage 3 or 4) of cancer (Chi Square = 11.27, p-value=0.01). Lower GI bleeding and obstruction were more often the presenting symptoms for patient under 50.

Chi Square = 11.27, p-value=0.01

Conclusion
47% of the patients under the age of 50 were at least 45 years old. Youth can no longer be considered a protective factor in colorectal cancer. By better understanding the predictive factors for patients between, 45 and 50 years of age, a targeted approach to screening can be used to reduce cost burden opposed to screening an entire population randomly.


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