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Geographic Patterns of Early-Onset Colorectal Cancer Diagnoses in the United States


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Over the past 3 decades, colorectal cancer survival in the United States has improved significantly, but in young people—particularly men diagnosed with colorectal cancer before age 50—incidence and mortality due to colorectal cancer are on the rise. Additionally, among patients with early-stage colorectal cancer, racial disparities have grown more pronounced, with survival after colorectal cancer diagnosis poorer among black patients than non-Hispanic white patients.

A report published by Rogers et al in the American Journal of Cancer Research found many of these new early-onset colorectal cancer diagnoses are occurring in counties in the lower Mississippi Delta, west-central Appalachia, and eastern Virginia/North Carolina. These “hotspot” areas—where colorectal cancer is on the rise and is fatal for young male patients at high rates—revealed several trends about who these men are and how their cancers progress. The researchers found that young adult non-Hispanic black men living in these areas are part of a group in which there is a trend of increasing rates of early-onset colorectal cancer, and that these men are more likely to die of the disease as compared to other racial groups.

“Distinct geographic patterns of early-onset colorectal cancer were predominantly located in the southern United States. Survival after early-onset colorectal cancer diagnosis was significantly worse among men residing in hotspot counties.”
— Rogers et al

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Methodology and Findings

The research team developed an analysis of counties with a high rate of early-onset colorectal cancer using data from Centers for Disease Control and Prevention during the years 1999 to 2017. They then linked this to Surveillance, Epidemiology, and End Results Program data from the National Cancer Institute for men aged 15 to 49. This revealed 232 hotspot counties for early-onset colorectal cancer in the U.S. The majority of these counties were in the south.

The team then studied a variety of factors of the diagnoses in these hotspot counties; these included age, race, tumor stage and grade, treatment approach, and marital status. In the hotspot counties, they identified that death rates in non-Hispanic black and Hispanic men with early-onset colorectal cancer outpaced other racial groups studied.

In addition, the team examined many other health and social factors, such as smoking. The team observed that although roughly 14% of all U.S. adults are current smokers, 24% of the adult population residing in hotspot counties reported currently smoking and having smoked at least 100 cigarettes in their lifetime.

“After identifying these geographic disparities, the focus of our study was to better understand the role of individual and county-level characteristics in explaining regional variations in early-onset colorectal cancer survival among these men,” said first study author Charles R. Rogers, PhD, MPH, MS, cancer researcher at the Huntsman Cancer Institute and Assistant Professor of Public Health at the University of Utah, in a statement.

Dr. Rogers said, “If young men are not already doing so, adults younger than 50 should have conversations with [their] health-care providers about early detection screening for colorectal cancer. This is especially the case if they have any symptoms of colorectal cancer, a family history of the disease, or if they live in the ‘hotspot’ counties we have identified for early-onset colorectal cancer.”

The study authors concluded, “Distinct geographic patterns of early-onset colorectal cancer were predominantly located in the southern United States. Survival after early-onset colorectal cancer diagnosis was significantly worse among men residing in hotspot counties.”

Disclosure: This study was supported by the National Institutes of Health/National Cancer Institute and by Huntsman Cancer Foundation. For full disclosures of the study authors, visit ncbi.nlm.nih.gov.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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