ASPO Abstracts
Red flag signs and symptoms and delays in diagnosis for early onset colorectal cancer: a systematic review and meta-analysis
Category: Early Detection & Risk Prediction
Conference Year: 2023
Abstract Body:
Study Purpose: Timely diagnosis and treatment of early-onset colorectal cancer (diagnosed at ages <50 years; EOCRC) may improve stage at detection and outcomes, but the relative risk of potential signs and symptoms, and time to diagnosis are not well characterized. We conducted a systematic review and meta-analysis that quantified frequency, associated risk, and time to diagnosis among adults ages <50 with purported signs and symptoms of EOCRC. Methods: A comprehensive literature search in Pubmed/MEDLINE, Embase, CINAHL and Web of Science through November 2021 was performed to identify studies conducted after 1996 and including individuals ages <50 with a diagnosis of non-hereditary colorectal cancer. We evaluated the proportion of presenting signs/symptoms pooled across studies using random-effects meta-analyses. We also assessed the association between signs/symptoms and EOCRC risk and time to diagnosis. Results: Of the 11,727 unique articles retrieved, 620 full texts were reviewed, and 71 studies were included. Studies were performed in Africa (n=5), Asia/Middle East (n=24), Europe (n=18), North America (n=17), South America (n=5) and Oceania (n=2). Among adults diagnosed with EOCRC, the most common presenting symptoms reported were hematochezia (pooled proportion 45%, 95% CI 41-50%), abdominal pain (42%, 95% CI 38-46%), change in bowel habits (30%, 95% CI 25-35%) and weight loss (21%, 95% CI 18-23%). Hematochezia (relative effect estimate range: 9.8-54.0) and abdominal pain (relative effective estimate range: 4.5-6.0) were associated with increased relative EOCRC risk. The time from symptom onset to EOCRC diagnosis was reported as a mean 6.5 months (range: 1.8-13.7 months) by 18 studies and as a median 4.0 months (range: 2-6 months) by 10 studies. Conclusions: Among individuals diagnosed with EOCRC, nearly half present with hematochezia and abdominal pain, symptoms associated with at least a 10-fold and 4-fold increased EOCRC risk, respectively. A delay in diagnosis of EOCRC for 4-6 months is common. These findings underscore an urgent need for clinicians to complete diagnostic work-up in patients under age 50 presenting with gastrointestinal symptoms in a timely manner, whether via symptom resolution or colonoscopy referral to identify or rule out CRC.
Keywords: early-onset, young-onset, colorectal cancer, symptoms, detection