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Increasing Incidence of Left-Sided Colorectal Cancer in the Young: Age Is Not the Only Factor

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Journal of Gastrointestinal Surgery

Abstract

Background

Recent single-institution studies have shown that colorectal cancer (CRC) in patients < 50 is predominantly left-sided. The aims of this study were to 1 compare the incidence of left-sided CRC in patients under and over 50, 2 investigate this trend over time, and 3 examine whether racial differences exist in the anatomical distribution of CRC.

Methods

We used the Nationwide Inpatient Sample to identify all patients with colon or rectal cancer who underwent a resection from 2000 to 2014. Logistic regression models were used to determine the odds of a patient having a left-sided CRC based on age and race.

Results

A total of 1,547,589 patients underwent resection, with a mean age of 68.6. Overall, 65.1% of patients < 50 had a left-sided CRC compared with 47.2% of patients ≥ 50 (OR = 2.1; 95% CI 2.0, 2.1). The difference was greater as patients became older with 39.9% of patients > 70 having a left-sided CRC (< 50 vs ≥ 70; OR = 2.8; 95% CI 2.7, 2.9). The incidence of CRC in those under 50 increased over the study period due to an increase in left-sided tumors. The distribution of CRC varied with race, with African-Americans having a lower odds for left-sided CRC (OR = 0.89; 95% CI 0.87, 0.91) and Asians/Pacific Islanders having a higher odds (OR = 1.8; 95% CI 1.7, 1.9).

Conclusion

In the < 50 age group, the incidence of CRC is increasing, with majority of these tumors left-sided. Tumor location varies with both age and race.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    David E. Kearney, Christy E. Cauley, Alexandra Aiello, Matthew F. Kalady, James M. Church, Scott R. Steele & Michael A. Valente

Authors
  1. David E. Kearney
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  2. Christy E. Cauley
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  3. Alexandra Aiello
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  4. Matthew F. Kalady
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  5. James M. Church
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  6. Scott R. Steele
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  7. Michael A. Valente
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Contributions

All of the above-listed authors had substantial contributions to the conception of the work, or acquisition, analysis, or interpretation of the data, and were involved in drafting and revising the manuscript, and approving the final version, and agreeing to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to David E. Kearney.

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Institutional Review Board approval for this study was granted (IRB number 18-1136).

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The authors declare that they have no conflict of interest.

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Kearney, D.E., Cauley, C.E., Aiello, A. et al. Increasing Incidence of Left-Sided Colorectal Cancer in the Young: Age Is Not the Only Factor. J Gastrointest Surg 24, 2416–2422 (2020). https://doi.org/10.1007/s11605-020-04663-x

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  • DOI: https://doi.org/10.1007/s11605-020-04663-x

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