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Colorectal Cancer in the Young

Current Gastroenterology Reports volume 20, Article number: 15 (2018) Cite this article

Abstract

Purpose of Review

Colorectal cancer incidence has been rapidly rising in those under the age of 50 over the last 20 years. This paper will review the epidemiology, clinicopathologic, molecular features, proposed risk factors, and prevention/treatment approach for early onset CRC (EOCRC) patients.

Recent Findings

EOCRC appears to have a different spectrum of clinical, pathologic, and molecular presentation compared to CRC diagnosed in older individuals. EOCRCs are disproportionately located in the distal colon; these patients tend to present with symptoms, and there is a longer interval between symptoms and diagnosis. There may be a distinct molecular signature, including progression through the microsatellite and chromosomal stable (MACS) pathway and LINE-1 hypomethylation for a subset of EOCRCs. The majority of EOCRCs are sporadic without clear risk factors that would have made the patient eligible for earlier screening.

Summary

There is an acute need for educational efforts aimed at both providers and patients to raise awareness about CRC in the young. Improving adherence to screening in young patients eligible for screening and emphasizing early evaluation of symptoms are important steps to decreasing the burden of CRC in younger patients. Modeling and empiric data are needed to determine whether our current screening approach should be modified and whether causation and treatment options may be different in a molecular subset EOCRCs.

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Fig. 1

Abbreviations

CRC:

Colorectal cancer

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67:177–93.

    Article  PubMed  Google Scholar 

  2. •• Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 2017;109. This is the latest in a series of papers by Siegel and colleagues documenting the increasing incidence of CRC in those under age 50 and for the first time showed that CRC risk has been increasing in sequential birth cohorts since 1990. Based on this date they reasoned that screening initiation before age 50 years should be considered in the average risk population.

  3. Chen FW, Sundaram V, Chew TA, Ladabaum U. Advanced-stage colorectal cancer in persons younger than 50 years not associated with longer duration of symptoms or time to diagnosis. Clin Gastroenterol Hepatol. 2017;15:728–737.e3.

    Article  PubMed  Google Scholar 

  4. Perea J, Rodriguez Y, Rueda D, et al. Early-onset colorectal cancer is an easy and effective tool to identify retrospectively Lynch syndrome. Ann Surg Oncol. 2011;18:3285–91.

    Article  PubMed  Google Scholar 

  5. Silla IO, Rueda D, Rodriguez Y, et al. Early-onset colorectal cancer: a separate subset of colorectal cancer. World J Gastroenterol. 2014;20:17288–96.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ballester V, Rashtak S, Boardman L. Clinical and molecular features of young-onset colorectal cancer. World J Gastroenterol. 2016;22:1736–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Patel SG, Ahnen DJ. Familial colon cancer syndromes: an update of a rapidly evolving field. Curr Gastroenterol Rep. 2012;14:428–38.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Stoffel EM, Mangu PB, Limburg PJ, American Society of Clinical Oncology, European Society for Medical Oncology. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology clinical practice guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology clinical practice guidelines. J Oncol Pract. 2015;11:e437–41.

    Article  PubMed  Google Scholar 

  9. Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110:223–62.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bhandari A, Woodhouse M, Gupta S. Colorectal cancer is a leading cause of cancer incidence and mortality among adults younger than 50 years in the USA: a SEER-based analysis with comparison to other young-onset cancers. J Investig Med. 2017;65:311–5.

    Article  PubMed  Google Scholar 

  11. O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Rates of colon and rectal cancers are increasing in young adults. Am Surg. 2003;69:866–72.

    PubMed  Google Scholar 

  12. Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomark Prev. 2009;18:1695–8.

    Article  Google Scholar 

  13. Murphy CC, Lund JL, Sandler RS. Young-onset colorectal cancer: earlier diagnoses or increasing disease burden? Gastroenterology. 2017;152:1809–1812.e3.

    Article  PubMed  Google Scholar 

  14. You YN, Xing Y, Feig BW, Chang GJ, Cormier JN. Young-onset colorectal cancer: is it time to pay attention? Arch Intern Med. 2012;172:287–9.

    Article  PubMed  Google Scholar 

  15. Griffin PM, Liff JM, Greenberg RS, Clark WS. Adenocarcinomas of the colon and rectum in persons under 40 years old. A population-based study. Gastroenterology. 1991;100:1033–40.

    Article  CAS  PubMed  Google Scholar 

  16. Rahman R, Schmaltz C, Jackson CS, Simoes EJ, Jackson-Thompson J, Ibdah JA. Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States. Cancer Med. 2015;4:1863–70.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ashktorab H, Vilmenay K, Brim H, Laiyemo AO, Kibreab A, Nouraie M. Colorectal cancer in young African Americans: is it time to revisit guidelines and prevention? Dig Dis Sci. 2016;61:3026–30.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Siegel RL, Miller KD, Jemal A. Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014. JAMA. 2017;318:572–4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Holowatyj AN, Ruterbusch JJ, Rozek LS, Cote ML, Stoffel EM. Racial/ethnic disparities in survival among patients with young-onset colorectal cancer. J Clin Oncol. 2016;34:2148–56.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ashktorab H, Kupfer SS, Brim H, Carethers JM. Racial disparity in gastrointestinal cancer risk. Gastroenterology. 2017;153:910–23.

    Article  PubMed  Google Scholar 

  21. Dozois EJ, Boardman LA, Suwanthanma W, Limburg PJ, Cima RR, Bakken JL, et al. Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome? Medicine (Baltimore). 2008;87:259–63.

    Article  Google Scholar 

  22. Teng A, Lee DY, Cai J, Patel SS, Bilchik AJ, Goldfarb MR. Patterns and outcomes of colorectal cancer in adolescents and young adults. J Surg Res. 2016;205:19–27.

    Article  PubMed  Google Scholar 

  23. Abdelsattar ZM, Wong SL, Regenbogen SE, Jomaa DM, Hardiman KM, Hendren S. Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer. 2016;122:929–34.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rho YS, Gilabert M, Polom K, Aladashvili A, Kopeckova K, Megdanova V, et al. Comparing clinical characteristics and outcomes of young-onset and late-onset colorectal cancer: an international collaborative study. Clin Colorectal Cancer. 2017;16:334–42.

    Article  PubMed  Google Scholar 

  25. Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS, Wang SM. Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg. 2003;90:205–14.

    Article  CAS  PubMed  Google Scholar 

  26. Hampel H, de la Chapelle A. The search for unaffected individuals with Lynch syndrome: do the ends justify the means? Cancer Prev Res (Phila). 2011;4:1–5.

    Article  Google Scholar 

  27. Murphy CC, Sanoff HK, Stitzenberg KB, et al. Patterns of sociodemographic and clinicopathologic characteristics of stages II and III colorectal cancer patients by age: examining potential mechanisms of young-onset disease. J Cancer Epidemiol. 2017;2017:4024580.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chang DT, Pai RK, Rybicki LA, Dimaio MA, Limaye M, Jayachandran P, et al. Clinicopathologic and molecular features of sporadic early-onset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features. Mod Pathol. 2012;25:1128–39.

    Article  PubMed  Google Scholar 

  29. •• Pearlman R, Frankel WL, Swanson B, et al. Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncol. 2017;3:464–71. The authors report the results of germline genetic testing using a cancer panel in a series 450 patients diagnosed with colorectal cancer younger than 50 years who were prospectively accrued from 51 hospitals. They found a 16% rate of a pathogenic germline mutations and only half were due to Lynch syndrome. The results support the notion that all patients with EOCRC should be offered genetic counseling and gene testing with a broad cancer panel

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stoffel EM, Koeppe E, Everett J, Ulintz P, Kiel M, Osborne J, et al. Germline genetic features of young individuals with colorectal cancer. Gastroenterology. 2017;

  31. Mork ME, You YN, Ying J, Bannon SA, Lynch PM, Rodriguez-Bigas MA, et al. High prevalence of hereditary cancer syndromes in adolescents and young adults with colorectal cancer. J Clin Oncol. 2015;33:3544–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. multi-society task force on colorectal cancer. Gastroenterology. 2017;153:307–23.

    Article  PubMed  Google Scholar 

  33. USPSTF. Screening for colorectal cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2008;149:627–37.

    Article  Google Scholar 

  34. NCCN. NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer Screening. Volume 2014. http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf, 2013.

  35. Chen FW, Sundaram V, Chew TA, Ladabaum U. Low prevalence of criteria for early screening in young-onset colorectal cancer. Am J Prev Med. 2017;53:933–4.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bhupathiraju SN, Hu FB. Epidemiology of obesity and diabetes and their cardiovascular complications. Circ Res. 2016;118:1723–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Statistics NCfH. Health, United States, 2016: with Chartbook on long-term trends in health. Hyattsville, MD. 2017, 2016.

  38. Zheng J, Zhao M, Li J, Lou G, Yuan Y, Bu S, Xi Y Obesity-associated digestive cancers: a review of mechanisms and interventions. Tumour Biol 2017;39:1010428317695020, 101042831769502.

  39. Pan SY, DesMeules M. Energy intake, physical activity, energy balance, and cancer: epidemiologic evidence. Methods Mol Biol. 2009;472:191–215.

    Article  PubMed  Google Scholar 

  40. Karahalios A, English DR, Simpson JA. Weight change and risk of colorectal cancer: a systematic review and meta-analysis. Am J Epidemiol. 2015;181:832–45.

    Article  PubMed  Google Scholar 

  41. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer. 2009;100:611–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106:1911–21. quiz 1922

    Article  PubMed  PubMed Central  Google Scholar 

  43. Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300:2765–78.

    Article  CAS  PubMed  Google Scholar 

  44. Fedirko V, Tramacere I, Bagnardi V, Rota M, Scotti L, Islami F, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol. 2011;22:1958–72.

    Article  CAS  PubMed  Google Scholar 

  45. Cho E, Smith-Warner SA, Ritz J, van den Brandt P, Colditz GA, Folsom AR, et al. Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Ann Intern Med. 2004;140:603–13.

    Article  PubMed  Google Scholar 

  46. Mizoue T, Inoue M, Wakai K, Nagata C, Shimazu T, Tsuji I, et al. Alcohol drinking and colorectal cancer in Japanese: a pooled analysis of results from five cohort studies. Am J Epidemiol. 2008;167:1397–406.

    Article  PubMed  Google Scholar 

  47. Thompson AB, Mowery PD, Tebes JK, et al. Time trends in smoking onset by sex and race/ethnicity among adolescents and young adults: findings from the 2006-2013 National Survey on drug use and health. Nicotine Tob Res. 2017;

  48. Hemminki K, Chen B. Familial risk for colorectal cancers are mainly due to heritable causes. Cancer Epidemiol Biomark Prev. 2004;13:1253–6.

    Google Scholar 

  49. Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, et al. Environmental and heritable factors in the causation of cancer—analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med. 2000;343:78–85.

    Article  CAS  PubMed  Google Scholar 

  50. Stigliano V, Sanchez-Mete L, Martayan A, Anti M. Early-onset colorectal cancer: a sporadic or inherited disease? World J Gastroenterol. 2014;20:12420–30.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Giraldez MD, Lopez-Doriga A, Bujanda L, et al. Susceptibility genetic variants associated with early-onset colorectal cancer. Carcinogenesis. 2012;33:613–9.

    Article  CAS  PubMed  Google Scholar 

  52. Bonilla C, Lefevre JH, Winney B, et al. Cyclin D1 rare variants in UK multiple adenoma and early-onset colorectal cancer patients. J Hum Genet. 2011;56:58–63.

    Article  CAS  PubMed  Google Scholar 

  53. Ogino S, Nosho K, Kirkner GJ, Kawasaki T, Chan AT, Schernhammer ES, et al. A cohort study of tumoral LINE-1 hypomethylation and prognosis in colon cancer. J Natl Cancer Inst. 2008;100:1734–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Antelo M, Balaguer F, Shia J, Shen Y, Hur K, Moreira L, et al. A high degree of LINE-1 hypomethylation is a unique feature of early-onset colorectal cancer. PLoS One. 2012;7:e45357.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Pritchard CC, Grady WM. Colorectal cancer molecular biology moves into clinical practice. Gut. 2011;60:116–29.

    Article  CAS  PubMed  Google Scholar 

  56. Banerjea A, Hands RE, Powar MP, Bustin SA, Dorudi S. Microsatellite and chromosomal stable colorectal cancers demonstrate poor immunogenicity and early disease recurrence. Color Dis. 2009;11:601–8.

    Article  CAS  Google Scholar 

  57. Lin JK, Chang SC, Yang YC, Li AFY. Loss of heterozygosity and DNA aneuploidy in colorectal adenocarcinoma. Ann Surg Oncol. 2003;10:1086–94.

    Article  PubMed  Google Scholar 

  58. Sameer AS. Colorectal cancer: molecular mutations and polymorphisms. Front Oncol. 2013;3:114.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sameer AS, Nissar S, Fatima K. Mismatch repair pathway: molecules, functions, and role in colorectal carcinogenesis. Eur J Cancer Prev. 2014;23:246–57.

    Article  CAS  PubMed  Google Scholar 

  60. Armaghany T, Wilson JD, Chu Q, Mills G. Genetic alterations in colorectal cancer. Gastrointest Cancer Res. 2012;5:19–27.

    PubMed  PubMed Central  Google Scholar 

  61. Pino MS, Chung DC. The chromosomal instability pathway in colon cancer. Gastroenterology. 2010;138:2059–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Migliore L, Migheli F, Spisni R, et al. Genetics, cytogenetics, and epigenetics of colorectal cancer. J Biomed Biotechnol. 2011;2011:792362.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011;42:1–10.

    Article  PubMed  Google Scholar 

  64. Grady WM. Genomic instability and colon cancer. Cancer Metastasis Rev. 2004;23:11–27.

    Article  CAS  PubMed  Google Scholar 

  65. Boland CR, Thibodeau SN, Hamilton SR, Sidransky D, Eshleman JR, Burt RW, et al. A National Cancer Institute workshop on microsatellite instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res. 1998;58:5248–57.

    CAS  PubMed  Google Scholar 

  66. Gryfe R, Kim H, Hsieh ET, et al. Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med. 2000;342:69–77.

    Article  CAS  PubMed  Google Scholar 

  67. Perea J, Rueda D, Canal A, Rodríguez Y, Álvaro E, Osorio I, et al. Age at onset should be a major criterion for subclassification of colorectal cancer. J Mol Diagn. 2014;16:116–26.

    Article  CAS  PubMed  Google Scholar 

  68. Hawkins NJ, Tomlinson I, Meagher A, Ward RL. Microsatellite-stable diploid carcinoma: a biologically distinct and aggressive subset of sporadic colorectal cancer. Br J Cancer. 2001;84:232–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Chan TL, Curtis LC, Leung SY, Farrington SM, Ho JWC, Chan ASY, et al. Early-onset colorectal cancer with stable microsatellite DNA and near-diploid chromosomes. Oncogene. 2001;20:4871–6.

    Article  CAS  PubMed  Google Scholar 

  70. Giardiello FM, Allen JI, Axilbund JE, Boland CR, Burke CA, Burt RW, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the U.S. multi-society task force on colorectal cancer. Gastrointest Endosc. 2014;80:197–220.

    Article  PubMed  Google Scholar 

  71. Giardiello FM, Brensinger JD, Petersen GM. AGA technical review on hereditary colorectal cancer and genetic testing. Gastroenterology. 2001;121:198–213.

    Article  CAS  PubMed  Google Scholar 

  72. Jarvinen HJ, Aarnio M, Mustonen H, et al. Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology. 2000;118:829–34.

    Article  CAS  PubMed  Google Scholar 

  73. Vasen HF, Abdirahman M, Brohet R, et al. One to 2-year surveillance intervals reduce risk of colorectal cancer in families with Lynch syndrome. Gastroenterology. 2010;138:2300–6.

    Article  PubMed  Google Scholar 

  74. NCCN. Genetic/Familial High-Risk Assessment: Colorectal. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp, 2016.

  75. Claes E, Denayer L, Evers-Kiebooms G, Boogaerts A, Philippe K, Tejpar S, et al. Predictive testing for hereditary nonpolyposis colorectal cancer: subjective perception regarding colorectal and endometrial cancer, distress, and health-related behavior at one year post-test. Genet Test. 2005;9:54–65.

    Article  PubMed  Google Scholar 

  76. Collins V, Meiser B, Gaff C, St. John DJB, Halliday J. Screening and preventive behaviors one year after predictive genetic testing for hereditary nonpolyposis colorectal carcinoma. Cancer. 2005;104:273–81.

    Article  PubMed  Google Scholar 

  77. Hadley DW, Jenkins JF, Dimond E, de Carvalho M, Kirsch I, Palmer CGS. Colon cancer screening practices after genetic counseling and testing for hereditary nonpolyposis colorectal cancer. J Clin Oncol. 2004;22:39–44.

    Article  PubMed  Google Scholar 

  78. Halbert CH, Lynch H, Lynch J, Main D, Kucharski S, Rustgi AK, et al. Colon cancer screening practices following genetic testing for hereditary nonpolyposis colon cancer (HNPCC) mutations. Arch Intern Med. 2004;164:1881–7.

    Article  PubMed  Google Scholar 

  79. Johnson KA, Trimbath JD, Petersen GM, Griffin CA, Giardiello FM. Impact of genetic counseling and testing on colorectal cancer screening behavior. Genet Test. 2002;6:303–6.

    Article  PubMed  Google Scholar 

  80. Wagner A, van Kessel I, Kriege MG, Tops CMJ, Wijnen JT, Vasen HFA, et al. Long term follow-up of HNPCC gene mutation carriers: compliance with screening and satisfaction with counseling and screening procedures. Familial Cancer. 2005;4:295–300.

    Article  PubMed  Google Scholar 

  81. Patel SG, Ahnen DJ, Kinney AY, Horick N, Finkelstein DM, Hill DA, et al. Knowledge and uptake of genetic counseling and colonoscopic screening among individuals at increased risk for lynch syndrome and their endoscopists from the family health promotion project. Am J Gastroenterol. 2016;111:285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Kastrinos F, Allen JI, Stockwell DH, Stoffel EM, Cook EF, Mutinga ML, et al. Development and validation of a colon cancer risk assessment tool for patients undergoing colonoscopy. Am J Gastroenterol. 2009;104:1508–18.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Evaluation of Genomic Applications in P, Prevention Working G. Recommendations from the EGAPP working group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from lynch syndrome in relatives. Genet Med. 2009;11:35–41.

    Article  Google Scholar 

  84. Gunaratnam NT, Akce M, Al Natour R, et al. Screening for cancer genetic syndromes with a simple risk-assessment tool in a community-based open-access colonoscopy practice. Am J Gastroenterol. 2016;111:589–93.

    Article  PubMed  Google Scholar 

  85. Lynch KL, Ahnen DJ, Byers T, Weiss DG, Lieberman DA. First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer. Clin Gastroenterol Hepatol. 2003;1:96–102.

    Article  PubMed  Google Scholar 

  86. Lieberman DA, Prindiville S, Weiss DG, Willett W, VA Cooperative Study Group 380. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA. 2003;290:2959–67.

    Article  PubMed  Google Scholar 

  87. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med. 1994;331:1669–74.

    Article  CAS  PubMed  Google Scholar 

  88. Butterworth AS, Higgins JP, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer. 2006;42:216–27.

    Article  PubMed  Google Scholar 

  89. Tsai MH, Xirasagar S, Li YJ, et al. Colonoscopy screening among US adults aged 40 or older with a family history of colorectal cancer. Prev Chronic Dis. 2015;12:E80.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Akhtar S, Sinha S, McKenzie S, Sagar PM, Finan PJ, Burke D. Awareness of risk factors amongst first degree relative patients with colorectal cancer. Color Dis. 2008;10:887–90.

    CAS  Google Scholar 

  91. Hogan NM, Hanley M, Hogan AM, et al. Awareness and uptake of family screening in patients diagnosed with colorectal cancer at a young age. Gastroenterol Res Pract. 2015;2015:194931.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Scott RB, Rangel LE, Osler TM, Hyman NH. Rectal cancer in patients under the age of 50 years: the delayed diagnosis. Am J Surg. 2016;211:1014–8.

    Article  PubMed  Google Scholar 

  93. Bat L, Pines A, Rabau M, Niv Y, Shemesh E. Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy. Isr J Med Sci. 1985;21:139–41.

    CAS  PubMed  Google Scholar 

  94. Goulston KJ, Cook I, Dent OF. How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Lancet. 1986;2:261–5.

    Article  CAS  PubMed  Google Scholar 

  95. Committee ASoP, Pasha SF, Shergill A, et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc. 2014;79:875–85.

    Article  Google Scholar 

  96. Manjelievskaia J, Brown D, McGlynn KA, et al. Chemotherapy use and survival among young and middle-aged patients with colon cancer. JAMA Surg. 2017;152:452–9.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Kneuertz PJ, Chang GJ, Hu CY, Rodriguez-Bigas MA, Eng C, Vilar E, et al. Overtreatment of young adults with colon cancer: more intense treatments with unmatched survival gains. JAMA Surg. 2015;150:402–9.

    Article  PubMed  Google Scholar 

  98. Kozak VN, Kalady MF, Gamaleldin MM, Liang J, Church JM. Colorectal surveillance after segmental resection for young onset colorectal cancer: is there evidence for extended resection? Color Dis. 2017;19:O386–92.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Campus Box 158, Aurora, Colorado, 80045, USA

    Swati G. Patel & Dennis J. Ahnen

  2. Veterans Affairs Hospital, Denver, Colorado, USA

    Swati G. Patel

  3. Gastroenterology of the Rockies, Boulder, Colorado, USA

    Dennis J. Ahnen

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  1. Swati G. Patel
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Correspondence to Swati G. Patel.

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Patel, S.G., Ahnen, D.J. Colorectal Cancer in the Young. Curr Gastroenterol Rep 20, 15 (2018). https://doi.org/10.1007/s11894-018-0618-9

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Keywords

  • Colorectal cancer
  • Lynch syndrome
  • Adenoma
  • Colonoscopy
  • LINE-1 hypomethylation
  • CpG island methylation
  • Chromosomal instability
  • Microsatellite instability