Colorectal cancer incidence and deaths are declining for people age 50 and older, but are increasing for those under 50.
A brand new study, led by researcher-clinician Thomas Imperiale, M.D., of the U.S. Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine, identifies seven risk aspects for early onset colorectal cancer in males. The chance evaluation model the researchers developed may help 45- to 49-year-olds accept and cling to recent national screening recommendations and may discover younger men for whom earlier screening ought to be considered.
“This study is essential since it puts whether, and possibly how, to screen people who find themselves younger than age 45 — below the age for advisable colorectal cancer screening and have among the risk aspects we discover — on the table for consideration for screening,” said Dr. Imperiale.
“We all know that colon cancer at younger ages is on the rise, although absolutely the risk continues to be much lower than even within the 45- to 54-year-old age group. Nonetheless, that doesn’t suggest that we should not be attempting to discover younger people at higher risk to screen them with some modality,” he said.
“Clinicians might need a discussion with a patient and say that although screening guidelines don’t kick in until age 45 and also you do not have a family history, you do have some risk aspects. Might you think about a noninvasive screening test? It may very well be fecal occult blood testing or multi-target stool DNA testing. It doesn’t must be a colonoscopy. For men younger than 45 who’re at higher-than-average risk, performing some style of screening would appear to make sense.
“When our study began it wasn’t clear whether the identical set of risk aspects for older folks would apply to those that were getting cancer at younger ages,” said Dr. Imperiale. “We found that while the weights assigned to some aspects, comparable to family history and alcohol use, were in regards to the same for men older and younger than 50, others, comparable to high body mass index (BMI) were risk aspects for older but not younger men.”
The study of 600 individuals with non-hereditary colon or rectal cancer plus 2,400 control patients from VA medical centers across the U.S., used electronic health record data and national VA datasets to find out sociodemographic and lifestyle aspects, family and private medical history, physical measures, vital signs, medications and laboratory values for six to 18 months. All participants were male veterans between the ages of 35 and 49. A complete of 65 percent were White and 30 percent were Black.
Initially identifying 15 variables related to early onset colorectal cancer, the researchers subsequently condensed the prediction model to seven aspects that provide similar precision and can be easier to make use of in clinical practice to estimate relative risk.
The seven aspects conveying higher-than-average risk for early onset colorectal cancer in males are:
- older age (throughout the 35- to 49-year-old age range)
- no regular use of non-steroidal anti-inflammatory drugs (comparable to aspirin or ibuprofen)
- no regular use of statins
- current alcohol use
- first or second degree relative with colorectal cancer
- the next disease burden
- service-connection/copay variable – a marker for socio-economic status
We don’t think that any of those risk aspects, apart from service-connection/copay variable, which we imagine could also be a proxy for income and/or socioeconomic status (and only an approximate one), are unique or specific to the veteran population.”
Dr. Thomas Imperiale, M.D.
He’s currently analyzing data on risk aspects for early onset colorectal cancer in female veterans. The chance of colorectal cancer is twice as high for men as for ladies in any age category.
“Risk Aspects for Early Onset Sporadic Colorectal Cancer in Male Veterans” is published within the peer-reviewed journal Cancer Prevention Research.
The study was funded by Health Services Research and Development, Veterans Health Administration (IIR 14-011) of the U.S. Department of Veterans Affairs.
Source:
Journal reference:
Imperiale, T. F., et al. (2023) Risk Aspects for Early Onset Sporadic Colorectal Cancer in Male Veterans. Cancer Prevention Research. doi.org/10.1158/1940-6207.CAPR-22-0506.