Younger Colorectal Cancer Patients May Delay Seeking Treatment

WASHINGTON--Colorectal cancers in patients younger than age 40 are reputedto behave more aggressively than similar lesions in persons over 40, resultingin poorer survival. Younger patients have also been reported to presentwith a higher tumor stage.

A new study suggests that delay in seeking treatment among younger patients,rather than a delay in diagnosis after help is sought, may account formuch of the difference in prognosis.

At their poster presentation during Digestive Disease Week 1997, G.Wilcox, MD, and colleagues, of Baylor College of Medicine and MethodistHospital, Houston, described their study, which began with a review ofthe tumor registry files of Methodist Hospital, Houston, between 1984 and1995.

The researchers found 34 patients diagnosed with colorectal carcinomaat 40 years of age or younger. Kaplan-Meier survival analysis was performedon 27 patients from this group and 27 patients who had been diagnosed withcolorectal cancer between ages 45 and 55. The two groups were matched forgender, histologic subtype, stage, grade and treatment.

Colorectal cancer in younger persons is often poorly differentiatedand includes a higher proportion of signet ring cell types. These two conditionsmay contribute to the less favorable prognosis in this subset of patients.However, in this study, five-year survival in younger and older patientswas identical when the two groups were matched for tumor stage, histologicsubtype, and treatment.

The study found that younger patients characteristically delay longerthan older patients before seeking medical attention. Eleven of 33 youngerpatients (33%), compared with one of 29 older patients (3%), sought medicalattention one year or more after the onset of symptoms (most frequently,pain and bleeding from the rectum).

Delay in diagnosis of six months or more after initial presentationwas about the same in both groups: five of 31 younger patients and threeof 32 older patients.

Positive family history was more likely to be obtained in younger patients(10/30, 30%) than in older patients (1/24, 4%).

"The study showed a significant difference between older and youngerpeople in the time elapsed between initial symptoms and seeking medicalattention, which may explain the reported poorer prognosis," Dr. Wilcoxsaid. "However, younger and older people with colorectal cancer havesimilar prognosis when matched for stage, grade, and treatment."

The researchers urged that younger persons be educated to seek immediatemedical attention for gastrointestinal symptoms, especially if they havea positive family history for the disease.