Disparities in the Age-Related Rates of Colorectal Cancer in the United States

The incidence of colorectal cancer (CRC) among Americans under the age of 50 years is increasing. The purpose of this study was to identify racial and socioeconomic disparities associated with this trend. The National Cancer Data Base was used to identify patients with CRC from 1998 to 2011. Patients were stratified by age (<50 versus >60 years), with ages 50 to 60 years omitted from the analysis to minimize overlapping trends between the two age groups. Relative frequencies (RFs) by year were plotted against demographic variables. Changes in RF over time and intervals from diagnosis to treatment (including surgery and chemotherapy) were compared. A total of 1,213,192 patients were studied; 885,510 patients with colon cancer and 327,682 with rectal or rectosigmoid cancer. Patients <50 years had higher RF for stage III/IV CRC compared with >60 years, with the highest rate of increase in stage III colon cancer (0.198% per year). Patients <50 years had higher RF for CRC if they were African-American or Hispanic. Hispanic patients <50 years had the highest rates of increase for both colon (RF = 0.300% per year) and rectal cancer (RF = 0.248% per year). Compared with race, other variables including education and income were not found to have as strong an association on age-related rates of CRC. No clinically significant differences were observed for time from diagnosis to treatment in either age group. Important racial disparities are associated with differences in age-related CRC rates, warranting further investigation to develop improved strategies for the earlier detection of CRC in these populations.

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Chemotherapy use in stage III colon cancer: A National Cancer Data Base (NCDB) analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.3576 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. 3576-3576

Author(s):

Sumit Dahal ◽

Vijaya Raj Bhatt ◽

Peter T. Silberstein

Keyword(s):

Colon Cancer ◽

Data Base ◽

National Cancer Data Base ◽

Stage Iii ◽

Cancer Data ◽

Stage Iii Colon Cancer

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Colorectal cancer under the age of 50 years in U.S. Department of Veterans Affairs: Is there a role of early screening?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4072 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4072-4072

Author(s):

Abdul Moiz Khan ◽

Zainub Ajmal ◽

Usman Naseer ◽

Darren Gemoets ◽

Syed Arzoo Mehdi

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

African Americans ◽

Age Groups ◽

Stage Iii ◽

Age Group ◽

Early Screening ◽

Screening Guidelines ◽

Colon And Rectal Cancer

4072 Background: While the overall incidence of colorectal cancer (CRC) is decreasing, the rate has increased in population under 50, with higher stages at diagnosis and a greater proportion of African Americans (AA). Hence, there is an ongoing debate about the age of CRC screening. These trends have not been studied in the VA population. Methods: ICD-10 codes C18-C20 were used to identify the cases of colon and rectal cancer in National VA Cancer Cube Registry. 43,544 cases of colon cancer, 1,278 below and 42,254 above age 50, and 19,815 cases of rectal cancer, 862 below and 18,948 above age 50 were identified between 2003-17. Younger age group was defined as patients less than 50 years old. IRB approval was obtained. Results: Our data comprised > 97% of male patients. In younger group, in the 5 year periods, 2003-07, 2008-12 and 2013-17, colon cancer rate increased from 2.59% to 2.79% to 3.59%, while for rectal cancer it increased from 3.5% to 4.3% to 5.3% (p < .0001). Blacks comprise 31.6% cases of colon cancer and 27.15% cases of rectal cancer in under 50 group, compared to 18.5% and 15.9% of cases in above 50 group respectively (p < .0001). For under 50 group, 48.6% cases of colon and 42.2% cases of rectal cancer were diagnosed in stage III or IV compared to 35.7% and 34.05% cases in above 50 group respectively (p < .0001). For colon cancer, 51.87% of patients in the younger group have a < 5 year survival, worse compared to 45.05% in 50-60 group (p < .0001) and similar to 49.3% in 60-70 group (p = .08). For rectal cancer, 5 year survival showed no difference between these groups. Stage specific survival shows no difference for either colon or rectal cancer across < 50, 50-60 and 60-70 age groups. Conclusions: Rate of CRC is rising in < 50 age group with more advanced stage at diagnosis and higher proportion of African Americans. For colon cancer, < 50 group has a worse 5 year survival as compared to 50-60 age group likely due to increased proportion of patients in stage III or IV, as there is no difference in stage specific survival. For rectal cancer, the 5 year survival or stage specific survival shows no difference in < 50, 50-60 and 60-70 groups. These results add to our understanding of the trends of CRC and should be accounted for in the screening guidelines.

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The National Cancer Data Base report on the utilization of an adjuvant immunotherapy in stage III melanoma in relation to age.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19000 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19000-e19000

Author(s):

Arden Fredeking ◽

Suraj S. Venna ◽

Sekwon Jang

Keyword(s):

Data Base ◽

Age Groups ◽

National Cancer Data Base ◽

Older Age ◽

Stage Iii ◽

Care Plan ◽

High Dose ◽

Adjuvant Immunotherapy ◽

Cancer Data ◽

Stage Iii Melanoma

e19000 Background: The 5-year survival of Stage III melanoma ranges from 30-70%. High dose interferon alfa-2b (IFN) is an adjuvant immunotherapy approved in 1995 for stage III melanoma, however, its use has been limited by its significant toxicity and modest benefit. We hypothesized the utilization of adjuvant immunotherapy is less in older age group compared to younger patients. Methods: Using the National Cancer Data Base (NCDB) aggregate data, demographic, socioeconomic, insurance information, and treatment data were analyzed. Proportions were compared using Pearson Chi squared tests. Results: From 2000-2008, 27,365 cases of stage III melanoma were reported to NCDB. Most patients were male (63%) and Caucasian (94.2%). Twenty-nine percent were over the age of 70. Educational and socioeconomic factors across all age groups were not significantly different. The primary insurer for patients younger than 60 was a managed care plan (54.3%) as compared to Medicare with supplemental insurance for patients older than 60 (47.4%). In terms of systemic therapy, 23% received immunotherapy alone, 6% received chemotherapy alone, 2% received both, and 66% received no therapy. When compared to patients under age 39, older age groups were significantly less likely to receive adjuvant immunotherapy as shown in the table below. Conclusions: There is an inverse relationship between age and the use of adjuvant immunotherapy. Further study is planned to adjust for comorbidity, socioeconomic status using patient-level data. [Table: see text]

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Factors contributing to the black/white colorectal cancer survival disparity in nonelderly patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3587 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3587-3587

Author(s):

Helmneh M. Sineshaw ◽

Kimmie Ng ◽

W. Dana Flanders ◽

Otis W. Brawley ◽

Ahmedin Jemal

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Cancer Survival ◽

Tumor Location ◽

National Cancer Data Base ◽

Future Research ◽

Treatment Matching ◽

Entire Cohort ◽

Cancer Data ◽

Survival Difference

3587 Background: Previous studies reported that black/white survival disparities among elderly colorectal cancer (CRC) patients largely reflect differences in tumor presentation rather than differences in treatment. We sought to determine the contribution of differences in tumor presentation and receipt of treatment to the black/white survival disparity among nonelderly CRC patients. Methods: We selected non-Hispanic black (black) and Non-Hispanic white (white) patients aged 18-64 years, and diagnosed between 2004-2012 with single or first primary invasive stage I-IV CRC in the National Cancer Data Base. Blacks were sequentially matched with three white comparison cohorts, using propensity score and greedy matching algorithm, by demographics (age, sex, diagnosis year, region), tumor presentation (stage, grade, margin, tumor location, node status, comorbidity score), and treatment (surgery, chemotherapy, radiotherapy, metastatectomy) characteristics. We used Kaplan-Meier method to estimate 5-year survival for blacks compared with whites in the entire cohort and in the three sequentially matched cohorts. Results: In the entire cohort, 5-year survival was 9.2% lower in nonelderly blacks than whites (57.3% vs 66.5%). The survival difference remained unchanged after demographic matching, but it decreased to 3.3% (5.9% absolute and 64% relative reductions) after tumor presentation matching, and to 2.6% (0.7% absolute and 7.6% relative reductions) after treatment matching. By anatomic subsite, treatment matching reduced the black/white 5-year survival difference by 26% (3%/11.5%) for rectal cancer, only by 5.6% (0.5%/9%) for left colon cancer, and no change for right colon cancer. Conclusions: Differences in tumor presentation characteristics explained about two-thirds of the black/white survival disparity in nonelderly CRC patients, while treatment explained less than ten percent of the disparity. Future research should explore the biological mechanisms underlying these observed differences in tumor presentation and implications for treatment.

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Age-Based Trends of Gastric Adenocarcinoma in the United States

The American Surgeon ◽

10.1177/0003134820947395 ◽

2020 ◽

pp. 000313482094739

Author(s):

Denslow Trumbull ◽

Riccardo Lemini ◽

Enrique F. Elli ◽

Sanjay P. Bagaria ◽

Kristopher Attwood ◽

...

Keyword(s):

United States ◽

Young Adults ◽

Gastric Adenocarcinoma ◽

Clinical Stage ◽

Age Groups ◽

The United States ◽

National Cancer Data Base ◽

Cancer Data ◽

Stage 4 ◽

Advanced Stages

Background Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States (US). Methods A retrospective review of the National Cancer Data Base was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013. Results A total of 93 734 patients were included. The 2 age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18-25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients. Conclusion Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.

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Patterns of colorectal cancer care in the United States: 1990-2010.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.684 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 684-684

Author(s):

Caitlin C. Murphy ◽

Linda C Harlan ◽

Jennifer Leigh Lund ◽

Charles Lynch ◽

Ann M. Geiger

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Radiation Therapy ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

The United States ◽

Stage Ii ◽

Stage Iii ◽

Adjuvant Therapies

684 Background: Colorectal cancer (CRC) incidence and mortality have declined in the U.S. over the past two decades. Much of the decline can be attributed to screening and advances in treatment. Few studies have evaluated the extent to which recommended therapies have been adopted in community settings and temporal changes in patterns of care. Methods: Patients diagnosed with stages II and III CRC were randomly sampled from the population-based Surveillance, Epidemiology, and End Results (SEER) program in 1990-91, 1995, 2000, 2005, and 2010 (n=7,056). Treatment data were obtained through medical record review and physician verification. We described the receipt of adjuvant chemotherapy among colon cancer patients and preoperative or postoperative radiation therapy among rectal cancer patients. Log-binomial regression was used to examine factors associated with receipt of therapy. Results: Receipt of adjuvant chemotherapy increased among stages II and III colon cancer patients from 1990 (stage II: 22%, stage III: 55%) to 2005 (stage II: 32%, stage III: 72%) and decreased in 2010 (stage II: 29%, stage III: 65%). Chemotherapy regimens changed over time; there was an increase in the use of capecitabine (3% in 2000 to 24% in 2010) and oxaliplatin (6% in 2000 to 79% in 2010). Stage III colon cancer patients who were older (75-79 years: RR 0.82, 95% CI 0.72, 0.94; ≥80 years: RR 0.36, 95% CI 0.27, 0.49) or had a comorbidity score ≥ 2 (RR 0.54, 95% CI 0.34, 0.86) were less likely to receive adjuvant chemotherapy. Receipt of radiation therapy among stages II and III rectal cancer patients increased across all study years from 46% to 66%, with a shift toward preoperative therapy in 2005. From 2005 to 2010, receipt of neoadjuvant chemoradiation followed by surgery and postoperative chemotherapy nearly doubled (11% in 2005 to 21% in 2010). Increasing age (75-79 years: RR 0.60, 95% CI 0.48, 0.75; ≥80 years: RR 0.34, 95% CI 0.25, 0.45) was associated with lower chemoradiation use in rectal cancer. Conclusions: Our findings demonstrate increased adoption of adjuvant therapies for both colon and rectal cancer patients and differences in therapy receipt by age, comorbidity, and diagnosis year. Improved receipt of adjuvant therapies in the community may further reduce CRC mortality.

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The National Cancer Data Base report on colon cancer

Cancer ◽

10.1002/(sici)1097-0142(19960815)78:4<918::aid-cncr32>3.0.co;2-w ◽

1996 ◽

Vol 78 (4) ◽

pp. 918-926 ◽

Cited By ~ 161

Author(s):

J. Milburn Jessup ◽

Lamar S. McGinnis ◽

Glenn D. Steele ◽

Herman R. Menck ◽

David P. Winchester

Keyword(s):

Colon Cancer ◽

Data Base ◽

National Cancer Data Base ◽

Cancer Data

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Public Interest and Behavior Change in the United States Regarding Colorectal Cancer Following the Death of Chadwick Boseman: Infodemiology Investigation of Internet Search Trends Nationally and in At-Risk Areas (Preprint)

10.2196/preprints.29387 ◽

2021 ◽

Author(s):

Nicholas B Sajjadi ◽

Kaylea Feldman ◽

Samuel Shepard ◽

Arjun K Reddy ◽

Trevor Torgerson ◽

...

Keyword(s):

Colorectal Cancer ◽

United States ◽

At Risk ◽

Colon Cancer ◽

Public Interest ◽

Black Population ◽

The United States ◽

American Cancer Society ◽

Cancer Society ◽

Search Volume

BACKGROUND Colorectal cancer (CRC) has the third highest cancer mortality rate in the United States. Enhanced screening has reduced mortality rates; however, certain populations remain at high risk, notably African Americans. Raising awareness among at-risk populations may lead to improved CRC outcomes. The influence of celebrity death and illness is an important driver of public awareness. As such, the death of actor Chadwick Boseman from CRC may have influenced CRC awareness. OBJECTIVE We sought to assess the influence of Chadwick Boseman’s death on public interest in CRC in the United States, evidenced by internet searches, website traffic, and donations to prominent cancer organizations. METHODS We used an auto-regressive integrated moving average model to forecast Google searching trends for the topic “Colorectal cancer” in the United States. We performed bivariate and multivariable regressions on state-wise CRC incidence rate and percent Black population. We obtained data from the American Cancer Society (ACS) and the Colon Cancer Foundation (CCF) for information regarding changes in website traffic and donations. RESULTS The expected national relative search volume (RSV) for colorectal cancer was 2.71 (95% CI 1.76-3.66), reflecting a 3590% (95% CI 2632%-5582%) increase compared to the expected values. With multivariable regression, the statewise RSV increased for each percent Black population by 1.09 (SE 0.18, <i>P</i><.001), with 42% of the variance explained (<i>P</i><.001). The American Cancer Society reported a 58,000% increase in CRC-related website traffic the weekend following Chadwick Boseman’s death compared to the weekend before. The Colon Cancer Foundation reported a 331% increase in donations and a 144% increase in revenue in the month following Boseman’s death compared to the month prior. CONCLUSIONS Our results suggest that Chadwick Boseman’s death was associated with substantial increases in awareness of CRC. Increased awareness of CRC may support earlier detection and better prognoses.

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