Eric Montminy MD Interventional Endoscopist Cook County Health and Hospitals System Chicago, Illinois

Advance Colon Cancer Findings Becoming More Common in Adults Ages 46-49 Interview with:

Eric Montminy MDInterventional Endoscopist Cook County Health and Hospitals System Chicago, Illinois

Dr. Montminy

Eric Montminy MD
Interventional Endoscopist
Cook County Health and Hospitals System
Chicago, Illinois What is the background for this study?

Response: This study was performed in the backdrop of recent colorectal cancer screening guideline updates.  Two national organizations are recommending screening initiation at two different ages: USPSTF recommends initiation at age 45 and the American College of Physicians (ACP) recommends initiation at age 50.

With now two national organizations recommending different ages to start screening, patients may become confused (particularly those between 45-50).  Prior confusion has been documented when breast cancer screening recommendations were being changed as well.  Our focus was to examine colorectal adenocarcinoma incidence rates with stage stratification of those who are between the ACP and USPSTF recommendations (ages 46-49). Our study utilized SEER17 data registries over 2000-2020 to collect incidence rates within the U.S. What are the main findings?

Response:  The main findings of this study are that regional and distant stage colorectal cancer incidence rates are increasing in patients aged 46-49 while localized incidence rates are decreasing over 2000-2020.  Regional stage was persistently the highest incidence over 2000-2020 (13.4/100,000 in 2020).

Importantly, distant stage adenocarcinoma (9.0/100,000 in 2020), once the least common stage, has now become statistically the same incidence as localized (7.7/100,000). Moreover, distant stage annual percent change in significantly increasing (APC +2.2) and the localized stage annual percent change is significantly decreasing (APC -0.6).  If current trends continue, distant stage disease will surpass localized stage and localized stage will become the lowest incidence rate of all stages in age 46-49.  Regional stage colorectal cancer annual percent change is also continuing to significantly rise (APC +1.3). What should readers take away from your report?

Response: Readers should take away from our study: regional and distant stage colorectal cancer in those between the two national screening recommendations are presenting with cancer that typically requires more invasive treatment beyond curative endoscopic management (i.e. endoscopic mucosal resection or endoscopic submucosal dissection). 

These findings should be taken into consideration when providers are counselling patient on when to initiate colorectal cancer screening. 

When combining regional and distant stage colorectal cancer incidence together in only age 46-49, the incidence is nearly double the amount of all pancreatic cancer in all ages/stages combined over similar years.  This is a concerning findings given that pancreatic cancer is the next most common gastrointestinal cancer in the United States. What recommendations do you have for future research as a results of this study?

Response: Future recommendations for research include a more focused prospective trial of incidence, treatment requirements, healthcare associated costs, and mortality of patients beginning screening initiation at age 45 and age 50.  

Disclosures:  We would like to thank all our collaborators that participated in this study.  Dr. Jordan Karlitz has one disclosure (GRAIL). Otherwise, the other authors have no disclosures.  This study does not necessarily reflect the opinions of the US Department of Defense or Department of Veterans Affairs.


Montminy EMZhou MEdelson JCKarlitz JJ. Stage-Stratified Incidence Rates of Colorectal Adenocarcinoma Among Patients Aged 46 to 49 in the United States. JAMA Netw Open. 2024;7(3):e241848. doi:10.1001/jamanetworkopen.2024.1848

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Last Updated on March 19, 2024 by Marie Benz MD FAAD