Early onset colorectal cancer (EOCRC) is rising, and a new study sheds light on the potential reasons for delayed diagnoses. The study, "Red flag signs and symptoms and delays in diagnosis for early-onset colorectal cancer: A systematic review and meta-analysis," was conducted by national nonprofit Fight Colorectal Cancer’s (Fight CRC) EOCRC working group and lead authors and researchers Joshua Demb, PhD, MPH, and Jennifer M. Kolb, MD, MS, and is published in the Open JAMA Network Publication.

The research aimed to report the frequency of presenting signs and symptoms among individuals with EOCRC, the association of symptoms with EOCRC risk, and the time to diagnosis. The study reviewed 81 articles from PubMed/Medline, Embase, CINAHL, and Web of Science, data was from articles as early as 1985 to May 2023. In this review of the literature around EOCRC sign or symptom presentation, nearly half of individuals with EOCRC presented with rectal bleeding or abdominal pain, and one-quarter indicated having altered bowel habits. The average time from initial presentation of a sign or symptom to diagnosis was between 4 to 6 months.

Key findings of the study include:

• The most common presenting symptoms among individuals with EOCRC were blood in the stool (hematochezia (45%)), abdominal pain (40%), and change in bowel habits (altered bowel habits) (27%).
• Blood in the stool and abdominal pain were associated with a significantly higher risk of EOCRC.
• The time from symptom onset to EOCRC diagnosis ranged from 1.8 months to 13.7 months, with an average of 6.4 months.

“Our goal with this review was to further clarify the ‘red flags’ that primary care providers and adults under 50 should be aware of that might merit further clinical investigation,” explained Joshua Demb, PhD, MPH. “Knowing the symptoms is half the battle—we also need to make sure these symptoms are either resolved or attributed to the correct condition (such as EOCRC) as quickly as possible.”

"In this study, nearly half of individuals with early onset colorectal cancer presented with rectal bleeding and abdominal pain and had a delay in diagnosis of up to 6 months,” Jennifer M. Kolb, MD, MS. “These results highlight the importance of having a high index of suspicion for CRC in young patients with common gastrointestinal symptoms. These patients should have a complete diagnostic workup including an expedited colonoscopy."

“Continuing to build the momentum for early onset colorectal cancer (EOCRC) research with our partners is critical,” said Andrea (Andi) Dwyer, BS, from the University of Colorado Cancer Center, advisor to Fight CRC. “We have already seen our convenings and outcomes from the meetings make a difference in funding, patient care, and generally raising awareness. Given the latest data from the American Cancer Society, it’s clear we need to take the information from this paper and put it into action.”

These findings underscore the urgent need for increased awareness and timely diagnostic work-up for colorectal cancer symptoms in adults under 50 years old. The study highlights the importance of recognizing red flag symptoms to expedite diagnosis and improve outcomes for individuals with EOCRC.

“I am excited about our upcoming convenings and our international work in the planning as well: This makes a difference for a young person every day and in the future,” said Dwyer.

This research was a collaboration of the lead authors; Joshua Demb, PhD, MPH; Jennifer M. Kolb, MD, MS; Jonathan Dounel, MD; Cassandra D.L. Fritz, MD, MPHS; Shailesh M. Advani, MD, PhD; Yin Cao, ScD, MPH; Penny Coppernoll-Blach, MLS; Andrea J. Dwyer, BS; Jose Perea, MD, PhD; Karen M. Heskett, MSI; Andreana N. Holowatyj, PhD, MS; Christopher H. Lieu, MD; Siddharth Singh, MD, MS; Manon C.W. Spaander, MD, PhD; Fanny E.R.Vuik, MD, PhD; and Samir Gupta, MD.