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Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis
Joshua Demb1,2, Jennifer M Kolb3, Jonathan Dounel4
1Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla.
JAMA Network Open
|May 24, 2024
Summary
Early-onset colorectal cancer (EOCRC) is rising in individuals under 50. Common symptoms like hematochezia and abdominal pain are often missed, leading to diagnostic delays of 4-6 months.
Area of Science:
- Oncology
- Gastroenterology
- Public Health
Background:
- Early-onset colorectal cancer (EOCRC), diagnosed before age 50, is an increasing concern.
- Red flag signs and symptoms are frequently overlooked in younger patients, causing diagnostic delays.
Purpose of the Study:
- To determine the prevalence of presenting signs and symptoms in EOCRC.
- To analyze the association between these signs/symptoms and EOCRC risk.
- To measure diagnostic delays from symptom onset in EOCRC patients.
Main Methods:
- Systematic review and meta-analysis of studies published up to May 2023.
- Inclusion of studies reporting signs, symptoms, or time to diagnosis for nonhereditary CRC in patients <50 years.
- Data extraction and quality assessment followed PRISMA guidelines; risk of bias assessed using JBI Critical Appraisal tools.
Main Results:
- 81 studies including 24,908,126 patients were analyzed.
- Most common symptoms: hematochezia (45%), abdominal pain (40%), altered bowel habits (27%).
- Hematochezia, abdominal pain, and anemia were associated with increased EOCRC likelihood. Diagnostic delay averaged 4-6 months.
Conclusions:
- Nearly half of EOCRC patients present with hematochezia or abdominal pain.
- Hematochezia significantly increases EOCRC risk (at least 5-fold).
- Timely diagnosis is crucial, especially when symptoms persist without an alternative explanation.
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