Early and late-onset colorectal cancer in African Americans during COVID-19

The incidence of early-onset colorectal cancer (EOCRC, < 45 years of age at onset) is on the rise among adults, including African Americans (AA).

To examine differences between EOCRC and late-onset colorectal cancer (LOCRC) among AA patients and any effect during coronavirus disease (COVID) by comparing data during pre-COVID (2015-2019) and the COVID era (2020-2023).

We conducted a retrospective review of Howard University Hospital records from 2015 to 2023 for colorectal cancer patients that included demographics, clinicals, pathology, and colonoscopy records. A three-year interval analysis was performed to compare post-COVID era (2020-2023) to preceding years to discern temporal trends.

The study included 138 LOCRC and 13 EOCRC cases of which > 80% of patients were AA. Compared to pre-COVID, LOCRC cases increased in number from 55 to 83, and EOCRC cases increased from 6 to 7 during COVID. There was no change in mean age for LOCRC (64.7 years vs 65.3 years) but mean age increased for EOCRC (37.3 years vs 41.5 years). Males predominated in both groups particularly during the pandemic. More than 65% of LOCRC patient colonoscopies were for diagnostic purposes. Gastrointestinal bleeding as a colonoscopy indication and reduced bowel preparation quality were increased during the pandemic. EOCRC patients showed a shift from stage 4 (49.2%) to stage 2 (30%) and LOCRC patients staging trends changed from stage 4 (40%) to stage 3 (28.6%).

We report increase in colorectal cancer cases during the COVID-19 era, especially among young AA males. EOCRC and LOCRC patients showed distal location predominance, most commonly in recto-sigmoid region. The decrease in staging or metastasis, which might be due to growing awareness and earlier detection among patients.