Symptomatic Identification of Early-Onset Colorectal Cancer: Strengthening the Case for Stool Blood Test Triage?

Colorectal cancer is the leading cause of cancer death among adults younger than 50 years in the United States. Recent updates to colorectal cancer screening guidelines only accommodate adults 45 to 49 years, who comprise about half the estimated incident early-onset colorectal cancer cases. Adults 18 to 44 years without access to average risk screening are likely to present symptomatically and require a well-defined system for symptom identification and workup to avoid diagnostic delays and worse outcomes. The study conducted by Chubak and colleagues sought to understand the role of symptoms as diagnostic indicators by measuring their positive predictive values for colorectal cancer. They provided evidence supporting the effectiveness of the combination of symptomatic identification and fecal testing to identify high-risk individuals requiring faster early-onset colorectal cancer diagnostic evaluation. Given its use in the United States for colorectal cancer screening and as a symptomatic triage test in other countries like the United Kingdom, symptomatic fecal testing has the capacity to be readily implemented in practice. However, further research is needed to develop an effective strategy in the United States to ensure that those individuals at risk for early-onset colorectal cancer without access to average-risk colorectal cancer screening experience little to no diagnostic delay. See related article by Chubak et al., p. 1276.