Red-flag Signs and Symptoms for Earlier Diagnosis of Early-Onset Colorectal Cancer
Menée aux Etats-Unis à partir de données portant sur 5 075 patients atteints d'un cancer colorectal et auprès de 22 378 témoins (âge : 18 à 64 ans), cette étude identifie, parmi 17 signes cliniques ou symptômes, ceux permettant de détecter le plus tôt possible un cancer colorectal de survenue précoce
Prompt detection of colorectal cancer under age 50 (early-onset CRC) is a clinical priority due to its alarming rise.We conducted a matched case-control study of 5075 incident early-onset CRC among U.S. commercial insurance beneficiaries (113 million adults aged 18-64) with ≥2 years of continuous enrollment (2006-2015) to identify red-flag signs/symptoms between 3 months to 2 years before the index date among 17 pre-specified signs/symptoms. We assessed diagnostic intervals according to the presence of these signs/symptoms before and within 3 months of diagnosis.Between 3 months to 2 years before the index date, four red-flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with ORs ranging from 1.34 to 5.13. Having 1, 2, or ≥ 3 of these signs/symptoms were associated with a 1.94 (95% CI, 1.76 to 2.14), 3.59 (2.89 to 4.44), and 6.52 (3.78 to 11.23)-fold risk (Ptrend < .001), with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity=0.012). The number of different signs/symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. About 19.3% of cases had their first sign/symptom occur between 3 months to 2 years before diagnosis (median diagnostic interval: 8.7 months), and around 49.3% had the first sign/symptom within 3 months of diagnosis (median diagnostic interval: 0.53 month).Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, or iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
Journal of the National Cancer Institute , article en libre accès, 2022