Su1039 Ethnic Differences in Early-Onset Colorectal Cancer

BACKGROUND: The incidence of colorectal cancer (CRC) in persons under the age of 50 is rising, and people of Hispanic ethnicity comprise a growing proportion of cases. Previous studies have shown that Hispanics present at younger ages and at later stages, and have poorer survival than non-Hispanic whites. However, little is known about differences in methods of presentation, tumor location, and family history of these patients. METHODS: All CRC patients under the age of 50 diagnosed from 1990 onwards were ascertained through our hospital's tumor registry. We reviewed endoscopy and surgery reports, clinic notes, laboratory results, radiology reports, pathology reports, and inpatient discharge summaries to determine key demographic and clinical features of these patients. RESULTS:We identified 139 patients, of whom 58 (41.3%) were Hispanic and 81 (58.3%) were non-Hispanic. Hispanics had a lower mean age at diagnosis (39 years vs. 42 years, p=0.01), and had a trend towards higher BMI (26.7 vs. 25.1 kg/m2, p= NS), with 49% being overweight. For both groups, the most common symptoms were abdominal pain (59%) and bleeding (38%). Weight loss was a more common presenting symptom among Hispanics (19% vs. 7%, p = 0.04). Most patients in both groups presented at late stage, with 72% having Stage III/IV disease. Among Stage IV patients, 44% had multiple sites of metastasis. Thirty eight percent of cancers were diagnosed at surgery, with the remainder being found via diagnostic colonoscopy or flexible sigmoidoscopy. None of the tumors were found by screening, even among patients with elevated risk. Rectal cancer comprised 20-30 % of tumors in both groups, and Hispanic patients had more cancers in the sigmoid or descending colon (49% vs. 31%, p =0.04). Although the majority of cases were sporadic rather than familial, Hispanics were more likely than non-Hispanics to have a family history of CRC (19% vs. 5%, p =0.009). CONCLUSIONS: Hispanics appear to be at high risk for early-onset CRC, possibly due to a higher prevalence of obesity. The majority of patients present at later stages. Presenting symptoms are non-specific, although a fair number of Hispanic CRC patients had involuntary weight loss prior to diagnosis. Although most cases of early-onset CRC are sporadic, a higher proportion of Hispanic patients reported a family history of colon cancer, suggesting that a thorough family history and possibly early screening colonoscopy is indicated in this population. Presenting Symptoms by Ethnicity