Early and late-onset colorectal cancers: a case-case comparison of risk factors

Purpose: Examine which demographic, lifestyle, and clinical risk factors differ between patients with early-onset colorectal cancers (EOCRC) compared to late-onset colorectal cancers (LOCRC). Methods: We conducted a case-case comparison of risk factors and symptoms for EOCRC and LOCRC, utilizing the Ohio Colorectal Cancer Prevention Initiative (OCCPI) data, a statewide study of newly diagnosed CRC among Ohio residents, aged 20–92 years. Unconditional logistic regression (odds ratios (OR) and 95% confidence intervals (CI)) was used to compare risk factors by age-at-diagnoses; those diagnosed < 50 years (EOCRC, N = 288) compared to those diagnosed ≥ 50 years (LOCRC, N = 1,018), adjusting for sex, race/ethnicity, education, smoking status, and family history of CRC. Results: Compared to LOCRC, EOCRC cases had higher odds of ever consuming alcohol (OR = 2.47, CI: 1.55–3.91), consuming more alcohol in their teens/twenties than in other decades (OR = 1.85, CI: 1.36–2.51), and binge drinking (OR = 3.15, CI: 2.31–4.30). EOCRC cases were more likely to have Lynch syndrome (OR = 4.61, CI: 2.72–7.84), and report experiencing pre-diagnostic CRC symptoms (OR = 6.08, CI: 3.77–9.82), including blood in stool (52.3 vs. 30.7%), change in bowel habits (37.2 vs. 19.8%), and bowel obstruction (13.9 vs. 7.7%). Birth weight, inflammatory bowel disease, irritable bowel syndrome, and sex did not differ by age-at-diagnosis. However, when birthweight was compared between the youngest EOCRC to the oldest LOCRC cases (< 40 vs. ≥ 65 years), odds of birthweight of < 6lbs was higher in the youngest cases (OR: 2.15, CI: 0.95–4.87). Conclusion: Alcohol consumption, consuming the most alcohol in one’s teens/twenties, binge drinking, having Lynch syndrome, and pre-diagnostic CRC symptoms were more associated with EOCRC than LOCRC.