Patients with early-onset colorectal cancer (CRC) have superior survival when compared with patients who have later-onset CRC, according to a study published in JAMA Network Open.

The study included 769,871 CRC patients enrolled in the National Cancer Database — 102,168 (13.3%) with early-onset CRC and 78,812 (10.2%) with later-onset CRC.

Early-onset CRC was defined as having a diagnosis before the age of 50, and later-onset CRC was defined as being diagnosed at 51-55 years of age. Patients diagnosed at 50 years of age were excluded from the study to minimize detection bias.   

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In an unadjusted analysis, the 10-year survival rate was lower in patients with early-onset CRC than in those with later-onset CRC — 53.6% and 54.3%, respectively (P <.001).

However, once the data were adjusted for other factors associated with mortality (including disease stage), patients with early-onset CRC had a 5% lower risk of death than patients with later-onset CRC (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.93-0.96; P <.001).

The survival advantage was most apparent for patients aged 35 to 39 years (aHR, 0.88; 95% CI, 0.84-0.92; P <.001), patients with stage I disease (aHR, 0.87; 95% CI, 0.81-0.93; P <.001), and those with stage II disease (aHR, 0.86; 95%CI, 0.82-0.90; P <.001).

There was no survival advantage for patients diagnosed at ages 20-24 or for patients who had stage III or IV disease.

These findings may reinforce the importance of early CRC detection in the younger population, according to the researchers.

“However, considering that younger people are generally healthier, with more years remaining to live, the survival advantage should be interpreted cautiously, especially given that the advantage has a small magnitude and is heterogeneous by ages and stage,” the researchers wrote.

They noted that a recent draft US Preventive Services Task Force guideline recommended CRC screening start at age 45.

“Our findings may have policy implications and may inform the current debate on whether to decrease the age of initial CRC screening,” the researchers wrote.

Disclosures: This research was supported by grants from the National Institutes of Health and the American Association for Cancer Research. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Cheng E, Blackburn HN, Ng K, et al. Analysis of survival among adults with early-onset colorectal cancer in the National Cancer Database. JAMA. 2021;4:e2112539.