Racial/Ethnic and Age-Related Disparities in Early-Onset Colorectal Cancer Diagnoses and Survival

Introduction: Early-onset colorectal cancer (EOCRC) patients are more likely to have advanced diagnoses across different race/ethnicity or age at diagnosis groups. Thus, we examined the relationship of racial/ethnic disparities with cancer diagnoses (tumor features and histologic types) and 5-year causes-specific survival for EOCRC across three age-at-diagnosis groups. Methods: We conducted a retrospective cohort analysis using the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program, using multivariable logistic and Cox proportional hazards models to examine the association of race/ethnicity and age with survival. Results: Among 46,956 EOCRC patients, racial minorities were diagnosed with EOCRC at age of 20-29 years while non-Hispanic White patients were more commonly diagnosed at age 40-49 years (P-value <0.001). In adjusted analysis, non-Hispanic Black (NHB) (AOR, 1.65; 95% CI, 1.24-2.18), Asian/Pacific Islander (AOR, 2.22; 95% CI, 1.60-3.08), and Hispanic (AOR, 1.56; 95% CI, 1.27-1.93) patients aged 20-29 years were more likely to be diagnosed at a late stage. These groups were also more likely to have mucinous adenocarcinoma or signet ring cell subtypes (NHB: AOR,1.46; 95% CI, 1.00-2.13; Asian/PI: AOR, 1.89; 95% CI, 1.28-2.77; Hispanic: AOR, 1.95: 95% CI, 1.48-2.59). Regardless of age groups, NHB patients were more likely to die from CRC by 34%-59% (20-29 years: AHR, 1.40; 95% CI, 1.11-1.76; 30-39 years: AHR, 1.59; 95% CI, 1.42-1.77; 40-49 years: AHR, 1.34; 95% CI, 1.26-1.41). Conclusion: Prioritizing prevention strategies and enhancing access to screening for racial minorities and the 20-29 age group is warranted.