Racial Disparities Highlighted in Early-Onset Colorectal Cancer Cases

‌ Updated May 31, 2025

CHICAGO — New research ⁢presented at the ⁢ASCO annual​ Meeting ​reveals meaningful disparities in‍ early-onset
‌ colorectal ‌cancer ⁢diagnosis‍ within⁣ community oncology settings. The study, analyzing data from over 100,000
​ individuals, indicates that Black, Asian, American Indian/Alaskan ⁣Native individuals, and those of Hispanic
ethnicity are ⁣overrepresented among those diagnosed with early-onset colorectal cancer compared to those with
average-onset disease. This underscores the importance ​of addressing‍ colorectal cancer disparities and improving
access to care.

The‌ study also found that patients with early-onset colorectal cancer are more likely to be diagnosed at stage
III or stage IV.

Jessica K. Paulus, ScD, senior⁣ director of real-world research at Ontada, emphasized the critical nature of
early ​detection. “Stage at diagnosis is the most important significant predictor of death in all patients with
colorectal cancer,” Paulus said.‍ “This underscores how​ critical it is for earlier detection and avoiding
diagnostic delays for all patients, but⁤ especially for younger patients given ⁣we see such marked
⁢ ​ disparities.”

Early-onset colorectal cancer, defined as diagnoses before age⁣ 50, is on the rise, even as incidence declines
‍ in older adults.⁣ Researchers are working to understand the social determinants of ⁤health, such as race,
‍ ethnicity, and healthcare access, that contribute to this trend.

Paulus and her team analyzed electronic health records from a large, diverse network of U.S. community oncology
‍practices to identify sociodemographic and clinical factors linked to early-onset colorectal cancer versus
⁤ ​ average-onset disease. ​They also examined overall survival (OS) based on age at diagnosis.

The study included data from 104,281 adults with colorectal cancer diagnosed between 2000 and 2024 within The
US⁣ Oncology Network and other practices using the same EHR system.⁤ The majority (86%) had average-onset
⁣ colorectal cancer, diagnosed at age 50 or​ older, with a median age of 67. The remaining 14%⁢ had early-onset
⁤ disease, diagnosed before age 50, with a‌ median age of 44.

the researchers used iKnowMed, an oncology-specific ⁣electronic health record system, to gather patient
‌⁢ ⁣ characteristics. They observed a higher representation‌ of Black/African American (11.1% vs. 8.2%), American
‍ ‌ Indian/Alaskan Native (1.3% vs. 0.8%), and Asian (4.8% vs. ⁢3.4%) individuals in the early-onset group.
​ Similarly, the percentage of Hispanic/Latino individuals was higher in the early-onset group (12% vs. 8.8%).
⁤⁣

Individuals with early-onset disease were also more ‌likely to reside in urban areas (69% vs. 63%) and have
obesity at diagnosis (36% vs. ​31%).

Further ⁤analysis revealed that a greater percentage of those with early-onset colorectal cancer had stage III
(37% vs. ‌34%) or stage IV (34% vs. 28%) disease at diagnosis.According to Paulus, this represents a nearly
10-percentage-point difference in the burden of advanced-stage diagnosis between the two age groups.

Additionally, a higher percentage ⁤of ‌patients with early-onset disease‍ reported moderate or high distress
​ levels (31% vs. 21%), as measured by the National Thorough Cancer ⁤Network Distress Thermometer⁣ scores.

The study indicated poorer overall⁢ survival among those with average-onset ‌disease compared to early-onset
disease (HR = 1.54;​ 95% CI, 1.46-1.62), with a higher 5-year OS probability in the early-onset group (72% vs.
64%). Stage ⁤IV disease at initial ⁣diagnosis was identified as the strongest predictor of survival, regardless
of age,‌ increasing the risk of death nearly fivefold (HR = 4.78;⁣ 95% CI, 4.79-4.98).

The researchers acknowledged that the sociodemographic factors identified may be specific to⁣ the community
oncology populations studied ⁢and their referral patterns.​ Paulus cautioned that these results may not fully
‍ ‍ represent the extent of disparities‍ in other U.S.settings.

what’s next

Future research should focus on identifying targeted interventions to address these disparities and improve
⁣ outcomes for all patients with colorectal cancer,especially those diagnosed at a young age.