Younger patients are more likely to present to their primary care clinician with nonspecific symptoms of colorectal cancer (CRC), leading to delays in appropriate referrals, according to study results published in Colorectal Disease.

Researchers utilized patient data from the Clinical Practice Research Datalink in which all patients with a diagnosis of CRC in the cancer registry were analyzed from 2006 to 2013. Initial presentation to a primary care clinician due to CRC was defined as the first consultation with a relevant symptom in the year leading up to the date of diagnosis. Red-flag symptoms included bleeding, anemia, change in bowel habits, diarrhea, and abdominal mass; nonspecific symptoms included constipation, abdominal pain, weight loss, and fatigue. Younger patients were defined as individuals age ≤50 years at the time of diagnosis.

A total of 13,911 patients had a diagnosis of CRC between 2006 and 2013, with 3448 patients excluded from the study after screening. Of the remaining 10,463 patients, 561 (5.0%) were age ≤50 years, 1287 (11.5%) were between age 50 and 59 years, 2458 (21.9%) were between age 60 and 69 years, and 3534 (31.5%) were between age 70 and 79 years. After excluding the oldest age group of patients age ≥80 years (3478; 30.9%), 7315 patients formed the study group.

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Colon cancer was the most common site for all age groups, with 67.5% of patients age 50 to 59 years receiving the diagnosis compared with 27.8% of patients age 70 to 79 years. Younger patients were commonly diagnosed as an emergency (29.1%) and less commonly diagnosed through a 2-week-wait referral (22.6%). The most common route to diagnosis in this group was a referral from a primary care clinician (33.3%). Patients age 60 to 69 years had the highest number of 2-week-wait referrals. Early stage cancer was significantly less common in patients age ≤50 years compared with all other age groups.

No significant difference was found in the number of consultations with associated symptoms among age groups. A total of 3.3% of young patients were seen by their primary care clinician ≥5 times before diagnosis. The youngest age group also represented the highest number of patients seen at least once with a nonspecific symptom (37.4%) but also represented the lowest number of patients seen at least once with a red-flag symptom.

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Young patients were more likely to present with bleeding (14.0%) compared with all other age groups except patients age 50 to 59 years. Abdominal pain (21.1%) and “other bowel function” (3.9%) were most common in the youngest age group, while symptoms such as change in bowel habits, anemia, and weight loss increased with age. Younger patients were more likely to present to a primary care clinician in the year leading up to diagnosis compared with all other age groups. All age groups were less likely than patients in the group age ≤50 years to be diagnosed as an emergency. However, compared with young patients, the 60 to 69 years age group were the only group less likely to be diagnosed as an emergency if the red flag symptoms were considered together.

“Our study demonstrates that young patients are more likely to present with nonspecific symptoms that fall outside the national referral criteria, such as abdominal pain, compared with older patients,” the investigators concluded. “Primary care physicians should be made aware of these differences if there is to be a reduction in missed opportunities to prevent emergency diagnoses.”


Arhi CS, Ziprin P, Bottle A, Burns EM, Aylin P, Darzi A. Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study [published online August 6, 2019]. Colorectal Dis. doi:10.1111/codi.14734