Women diagnosed with early-onset colon and rectal cancer have a greater risk of dying from the disease depending upon their county of residence in the US. Defining specific geographic areas in the US where women diagnosed with colorectal cancer before age 50 have higher death rates, a research team has found that Davidson County, where Nashville is located, is among the ‘hotspot’ counties.
Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.
“Colorectal cancer is becoming more common in young adults, and we don’t entirely understand the ‘why’ just yet. This rising burden among young adults stresses the importance for accurate and early diagnosis of these malignancies,” says lead author Dr Andreana Holowatyj, an assistant professor of Medicine and Cancer Biology at Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center. She suggests, “Primary care physicians and gastroenterologists around the country, and particularly in Nashville and other hotspot regions, should keep colorectal tumors in the differential diagnosis of young patients presenting with signs/symptoms of colorectal cancer.”
Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 53,200 people dying from it in the US in 2020. The American Cancer Society (ACS) estimates 104,610 new cases of colon cancer in the US in 2020, and 43,340 new cases of rectal cancer. According to experts, early-stage diagnosis increases survival odds as the cancer may be easier to treat, but for many people with early-onset colorectal cancer diagnosis may be delayed as colonoscopies — a routine method of detection for colorectal polyps and tumors — are not recommended for individuals at average risk of colorectal cancer until age 45.
What did the investigators find?
The team obtained data from the US Centers for Disease Control and Prevention and then analyzed data on 28,790 women collected from 1999 to 2016 by the Surveillance, Epidemiology, and End Results program from the National Cancer Institute. The objective was to understand patterns of community health behaviors that may be linked to these survival disparities.
The hotspot areas — where colorectal cancer is killing young women at high rates — revealed the geographic variation and other trends. Approximately one in every 16 counties were identified as hotspots across the US, according to the findings published in the journal Clinical and Translational Gastroenterology.
Other large-population counties with high mortality rates for women diagnosed with early-onset colorectal cancer include Miami-Dade County, Cook County (Chicago), Fulton County (Atlanta), New Castle County (Wilmington, Delaware), Fairfield County (Bridgeport, Connecticut), St Louis County, Bergen County (New Jersey suburbs of New York metropolitan area), Queens County (Queens borough of New York), Mecklenburg County (Charlotte, North Carolina), Hamilton County (Cincinnati, Ohio), Tulsa County and Philadelphia County.
The authors suggest that physical inactivity and fertility may be factors contributing to this geographic variation in survival among young women with colorectal cancer since those community health behaviors modestly correlated with hotspot residence. However, they note that more study is needed to identify health behaviors that can be modified within these populations to improve patient survival. Nearly one-quarter of adults living in hot spot counties reported no physical activity during their leisure time. About 5% of women in these counties had a live birth in the past year. Non-Hispanic Black individuals comprised on average 19.3% of the population in hotspot counties.
A previous analysis that looked at the variation in overall early-onset colorectal cancer mortality found that 92% of hotspot counties were in the South. “In our study published earlier this year, Nashville is not an area of high mortality for both men and women diagnosed with early-onset colorectal cancer, but when you take a step back and look at only women, now Davidson County and Nashville emerge. These results emphasize the need to understand these pronounced disparities in early-onset colorectal cancer burden not only by geographic region but also by sex and race/ethnicity,” concludes Dr Holowatyj.