EP116 - A Cross-Sectional Study of Early Onset Colorectal Cancer Trends in a Puerto Rican Cohort

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Purpose/Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Recently, there has been an increase in CRC cases, particularly among young individuals, leading to a modification of screening guidelines to begin at age 45. Early Onset Colorectal Cancer (EOCRC) refers to individuals diagnosed under 50, in contrast to previous screening guidelines. This study aims to investigate EOCRC trends within a Puerto Rican cohort and compare them to established trends in the U.S. population. Additionally, we evaluate the impact of risk factors such as BMI, social history, tumor histopathology, and genetic predispositions.

Methods/Interventions: This retrospective cohort study analyzed 60 patients aged 18-50 diagnosed with colorectal cancer between 2017 and 2023 at St Luke’s Episcopal Medical Center in Ponce, Puerto Rico. Clinical and demographic data, including BMI, comorbidities, tumor characteristics, and staging, were collected using the REDCap platform. Surgical interventions and outcomes were reviewed, focusing on EOCRC presentation, staging, and tumor location. Comparative analysis was conducted to identify trends relative to the U.S. population.

Results/Outcomes: The mean age of patients was 42.98 years, with males and females being almost equally affected, and up to 70% presenting with stage III-IV disease. Adenocarcinoma was the most common histopathology (74%), while only 3.3% of cases exhibited mucinous features, and no signet ring cell carcinoma was observed. Tumor location showed a predominance of left-sided lesions, consistent with U.S. trends. Social habits related to CRC included alcohol intake, which was reported by all patients (100%). A BMI greater than 25 was present in more than 50% of cases. Interestingly, overweight patients had a higher prevalence of cecal tumors. Rectal bleeding was the most common presentation, followed by obstruction. Despite known genetic factors in the literature affecting young individuals, only 1.7% of patients had a confirmed genetic predisposition. A significant proportion (50%) of patients presented with symptoms lasting for more than three months.

Conclusion/Discussion: Our study highlights distinct trends in EOCRC within a Puerto Rican population compared to national data, particularly regarding tumor location, histopathologic findings, and genetic predispositions. The most common histopathology was adenocarcinoma (74%) aligning with statements made by the American Cancer Society, when comparing our population to other studies where mucinous adenocarcinoma was found in 20-64% or signet ring cell predominance, our population had only a 3.3% prevalence of mucinous and no signet cell histopathology. We found a unique association between obesity and cecal tumors. The increased rate of advanced-stage presentation also supports the need for earlier screening in younger populations. The absence of genetic factors in our cohort, suggests that environment and lifestyle, particularly alcohol intake, may play a role in developing EOCRC. These findings support the need for improved screening protocols for high-risk groups and further research to identify patterns related to genetic and environmental factors that contribute to EOCRC.