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October 11, 2025Open Access

Young-onset versus late-onset colorectal cancer: clinicopathological features and survival outcome: a decade-long analysis from a middle Eastern tertiary center

Key Points

Young patients with colorectal cancer show a higher incidence rate and aggressive features than older patients.
About 24.8% of newly diagnosed colorectal cancer cases are in young individuals aged 45 and younger.
Advanced stages of colorectal cancer are predominantly found in young patients, indicating more severe disease at diagnosis.
Public awareness and updated screening policies are crucial for managing younger colorectal cancer patients.

Abstract

Abstract Background Colorectal cancer (CRC) incidence is reported to be declining overall in many countries but growing among young adults. The updated American Cancer Society (ACS) guidelines recommend screening starting at age 45 years. We sought to evaluate population-level trends in young colorectal cancer (yCRC) epidemiology in Qatar, a country in the Middle East. Methods Between January 2010 and December 2020, we included 1529 patients from the National Registry Database with a 5-year follow-up. The patients were divided into two groups. Group 1 ( n = 380, ≤ 45 years) and group 2 ( n = 1149, > 45). The epidemiological and clinicopathological features were analyzed and compared in the two groups. Results The annual incidence rate of CRC in Qatar from 2010 to 2020 ranged from 5.3 to 7.2 per 100,000 population, with an average of 5.79 per 100,000 population over this period. The overall prevalence among males was 65.6%. The incidence of CRC in young patients was approximately 1 in every four patients (24.8%). Males comprised almost two-thirds of the entire CRC cohort, yCRC, as well as the old-onset CRC cohort. The poorly differentiated CRC (including mucinous and signet ring features) was more prevalent in group 1 compared to group 2 (21.2% vs. 8%) ( p = 0.001). Advanced CRC stages (III, IV) were significantly higher among the yCRC patients, with 63.3% of patients in group 1 diagnosed with advanced stages, compared to 59.6% ( p = 0.001). Young patients with CRC were found to have more rectal involvement, with 35.6% of patients ≤ 45 years old compared to 23.9% in patients > 45 years old ( p = 0.001). Conclusion The reported incidence rate is approximately one-quarter of the newly diagnosed patients in Qatar. Patients with yCRC have a more aggressive and poorly differentiated histological type. The incidence of rectal cancer is higher in younger patients. Public awareness and screening policy have been implemented for better management.

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