42 Background: Early-onset colorectal cancer (EOCRC), defined as a diagnosis of colorectal cancer in a patient <50 years old, has been steadily increasing in incidence in resource-rich nations. It tends to be diagnosed at advanced stages, reinforcing the importance of timely diagnosis. Objectives: To describe the barriers to timely diagnosis of early-onset colorectal cancer. Methods: We performed a systematic review according to PRISMA guidelines, searching MEDLINE and Embase. Screening was done by two reviewers. Studies on experiences of patients with EOCRC and/or their caregivers or physicians were included. Case reports and literature reviews were excluded. A qualitative/thematic analysis was performed. Results: 14 studies with 4439 participants from the USA, Canada, Oceania, and Europe were selected for thematic analysis; they consisted of 6 surveys, 5 interviews, and 3 thematic analyses of internet forum posts. Patients and caregivers named misdiagnoses (11 studies), dismissive attitudes from physicians (8 studies), and lack of patient awareness of red flag symptoms (8 studies) as major factors delaying EOCRC diagnosis. The most common misdiagnosis was hemorrhoids (6 studies). Younger age (9 studies), female sex (3 studies) and non-specific symptoms (1 study) contributed to dismissal of patient concerns. None of the studies discussed lack of access to primary care as a factor. Patients reported having to self-advocate (6 studies) and see multiple physicians (5 studies) before their diagnosis with EOCRC. Conclusions: Given the rising incidence of advanced-stage EOCRC, it is imperative that physicians seriously consider possible malignancy in symptomatic patients <50 years old to allow timely diagnosis and treatment. Increased awareness of EOCRC has led to a lowered colon cancer screening age starting at 45 years old by The US Preventive Services Task Force. However, the starting age for colon cancer screening in Canada remains at 50 years old.
Nguyen et al. (Sat,) studied this question.