Uncovering Social Disparities in Early-Onset Colorectal Cancer

Real-world social determinants of health (SDOH) and outcomes of early-onset colorectal cancer (EO-CRC): An analysis of a large, nationally representative US community oncology network.

Oral Abstract #11005, 2025 ASCO Annual Meeting

By Lisa Herms, Saamir Pasha, Jinhong Guo, Paul Conkling, Jess Paulus

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Background

Researchers analyzed health records from almost 15,000 patients under 50 with colorectal cancer to shed light on the social determinants of health and other factors causing a significant rise in early-onset colorectal cancer in patients. While there has been a decrease in colorectal cancer rates among older adults, there has been a significant rise in patients diagnosed before age 50.

Key Findings

• Disproportionate impact on certain groups

  • Younger patients from Black, Asian, Hispanic, American Indian, and Alaska Native backgrounds were more commonly seen in the under-50 group than in the average-onset group

• More common advanced cancer at diagnosis

  • Under-50 patients were more likely to be diagnosed at a late stage (Stage III or IV), which significantly worsens survival chances 

• Slightly more obesity and smoking among younger patients

  • Those under 50 were more likely to be obese or smokers compared to older colorectal cancer patients

• Stage at diagnosis is critical

  • Regardless of age, how advanced the cancer is when first found is the strongest predictor of survival, so finding it early is key

What This Means

• Current screening starts too late: Even after U.S. guidelines lowered the recommended age to 45, half of the early-onset cases occurred in people younger than that, meaning they’d still be missed 

• Better targeting may help: Instead of screening everyone younger than 45, researchers suggest identifying high-risk individuals—for example, those with obesity or certain racial/ethnic backgrounds—and screening them earlier 

Conclusion

Bottom Line: Early detection saves lives. Colorectal cancer is increasingly affecting adults under 50, especially from certain racial backgrounds and those with obesity. These cases are often diagnosed too late, which drastically lowers survival chances. To address this, experts recommend smarter screening strategies focused on high-risk younger adults and quicker diagnostic steps when symptoms appear.

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