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Early and late-onset colorectal cancers: a case-case comparison of risk factors.

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Title: Early and late-onset colorectal cancers: a case-case comparison of risk factors.
Authors: Rees S; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA. ssmith67@buffalo.edu., Pearlman R; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Paskett ED; Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA., Shields PG; The Ohio State University Comprehensive Cancer Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA., Hampel H; Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA., Freudenheim JL; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
Source: Cancer causes & control : CCC [Cancer Causes Control] 2026 Jul 11; Vol. 37 (8). Date of Electronic Publication: 2026 Jul 11.
Publication Type: Journal Article; Comparative Study
Language: English
Journal Info: Publisher: Kluwer Academic Publishers Country of Publication: Netherlands NLM ID: 9100846 Publication Model: Electronic Cited Medium: Internet ISSN: 1573-7225 (Electronic) Linking ISSN: 09575243 NLM ISO Abbreviation: Cancer Causes Control Subsets: MEDLINE
Imprint Name(s): Publication: Dordrecht : Kluwer Academic Publishers
Original Publication: Oxford, UK : Rapid Communications of Oxford Ltd., 1990-
MeSH Terms: Colorectal Neoplasms*/epidemiology , Colorectal Neoplasms*/etiology , Colorectal Neoplasms*/diagnosis, Ohio/epidemiology ; Alcohol Drinking/adverse effects ; Alcohol Drinking/epidemiology ; Humans ; Female ; Male ; Risk Factors ; Middle Aged ; Age of Onset ; Aged ; Aged, 80 and over ; Case-Control Studies ; Adult ; Young Adult
Abstract: Purpose: Examine which demographic, lifestyle, and clinical risk factors differ between patients with early-onset colorectal cancers (EOCRC) compared to late-onset colorectal cancers (LOCRC).
Methods: We conducted a case-case comparison of risk factors and symptoms for EOCRC and LOCRC, utilizing the Ohio Colorectal Cancer Prevention Initiative (OCCPI) data, a statewide study of newly diagnosed CRC among Ohio residents, aged 20-92 years. Unconditional logistic regression (odds ratios (OR) and 95% confidence intervals (CI)) was used to compare risk factors by age-at-diagnoses; those diagnosed < 50 years (EOCRC, N = 288) compared to those diagnosed ≥ 50 years (LOCRC, N = 1,018), adjusting for sex, race/ethnicity, education, smoking status, and family history of CRC.
Results: Compared to LOCRC, EOCRC cases had higher odds of ever consuming alcohol (OR = 2.47, CI: 1.55-3.91), consuming more alcohol in their teens/twenties than in other decades (OR = 1.85, CI: 1.36-2.51), and binge drinking (OR = 3.15, CI: 2.31-4.30). EOCRC cases were more likely to have Lynch syndrome (OR = 4.61, CI: 2.72-7.84), and report experiencing pre-diagnostic CRC symptoms (OR = 6.08, CI: 3.77-9.82), including blood in stool (52.3 vs. 30.7%), change in bowel habits (37.2 vs. 19.8%), and bowel obstruction (13.9 vs. 7.7%). Birth weight, inflammatory bowel disease, irritable bowel syndrome, and sex did not differ by age-at-diagnosis. However, when birthweight was compared between the youngest EOCRC to the oldest LOCRC cases (< 40 vs. ≥ 65 years), odds of birthweight of < 6lbs was higher in the youngest cases (OR: 2.15, CI: 0.95-4.87).
Conclusion: Alcohol consumption, consuming the most alcohol in one's teens/twenties, binge drinking, having Lynch syndrome, and pre-diagnostic CRC symptoms were more associated with EOCRC than LOCRC.
(© 2026. The Author(s).)
Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to report.
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Grant Information: T32CA113951 United States CA NCI NIH HHS; P30 CA016058 United States CA NCI NIH HHS
Contributed Indexing: Keywords: Early-onset colorectal cancer; case-case comparison study; epidemiology; risk factors
Entry Date(s): Date Created: 20260711 Date Completed: 20260711 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13356065
DOI: 10.1007/s10552-026-02208-2
PMID: 42435229
Database: MEDLINE
Description
ISSN:1573-7225
DOI:10.1007/s10552-026-02208-2