Experts urge action to cut diagnostic delays in deadliest cancer affecting young adults

Early-onset colorectal cancer (bowel cancer), diagnosed in individuals younger than 50, is on the rise, with critical warning signs often overlooked, leading to delays in diagnosis.

An international systematic review and meta-analysis involving nearly 25 million patients from 81 studies identified the most common symptoms of early-onset bowel cancer. These include blood in the stool (hematochezia), abdominal pain, altered bowel habits, and unexplained weight loss.

“In Australia, the risk of diagnosis with bowel cancer before age 40 has more than doubled since 2000, and knowing the symptoms is only part of the solution,” said Bowel Cancer Australia Medical Director, A/Prof Graham Newstead AM.

The study found that blood in the stool and abdominal pain were significantly associated with early-onset bowel cancer, with likelihoods increased by 5 to 54-fold and 1.3 to 6-fold, respectively.

“This latest study sends a clear message to GPs and younger people of the need to have a high suspicion of red flag signs and symptoms and to work together to ensure prompt access to colonoscopy to rule out early-onset bowel cancer as an underlying cause or to improve outcomes,” added A/Prof Newstead.

The researchers recommend that GPs implement a follow-up visit within 30 to 60 days for younger patients to confirm the initial diagnosis, check if the symptoms persist, or refer for a colonoscopy to exclude early-onset bowel cancer.

“Regardless of age, blood in the stool must be investigated for possible underlying bowel cancer,” A/Prof Newstead emphasised.

The analysis also highlighted that diagnostic delays are common, with the time from symptom onset to bowel cancer diagnosis ranging from 1.8 to 13.7 months, averaging 6.4 months. These delays are up to 40% longer for younger patients compared to older individuals, potentially leading to more late-stage diagnoses and higher mortality rates.

Supporting recent Australian research, the systematic review and meta-analysis revealed that younger people see multiple doctors over three months to five years before receiving a diagnosis. They make ten or more GP visits, with diagnostic times up to 60% longer than older patients, often resulting in later-stage diagnoses.

Early-onset bowel cancer is increasingly prevalent both in Australia and globally and is the deadliest cancer for individuals aged 25-44.

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