Systematic review and meta-analysis of red flag signals and symptoms among patients with early-onset colorectal cancer

Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes. In a systematic review and meta-analysis including 81 studies and more that 24.9 million patients, nearly half of individuals with EOCRC presented with hematochezia and abdominal pain and one-quarter presented with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months from time of initial presentation were common. The authors conclude that these findings underscore the need to identify signs and symptoms concerning for EOCRC and complete timely diagnostic workup for individuals without an alternative diagnosis or sign or symptom resolution.