• Nik Razima Wan Ibrahim, Huan-Keat Chan, Shahrul Aiman Soelar, Ahmad Najib Azmi, Rosaida Mohd Said, and Abu HassanMuhammad RadziMRClinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia.Sultana Bahiya Hospital, Alor Setar, Kedah, Malaysia..
• Gastroenterology Unit, Department of Medicine, Ampang Hospital, Ampang, Selangor, Malaysia.
• Asian Pac. J. Cancer Prev. 2020 Apr 1; 21 (4): 1057-1061.

BackgroundWhile the world witnesses an increasing trend of young-onset colorectal cancer (CRC), the information regarding the impact of age on CRC is limited in Malaysia. This study aimed to compare the incidence, clinic-demographic profiles and survival rates of CRC between patients above and under 50 years of age in northern Malaysia.MethodsThis was a registry-based, cross-sectional study. All the CRC cases reported by 18 hospitals to the National Cancer Patient Registry - Colorectal Cancer (NCPR-CC) between January 2007 and December 2017 were included in the analysis. The patients were categorized by age into the above-50 and under-50 groups. The changes in the age-standardized incidence and mortality rates of both the age groups were determined using the time-series analysis, and the impact of age on the mortality risk was assessed using the Cox regression analysis.ResultsOf the 6,172 CRC patients enrolled in the NCPR-CC, 893 (14.5%) were in the under-50 group. As compared with their older counterparts, the patients in the under-50 group were more likely to be female, be of Malay ethnicity, be non-smokers, have a family history of CRC, and present late for treatment. The age-standardized incidence and mortality rates of CRC in the under-50 group remained stable over the years, while a decreasing trend was clearly seen in the mortality rates of CRC in the above-50 group (p=0.003). Nevertheless, the two age groups also did not differ in the mortality risk (adjusted hazards ratio: 1.10; 95% CI: 0.90, 1.36).ConclusionYoung-onset CRC constituted a considerable proportion of CRC cases in Malaysia. However, in contrast with the findings of most studies, it demonstrated neither an uptrend in age-standardized incidence rates nor a higher mortality risk. Our findings suggest the need to upscale and lower the recommended age for CRC screening in Malaysia.

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