Most of the US contiguous regions associated with a high mortality rate for women with early-onset colorectal cancer (CRC) were located in Eastern states, according to findings from a population-based cohort study published in Clinical and Translational Gastroenterology.

“Despite reductions in the overall CRC burden, incidence rates are rising at an alarming rate with unknown etiologies for men and women younger than 50 years,” the study investigators noted.

The aim of this study was to identify individual and community-based characteristics associated with an increased risk of death in US women with early-onset CRC.

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Data related to mortality and cause of death were obtained using databases from the National Institutes for Health/National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program and the US Centers for Disease Prevention and Control (CDC).

This study included 28,790 women with a first primary invasive CRC diagnosed at age 15 to 49 years between 1999 and 2016 who resided in the contiguous United States. Residential area was characterized at the county level, and survival time was defined as the period between diagnosis and last follow-up or death.

A key finding was that 1 in every 16 contiguous US counties was found to be a high-mortality “hot spot” for women with early-onset CRC. In this study, 3954 (13.7%) of cases were in women who resided in hot-spot counties. Furthermore, although 52.9% of these counties were located in the South, most of the hot spot counties were located in Eastern states or primarily eastern regions of Midwestern states.

In addition, residence within these hot-spot counties correlated modestly with higher rates of physical inactivity and having fewer live births within the last year.  

The study investigators noted, “Our findings emphasize the importance of defining patterns of variance in early-onset CRC survival to understand the impact of community health behaviors on early-onset CRC outcomes.”

They added that “further study of community health behaviors and healthcare access, as well as modifiable CRC risk factors, is critical to elucidate the unexplained variance in early-onset CRC survival among women in the United States — particularly in counties with high rates of early-onset CRC mortality — to reduce disparities in the early-onset CRC burden and improve young patient outcomes.”

Disclosures: Multiple authors declared affiliation with or received research funds from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Holowatyj AN, Langston ME, Han Y, et al. Community health behaviors and geographic variation in early-onset colorectal cancer survival among women.Clin Transl Gastroenterol. 2020;11(12):e00266. doi:10.14309/ctg.0000000000000266