ArticleGut2020
Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia.
Article in Gut, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- An Evidence Map of the Women Veterans' Health Literature, 2016 to 2023: A Systematic Review.JAMA network open · 2025Pooled it
- The Landscape of Care for Women Veterans with Cancer: An Evidence Map.Journal of general internal medicine · 2024Pooled it
- Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023Guideline
- Anemia-Related Red Flags as Distinctive Early Indicators for Colorectal Cancer Diagnosis in Older Adults.Journal of clinical medicine · 2026Article
- Iron deficiency without anemia: An underrecognized and undertreated clinical condition with special focus on colorectal cancer.Clinical hematology international · 2026Review
- When the carcinogenic window opens before the screening window: the age-threshold blind spot in early-onset colorectal cancer.Frontiers in oncology · 2026Article
- Serum ferritin and the risk of early-onset colorectal cancer.World journal of gastrointestinal oncology · 2024Article
- Serum ferritin and risk of colonic neoplasia: Implications for the workup and treatment of iron deficiency.European journal of haematology · 2024Review
- Time to Endoscopy or Colonoscopy Among Adults Younger Than 50 Years With Iron-Deficiency Anemia and/or Hematochezia in the VHA.JAMA network open · 2023Article
- DNA Methylation-Based Testing in Peripheral Blood Mononuclear Cells Enables Accurate and Early Detection of Colorectal Cancer.Cancer research · 2023Article
- Colorectal cancer in adolescent and young adults: epidemiology in Japan and narrative review.Journal of gastrointestinal oncology · 2023Review
- Symptoms and early-onset colorectal cancer: red flags are common flags!Journal of the National Cancer Institute · 2023Article
- Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer.Journal of the National Cancer Institute · 2023Article
- Risk factors for early-onset colorectal cancer: A large-scale Chinese cohort study.Journal of the National Cancer Center · 2023Article
- Risk factors for early-onset colorectal cancer: systematic review and meta-analysis.Frontiers in oncology · 2023Review
- Iron deficiency and symptoms in women aged 20-49 years and relation to upper gastrointestinal and colon cancers.BMJ open gastroenterology · 2022Article
- Colorectal Cancer in Younger Adults.Hematology/oncology clinics of North America · 2022Review
- Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer.Gastrointestinal endoscopy clinics of North America · 2022Review
- An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer.Gastroenterology · 2021Review
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveYoung-onset colorectal cancer (YCRC) incidence is rising. Scant data exist on YCRC risk after presentation with concerning symptoms such as iron-deficiency anaemia (IDA) or haematochezia. We examined the association between IDA and YCRC, and haematochezia and YCRC.
designCohort study of US Veterans aged 18-49 years receiving Veterans Health Administration (VHA) care 1999-2016. IDA analytic cohort was created matching individuals without incident IDA to those with IDA 4:1 based on sex, birth year and first VHA visit date (n=239 000). We used this approach to also create a distinct haematochezia analytic cohort (n=653 740). Incident YCRC was ascertained via linkage to cancer registry and/or cause-specific mortality data. We computed cumulative incidence, risk difference (RD) and HRs using Cox models in each cohort.
resultsFive-year YCRC cumulative incidence was 0.45% among individuals with IDA versus 0.05% without IDA (RD: 0.39%, 95% CI: 0.33%-0.46%), corresponding to an HR of 10.81 (95% CI: 8.15-14.33). Comparing IDA versus no IDA, RD was 0.78% for men (95% CI: 0.64%-0.92%) and 0.08% for women (95% CI: 0.03%-0.13%), and RD increased by age from 0.14% for <30 years to 0.53% for 40-49 years. YCRC cumulative incidence was 0.33% among individuals with haematochezia versus 0.03% without haematochezia (RD: 0.30%, 95% CI: 0.26%-0.33%), corresponding to an HR of 10.66 (95% CI: 8.76-12.97). Comparing haematochezia versus no haematochezia, RD increased by age from 0.04% for <30 years to 0.43% for 40-49 years.
conclusionColonoscopy should be strongly considered in adults aged <50 years with IDA or haematochezia without a clinically confirmed alternate source.
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