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Session:: ePosters-Mon330-M6: Colon & Colorectal Cancer

EP1076 - Treatment Variation and Disparities in a Population-Based Sample of Patients Diagnosed with Early Onset Colon Cancer

Monday, May 11, 2026
4:52 PM - 4:57 PM ET

    ePoster Presenter(s)

  • CJ

    Clare E. Jacobson, MD

    General Surgery Resident
    University of Michigan
    University of Michigan
    Ann Arbor, MI, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    View ePoster

    • Author(s)

  • PA

    Paul Abrahamse, MA

    Statistician
    University of Michigan
    Ypsilanti, Michigan, United States

    Disclosure information not submitted.

  • CD

    Claire Dickey, PhD

    Statistician
    University Of Michigan
    Ann Arbor, Michigan, United States

    Disclosure information not submitted.

  • AH

    Ann Hamilton, PhD

    Research Professor
    Department of Epidemiology, University of Southern California
    Los Angeles, California, United States

    Disclosure information not submitted.

  • KW

    Kevin Ward, PhD, MPH

    Assistant Professor
    Department of Epidemiology, Emory University
    Atlanta, Georgia, United States

    Disclosure information not submitted.

  • BH

    Bin Huang, DrPH

    Associate Professor
    University of Kentucky
    Lexington, Kentucky, United States

    Disclosure information not submitted.

  • ES

    Elena Stoffel, MD, MPH

    Associate Professor
    Department of Gastroenterology, University of Michigan
    Ann Arbor, Michigan, United States

    Disclosure information not submitted.

  • CV

    Christine M. Veenstra, MD. MSHP

    Associate Professor
    University of Michigan
    Ann Arbor, Michigan, United States

    Disclosure information not submitted.

  • LW

    Lauren P. Wallner, PhD, MPH

    Associate Professor of Medicine
    University of Michigan
    Ann Arbor, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Pasithorn Amy Suwanabol, MD, MS (she/her/hers)

    Associate Professor
    University of Michigan
    University of Michigan
    Ann Arbor, MI, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Rising rates of colon cancer in those < 50 years (i.e., early-onset colon cancer) have created a growing population of younger adults for whom treatment guidelines have not been specifically tailored. Despite equivalent survival rates, patients with early-onset colon cancer, stage for stage, receive adjuvant chemotherapy (ACT) at significantly higher rates than their older counterparts. However, the specific patient or clinical factors contributing to receipt of ACT among this growing population remain unclear.

Methods/Interventions: We identified adults aged 18-50 years newly diagnosed with stage I-III colon cancer (2015-2018) across three geographically diverse Surveillance, Epidemiology, and End Results Program (SEER) cancer registry sites (Los Angeles County, Georgia, and Kentucky) who underwent curative-intent surgical resection (N=2,060). We defined ACT as the first chemotherapy after surgical resection. We estimated associations between patient and clinical factors and receipt of ACT using multivariable logistic regression adjusting for age, T stage, grade, number of lymph nodes examined, and margin status.

Results/Outcomes: In our cohort, 51.1% (n=1,054) of patients received ACT. In unadjusted analyses, white race, younger age, higher overall stage and T stage, positive lymphovascular invasion (LVI), and positive margins were associated with a higher odd of receipt of ACT (all p-values < 0.01). In multivariable-adjusted models, nonwhite race (adjusted odds ratio (aOR) 0.67, confidence interval (CI) 0.52-0.86) was associated with lower odds of ACT while higher stage (II vs. I, aOR 25.2, CI11.0-57.6) and LVI (aOR 1.6, CI 1.1-2.2) were associated with higher odds of ACT. Among patients with stage I-II diseases, stage II vs I (aOR 15.5, CI 3.0-80.8), T4 tumors (aOR 12.6, CI 1.4-112.5), and LVI (aOR 2.7, CI 1.7-4.2) remained independently associated with receipt of ACT.

Conclusion/Discussion: In this population-based sample of patients with early-onset colon cancer, we saw a risk of over-treatment of patients with stage I or II disease for whom ACT is not indicated, associated primarily with pathologic risk factors such as T4 tumors and LVI. At the same time, we saw a risk of under-treatment of non-white patients. These findings suggest the need for future research focused on improved risk stratification to guide ACT use while also ensuring equity-focused implementation.