Prolonged Diagnostic Pathways and Advanced-Stage Presentation in Early-Onset Colorectal Cancer: A Mexican Cohort Study.

Authors

Andrea Fabiola Hernandez Trejo, Ana Jimena Iberri Jaime, Billy Jimenez Bobadilla

Published in

Cureus. Volume 18. Issue 7. Pages e112398. Epub Jul 10, 2026.

Abstract

Background Early-onset colorectal cancer (EOCRC) (diagnosed before age 50) is rising worldwide, with the steepest increases in rectal and distal colonic tumors and a disproportionate burden in Latin American populations. Because young patients are diagnosed through symptoms rather than screening, they often present with advanced disease; yet the diagnostic pathway that precedes this presentation - and whether delay shapes stage - remains uncharacterized in Mexico. We aimed to quantify the diagnostic and treatment pathway of Mexican patients with EOCRC and to examine its association with advanced-stage presentation. Methods Single-center, retrospective, cross-sectional study of patients younger than 50 years with histopathologically confirmed adenocarcinoma of the colon or rectum managed at a tertiary referral center in Mexico City (January 2016-June 2026). Diagnostic intervals were reconstructed from the medical record using the Aarhus framework. Advanced stages were clinical stages III-IV. Groups were compared (Mann-Whitney U; χ²/Fisher), and multivariable logistic regression identified factors associated with advanced stage; we compared patients with and without computable intervals and performed a sensitivity analysis in those diagnosed from 2019 onward. Results Among 226 patients (median age 41 years (IQR 35-45); 91 (40%) aged <40 years; 118 (52%) male), tumors were located in the rectum in 121 (54%). Advanced stages (III-IV) were present in 176/226 (78%). The median total interval from symptom onset to treatment was 243 days (IQR 142-407); 72/108 (67%) exceeded 180 days, and the diagnostic interval exceeded 90 days in 51/141 (36%). Delay intervals did not differ between advanced- and early-stage disease (all p > 0.33), a finding confirmed in a sensitivity analysis restricted to patients diagnosed from 2019 onward. The advanced stage was independently associated with rectal location (adjusted OR 2.97, 95% CI 1.52-5.78; p = 0.001) and higher carcinoembryonic antigen (CEA) at diagnosis (p < 0.001). Conclusions Young Mexican patients with EOCRC present overwhelmingly with advanced disease after markedly prolonged diagnostic pathways (median ~8 months). Although delay was not statistically associated with stage, the high burden of advanced presentation and rectal predominance highlights an actionable gap in early recognition and timely referral.

PMID:
42436705
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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