Evolving trends in young adult (YA) gastrointestinal (GI) cancer: Philadelphia in national context.

Abstract

e15706 Background: GI malignancies in YA (ages 18-39) have increased in the past several decades, with advanced stages at diagnosis and aggressive tumor features relative to patients (pts) with average age onset disease. In Pennsylvania, age-adjusted incidence reached as high as 119.6 per 100,000 in 2015 among individuals under 50—exceeding the national average of 102.97. We evaluated differences in disease burden of YA GI cancers at Temple University Hospital System (TUHS), Philadelphia’s primary safety net hospital, compared with national data. Methods: A retrospective analysis of pts aged 18-44 with GI malignancies at TUHS (2010-2024) relative to data available at the National Cancer Database (NCDB). Group differences were assessed with Chi-square or Fisher’s exact tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables, with temporal trends in GI cancer subtypes evaluated using yearly plots. Results: 530 pts at TUHS and 81,097 in the NCDB were included. The average age at diagnosis was higher at TUHS (37.6 vs 32.9 years), with a greater portion of black pts (22.1% vs 15.5%). TUHS pts presented with more advanced stages at diagnosis and were more likely to rely on government insurance (30.3 vs 27.5%). Compared with the NCDB, TUHS pts were diagnosed with more stage III (27.4% vs 12.6%) and stage IV disease (33.8% vs 22.1%), however a portion of pts in the NCDB did not have stage reported. Time from diagnosis to treatment was longer at TUHS, with black pts nearly 9 days longer than the overall national average (31.72 vs 22.8 days). Black pts had higher rates of pancreas (8.6 vs 7.6%), small intestine (5.6 vs 4.3%) and anal (8.7 vs 3%) cancers compared to white pts in both TUHS and NCDB, with starker contrast in the TUHS population (13.7 vs 7.2%, 8.5 vs 6.2%, 5.1 vs 1.2% ). Rectal cancer was lower in black pts relative to white (13.3 vs 17.2%) in both cohorts. At TUHS, black pts had a higher rate of colon/rectosigmoid (42.8 vs 41.7%), esophageal (3.4 vs 3.1%) and intrabiliary (2.6 vs 2.5%) cancers relative to white pts, which was converse to the NCDB. Asian/Pacific Islander pts had a higher percentage of stomach and liver cancer across all races, with the largest difference seen relative to white pts (14.7 vs 8.4%, 8.4 vs 2.9% respectively). Conclusions: GI malignancies in YA treated at TUHS had similar disease burden compared to national counterparts, but was characterized by advanced stages at diagnosis, longer time to treatment, and greater racial disparities in tumor distribution. These findings suggest that structural and sociodemographic factors, including insurance status and race, may contribute to delayed diagnosis and inequities in care. Targeted interventions aimed at improving early detection, expediting treatment initiation, and addressing race-specific and site-specific cancer disparities are urgently needed to mitigate the growing burden of YA GI cancers in underserved populations.