Colorectal
Signal score, how each part rates
ActionabilityPrevalenceStakesEvidence strengthNovelty
See the full rubric →Delays in Diagnosis of Early-Onset Colorectal Cancer Across the United States: A Systematic Review.
Clinical takeawayMaintain a high index of suspicion for colorectal cancer in adults under 50 with persistent GI symptoms (e.g., rectal bleeding, change in bowel habits, abdominal pain), recognizing that diagnostic delays are common and stem from a combination of patient, provider, and system factors. Advocate for system-level interventions to support earlier detection.
What it foundThis systematic review of 35 studies on early-onset colorectal cancer found that most research uses advanced stage at diagnosis as a proxy for delay and identifies complex, crosscutting patient, provider, and system-level factors rather than a single quantifiable cause.
ContextThis review formalizes the widely recognized clinical problem of diagnostic delays in early-onset colorectal cancer, confirming that the issue is multifactorial and highlighting the limitations of the current evidence base, which often relies on stage at diagnosis as a proxy for delay. The findings emphasize the need for more qualitative research to identify effective interventions.
Refinessuggested applicable standard· U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017
Decision at stakethe need for heightened awareness of early-onset colorectal cancer in patients under 45
U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017 · reviewed 2026-07-23 ↗Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA every 3 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 to 10 years as Tier 2 alternatives. A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.
Marzoughi M … Suwanabol PA · Diseases of the Colon and Rectum · IF 3.5 · PubMed ↗