{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T05:32:02Z","timestamp":1793943122871,"version":"4.8.0"},"reference-count":37,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T00:00:00Z","timestamp":1712707200000},"content-version":"am","delay-in-days":345,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32#CA078586"],"award-info":[{"award-number":["T32#CA078586"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","surgjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Surgery"],"published-print":{"date-parts":[[2023,5]]},"DOI":"10.1016\/j.surg.2023.01.018","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T08:21:58Z","timestamp":1677831718000},"page":"1137-1143","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":35,"title":["Characteristics and symptomatology of colorectal cancer in the young"],"prefix":"10.1016","volume":"173","author":[{"given":"Mary Kate","family":"Skalitzky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2651-0506","authenticated-orcid":false,"given":"Peige P.","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7078-6625","authenticated-orcid":false,"given":"Paolo","family":"Goffredo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2008-5577","authenticated-orcid":false,"given":"Kristina","family":"Guyton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4903-0422","authenticated-orcid":false,"given":"Scott K.","family":"Sherman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-8972","authenticated-orcid":false,"given":"Irena","family":"Gribovskaja-Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-880X","authenticated-orcid":false,"given":"Muneera R.","family":"Kapadia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7276-8794","authenticated-orcid":false,"given":"Jennifer E.","family":"Hrabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.surg.2023.01.018_bib1","doi-asserted-by":"crossref","first-page":"djw322","DOI":"10.1093\/jnci\/djw322","article-title":"Colorectal cancer incidence patterns in the United States, 1974\u20132013","volume":"109","author":"Siegel","year":"2017","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.surg.2023.01.018_bib2","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1007\/s00384-015-2341-4","article-title":"Young age of onset colorectal cancers","volume":"30","author":"Liang","year":"2015","journal-title":"Int J Colorectal Dis"},{"key":"10.1016\/j.surg.2023.01.018_bib4","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s00384-017-2837-1","article-title":"Young colorectal cancer patients often present too late","volume":"32","author":"Law","year":"2017","journal-title":"Int J Colorectal Dis"},{"key":"10.1016\/j.surg.2023.01.018_bib5","first-page":"195","article-title":"Rising incidence of colorectal cancer in patients younger than age 50 in Hawai\u2018i","volume":"78","author":"Jain","year":"2019","journal-title":"Hawaii J Med Public Health"},{"key":"10.1016\/j.surg.2023.01.018_bib6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/1878-0261.12417","article-title":"Early-onset colorectal cancer in young individuals","volume":"13","author":"Mauri","year":"2019","journal-title":"Mol Oncol"},{"key":"10.1016\/j.surg.2023.01.018_bib7","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1177\/000313480306901010","article-title":"Rates of colon and rectal cancers are increasing in young adults","volume":"69","author":"O\u2019Connell","year":"2003","journal-title":"Am Surg"},{"key":"10.1016\/j.surg.2023.01.018_bib8","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.amjsurg.2003.12.020","article-title":"Colorectal cancer in the young","volume":"187","author":"O\u2019Connell","year":"2004","journal-title":"Am J Surg"},{"key":"10.1016\/j.surg.2023.01.018_bib9","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1158\/1055-9965.EPI-09-0186","article-title":"Increase in incidence of colorectal cancer among young men and women in the United States","volume":"18","author":"Siegel","year":"2009","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"10.1016\/j.surg.2023.01.018_bib10","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.mayocp.2013.09.006","article-title":"The increasing incidence of young-onset colorectal cancer: a call to action","volume":"89","author":"Ahnen","year":"2014","journal-title":"Mayo Clin Proc"},{"key":"10.1016\/j.surg.2023.01.018_bib11","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1158\/1055-9965.EPI-18-1111","article-title":"Global increasing incidence of young-onset colorectal cancer across 5 continents: a joinpoint regression analysis of 1,922,167 cases","volume":"28","author":"Lui","year":"2019","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"10.1016\/j.surg.2023.01.018_bib12","first-page":"1","article-title":"Colorectal cancer in the young: epidemiology, prevention, management","volume":"40","author":"Siegel","year":"2020","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"10.1016\/j.surg.2023.01.018_bib13","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/cncr.29716","article-title":"Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening","volume":"122","author":"Abdelsattar","year":"2016","journal-title":"Cancer"},{"key":"10.1016\/j.surg.2023.01.018_bib14","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1007\/s11605-020-04663-x","article-title":"Increasing incidence of left-sided colorectal cancer in the young: age is not the only factor","volume":"24","author":"Kearney","year":"2020","journal-title":"J\u00a0Gastrointest Surg"},{"key":"10.1016\/j.surg.2023.01.018_bib15","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1097\/DCR.0000000000001062","article-title":"Left-sided dominance of early-onset colorectal cancers: a rationale for screening flexible sigmoidoscopy in the young","volume":"61","author":"Segev","year":"2018","journal-title":"Dis Colon Rectum"},{"key":"10.1016\/j.surg.2023.01.018_bib16","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.3748\/wjg.v22.i5.1736","article-title":"Clinical and molecular features of young-onset colorectal cancer","volume":"22","author":"Ballester","year":"2016","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.surg.2023.01.018_bib17","first-page":"177","article-title":"Colorectal cancer statistics, 2017","volume":"67","author":"Siegel","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.surg.2023.01.018_bib18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1200\/JOP.19.00153","article-title":"Colorectal cancer in the adolescent and young adult population","volume":"16","author":"You","year":"2020","journal-title":"JCO Oncol Pract"},{"key":"10.1016\/j.surg.2023.01.018_bib19","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jama.2017.7630","article-title":"colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970\u20132014","volume":"318","author":"Siegel","year":"2017","journal-title":"JAMA"},{"key":"10.1016\/j.surg.2023.01.018_bib20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1053\/j.seminoncol.2009.03.004","article-title":"CAUTION! Consider cancer: common symptoms and signs for early detection of cancer in young adults","volume":"36","author":"Bleyer","year":"2009","journal-title":"Semin Oncol"},{"key":"10.1016\/j.surg.2023.01.018_bib21","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/MD.0b013e3181881354","article-title":"Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome?","volume":"87","author":"Dozois","year":"2008","journal-title":"Medicine (Baltimore)"},{"key":"10.1016\/j.surg.2023.01.018_bib22","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J\u00a0Royal Stat Soc Ser B"},{"key":"10.1016\/j.surg.2023.01.018_bib23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958","journal-title":"J\u00a0Am Stat Assoc"},{"key":"10.1016\/j.surg.2023.01.018_bib24","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/0197-2456(96)00075-X","article-title":"A\u00a0note on quantifying follow-up in studies of failure time","volume":"17","author":"Schemper","year":"1996","journal-title":"Control Clin Trials"},{"key":"10.1016\/j.surg.2023.01.018_bib26","first-page":"250","article-title":"Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society","volume":"68","author":"Wolf","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.surg.2023.01.018_bib27","doi-asserted-by":"crossref","first-page":"203","DOI":"10.5217\/ir.2017.15.2.203","article-title":"Red flag symptoms: detailed account of clinicopathological features in young-onset colorectal cancer","volume":"15","author":"Riaz","year":"2017","journal-title":"Intest Res"},{"key":"10.1016\/j.surg.2023.01.018_bib28","first-page":"e405","article-title":"Systematic review of clinical features of suspected colorectal cancer in primary care","volume":"60","author":"Del Giudice","year":"2014","journal-title":"Can Fam Physician"},{"key":"10.1016\/j.surg.2023.01.018_bib29","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1093\/fampra\/cmq008","article-title":"Rectal bleeding in patients with haemorrhoids: coincidental findings in colon and rectum","volume":"27","author":"Koning","year":"2010","journal-title":"Fam Pract"},{"key":"10.1016\/j.surg.2023.01.018_bib30","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/1477-7819-8-82","article-title":"Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: analysis of survival and prognostic markers","volume":"8","author":"Chan","year":"2010","journal-title":"World J Surg Oncol"},{"key":"10.1016\/j.surg.2023.01.018_bib31","doi-asserted-by":"crossref","first-page":"5041","DOI":"10.3748\/wjg.v23.i28.5041","article-title":"Colorectal cancer in young adults: a difficult challenge","volume":"23","author":"Campos","year":"2017","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.surg.2023.01.018_bib32","first-page":"717","article-title":"Guideline for referral of patients with suspected colorectal cancer by family physicians and other primary care providers","volume":"60","author":"Del Giudice","year":"2014","journal-title":"Can Fam Physician"},{"key":"10.1016\/j.surg.2023.01.018_bib34","first-page":"e87","article-title":"Rising proportion of young individuals with rectal and colon cancer","volume":"18","author":"Kasi","year":"2019","journal-title":"Clin Colorectal Cancer"},{"key":"10.1016\/j.surg.2023.01.018_bib35","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S1470-2045(19)30595-9","article-title":"Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study","volume":"21","author":"Koo","year":"2020","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.surg.2023.01.018_bib36","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/j.ejca.2009.03.014","article-title":"Duration of symptoms, stage at diagnosis and relative survival in colon and rectal cancer","volume":"45","author":"Jullumstr\u00f8","year":"2009","journal-title":"Eur J Cancer"},{"key":"10.1016\/j.surg.2023.01.018_bib37","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12875-021-01452-6","article-title":"Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care","volume":"22","author":"Holtedahl","year":"2021","journal-title":"BMC Fam Pract"},{"key":"10.1016\/j.surg.2023.01.018_bib38","doi-asserted-by":"crossref","first-page":"121","DOI":"10.3399\/bjgp10X483175","article-title":"Cancer diagnosis in primary care","volume":"60","author":"Hamilton","year":"2010","journal-title":"Br J Gen Pract"},{"issue":"Suppl 1","key":"10.1016\/j.surg.2023.01.018_bib39","doi-asserted-by":"crossref","first-page":"s62","DOI":"10.1007\/s10151-004-0114-0","article-title":"Anaemia as a symptom of right colon cancer","volume":"8","author":"Kanellos","year":"2004","journal-title":"Tech Coloproctol"},{"key":"10.1016\/j.surg.2023.01.018_bib40","doi-asserted-by":"crossref","first-page":"795","DOI":"10.3109\/00365521.2012.672589","article-title":"Association of symptoms of colon cancer patients with tumor location and TNM tumor stage","volume":"47","author":"Alexiusdottir","year":"2012","journal-title":"Scand J Gastroenterol"}],"container-title":["Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0039606023000442?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0039606023000442?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T11:05:03Z","timestamp":1758539103000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0039606023000442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["S0039606023000442"],"URL":"https:\/\/doi.org\/10.1016\/j.surg.2023.01.018","relation":{},"ISSN":["0039-6060"],"issn-type":[{"value":"0039-6060","type":"print"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Characteristics and symptomatology of colorectal cancer in the young","name":"articletitle","label":"Article Title"},{"value":"Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.surg.2023.01.018","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}