Evolving Trends in Early-Onset and Young Adult Gastrointestinal Cancer: Philadelphia in a National Context

Background: Early-onset (EO) GI malignancies, especially in younger adults, have increased in the past several decades, with advanced stages at diagnosis and aggressive tumor features relative to patients with average-age-onset disease. Methods: We performed a retrospective analysis of patients aged 18–44 years diagnosed with a GI malignancy within TUHS between 2010 and 2025 and compared with data via the National Cancer Database. Results: A total of 530 pts at TUHS and 81,097 in the NCDB were included. Average age at diagnosis was higher at TUHS (37.6 vs. 32.9 years). Compared with NCDB, TUHS also saw a greater proportion of Black patients (22.1% vs. 15.5%). TUHS patients presented with more advanced stages at diagnosis, with more stage III (27.4% vs. 12.6%) and stage IV disease (33.8% vs. 22.1%). Among those that were insured, patients at TUHS saw more reliance on government insurance (30.3 vs. 27.5%) compared to the rates from NCDB. Although unadjusted time from diagnosis to treatment was longer at TUHS, this difference was not statistically significant after adjustment. More specifically, this duration was longer for Black patients by nearly 7 days compared with the national average (31.77 vs. 24.62 days). Conclusions: TUHS had a similar cancer case distribution compared to national counterparts, but was characterized by more advanced stages at diagnosis and longer time to treatment. These findings necessitate investigation into potential structural and sociodemographic factors that may contribute to delayed diagnosis and inequities in care. Targeted interventions are urgently needed to mitigate the growing burden of EO GI cancers in underserved populations.