Grant Number:	1R21CA317745-01 Interpret this number
Primary Investigator:	Tsai, Meng-Han
Organization:	Augusta University
Project Title:	Cancer at the Crossroads: Translating Social Contexts Into Actionable Insights for Early-Onset Colorectal Cancer Care (CROSS)
Fiscal Year:	2026

PROJECT SUMMARY/ABSTRACT Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is increasing rapidly in the United States and disproportionately impacts under-resourced communities. Area-level social determinants of health (SDoH), including socioeconomic status, healthcare access, health behaviors, and physical environment, influence timely diagnosis, treatment initiation, and utilization of genetic testing, which can guide prevention strategies and precision cancer care after diagnosis. To our knowledge, no studies have integrated these outcomes within a comprehensive SDoH framework to identify patient subgroups disproportionately affected by EOCRC. Objective/hypothesis: The CROSS (Cancer at the Crossroads) project, will evaluate how specific area-level SDoH dimensions impact mortality, treatment initiation, and genetic testing use among EOCRC patients. The central hypothesis is that adverse SDoH are associated with poorer survival, lower rates of treatment initiation, and reduced genetic testing use, with variation by demographic characteristics. Aim 1a: Using SEER 17 data linked with County Health Rankings, we will identify area-level SDoH dimensions associated with overall survival (OS) in CRC patients, comparing EOCRC to average-onset CRC (≥50 years). Aim 1b: This study will evaluate cause-specific survival and receipt of initial treatment among EOCRC patients relative to area-level SDoH. Aim 2: Using Genetic Testing Linkage data from California and Georgia, we will assess the impact of area-level SDoH on genetic testing utilization in EOCRC patients, with analyses stratified by sex and race. Innovation: CROSS uniquely integrates population-based SEER 17 incidence data with County Health Rankings and Genetic Testing Linkage databases, applying a comprehensive SDoH framework that emphasizes health behaviors alongside clinical care, socioeconomic, and environmental factors. This is the first population-based study to evaluate genetic testing utilization within an area-level SDoH context for EOCRC. Using piecewise Cox models, the study will assess time-varying survival effects and uncover nuanced risk patterns.





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