BACKGROUND: Colorectal cancer (CRC) is estimated to be the fourth most common cancer diagnosis in Canada (except for nonmelanoma skin cancers) and the second and third leading cause of cancer-related death in male and female individuals, respectively.
OBJECTIVE: The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients\' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis.
METHODS: We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as \"cases\"), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older).
RESULTS: We included 1001 EAO-CRC cases (n=450, 45% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95% CI 13.1-18.6).
CONCLUSIONS: We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC.

Mycteroperca bonaci (black grouper) is one of the most sought species of grouper along its entire distribution, being a prime target for demersal line fisheries because of its high commercial value. Nonetheless, because of population declines the species is considered near threatened according to the IUCN red list. The present study aimed to determine the population parameters of M. bonaci, including growth, reproduction and mortality, and thus contributes to measures towards its conservation and management in the southwestern Atlantic. The sampling area is in the North Brazil Shelf, off Maranhão State, an area of intense fisheries development and yet poorly known. The large continental shelf harbours unique coral reef formations and has been declared an ecologically or biologically significant marine area (EBSA). Sampling on landing sites was carried out monthly between May 2017 and January 2019. A total of 137 black grouper specimens were sampled from commercial landings of artisanal fisheries. The size of the specimens ranged from 44 to 157 cm, and the weight varied from 0.976 to 54 kg. The length-weight was established: log(TW) = -11.26 + 3.01log(TL). Histological analysis of the gonads confirmed only the presence of female individuals, and the occurrence of individuals in the sexual transition was not recorded. Higher GSI values and higher frequency of spawning capable staged individuals occurred during the months of June to August, indicating spawning peaks. The estimated age of sexual maturity A50 for females was 4.62 years ( x _ 93 cm-TL). The growth parameters for the Von Bertalanffy model were TL∞ (cm): 185.5, k: 0.04, t0 (year): -4.75 (t0 not fixed) and TL∞ (cm): 141, k: 0.11 (t0  = 0 fixed). The total estimated mortality rate (Z) according to catch length presented a Z value = 0.11, and the natural mortality was M = 0.04 year-1 . This is the first study on the age and growth of M. bonaci in the SWA, a region where the species is considered as endangered according to Brazil\'s red list regional assessment. Only females were present in the samples, results that suggest either differential capturability of sexes because of distinct patterns of behaviour or distribution or an effect of selective mortality upon larger and older individuals, as the species is described as a protogynous hermaphrodite. This indicates the need to closely manage this population to avoid collapses. Recovery plans that have been planned by the Brazilian government but not yet implemented for the species must be put into practice to avoid progressive decline as fisheries target more remote areas.