Trends in the incidence of early‐onset colorectal cancer in all 50 United States from 2001 through 2017

Abstract

Background The rate of change in the incidence of colorectal cancer (CRC) among persons younger than 50 years in the United States appears to vary by demographics, tumor location, and geography. This study analyzed data from all 50 states to examine recent changes in the incidence of CRC among persons younger than 50 years and to identify key subgroups with disproportionate risk. Methods Annual incidence rates for CRC, colon cancer, and rectal cancer in persons aged 20 to 49 years were extracted from the US Cancer Statistics for the period 2001‐2017. Secular trends were examined overall and by age group, sex, race/ethnicity, stage, and state. Joinpoint regression was used to compute annual percent changes and average annual percent changes (AAPCs) as well as corresponding 95% confidence intervals (95% CIs). Results The incidence of CRC increased by 1.27% (95% CI, 0.95%‐1.60%) annually from 2001 to 2012 and by 3.00% (95% CI, 2.06%‐3.95%) annually from 2012 to 2017. AAPCs for the period 2001‐2017 were higher among persons aged 20 to 24 years (AAPC, 6.62%; 95% CI, 3.86%‐9.45%) in comparison with other age groups and higher among non‐Hispanic Whites (AAPC, 2.38%; 95% CI, 1.98%‐2.79%) in comparison with other racial/ethnic groups. In 2001‐2002, only 1 state had an age‐standardized incidence rate > 13.0 per 100,000, but this number increased to 32 states by 2016‐2017. Conclusions CRC rates among US adults aged 20 to 49 years increased from 2001 to 2017, with the fastest increases observed from 2012 to 2017. Increases were observed among the youngest age groups, among non‐Hispanic Whites, and in states in the West, Midwest, and Rocky Mountain regions. Increasing rates across all tumor stages suggest a real increase in CRC incidence.

Practical Considerations in Diagnosing and Managing Early-Onset GI Cancers

“…CRC is the third most common cause of cancer-related death in the United States and accounts for 8%-9% of newly diagnosed cancers 18,19 (Fig 1). Although screening for CRC among adults age 50 years and older has dramatically reduced the incidence of CRC in this age group, the incidence of CRC overall has continued to increase, driven by the rise in CRC among those younger than age 50 years.…”

Optimal Surgical Approach for Mid-Transverse Colon Cancer; a systematic review and meta-analysis

“…In the past few years, the incidence of cancer colon has increased dramatically, especially below the age of 50. 1 In addition to that, colon and rectal cancer altogether is considered the second leading cause of cancer-related mortality worldwide. 2 Transverse colon cancer, which accounts for 10% of all colorectal cancer 3 , is de ned as cancer that occurs in hepatic exure, mid-transverse or splenic exure.…”

Early-Onset Colorectal Cancer Survival Differences and Potential Geographic Determinants Among Men and Women in Utah

“…4 Moreover, although overall CRC incidence in the United States increased by 1.27% each year between 2001 and 2007, and 3.0% annually between 2012 and 2017, the greatest average annual percentage change in incidence occurred among those age 20 to 24. 5 Because EOCRC is more likely than later-onset CRC to lead to poor outcomes, the U.S. Preventive Services Task Force now recommends the initiation of CRC screening at age 45 instead of age 50. 6 Experts remain puzzled as to the cause of the alarming rise in EOCRC, but some potential factors include the Western-style diet, obesity, physical inactivity, socioeconomic status, and antibiotic use, especially during the early prenatal to adolescent period.…”

“…Low rates of CRC screening have been associated with low socioeconomic status, low household income, lack of health insurance, and smoking, among other factors, likely contributing to the increasing disparity in EOCRC incidence in these populations. [14][15][16] Siegel et al 17 identified distinct geographic areas in the United States where CRC mortality is highest among those age 50 and older; these regions, as well as additional areas identified in other studies, 5,18 have been identified as EOCRC hotspots-that is, counties with high EOCRC mortality rates. 19 Specifically, African American men younger than age 50 with a diagnosis of advancedstage CRC have a significantly higher EOCRC mortality burden and worse survival in hotspots, compared with White men in nonhotspot counties.…”