Trends in the incidence of young-onset colorectal cancer with a focus on years approaching screening age: A population-based longitudinal study

Abstract

Background With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), our objective was to evaluate the incidence of yCRC in one-year age increments, particularly focusing around the screening age of 50 years. Methods We conducted a longitudinal study using linked administrative health databases in British Columbia, Canada including a provincial cancer registry, inpatient/outpatient visits, and vital statistics from January 1, 1986 to December 31, 2016. We calculated incidence rates per 100,000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis. Results We identified 3,614 individuals with yCRC (49.9% women). The incidence of CRC steadily rose from 20 to 60 years, with a marked increase from 49 to 50 years (incidence rate ratio = 1.19; 95% confidence interval [CI] = 1.04 to 1.34). Furthermore, there was a trend of increased incidence of yCRC among women (APCi = 0.79%; 95% CI = 0.22% to 1.36%) and men (APCi = 2.17%; 95% CI = 1.59% to 2.76%). Analyses stratified by age yielded APCi’s of 2.49% (95% CI = 1.36% to 3.63%) and 0.12% (95% CI = -0.54% to 0.79%) for women aged 30-39 years and 40-49 years, respectively and 2.97% (95% CI = 1.65% to 4.31%) and 1.86% (95% CI = 1.19% to 2.53%) for men. Conclusion Our findings indicate a steady increase over one-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age.

Patterns of Healthcare Utilization Leading to Diagnosis of Young-Onset Colorectal Cancer (yCRC): Population-Based Case-Control Study

“…Abualkhair et al found a drastic increase of CRC patients as individuals shifted from the 49 to 50 years old, suggesting a large number of preclinical undetected yCRC cases that might be detected with a lower age for guideline-based screening [ 28 ]. Our group similarly found a steady increase through this same age transition [ 5 ]. Modeling of CRC screening strategies in Canada suggest that stool-based screening would yield 20 additional life-years per 1000 people screened along with a 10% increase in colonoscopy demand, compared to ages 50 to 74 [ 27 ].…”

“…The US Preventative Services Task Force recently lowered the age for screening for average risk patients to age 45 [ 26 ]. Results on the effectiveness of decreasing the age for eligibility for screening has been mixed [ 5 , 27 , 28 ]. Abualkhair et al found a drastic increase of CRC patients as individuals shifted from the 49 to 50 years old, suggesting a large number of preclinical undetected yCRC cases that might be detected with a lower age for guideline-based screening [ 28 ].…”

“…Recent evidence has demonstrated an increase in the incidence of CRC amongst young adults [ 3 , 4 ]. In Canada, the incidence of young-onset CRC (yCRC) diagnosed in adults less than 50 years of age has increased by a mean annual percentage change (APC) of 4.45% for men since 2010 and by 3.47% for women since 2006 [ 5 ]. Approximately 10% of cases of CRC in Canada are now diagnosed in individuals <50 years of age [ 4 , 5 ].…”

Risk factors for the diagnosis of colorectal cancer

“…The incidence of CRC in men and women under the age of 50 in the United States continued to increase at a rate of 2% annually from 1995 to 2016. Registries show an increased incidence of CRC among young adults aged 20-39 years, although the total number of cases in this age group remains signi cantly lower than that of adults aged 50 years and older [17][18][19][20][21][22][23][24][25][26]. Most cases of colorectal cancer occur in people with no family history of colorectal cancer or a predisposing disease, as our research con rms.…”

Perfil Epidemiológico De Pacientes Com Câncer Colorretal

“…Essa neoplasia é incomum antes dos 40 anos, com aumento significativo da incidência entre as idades de 40-50. Embora dados mais recentes do banco de dados de Vigilância, Epidemiologia e Resultados Finais (SEER) dos Estados Unidos e outros registros de câncer ocidentais sugiram que a incidência esteja aumentando no grupo de menores de 50 anos e diminuindo nos mais velhos 7,10,12 ; neste estudo observou-se que a média de idade continua acima de 50 anos. Esse aumento está sendo notado predominantemente por cânceres do lado esquerdo e do reto em particular.…”