Special articleThe Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action
Section snippets
Young-Onset CRC Incidence and Mortality
In Americans younger than 50 years, CRC incidence per 100,000 individuals ranges from 0.85 (ages 20-24 years) to 28.8 (ages 45-49 years).17 Although these rates are substantially lower than those in older age groups, the incidence has increased significantly in younger individuals and decreased in older individuals (Figure 1).18 The national 1987-2006 Surveillance, Epidemiology, and End Results (SEER) data (Figure 2, A-C) reveal increased colon and rectal cancer incidence in all 5-year age
Why is Young-Onset CRC Increasing?
Drivers of increasing young-onset CRC incidence are not well understood. In the absence of rigorous epidemiologic studies, it is noteworthy that young-onset CRC incidence increased, whereas CRC risk factors, such as sedentary lifestyle, obesity, and diabetes mellitus, were common or increasing.23, 24, 25 Each 5-unit increase in body mass index is associated with an estimated 13% to 18% increase in CRC risk.3, 26 Diabetes mellitus has been associated with up to a 38% (summary relative risk 95%
Distinctive Biology and Genetics of Young-Onset CRC
Single-institution and population-based studies have found distinctive tumor location, stage at presentation, and histologic features in young-onset CRC.10, 30, 31, 32, 33 These tumors occur more often than later-onset tumors in the distal colon and the rectum (69.0% vs 57.7%, P<.001).10 In individuals 35 to 39 years of age, 32% of CRC tumors occurred in the rectum. The percentages decreased in subsequent age groups to a low of 15.1% in the 85 years and older group.19 The proportion of rectal
High-Risk Individuals: Early Screening for Young Adults With Family History, Predisposing Conditions, or Hereditary Syndromes
A family history of CRC or advanced adenomatous polyps in a first-degree relative (FDR), particularly if the CRC occurred before 60 years of age, can increase an individual’s CRC risk up to 4-fold.42 Approximately 10% to 15% of American adults have at least 1 FDR with CRC and are therefore at increased risk for this disease (Table 2).42 Individuals with an FDR younger than 60 years diagnosed as having CRC should begin screening either at 40 years of age or 10 years earlier than the youngest age
Evaluation of Colorectal Symptoms in Young Individuals
Screening is relevant only for asymptomatic individuals. Once CRC symptoms arise, however, an expeditious work-up is essential for all patients. Unfortunately, lack of awareness of the increasing incidence of young-onset CRC and, consequently, a low suspicion of cancer may delay the thorough symptom evaluation needed to effectively establish or rule out young-onset CRC.
Patients with young-onset CRC and their physicians both appear to contribute to delayed diagnosis. On average, symptomatic
Should Average-Risk CRC Screening be Initiated Earlier?
Population-based CRC screening for asymptomatic, average-risk individuals starting at 50 years of age is supported by the US Preventive Services Task Force, the Agency for Healthcare Policy and Research, the US Multi-Society Task Force, and various specialty organizations.46, 47, 64, 65, 66 From 1975 to 2000, screening has been credited with approximately half of the 22% decrease in CRC incidence and the 26% reduction in CRC mortality, with treatment and risk factor reductions accounting for
Conclusion
In the United States, CRC incidence and mortality are increasing at a significant rate each year in men and women younger than 50 years and steadily decreasing in all other age groups. Primary care physicians can play a critical role in decreasing the incidence and mortality of young-onset CRCs by changing their approach to evaluating and educating their younger patients. Primary care physicians can use readily available tools to obtain a detailed family history, taken well before the age of 50
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Cited by (0)
Grant Support: This work was supported by the Colon Cancer Alliance and partially supported by the University of Texas MD Anderson Cancer Center G. S. Hogan Gastrointestinal Cancer Research Fund (Y.N.Y.).
Potential Competing Interests: Dr Ahnen serves on the scientific advisory boards of EXACT Sciences and CM&L Pharma. Dr Jones is a member of the Salix Pharmaceuticals speaker’s bureau and a partner in Premier Surgical Center, Louisville, KY. Dr You receives funding from the University of Texas MD Anderson Cancer Center G. S. Hogan Gastrointestinal Cancer Research Fund. Ms Guiffre, Dr Mendoza Silveiras, Mr Spiegel, and Ms Greenamyer are employees of the Colon Cancer Alliance, and Ms Wade serves as a consultant to the Colon Cancer Alliance. Dr Sifri and Ms Axilbund have no conflicts of interest to disclose.