Young Onset Disease/Trends

Due potentially to changes in risk factors associated with lifestyle, environment, and metabolic influences, incidence of colorectal cancer (CRC) is rising in a younger population.1 In adults with CRC who are less than 50 years of age, a higher proportion present with primary tumors located in the distal colon and rectum.2 This age group has the highest proportion (~30%) of diagnoses with distant stage CRC,3 which is associated with the lowest 5-year survival rate.4

By 2030:

Nearly 1 in 4 of rectal cancers

and more than 1 in 10 of colon cancers

will be diagnosed in people younger than 505

In 2021, the United States Preventive Services Task Force recommended CRC screening beginning at age 45 years for average risk individuals (Grade Ba)6

TRENDS IN COLORECTAL CANCER INCIDENCE RATES BY AGE AND YEAR OF BIRTH, AND BY AGE AND YEAR OF DIAGNOSIS, US, 1975 TO 20147

Graph of disease onset by age group
  • Younger-birth cohorts carry an elevated risk of developing CRC with age7
  • Incidence rates for colon cancer began increasing in the mid-1990s for adults aged 40–49 (1.3%/year) and is >2x the rate for adults aged 50–54 years (0.5%/year)7
  • A 2.3%/year increase in rectal cancer incidence rates began in the 1990s in adults 40–54 years8
  • A retrospective cohort analysis of SEER data from 1974-2013 found that adults born ~1990 have 2x the risk of colon cancer and 4x the risk of rectal cancer compared with adults born ~1950, who have the lowest risk8

POTENTIAL CONTRIBUTING FACTORS TO ONSET BEFORE AGE 501

Pie chart of Potential Contributing Factors to CRC Onset Before Age 50
  • Approximately 16% of CRC in patients younger than 50 years is associated with a germline genetic predisposition to cancer; another 20-25% of cases are associated with family history of CRC, and the remaining cases are sporadic1
  • Early-onset CRC in adults <50 years is associated with primary tumors in the distal colon or rectum compared to older populations in whom proximal colon tumors predominate2
  • Learn more about pathobiology in younger patients with CRC
     

DELAY-ADJUSTED CRC INCIDENCE RATE, AGES <50 YEARS, 1995-20161,b

Delay-Adjusted CRC Incidence Rate
  • There’s been a ~51% increase in CRC incidence among those <50 years old from 1994 to 20147
  • There’s been an 11% increase in CRC mortality among those <55 years old from 2005 to 20157
  • More than 50% of adults younger than 50 years present with advanced disease9,c

COLORECTAL CANCER INCIDENCE RATES PER 100,000 POPULATION IN 1-YEAR AGE INCREMENTS IN THE US SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS 18 REGISTRIES AMONG PATIENTS AGED 30 TO 60 YEARS, 2000–201510,e

Graph of Incidence in Younger Populations
  • 46.1% increase in the incidence of CRC in the SEER 18 registries were found from 49 to 50 years of age10
  • The study investigators interpreted this one-year jump as most likely indicating cancers that began before age 50 but went undetected due to the absence of screening prior to that age10
  • 8799 of the 9474 cases (92.9%) of CRC in the SEER 18 registries from 2000 to 2015 that were diagnosed among individuals aged 50 years were invasive10

Related Topics

References

1 Patel SG, Boland CR. Colorectal cancer in persons under age 50: seeking causes and solutions. Gastrointestin Endosc Clin N Am. 2020;30:441-455.

2 Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterol. 2020;158:341–353.

3 Siegel RL, Miller KD, Wagle NS, et al. Colorectal cancer statistics. CA Cancer J Clin. 2023;73(3):233-254.

4 American Cancer Society. Colorectal Cancer Facts & Figures 2023-2025. Atlanta: American Cancer Society; 2023.

5 Bailey CE; Hu CY; You, YN, et al. Increasing disparities in age-related incidence of colon and rectal cancer in the United States, 1975-2010. JAMA Surg. 2015;150(1):17-22.

6 Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.

7 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.

8 Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8).

9 Virostko J, Capasso A, Yankeelov TE, et al. Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004-2015. Cancer. 2019;125(21):3828-3835. 

10 Abualkhair WH, Zhou M, Ahnen D, et al. Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age. JAMA Netw Open. 2020;3(1):e1920407. 

 

Footnotes

a The USPSTF concludes with moderate certainty that screening for CRC in adults aged 45 to 49 years has moderate net benefit (Grade B).

b Rates are adjusted for delays in reporting and are plotted as average rates of change over several years.

c Stage III/IV; vs 40.0% for those 50 years or older.

d Includes diabetes/metabolic syndrome, obesity, smoking, moderate alcohol consumption, red meats and processed meats.

e Increase in incidence rate at age 50 is confounded by the recommendation to begin average risk of screening at this age.

Last Updated: 06/04/2023