Mayo Clinic Minute: Colorectal cancer rates rising among younger people



Colorectal Cancer Rates on the Rise in Younger People Colorectal Cancer Rates on the Rise in Younger People

Colorectal Cancer Rates on the Rise in Younger People

In 35-year study, the largest increase was reported in people ages 20 to 34.

By Charles Bankhead, MedPage Today

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If the observed trends continue, by 2030 one of every nine newly diagnosed colon cancers will be someone under the age of 50.
If the observed trends continue, by 2030 one of every nine newly diagnosed colon cancers will be someone under the age of 50.
Martin Barraud/Getty Images

The incidence of colon and rectal cancer increased significantly in people younger than 50, but decreased overall and among older people, according to a 35-year trend analysis.

The largest increase occurred in people ages 20 to 34, averaging almost 2% per year from 1975 to 2010. Colorectal cancer (CRC) incidence increased by 0.41% annually in people ages 35 to 49.

In contrast, the overall rate of CRC declined by almost 1% a year during the study period, including a 1.15% annual decrease in people ages 75 and up.

The rising incidence in younger people is consistent with previous studies, although the reason remains unclear, reported George J. Chang, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues in JAMA Surgery.

"It may be environmental, it may be behavioral, it may be the type of foods we eat, it may be the type of physical activity or lack thereof," Chang told MedPage Today. "There are a number of factors that we need to understand better."

If the observed trends continue, by 2030 one of every four newly diagnosed rectal cancers and of every nine colon cancers will involve patients younger than the currently recommended screening age of 50, he added.

Several studies have documented a declining incidence of CRC in the UlS., including men and women. Most observers have attributed the decline to increased rates of screening for CRC, particularly use of colonoscopy. Current clinical guidelines recommend that screening colonoscopy begin at age 50.

RELATED: Doctors Skill at Colonoscopy May Affect Colon Cancer Risk

Coincident with the overall decline in CRC incidence, rates have appeared to increase in younger adults, who are not included in current screening recommendations. Similar age-related differences have been observed with respect to breast cancer in younger women, the authors noted.

To gain more insight into secular trends in CRC, Chang and colleagues analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. They identified all patients with newly diagnosed CRC from January 1975 through December 2010, and analyzed incidence trends by 15-year age intervals, beginning with the 20 to 34 age range.

The analysis involved 393,241 patients, consisting of 281,462 (71.6%) patients with colon cancer and 111,779 (28.4%) patients with rectosigmoid and rectal cancers. A majority of cases (219,059, 55.7%) occurred in patients 50 to 74, followed by patients ≥75 (143,474, 36.5%), 35 to 49 (26,893, 6.8%), and 20 to 34 (3,815, 1.0%).

Overall, the age-adjusted incidence of CRC decreased by 0.92% annually (95% CI -1.14 to -0.70%, P

White patients, who accounted for 84.4% of the patient population, had an annualized percentage change of -1.0%. Blacks had a smaller decrease in CRC incidence (-0.17% annually), and all other racial/ethnic groups had a combined annualized decrease of 0.53%.

CRC incidence declined significantly over the 35-year period in patients ≥75 and those 50 to 74 (-0.97%/year). Annual incidence of CR increased by 0.41% in patients 35 to 49 and by 1.99% in the youngest age group.

Analysis of colon cancer incidence by stage at diagnosis showed overall decreases for localized (-0.39%/year), regional (-1.32%/year), and distant disease (-1.24%/year). Patients 50 to 74 and ≥75 had significant decreases across all stages. Patients 35 to 50 had a numerical decrease in the incidence of localized disease, a significant decrease in regional disease at diagnosis, and a nonsignificant increase in distant disease.

Among the youngest patients, the incidence of colon cancer increased significantly for localized disease (1.10%/year), regional disease (0.91%/year), and distant disease (1.81%/year).

Similar age-associated incidence disparities emerged from an analysis of rectal and rectosigmoid cancers, as rates of localized, regional, and distant disease decreased steadily among patients ≥50. The largest declines occurred among patients ≥75 (-1.49%, -1.63%, and -2.39%, P

In contrast, annual percent changes increased across all stages for patients younger than 50. Annual increases were greatest for the youngest patients (4.03%, 3.0%, and 2.66%).

If the observed trends continue, the authors estimate that by 2030, one in four newly diagnosed rectal cancers and 1 in 9 colon cancers will occur in patients younger than the currently recommended screening age of 50.

The author of an accompanying commentary acknowledged that the incidence trends among younger people is unsettling. Nonetheless, any call for universal screening should be tempered by a big-picture perspective.

"While it is attractive to suggest that all adults should obtain a colonoscopy, especially given the possible durability of cancer risk reduction, it is important to note that the absolute incidence of colorectal cancer in the young adults (20 to 34) is 1% of the total colorectal cancer burden and similarly fairly low in the 35- to 49-year-old age group," wrote Kiran K. Turaga, MD, MPH, of the Medical College of Wisconsin in Milwaukee.

"Hence, widespread application of colonoscopic screening might add significant cost and risk without societal benefit.






Video: Colon Cancer Rates Increasing in Young Adults

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Date: 19.12.2018, 07:39 / Views: 75255