Abstract
BackgroundEvidence is emerging that the incidence of colorectal cancer is increasing in young adults, but the descriptive epidemiology required to better understand these trends is currently lacking.MethodsA population‐based cohort study was carried out including all adults aged 20–49 years diagnosed with colorectal cancer in England between 1974 and 2015. Data were extracted from the National Cancer Registration and Analysis Service database using ICD‐9/10 codes for colorectal cancer. Temporal trends in age‐specific incidence rates according to sex, anatomical subsite, index of multiple deprivation quintile and geographical region were analysed using Joinpoint regression.ResultsA total of 56 134 new diagnoses of colorectal cancer were analysed. The most sustained increase in incidence rate was in the group aged 20–29 years, which was mainly driven by a rise in distal tumours. The magnitude of incident rate increases was similar in both sexes and across Index of Multiple Deprivation quintiles, although the most pronounced increases in incidence occurred in the southern regions of England.ConclusionColorectal cancer should no longer be considered a disease of older people. Changes in incidence rates should be used to inform future screening policy, preventative strategies and research agendas, as well as increasing public understanding that younger people need to be aware of the symptoms of colorectal cancer.
Highlights
Colorectal cancer is a major cause of cancer-related mortality and is the third most common cause of cancer death in the UK1,2
The incidence rate trends observed in the younger age groups were more attenuated in 40–49 year olds, with small increases observed from 2003 onwards in both women (APC 1⋅5 (0⋅5 to 2⋅5) per cent) and men (APC 0⋅8 (–0⋅1 to 1⋅6) per cent) (Fig. 1c)
By 2005, the most rapid increase in age-standardized incidence rates of distal cancer was noted in the South West (APC 10⋅1 (6⋅1 to 14⋅1) per cent); all other southern regions experienced annual increases of more than 5 per cent. This large study based on a single, national population registry describes detailed epidemiological changes in colorectal cancer incidence in a young adult population
Summary
Colorectal cancer is a major cause of cancer-related mortality and is the third most common cause of cancer death in the UK1,2. A US study[4], using Surveillance, Epidemiology, and End Results data, revealed a doubling in the incidence rate of both colonic and rectal cancers among patients aged between 20 and 54 years since 1974. Men are well recognized to have a higher incidence of colonic and rectal cancer in older age groups, there is little difference in the incidence rates between men and women aged less than 40 years[10,11]. Evidence is emerging that the incidence of colorectal cancer is increasing in young adults, but the descriptive epidemiology required to better understand these trends is currently lacking. Methods: A population-based cohort study was carried out including all adults aged 20–49 years diagnosed with colorectal cancer in England between 1974 and 2015. Temporal trends in age-specific incidence rates according to sex, anatomical subsite, index of multiple deprivation quintile and geographical region were analysed using Joinpoint regression. Presented to a conference of the Association of Coloproctologists of Great Britain and Ireland, Dublin, Ireland, July 2019; published in abstract form as Colorectal Dis 2019; 21(Suppl 2): 4
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