Abstract
AimPrevious studies showed that the incidence of early-onset colorectal cancer (EO-CRC, diagnosis <50 years) is rising in Western countries. Additionally, young patients present with more advanced disease. Integrated nationwide assessment of epidemiologically and clinically relevant trends would provide more insight into this specific group of patients with CRC. We aimed to provide an analysis of trends in age- and stage-specific incidence, characteristics, treatment and relative survival of patients with EO-CRC in the Netherlands and compare these with 50- to 59-year-old patients. MethodsData from 1989 to 2018 were retrieved from the Netherlands Cancer Registry. Non-standardised age-specific incidence rates were calculated, and trends were assessed using Joinpoint regression. Treatment and 5-year relative survival trends were provided and compared between EO-CRC and 50- to 59-year-old patients. ResultsThe EO-CRC incidence annually increased with 0.7–2.1% over the last decades. CRC incidence for the 50- to 59-year-old population annually increased with 0.8–1.7% until 2006 and showed a major increase in incidence after the introduction of nationwide screening in 2014. Stage III and Stage IV CRC primarily increased across the studied age groups, while Stage I and Stage II CRC did not. Patients with EO-CRC received multimodal treatment more often than 50- to 59-year-old patients, but differences were minor. Relative survival increased over time and showed little differences between EO-CRC and 50- to 59-year-old patients. Concluding statementOnly few epidemiological and clinical differences were found between EO-CRC and 50- to 59-year-old patients; hence, the urge for a specific approach of EO-CRC in screening and treatment guidelines might be tempered.
Highlights
While the median age at diagnosis of patients with colorectal cancer (CRC) is 70 years [1], the incidence of early-onset colorectal cancer (EO-CRC)dpresentation of disease before the age of 50 yearsdis reportedly increasing in several Western populations [2e9]
Pathogenic germline variants have been associated with CRC in young patients; no germline mutation can be identified in 80% of EO-CRC cases [16]
Following the introduction of nationwide CRC screening for the population aged 55e74 years in 2014, Stage I and Stage II incidence increased, while Stage III and Stage IV remained comparable with EO-CRC
Summary
While the median age at diagnosis of patients with colorectal cancer (CRC) is 70 years [1], the incidence of early-onset colorectal cancer (EO-CRC)dpresentation of disease before the age of 50 yearsdis reportedly increasing in several Western populations [2e9]. Is this increase in incidence unexplained, and younger patients more often seem to have an advanced stage of disease at diagnosis [10]. Large population-based studies have shown that young patients receive more intensive treatment and achieve comparable or longer cancerspecific survival than older patients despite more morphologically unfavourable characteristics [17e19]. A recent study concluded that there is no evidence that sporadic EO-CRC is biologically different from the presentation of CRC at an older age, advocating no clinically different approach of EO-CRC [19]
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