Mo1136 Colorectal Cancer Under Age 50 Years: a Surveillance Epidemiology and End Results Based Analysis of CRC Incidence and Mortality in Young Adults Overall, Stratified by Sex, and Relative to Other Common Cancers

Abstract

Background: Colorectal cancer (CRC) is a leading cause of cancer death worldwide, accounting for 608,000 deaths in 2008 (World Health Organization, 2013). Largely as a result of screening, CRC incidence is declining, but the trend is restricted to individuals age >50 years (Edwards BK 2010). Indeed, CRC incidence is increasing among individuals younger than 50 (World Health Organization, 2013; Siegel RL 2009). Setting public health priorities for screening research and interventions requires understanding absolute rates of CRC incidence and mortality, and assessment of CRC incidence and mortality relative to other cancer types. Our aim was to use population-based cancer registry data to contrast CRC incidence and mortality relative to other common cancers, overall, and by sex. Methods: We utilized the Surveillance, Epidemiology, and End Results [SEER] Cancer Query system to obtain cancer incidence and mortality data from the SEER Registry 20012010. To compare cancer site-specific mortality rates, we extracted age-adjusted mortality per 100,000 for individuals aged 20-44 years. To compare cancer site-specific incidence rates, we extracted age-specific incidence per 100,000 for individuals aged 15-49 years. We present mortality and incidence data for the common young-onset cancers overall as well as stratified by sex. Results: Figure 1 demonstrates that CRC is the 3rd leading cause of cancer death among young adults, after breast and lung cancer, at 1.67 cases per 100,000. Among males under age 45 yrs, CRC was the 2nd leading cause of cancer death, at 1.82 cases per 100,000, 2nd only to lung cancer. Among females under age 45 yrs, CRC was the 4th leading cause of cancer death, at 1.51 per 10000, behind breast, lung, and cervical cancer, respectively. Sexspecific differences in young onset CRC incidence patterns were noted. Among males, CRC became the 2nd most incident cancer after age 30, with 4.9, 9.0, 16.4, and 30.8 cases per 100,000 for ages 30-34, 35-39, 40-44, and 45-49 yrs, respectively (Figure 2A). Among females, CRC incidence patterns were similar to males after age 30, with 4.2, 7.6, 15.3, and 25.9 cases per 100,000 for ages 30-34, 35-39, 40-44, and 45-49 yrs, respectively (Figure 2B). However, among females, CRC incidence was dwarfed by breast cancer incidence overall, and less distinct from other cancers as compared to males. Conclusions: CRC is a frequent cause of cancer incidence and mortality among young adults in the U.S. Given the overall incidence and mortality of CRC among young adults, and previously reported increasing trends in incidence, and availability of effective screening tests for CRC, new strategies for identifying young adults at risk for CRC who may be candidates for screening should be developed.