Abstract
BackgroundIncidence of early-onset (younger than 50 years of age) colorectal cancer (CRC) is increasing in many countries. Thus, elucidating the role of traditional CRC risk factors in early-onset CRC is a high priority. We sought to determine whether risk factors associated with late-onset CRC were also linked to early-onset CRC and whether association patterns differed by anatomic subsite.MethodsUsing data pooled from 13 population-based studies, we studied 3767 CRC cases and 4049 controls aged younger than 50 years and 23 437 CRC cases and 35 311 controls aged 50 years and older. Using multivariable and multinomial logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association between risk factors and early-onset CRC and by anatomic subsite.ResultsEarly-onset CRC was associated with not regularly using nonsteroidal anti-inflammatory drugs (OR = 1.43, 95% CI = 1.21 to 1.68), greater red meat intake (OR = 1.10, 95% CI = 1.04 to 1.16), lower educational attainment (OR = 1.10, 95% CI = 1.04 to 1.16), alcohol abstinence (OR = 1.23, 95% CI = 1.08 to 1.39), and heavier alcohol use (OR = 1.25, 95% CI = 1.04 to 1.50). No factors exhibited a greater excess in early-onset compared with late-onset CRC. Evaluating risks by anatomic subsite, we found that lower total fiber intake was linked more strongly to rectal (OR = 1.30, 95% CI = 1.14 to 1.48) than colon cancer (OR = 1.14, 95% CI = 1.02 to 1.27; P = .04).ConclusionIn this large study, we identified several nongenetic risk factors associated with early-onset CRC, providing a basis for targeted identification of those most at risk, which is imperative in mitigating the rising burden of this disease.
Highlights
Incidence of early-onset colorectal cancer (CRC) is increasing in many countries
From 3 large consortia—the Colon Cancer Family Registry, the Colorectal Transdisciplinary study, and the Genetics and Epidemiology of Colorectal Cancer Consortium—including 67 168 CRC cases and 710 377 controls, we identified epidemiologic studies that surveyed for detailed CRC risk factors and included a minimum of 20 early-onset CRC cases
Early-onset CRC cases and controls were similar in reference age (45.0 years and 44.7 years, respectively), and men and women were approximately distributed across the 2 groups, as expected because of matching on these variables for many of the included studies (Table 1)
Summary
Incidence of early-onset (younger than 50 years of age) colorectal cancer (CRC) is increasing in many countries. We sought to determine whether risk factors associated with late-onset CRC were linked to early-onset CRC and whether association patterns differed by anatomic subsite. Using multivariable and multinomial logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association between risk factors and early-onset CRC and by anatomic subsite. No factors exhibited a greater excess in early-onset compared with late-onset CRC. Evaluating risks by anatomic subsite, we found that lower total fiber intake was linked more strongly to rectal (OR 1⁄4 1.30, 95% CI 1⁄4 1.14 to 1.48) than colon cancer (OR 1⁄4 1.14, 95% CI 1⁄4 1.02 to 1.27; P 1⁄4 .04). Conclusion: In this large study, we identified several nongenetic risk factors associated with early-onset CRC, providing a basis for targeted identification of those most at risk, which is imperative in mitigating the rising burden of this disease
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