Abstract
Evidence of the risk factors associated with early-onset colorectal neoplasm from prospective population-based studies is limited. We enrolled 17,293 participants younger than 50 years from the Shanghai colorectal cancer (CRC) screening program cohort. Face-to-face interviews were performed by trained primary care physicians using a standardized questionnaire to collect the information on potential risk factors at baseline entry. Furthermore, 124 cases of early-onset colorectal neoplasm, including six CRC cases and 118 colorectal adenoma (CRA) cases, were detected between 2012 and 2016. Multivariable logistic regression models and restricted cubic spline (RCS) were used to evaluate the risk factors associated with early-onset colorectal neoplasm. We found that sex, body mass index (BMI), and family history of CRC were associated with the early onset of colorectal neoplasm. The RCS model showed a positive dose–response and linear association between BMI and risk of early-onset colorectal neoplasm among young participants (p-overall = 0.19, p-nonlinear = 0.97). The findings indicated that it was beneficial for normal people younger than 50 years to start opportunistic CRC screening. As for those at high risk, increased surveillance is strongly recommended. Further close follow-up is required for research on the underlying causes of early-onset CRC.
Highlights
The burden of colorectal cancer (CRC) incidence and mortality is rapidly growing worldwide
Excluding participants who had a positive history of polyps (n = 280), still a positive association was found between risk of the early-onset colorectal neoplasm and sex (OR = 2.04, 95% confidence interval (CI): 1.14-3.66), body mass index (BMI) (OR = 1.08, 95% CI: 1.01-1.15), and family history of CRC (OR = 5.26, 95% CI: 3.02-9.16) (Table 3). This large prospective cohort study on Chinese youth included 17,293 local residents younger than 50 years who participated in the CRC screening program in Shanghai
Sex, BMI, and family history of CRC were found to be significantly associated with the risk of early-onset colorectal neoplasm
Summary
The burden of colorectal cancer (CRC) incidence and mortality is rapidly growing worldwide. CRC incidence and mortality rates have declined substantially in the United States (US) over the past four decades due to CRC screening and improvements in treatment [2]. The decrease in incidence and mortality occurred mostly among adults older than 50 years. The incidence of CRC kept increasing and nearly doubled in younger adults since the 1990s [3, 4]. In China, a steady increase in CRC incidence was observed over the past three decades, with the most pronounced increase in the youth aged 15-49 years [6]. The increasing incidence of CRC among younger individuals has become a global trend; the reason remains unclear
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