CRC incidence more than triples among children, teens from 1999 to 2020
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Key takeaways:
- The actual number of CRC cases among children and adolescents is not high enough to warrant widespread screening.
- Those aged 40 to 44 years had the lowest percent increase but the highest incidence rate in 2020.
Colorectal cancer incidence climbed 500% from 1999 to 2020 among children aged 10 to 14 years and 333% among adolescents aged 15 to 19 years, according to research presented at the Digestive Disease Week media briefing.
“Colorectal cancer is a major cause of cancer-related morbidity and mortality in the United States,” Islam Mohamed, MD, an internal medicine resident at the University of Missouri-Kansas City, said. “Incidence and mortality rates have decreased in adults older than age 50 over the last three decades. By contrast, incidence rates have doubled in younger age groups.”
He continued: “Our aim was to examine the differences in incidence among young age groups below age 45 around the duration 1999 to 2020.”
Using the CDC Wonder database, Mohamed and colleagues calculated trends in CRC incidence rates per 100,000 persons for individuals aged 10 to 44 years, divided into distinct age groups. Researchers reported a 500% increase in CRC incidence among children aged 10 to 14 years, a 333% increase among adolescents aged 15 to 19 years and a 185% increase among young adults aged 20 to 24 years.
“While the trends are alarming, the actual numbers of colorectal cancer among children and teens are not high enough to suggest widespread screening protocols,” Mohamed said. “Only 0.6 children aged 10 to 14 per 100,000 people were diagnosed with colorectal cancer in 2020 compared to just 0.1 per 100,000 in 1999. Cases in teens aged 15 to 19 went from 0.3 to 1.3 per 100,000 and in young adults aged 20 to 24 cases rose from 0.7 to 2 per 100,000.”
Further, results demonstrated a 68% increase (1.9-3.2/100,000) among those aged 25 to 29 years, a 71% increase (3.8-6.5/100,000) among those aged 30 to 34 years and a 58.1% increase (7.4-11.7/100,000) among those aged 35 to 39 years. Although those aged 40 to 44 years had the lowest percentage increase in CRC incidence (45%), Mohamed noted they had the highest incidence rate, reaching 20 per 100,000 individuals in 2020.
“Colorectal cancer is no longer considered just a disease of the elderly population,” Mohamed said. “It is important that the public is aware of signs and symptoms of colorectal cancer.”
He continued, “These findings emphasize the urgent need for public awareness and personalized screening approaches, particularly among younger populations where the most substantial increases in colorectal cancer incidence were observed.”
Perspective
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Jacob Kurowski, MD
The incidence of CRC has been increasing in the United States since the 1980s, with a gradual but predictable shift in the age at diagnosis.
Although screening colonoscopy tools, including high-definition endoscopy and advanced endoscopy with endoscopic mucosal resection, have increased the rate of adenoma detection and reduced the need for surgery, one would hope the age of diagnosis of CRC would only increase. Quite the contrary, CRC is being diagnosed with greater frequency at a younger age to the point that in 2021 the U.S. Preventive Services Task Force changed the recommendation to begin screening average-risk individuals for colon cancer at age 45 years instead of 50 years.
Going one step further, several studies — including this one — continue to report the fastest incidental rise in CRC in the youngest populations starting as early as childhood. That said, the incidence of CRC is rising at a rapid rate among all age groups younger than 45 years or among those for whom CRC screening is not yet indicated. Should this trend continue, we will continue to see a persistent reduction in age at which initiation of screening colonoscopy is recommended.
This begs the bigger question: Why is this shift occurring and at such a rapid rate? As a pediatric gastroenterologist, I am seeing immune-mediated diseases such as inflammatory bowel disease present younger and younger with increasing severity. While there is no unified causality or risk factor for this shift in disease, the shift in the U.S. environment over the past 60 years is catching up to us in more ways than not. There is evidence that the Western diet of ultra-processed foods, changes in the microbiome and now even microplastics may play a role in the development of CRC.
Further, environmental risk factors may increase the velocity of a genetic predisposition to develop cancer seen in at least 25% of those with young-onset CRC — including the most common genetic cause, Lynch syndrome — resulting in deficient DNA mismatch repair and high-frequency microsatellite instability.
Identifying the causality and underlying risk factors is limited in this database study, and a nationwide registry of young-onset CRC is needed to better understand our knowledge deficiency if we want to attempt to change this course.
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Mohamed I, et al. Evolving trends in colorectal cancer incidence among young patients under 45: A 22-year analysis of CDC Wonder database. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
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