Trends in the epidemiology of young-onset colorectal cancer: a worldwide systematic review

• Published in: BMC cancer Vol. 20; no. 1; pp. 288 - 14
• Main Authors: Saad El Din, Khalid, Loree, Jonathan M., Sayre, Eric C., Gill, Sharlene, Brown, Carl J., Dau, Hallie, De Vera, Mary A.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.04.2020; BioMed Central; BMC
• Subjects: Adenomatous polyposis coli; Adult; Africa - epidemiology; Age; Age of Onset; Analysis; Annual reports; Asia - epidemiology; Australia - epidemiology; Cancer; Cancer research; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Confidence intervals; Databases, Factual - statistics & numerical data; Epidemiology; Estimates; Europe - epidemiology; Global Burden of Disease - trends; Humans; Incidence; Meta-analysis; Middle Aged; North America - epidemiology; Oceania - epidemiology; Population studies; Prevalence; Prevalence studies (Epidemiology); Quality; Rectum; Reviews; Studies; Subject heading schemes; Systematic review; Trends; Young Adult; Young-adult cancer; Australia; Asia; North America; Europe; Africa; Oceania; Canada; United States > US; Epidemiology; Cancer; Incidence; Meta-analysis; Young-adult cancer
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-06766-9

Recent data suggest that the risk of young-onset colorectal cancer (yCRC), in adults less than 50 years of age, is increasing. To confirm findings and identify contemporary trends worldwide, we conducted a systematic review of studies examining population-level trends in yCRC epidemiology. We searched MEDLINE (1946-2018), EMBASE (1974-2018), CINAHL (1982-2018), and Cochrane Database of Systematic Reviews (2005-2018) for studies that used an epidemiologic design, assessed trends in yCRC incidence or prevalence, and published in English. Extracted information included country, age cut-off for yCRC, and reported trends in incidence or prevalence (e.g. annual percent change [APC]). We pooled similarly reported trend estimates using random effects models. Our search yielded 8695 articles and after applying our inclusion criteria, we identified 40 studies from 12 countries across five continents. One study assessed yCRC prevalence trends reporting an APCp of + 2.6 and + 1.8 among 20-39 and 40-49 year olds, respectively. 39 studies assessed trends in yCRC incidence but with substantial variability in reporting. Meta-analysis of the most commonly reported trend estimate yielded a pooled overall APCi of + 1.33 (95% CI, 0.97 to 1.68; p < 0.0001) that is largely driven by findings from North America and Australia. Also contributing to these trends is the increasing risk of rectal cancer as among 14 studies assessing cancer site, nine showed an increased risk of rectal cancer in adults less than 50 years with APCi up to + 4.03 (p < 0.001). Our systematic review highlights increasing yCRC risk in North America and Australia driven by rising rectal cancers in younger adults over the past two decades.