EP229 - Temporal trends in early-onset colorectal cancer incidence and cancer mortality among young Americans

ePoster Presenter(s)

• AJ

  Annabelle Jones, MD, MPH

  Resident Physician
  Brigham & Women's Hospital
  Cambridge, Massachusetts, United States

  Disclosure information not submitted.

Author(s)

• ZQ

  Zhiyu Qian, MD

  Resident
  Department of Urology, Brigham and Women's Hospital, Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• 

  George Q. Zhang, MD, MPH

  Resident
  Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
  Brigham and Women's Hospital, Boston, MA
  Boston, MA, United States

  Disclosure information not submitted.
• 

  Ezra S. Brooks, MD

  Surgery Resident
  Brigham and Women's Hospital
  Brigham and Women’s Hospital
  Brookline, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Nelya Melnitchouk, MD

  Assistant Professor
  Brigham and Women's Hospital
  Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• 

  Jennifer Irani, MD (she/her/hers)

  Assistant Professor of Surgery
  Brigham and Women's Hospital
  Boston, MA, United States

  Disclosure information not submitted.
• 

  Ronald Bleday, M.D.

  Chief of Colorectal Surgery
  Brigham and Woman's Hospital
  Boston, Massachusetts, United States

  Disclosure information not submitted.

Senior Author(s)

• JG

  Joel E. Goldberg, MD, MPH

  Colorectal Surgeon
  Brigham and Women's Hospital
  Boston, Massachusetts, United States

  Disclosure information not submitted.

Purpose/Background: The incidence of early-onset colorectal cancer (eoCRC) in the United States (US) and worldwide is increasing. Though some studies have suggested that eoCRC is biologically distinct and more aggressive when compared to average-onset disease, it remains unclear how trends in incidence parallel with overall outcomes of treatment. We compared temporal trends in eoCRC incidence and cancer-specific mortality to further evaluate this.

Methods/Interventions: We conducted an analysis using the Surveillance, Epidemiology, and End Results (SEER) Program from 2000-2022, which captures cancer incidence, prevalence, and survival data from US cancer registries representing approximately 30% of the population. We collected population-level, age-adjusted CRC incidence and cancer mortality rates by year for adults under 50 years of age at time of diagnosis. Five-year cancer mortality was estimated using an actuarial method for individuals diagnosed between 2000-2017. Patients were stratified by sex, race (White, Black, Asian/Pacific Islander), and location of primary malignancy (colon, rectum). Temporal changes were evaluated using average annual percent change (AAPC) using the first and last year of available data.

Results/Outcomes: Between 2000 and 2022, the overall age-adjusted incidence of eoCRC increased from 5.8 to 9.5 per 100,000 individuals (AAPC=2.28%; Figure), whereas the estimated 5-year cancer-specific mortality remained relatively stable between 2000 and 2017, from 1.9 to 2.0 per 100,000 individuals (AAPC=0.35%). The incidence of eoCRC increased from 6.2 to 9.7 (AAPC=2.06%) for males and 5.4 to 9.4 (AAPC=2.53%) for females during the study period, whereas the estimated cancer mortality remained similar (AAPC=0.48% for males, 0.19% for females). There was an increased incidence of eoCRC among White (5.8 to 9.6; AAPC=2.31%) and Asian/Pacific Islander (5.4 to 8.4; AAPC=2.00%) individuals compared to Black individuals (6.2 to 8.5; AAPC=1.41%); trends in cancer-specific mortality across race groups did not significantly differ. Incidence of colon and rectal primary cancers increased similarly (3.5 to 5.8, AAPC=2.29%; 2.3 to 3.7, AAPC=2.27%; respectively), whereas there was a slightly greater increase in mortality among colon vs. rectal cancers (AAPC=0.52% vs. 0.10%, respectively).

Conclusion/Discussion: The incidence of eoCRC in the US appears to be rising across sex, race, and tumor location, though cancer-specific mortality was relatively stable across the study period. These findings may reflect improved detection and disease occurrence, balanced with improved treatment strategies and access to care for young patients. Ongoing investigation into specific drivers of CRC incidence and mortality among young patients is needed.

Figure. Trends in early-onset colorectal cancer incidence and cancer-specific mortality.
Mortality data available from 2000-2017 given derivation from 5-year follow-up estimates.