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Original article
Global patterns and trends in colorectal cancer incidence in young adults
  1. Rebecca L Siegel1,
  2. Lindsey A Torre1,
  3. Isabelle Soerjomataram2,
  4. Richard B Hayes3,
  5. Freddie Bray2,
  6. Thomas K Weber4,5,
  7. Ahmedin Jemal1
  1. 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA
  2. 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
  3. 3 Department of Population Health, New York University School of Medicine, New York, New York, USA
  4. 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  5. 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA
  1. Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; rebecca.siegel{at}


Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking.

Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA).

Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)).

Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.

  • colorectal cancer
  • epidemiology
  • gastrointestinal cancer

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  • Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.