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This study looked at a range of countries and territories to compare how rates of colorectal cancer have changed in both younger (20-49) and older (50-74). The study found that rates of colorectal cancer are increasing in 27 of the 50 countries and territories they looked at. England saw one of the highest increases diagnosis rates behind New Zealand, Chile and Puerto Rico.
In Ireland, rates of diagnosis have remained relatively stable in older adults, but have increased among younger adults.
Studies like this do not attempt to demonstrate the cause of these statistics, and in studies like this it’s worth noting that the amount and quality of data can vary country to country.
Dr Damien Bennett, Director, Northern Ireland Cancer Registry, School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast, said:
The results show an increase in the global incidence of EOCRC in many countries over several decades up to 2017. This paper finds that early-onset colorectal cancer (EOCRC) incidence is increasing in over half the countries or territories (27 of 50) and that in 20 of these the increase is either exclusively occurring in the younger group or is increasing faster than in older adults. Countries like Australia, the USA, and New Zealand were found to have higher EOCRC rates, while there was a faster rise among men in some regions (e.g. Chile, Argentina, Thailand, Sweden) and women in others (England, Scotland, Norway, Australia). These trends are concerning for many reasons – they provide an indicator of future disease burden on an already-stretched health service and also of potential loss of productivity and economic impact which CRC may have in those of working age.
The study emphasises the importance of seeking to understand why this is happening, and at present there is not a definitive answer for the observed increase in EOCRC. Risk factors identified for EOCRC to date include dietary factors, alcohol consumption, tobacco use and increased BMI, factors that are also associated with late onset CRC. Better understanding of the reasons driving the observed trends remains difficult, although lifestyle factors are likely contributing. Novel areas of research being explored include antibiotic usage, gut microbiome, outdoor air pollution and early life exposures, but the exact nature of their contributions is yet to be established.
Education of healthcare professionals and the general public about EOCRC is vital, as increasing awareness should support earlier detection and improved outcomes for patients with EOCRC. EOCRC patients are a group with unique supportive care needs, given their stage in life. Holistic care providing support in the areas of mental health, fertility, sexual health, financial support and family support is key.
However, the paper has some limitations including the lack of data on the stage of cancer, which is the severity of disease or extent of its spread, and also the lack of information on, for example, levels of obesity and physical activity or the availability of bowel cancer screening in the various countries studied.
The findings provide a high-level global overview of trends in EOCRC, which is increasing in many countries. This is a very useful update which builds on previous work in the field, and demonstrates trends which demand immediate action. Global research and collaboration is urgently required, to address questions such as EOCRC risk factors, early detection and prevention measures, optimal treatment strategies for these patients, and how to integrate holistic care into current clinical pathways.
Dr David Robert Grimes, Assistant Professor of Biostatistics, School of Medicine, Trinity College Dublin, said:
“Comparing international data about cancer rates is a difficult undertaking, as there is consideration variation in data quality and availability. The researchers found that early onset colorectal cancer rates appear to be increasing in 27 of the 50 territories analysed, but this study cannot tell us why this might be, nor why this isn’t consistent for all countries. It is accordingly crucial that we do not over interpret such findings; while the headline might seem worrying in isolation, it could also mean that screening and improved detection are allowing us to catch cancers earlier. This finding is interesting, but we have to resist the urge to jump to conclusions, especially with conflicting and complicated data.”
Prof Mark Lawler, Professor of Digital Health at Queen’s University Belfast, said:
“This data intelligence reflects a really worrying trend in colorectal cancer in younger people, with Ireland showing increases in this demographic, while colorectal cancer incidence in older people in Ireland remains broadly the same. This development, which may reflect diet, a more sedentary lifestyle and obesity, could reverse the decades of progress that have been made against this disease which kills nearly 1,500 people on the island of Ireland each year”
‘Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data’ by Sung et. al was published in The Lancet Oncology at 23:30 Irish time Wednesday 11th December 2024.
DOI: https://doi.org/10.1016/S1470-2045(24)00600-4
Declarations of Interest:
Prof Lawler is a member of the Scientific Advisory Board of Bowel Cancer UK.
For all other experts, no reply to our request for DOIs was received.