Early‐onset colorectal cancer

Joanne P Young, Aung Ko Win, Christophe Rosty, Ingrid Flight, David Roder, Graeme P Young, Oliver Frank, Graeme K Suthers, Peter J Hewett, Andrew Ruszkiewicz, Ehud Hauben, Barbara‐Ann Adelstein, Susan Parry, Amanda Townsend, Jennifer E Hardingham, Timothy J Price

The average age at diagnosis for colorectal cancer in Australia is 69, and the age-specific incidence rises rapidly after age 50 years. The incidence has stabilised or is declining in older age groups in Australia during recent decades, possibly related to the increased uptake of screening and high-risk surveillance. In the same time frame, a rising incidence of colorectal cancer in younger adults has been well-documented in the United States. This rise in incidence in the young has not been reported from other countries which share long-term exposure to westernised urban lifestyles. Using data from the Australian Institute of Health and Welfare, we examined trends in national incidence rates for colorectal cancer under age 50 years, and observed that rates in people under age 40 years have been rising for the last two decades. We further performed a review of the literature regarding colorectal cancer in young adults, to outline the extent of current understanding, explore potential risk factors such as obesity, alcohol and sedentary lifestyles, and to identify the questions remaining to be addressed. Though absolute numbers might not justify a population screening approach, the dispersal of young adults with colorectal cancer across the primary healthcare system decreases probability of their recognition. Patient and physician awareness, aided by stool and emerging blood screening tests and risk profiling tools, have the potential to aid in identification of those young adults who would most benefit from a colonoscopy through early detection of colorectal cancers or by removal of advanced polyps.