Greatest Increase in Mortality from Early-Onset Colorectal Cancer Seen Among Youngest US Adults

An “alarming” rise in mortality from early-onset colorectal cancer (EO-CRC) over the past 20 years has been most pronounced in young adults, aged 20 to 44 years, according to research presented at the 2024 annual scientific meeting of the American College of Gastroenterology, held October 25-30, in Philadelphia, PA.

Yazan Abboud, MD

Rutgers New Jersey Medical School

The increased incidence of CRC among young adults prompted US professional organizations, including the US Preventive Services Task Force, to lower the recommended age from 50 to 45 to initiate annual screening, investigators from Rutgers New Jersey Medical School in Newark, NJ, observed. Their study was designed to better understand the age at which deaths are occurring and at what stage of CRC disease. 

Led by Yazan Abboud, MD, from the department of internal medicine, the researchers compared EO-CRC mortality between young (age 20 to 44 years) and younger-age (45 to 54 years) cohorts across different stages of clinical diagnosis. Abboud and colleagues collected data on EO-CRC age-adjusted mortality rates between 2000 and 2020 from the database of the National Center of Health Statistics of the CDC. For stage-specific incidence-based mortality rates, the team collected data from the Surveillance, Epidemiology, and End Results 22 (SEER 22) database from 2004 to 2020. Stage at diagnosis was divided between early (in situ, localized) and late (regional, distant).

The researchers found overall that a decrease in EO-CRC mortality between 2000 and 2005 was followed by an increase between 2005 and 2022 (annual percentage change [APC], 0.87). Trends were similar to those overall in the cohort aged 45 to 54 years (107,280 deaths), with a decrease in mortality seen between 2000 and 2005 followed by an increase between 2005 and 2022 (APC, 0.87). For the youngest participants, aged 20 to 44 years (39,746 deaths) a steady increase in EO-CRC was seen across the study period, between 2000 and 2022 (APC, 0.93).

When Abboud and colleagues compared the increase in mortality between the age cohorts, the increase was greater among the 20- to 44-years-old vs the 45- to 54-year-olds, with nonidentical, nonparallel data and an average APC (AAPC)-difference of 0.85 (P <.01).

Deaths attributed to EO-CRC in the SEER 22 database numbered 147 026, according to the study abstract. Mortality for early-stage disease (4,026 deaths) increased (AAPC, 12.37) in the age 45 to 54 years cohort. Researchers said that the sample size was insufficient for analysis among those aged 20 to 44 years. For late-stage tumors (37 875 deaths) mortality increased (AAPC, 10.56) across the 2 cohorts: 45 to 54 years (AAPC, 11.17) and 20 to 44 years (AAPC, 13.87).

The concerning rise in EO-CRC mortality over the 2-decade study period was seen for both early- and late-stage tumors, the authors concluded. "These findings reinforce the need for increased advocacy for CRC screening in younger patients aiming to improve outcomes," they wrote.

Source: Abboud Y, Shah A, Hajifathalian K, Gaglio P, Al-Khazraji A. Rising mortality of early-onset colorectal cancer particularly in patients younger than 45 years: insights from the largest mortality databases in the US over two decades. Abstract presented at: American College of Gastroenterology 2024 Scientific Meeting; October 25-30, 2024; Philadelphia, PA. https://acgposters2024.eventscribe.net/fsPopup.asp?PosterID=683312&mode=posterInfo