title: Rising incidence of early-onset colorectal cancer in Australia over two decades: report and review.
abstract: The average age at diagnosis for colorectal cancer (CRC) in Australia is 69, and the age-specific incidence rises rapidly after age 50 years. The incidence has stabilized 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 CRC 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 that 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 CRC 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 CRC 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. Although absolute numbers might not justify a population screening approach, the dispersal of young adults with CRC across the primary health-care 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 CRCs or by removal of advanced polyps.
authors.affiliation: Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; South Australian Health and Medical Research Institute (SAHMRI) Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Young
authors.forename: Aung Ko
authors.initials: AK
authors.lastname: Win
authors.forename: Christophe
authors.initials: C
authors.lastname: Rosty
authors.forename: Ingrid
authors.initials: I
authors.lastname: Flight
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Young
authors.forename: Oliver
authors.initials: O
authors.lastname: Frank
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Suthers
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hewett
authors.forename: Andrew
authors.initials: A
authors.lastname: Ruszkiewicz
authors.forename: Ehud
authors.initials: E
authors.lastname: Hauben
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Adelstein
authors.forename: Susan
authors.initials: S
authors.lastname: Parry
authors.forename: Amanda
authors.initials: A
authors.lastname: Townsend
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Hardingham
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control; D042241:Early Diagnosis; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: early-onset colorectal cancer; outcomes; presentation; risk factors