Increasing incidence of young-onset colorectal cancers in the UK and rising mortality in rectal cancers

Yong, Karl King; Kyaw, Moe H.; Chadwick, Georgina; Sundaram, Krishna

doi:10.1136/gutjnl-2020-321069

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…According to studies conducted around the world, the incidence of CRC is increasing in people under 50 and at a slower rate in people over 50 [34][35][36]. The total incidence of YoCRC in the United States and the number of cases of advanced-stage colorectal carcinomas increased twofold between 1990 and 2013, according to a study analyzing the SEER database [37].…”

Section: Discussionmentioning

confidence: 99%

National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20–49 Years): An 18-Year SEER Database Analysis

Aloysius,

Nikumbh,

Yadukumar

et al. 2024

Medicina

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Background and Objectives: Conflicting guidelines exist for initiating average-risk colorectal cancer screening at the age of 45 years. The United States Preventive Services Task Force (USPSTF) changed its guidelines in 2021 to recommend initiating screening at 45 years due to an increasing incidence of young-onset colorectal cancer. However, the American College of Physicians (ACP) recently recommended not screening average-risk individuals between 45 and 49 years old. We aim to study the national trends in the incidence of sporadic malignant polyps (SMP) in patients from 20 to 49 years old. Materials and Methods: We analyzed the Surveillance, Epidemiology, and End Results database (2000–2017) on patients aged 20–49 years who underwent diagnostic colonoscopy with at least a single malignant sporadic colorectal polyp. Results: Of the 10,742 patients diagnosed with SMP, 42.9% were female. The mean age of incidence was 43.07 years (42.91–43.23, 95% CI). Approximately 50% of malignant polyps were diagnosed between 45 and 49 years of age, followed by 25–30% between 40 and 45. There was an upward trend in malignant polyps, with a decreased incidence of malignant villous adenomas and a rise in malignant adenomas and tubulovillous adenomas. Conclusions: Our findings suggest that almost half of the SMPs under 50 years occurred in individuals under age 45, younger than the current screening threshold recommended by the ACP. There has been an upward trend in malignant polyps in the last two decades. This reflects changes in tumor biology, and necessitates further research and support in the USPSTF guidelines to start screening at the age of 45 years.

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Section: Discussionmentioning

confidence: 99%

National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20–49 Years): An 18-Year SEER Database Analysis

Aloysius,

Nikumbh,

Yadukumar

et al. 2024

Medicina

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“…The American Cancer Society (ACS) has updated its guideline on colorectal cancer screening and now recommends screening at 45 years of age for patients at average risk [34]. In a UK population-based analysis, Yong et al demonstrate the rising incidence of CRC in AYAs [35]. While a cost-effectiveness analysis needs to be carried out before any changes can be made to UK National Bowel Cancer screening guidelines, based on our scoping review, we propose screening with a flexible sigmoidoscopy at the age of 40 in patients at average risk.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of young adults with CRC across the included studies presented with rectal bleeding. The vague presentation of this disease requires increased awareness amongst clinicians, thus avoiding delayed diagnosis which may result in more advanced disease at presentation [35].…”

Section: Discussionmentioning

confidence: 99%

Sporadic colorectal cancer in adolescents and young adults: a scoping review of a growing healthcare concern

Christodoulides

Lami

Malietzis

et al. 2020

Int J Colorectal Dis

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Purpose Sporadic colorectal cancer (CRC) amongst adolescents and young adults (AYA) is increasing in incidence. The reasons for this trend are not well understood. Current guidelines do not specifically address this patient cohort. A scoping review was performed to summarise the range of available evidence and identify key areas that need to be addressed in current guidelines. Methods A systematic literature search was conducted adhering to the PRISMA statement. All potentially eligible studies were screened, and data extraction was performed by two reviewers independently. The studies were then divided into 5 broad subgroups: (1) risk factors, (2) screening, (3) clinicopathological and molecular features, (4) presentation and (5) management. Descriptive statistics were used for data analysis. Results A total of 17 studies were included from 2010 to 2019. Overall, young adults with CRC tend to present with non-specific symptoms. The majority of these patients have a delayed diagnosis and more advanced disease at presentation, with a rise in prevalence of distal colon and rectal cancers. AYAs tend to have poorly differentiated tumours and are managed more aggressively. Overall 5-year survival varies between studies. Conclusion This is, to our knowledge, the first scoping review presenting the range of available evidence on CRC in AYAs. Although the rise in incidence is recognised by specialist bodies, recommendations are limited by the sparsity of available data. We seek to highlight the need for further research, define the role of earlier screening and raise awareness to promote thorough assessment of young patients.

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“…Even though screening is feasible for colorectal neoplasia, it represents the second leading cause of cancer death globally, and its incidence continues to increase in developing nations. 1 Several studies have shown that colorectal cancer increasingly affects younger patients in the USA, the UK and Europe, 2 , 3 suggesting the need for a lower age to start screening, of 45 years old in a recent guideline. 4 This recommendation enlarges the proportion of patients who require a screening investigation, potentially increasing the unmet demands on endoscopy resources.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic?

et al. 2022

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Aim To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. Methods Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50–75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. Results Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84–0.91) / 88% (95% CI: 0.82–0.93), specificity: 94% (95% CI: 0.92–0.95) / 95.5% (95% CI: 0.94–0.97); positive likelihood ratio: 11.86 (95% CI: 5.53–25.46) / 23.07 (95% CI: 6.163–86.36); negative likelihood ratio: 0.14 (95% CI: 0.1–0.21) / 0.14 (95% CI: 0.09–0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. Conclusion CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.

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Increasing incidence of young-onset colorectal cancers in the UK and rising mortality in rectal cancers

Cited by 7 publications

References 3 publications

National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20–49 Years): An 18-Year SEER Database Analysis

National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20–49 Years): An 18-Year SEER Database Analysis

Sporadic colorectal cancer in adolescents and young adults: a scoping review of a growing healthcare concern

Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic?

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