Colorectal cancer incidence among young adults in England: Trends by anatomical sub-site and deprivation

Autoři: Aimilia Exarchakou aff001;  Liam J. Donaldson aff002;  Fabio Girardi aff001;  Michel P. Coleman aff001
Působiště autorů: Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom aff001;  Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225547



Colorectal cancer incidence in the UK and other high-income countries has been increasing rapidly among young adults. This is the first analysis of colorectal cancer incidence trends by sub-site and socioeconomic deprivation in young adults in a European country.


We examined age-specific national trends in colorectal cancer incidence among all adults (20–99 years) diagnosed during 1971–2014, using Joinpoint regression to analyse data from the population-based cancer registry for England. We fitted a generalised linear model to the incidence rates, with a maximum of two knots. We present the annual percentage change in incidence rates in up to three successive calendar periods, by sex, age, deprivation and anatomical sub-site.


Annual incidence rates among the youngest adults (20–39 years) fell slightly between 1971 and the early 1990s, but increased rapidly from then onwards. Incidence Rates (IR) among adults 20–29 years rose from 0.8 per 100,000 in 1993 to 2.8 per 100,000 in 2014, an average annual increase of 8%. An annual increase of 8.1% was observed for adults aged 30–39 years during 2005–2014. Among the two youngest age groups (20–39 years), the average annual increase for the right colon was 5.2% between 1991 and 2010, rising to 19.4% per year between 2010 (IR = 1.2) and 2014 (IR = 2.5). The large increase in incidence rates for cancers of the right colon since 2010 were more marked among the most affluent young adults. Smaller but substantial increases were observed for cancers of the left colon and rectum. Incidence rates in those aged 50 years and older remained stable or decreased over the same periods.


Despite the overall stabilising trend of colorectal cancer incidence in England, incidence rates have increased rapidly among young adults (aged 20–39 years). Changes in the prevalence of obesity and other risk factors may have affected the young population but more research is needed on the cause of the observed birth cohort effect. Extension of mass screening may not be justifiable due to the low number of newly diagnosed cases but clinicians should be alert to this trend.

Klíčová slova:

Age groups – Antigen-presenting cells – Cancer detection and diagnosis – Colon – Colorectal cancer – England – Rectum – Young adults


1. Office for National Statistics. Cancer Registration Statistics, England: 2016. Newport: Office for National Statistics; 2018.

2. American Cancer Society. Colorectal Cancer Facts & Figures 2017–2019. Atlanta: American Cancer Society, 2017.

3. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, et al. Colorectal cancer statistics, 2017. CA: A Cancer Journal for Clinicians. 2017;67:177–93.

4. Welch HG, Robertson DJ. Colorectal Cancer on the Decline—Why Screening Can’t Explain It All. N Engl J Med. 2016;374:1605–7. doi: 10.1056/NEJMp1600448 27119236

5. Austin H, Jane Henley S, King J, Richardson LC, Eheman C. Changes in colorectal cancer incidence rates in young and older adults in the United States: what does it tell us about screening. Cancer Causes & Control. 2014;25:191–201.

6. Brenner DR, Ruan Y, Shaw E, De P, Heitman SJ, Hilsden RJ. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med. 2017;105:345–9. doi: 10.1016/j.ypmed.2017.10.007 28987338

7. Campos FGCM Figueiredo MN, Monteiro M Nahas SC, Cecconello I. Incidence of colorectal cancer in young patients. Rev Col Bras Cir. 2017;44:208–15. doi: 10.1590/0100-69912017002004

8. Troeung L, Sodhi-Berry N, Martini A, Malacova E, Ee H, O’Leary P, et al. Increasing incidence of colorectal cancer in adolescents and young adults aged 15–39 years in Western Australia 1982–2007: Examination of colonoscopy history. Front Public Health. 2017;5:1–8. doi: 10.3389/fpubh.2017.00001

9. Vuik FE, Nieuwenburg SA, Bardou M, Lansdorp-Vogelaar I, Dinis-Ribeiro M, Bento MJ, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut. 2019.

10. Araghi M, Soerjomataram I, Bardot A, Ferlay J, Cabasag CJ, Morrison DS, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol. 2019.

11. You Y, Xing Y, Feig BW, Chang GJ, Cormier JN. Young-onset colorectal cancer: Is it time to pay attention? Arch Intern Med. 2012;172:287–9. doi: 10.1001/archinternmed.2011.602 22157065

12. Singh KE, Taylor TH, Pan CJG, Stamos MJ, Zell JA. Colorectal cancer incidence among young adults in California. Journal of Adolescent and Young Adult Oncology. 2014;3:176–84. doi: 10.1089/jayao.2014.0006 25538862

13. Bhandari A, Woodhouse M, Gupta S. Colorectal cancer is a leading cause of cancer incidence and mortality among adults younger than 50 years in the USA: a SEER-based analysis with comparison to other young-onset cancers. J Investig Med. 2017;65:311–5. doi: 10.1136/jim-2016-000229 27864324

14. Oliphant R, Brewster DH, Morrison DS. The changing association between socioeconomic circumstances and the incidence of colorectal cancer: a population-based study. Br J Cancer. 2011;104:1791–6. doi: 10.1038/bjc.2011.149 21559020

15. National Cancer Intelligence Network. Cancer by deprivation in England: Incidence, 1996–2010 & Mortality, 1997–2011. United Kingdom: Public Health England and Cancer Research UK; 2014.

16. Tweed EJ, Allardice GM, McLoone P, Morrison DS. Socio-economic inequalities in the incidence of four common cancers: a population-based registry study. Public Health. 2018;154:1–10. doi: 10.1016/j.puhe.2017.10.005 29128730

17. Li R, Abela L, Moore J, Woods LM, Nur U, Rachet B, et al. Control of data quality for population-based cancer survival analysis. Cancer epidemiology. 2014;38:314–20. doi: 10.1016/j.canep.2014.02.013 24685409

18. World Health Organisation. International Classification of Diseases, 8th edition. Geneva: World Health Organisation; 1965. 85–119 p.

19. World Health Organisation. International Classification of Diseases, 1975. Ninth revision. Geneva: WHO; 1977.

20. World Health Organisation. International statistical classification of diseases and related health problems. Tenth revision. Geneva: World Health Organization; 1994.

21. Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;109.

22. Department for Communities and Local Government. The English Indices of Deprivation 2015. Ministry of Housing, Communities & Local Government; 2015.

23. Woods LM, Rachet B, Coleman MP. Choice of geographic unit influences socioeconomic inequalities in breast cancer survival. British Journal of Cancer. 2005;92:1279–82. doi: 10.1038/sj.bjc.6602506 15798765

24. England Population Estimates 1971 to 2014 [Internet]. Available from:

25. Number of deaths and populations in deprivation decile areas by sex and single year of age, England and Wales, registered years 2001 to 2016 [Internet]. 2017. Available from:

26. National Cancer Institute. Joinpoint Regression Program, Version Statistical Methodology and Applications Branch, Surveillance Research Program; 2017 [cited 2018 07 January]. Available from:

27. Crosbie AB, Roche LM, Johnson LM, Pawlish KS, Paddock LE, Stroup AM. Trends in colorectal cancer incidence among younger adults-Disparities by age, sex, race, ethnicity, and subsite. Cancer Med. 2018;7:4077–86. doi: 10.1002/cam4.1621 29932308

28. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81. doi: 10.1016/S0140-6736(14)60460-8 24880830

29. Kantor ED, Udumyan R, Signorello LB, Giovannucci EL, Montgomery S, Fall K. Adolescent body mass index and erythrocyte sedimentation rate in relation to colorectal cancer risk. Gut. 2016;65:1289–95. doi: 10.1136/gutjnl-2014-309007 25986947

30. NHS Digital. Statistics on Obesity, Physical Activity and Diet, England, 2019. 2019.

31. Meat Red and Meat Processed. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon (FR)2018.

32. World Cancer Research Fund International, American Institute for Cancer Research. Continuous update project report: diet, nutrition, physical activity and colorectal cancer. London: 2017.

33. Poti JM, Popkin BM. Trends in energy intake among US children by eating location and food source, 1977–2006. J Am Diet Assoc. 2011;111:1156–64. doi: 10.1016/j.jada.2011.05.007 21802561

34. Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med. 2002;35:107–13. doi: 10.1006/pmed.2002.1037 12200094

35. Nimptsch K, Wu K. Is Timing Important? The Role of Diet and Lifestyle during Early Life on Colorectal Neoplasia. Curr Colorectal Cancer Rep. 2018;14:1–11. doi: 10.1007/s11888-018-0396-7 30140177

36. Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013;369:954–64. doi: 10.1056/NEJMra1203528 24004122

37. Lacy BE, Patel H, Guerin A, Dea K, Scopel JL, Alaghband R, et al. Variation in Care for Patients with Irritable Bowel Syndrome in the United States. PLoS One. 2016;11.

38. El-Sayed AM, Scarborough P, Galea S. Unevenly distributed: a systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom. BMC Public Health. 2012;12:18. doi: 10.1186/1471-2458-12-18 22230643

39. Shather Z, Laverty AA, Bottle A, Watt H, Majeed A, Millett C, et al. Sustained Socioeconomic Inequalities in Hospital Admissions for Cardiovascular Events Among People with Diabetes in England. Am J Med. 2018;131:1340–8. doi: 10.1016/j.amjmed.2018.07.003 30055121

40. Everson SA, Maty SC, Lynch JW, Kaplan GA. Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes. J Psychosom Res. 2002;53:891–5. doi: 10.1016/s0022-3999(02)00303-3 12377299

41. Hirst Y, Stoffel S, Baio G, McGregor L, von Wagner C. Uptake of the English Bowel (Colorectal) Cancer Screening Programme: an update 5 years after the full roll-out. Eur J Cancer. 2018;103:267–73. doi: 10.1016/j.ejca.2018.07.135 30196989

42. McPhail S, Elliss-Brookes L, Shelton J, Ives A, Greenslade M, Vernon S, et al. Emergency presentation of cancer and short-term mortality. Br J Cancer. 2013;109:2027–34. doi: 10.1038/bjc.2013.569 24045658

43. Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva: World Health Organization, 1968.

44. Department of Health. Be clear on cancer—national campaign to promote earlier diagnosis of bowel cancer. London: Department of Health, 2011.

45. Cancer Research UK. Be Clear on Cancer evaluation update 2014. Available from:

46. Bowel Cancer Symptom Checker. Available from:

Článok vyšiel v časopise


2019 Číslo 12