Colorectal Cancer Incidence Patterns in the United States, 1974-2013

Abstract

Background: Colorectal cancer (CRC) incidence in the United States is declining rapidly overall but, curiously, is increasing among young adults. Age-specific and birth cohort patterns can provide etiologic clues, but have not been recently examined.

Methods: CRC incidence trends in Surveillance, Epidemiology, and End Results areas from 1974 to 2013 (n = 490 305) were analyzed by five-year age group and birth cohort using incidence rate ratios (IRRs) and age-period-cohort modeling.

Results: After decreasing in the previous decade, colon cancer incidence rates increased by 1.0% to 2.4% annually since the mid-1980s in adults age 20 to 39 years and by 0.5% to 1.3% since the mid-1990s in adults age 40 to 54 years; rectal cancer incidence rates have been increasing longer and faster (eg, 3.2% annually from 1974-2013 in adults age 20-29 years). In adults age 55 years and older, incidence rates generally declined since the mid-1980s for colon cancer and since 1974 for rectal cancer. From 1989-1990 to 2012-2013, rectal cancer incidence rates in adults age 50 to 54 years went from half those in adults age 55 to 59 to equivalent (24.7 vs 24.5 per 100 000 persons: IRR = 1.01, 95% confidence interval [CI] = 0.92 to 1.10), and the proportion of rectal cancer diagnosed in adults younger than age 55 years doubled from 14.6% (95% CI = 14.0% to 15.2%) to 29.2% (95% CI = 28.5% to 29.9%). Age-specific relative risk by birth cohort declined from circa 1890 until 1950, but continuously increased through 1990. Consequently, compared with adults born circa 1950, those born circa 1990 have double the risk of colon cancer (IRR = 2.40, 95% CI = 1.11 to 5.19) and quadruple the risk of rectal cancer (IRR = 4.32, 95% CI = 2.19 to 8.51).

Conclusions: Age-specific CRC risk has escalated back to the level of those born circa 1890 for contemporary birth cohorts, underscoring the need for increased awareness among clinicians and the general public, as well as etiologic research to elucidate causes for the trend. Further, as nearly one-third of rectal cancer patients are younger than age 55 years, screening initiation before age 50 years should be considered.

Figure 1.

Annual percent change (APC) in age-specific colon cancer incidence rates in the United States, 1974–2013. An asterisk indicates that the APC is statistically significantly different from zero (P < .05) using a two-sided test based on the permutation method. In order to highlight trends, the scale of the y-axis varies.

Figure 2.

Annual percent change (APC) in age-specific rectal cancer incidence rates in the United States, 1974–2013. An asterisk indicates that the APC is statistically significantly different from zero (P < .05) using a two-sided test based on the permutation method. In order to highlight trends, the scale of the y-axis varies.

Figure 3.

Summary age-specific annual percent change (i.e., local drift) and birth cohort rate ratios of colorectal cancer incidence rates in the United States. A) Local drift: summary age-specific annual percent change for colon and rectal cancer. B) Incidence rate ratios by birth cohort for colon and rectal cancer (referent cohort = 1949). Shaded bands indicate 95% confidence interval.