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. 2019 Oct 1;111(10):1104-1106.
doi: 10.1093/jnci/djz098.

State Variation in Early-Onset Colorectal Cancer in the United States, 1995-2015

Rebecca L Siegel, Genet A Medhanie, Stacey A Fedewa, Ahmedin Jemal

State Variation in Early-Onset Colorectal Cancer in the United States, 1995-2015

Rebecca L Siegel et al. J Natl Cancer Inst. .

Abstract

The extent to which the increase in early-onset colorectal cancer (CRC) in the United States varies geographically is unknown. We analyzed changes in CRC incidence and risk factors among people aged 20-49 years by state using high-quality population-based cancer registry data provided by the North American Association of Central Cancer Registries and national survey data, respectively. Early-onset CRC incidence was mostly stable among blacks and Hispanics but increased in 40 of 47 states among non-Hispanic whites, most prominently in western states. For example, rates increased in Washington from 6.7 (per 100 000) during 1995-1996 to 11.5 during 2014-2015 (rate ratio = 1.73, 95% confidence interval = 1.48 to 2.01) and in Colorado from 6.0 to 9.5 (rate ratio = 1.57, 95% confidence interval = 1.30 to 1.91). Nevertheless, current CRC incidence was highest in southern states. From 1995 to 2005, increases occurred in obesity prevalence in all states and heavy alcohol consumption in one-third of states, but neither were correlated with CRC incidence trends. Early-onset CRC is increasing most rapidly among whites in western states. Etiologic studies are needed to explore early life colorectal carcinogenesis.

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Figures

Figure 1.
Figure 1.
Average annual percent change (AAPC) in colon and rectal cancer incidence rates during 2006–2015 among non-Hispanic white adults aged 20 to 49 years by state. Trend was designated as “stable” if the AAPC was not statistically significantly different from zero. Because of missing data years, AAPC is based on 2001–2010 for Nevada and 2003–2012 for New Mexico. AAPC could not be calculated for states with fewer than 6 cases per year. CRC = colorectal cancer.
Figure 2.
Figure 2.
Colorectal cancer incidence rates during 2011–2015 among non-Hispanic white adults aged 20 to 49 years by state. Rates are per 100 000 population and age-standardized to the 2000 US standard population. Incidence rate is based on data during 2011–2014 for the District of Columbia, 2011–2012 for New Mexico, and 2006–2010 for Nevada.
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