Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004-2015

Abstract

Background: The incidence of colorectal cancer (CRC) in adults younger than 50 years has increased in the United States over the past decades according to Surveillance, Epidemiology, and End Results data. National guidelines conflict over beginning screening at the age of 45 or 50 years.

Methods: This was a retrospective study of National Cancer Data Base data from 2004 to 2015. The Cochran-Armitage test for trend was used to assess changes in the proportion of cases diagnosed at an age younger than 50 years.

Results: This study identified 130,165 patients diagnosed at an age younger than 50 years and 1,055,598 patients diagnosed at the age of 50 years or older. The proportion of the total number of patients diagnosed with CRC at an age younger than 50 years rose (12.2% in 2015 vs 10.0% in 2004; P < .0001). Younger adults presented with more advanced disease (stage III/IV; 51.6% vs 40.0% of those 50 years old or older). Among men, diagnosis at ages younger than 50 years rose only in non-Hispanic whites (P < .0001), whereas among women, Hispanic and non-Hispanic whites had increases in younger diagnoses over time (P < .05). All income quartiles had a proportional increase in younger adults over time (P < .001), with the highest income quartile having the highest proportion of younger cases. The proportion of younger onset CRC cases rose in urban areas (P < .001) but did not rise in rural areas.

Conclusions: The proportion of persons diagnosed with CRC at an age younger than 50 years in the United States has continued to increase over the past decade, and younger adults present with more advanced disease. These data should be considered in the ongoing discussion of screening guidelines.

Keywords: National Cancer Data Base (NCDB); age; colorectal cancer; diagnosis.

Figure 1

A) The mean age of diagnosis of rectal and colon cancer cases in the NCDB has declined from 2004 to 2015 at a rate of 0.21(95% CI 0.18 to 0.24) years of age per year for rectal cancer and 0.19 (95% CI 0.16 to 0.22) years of age per year for colon cancer. B) The proportion of both rectal and colon cancer cases diagnosed prior to age 50 has increased significantly from 2004 to 2015 (p < 0.0001). Error bars indicate the 95% confidence interval. Note error bars are smaller than the points used to display some data.

Figure 2

A) The proportion of cases of colorectal cancer in the NCDB diagnosed prior to age 50 increased from 2004 to 2015 in both men and women (p < 0.0001, both groups). B) Across men and women, the proportion of cases of colorectal cancer diagnosed prior to age 50 increased from 2004 to 2015 in Hispanic whites (p < 0.05) and non-Hispanic whites (p < 0.001). C) In men, the proportion of cases of colorectal cancer diagnosed prior to age 50 increased only in non-Hispanic whites (p < 0.0001). D) In women, the proportion of cases of colorectal cancer diagnosed prior to age 50 increased in Hispanic whites (p < 0.05) and non-Hispanic whites (p < 0.001). Error bars indicate the 95% confidence interval. Note error bars are smaller than the points used to display some data.

Figure 3

A) The proportion of colorectal cancer cases in the NCDB diagnosed prior to age 50 increased from 2004 to 2015 in urban areas (counties with populations of 2500 or more, p < 0.0001), but not in rural areas (counties with populations less than 2500). B) The proportion of colorectal cancer cases diagnosed prior to age 50 increased across all income quartiles (p < 0.0001). C) The proportion of colorectal cancer cases diagnosed prior to age 50 increased over the study years in individuals with private insurance (p < 0.0001), but declined in individuals with no insurance or Medicaid coverage (p < 0.0001, both groups). Error bars indicate the 95% confidence interval. Note error bars are smaller than the points used to display some data.