Age and Stage Trends in Early-Onset Colorectal Cancer Incidence Before and After the USPSTF 2021 Update.

Abstract

Early-onset colorectal cancer (CRC) incidence has increased in the US, raising concern about changing risk among adults aged 20-49 years. In 2021, the US Preventive Services Task Force lowered the recommended starting age for average-risk CRC screening from 50 to 45 years. This study examined whether CRC incidence trends were concentrated among adults newly eligible for screening. Analyzing the latest SEER data for malignant CRCs from 2004-2023, the study estimated annual percentage changes (APCs) using log-linear regression for adults aged 20-49 years overall and for age groups 20-44, 45-49, and 50-54 years, further stratified by early-stage and late-stage diagnosis. Joint-Point analyses were performed as a sensitivity check. In 2023, there were 10,395 early-onset CRC diagnoses, corresponding to an incidence rate of 18.1 per 100,000. Overall early-onset CRC incidence increased by 1.95% per year in 2004-2019 and 8.41% per year in 2021-2023. The largest recent increase occurred among adults aged 45-49 years, whose all-stage APC rose from 1.31% in 2004-2019 to 14.38% in 2021-2023. Among adults aged 45-49 years, early-stage CRC increased by 32.14% per year in 2021-2023, compared with 0.12% per year in 2004-2019; late-stage CRC increased by 3.29% per year in 2021-2023. Trends among adults aged 20-44 and 50-54 years were comparatively stable, but rising. Recent acceleration in early-onset CRC incidence was concentrated among adults aged 45-49 years, especially early-stage diagnoses, suggesting increased detection after expanded screening eligibility.