The Rising Incidence of Early-Onset Colorectal Cancer

Background: The incidence of early-onset (diagnosis before age 50) colorectal cancer (EO-CRC) is increasing in some high-income countries. The present study analyzed this trend in Germany.Methods: The epidemiological data on the incidence of colorectal cancer (ICD-10 C18-C20) in the federal states of Germany were obtained from the German Center for Cancer Registry Data (ZfKD). The regions included were those with adequate documentation, according to the ZfKD criteria, for the years 1999-2018. Cases identified from death certificates alone were excluded. The data on mortality were derived from the official cause of death statistics. Time trends for persons aged 20-49 years were expressed as the average annual percentage change (AAPC) with 95% confidence interval. The incidence was stratified by sex, site (proximal colon, distal colon, rectum), 10-year age group (20-29, 30-39, 40-49), and tumor size (T).Results: EO-CRC accounted for 5.1% (9529 cases) of all colorectal cancers in the selected German regions. The EO-CRC incidence rose annually by 1.16% [0.51; 1.81] in men and 1.32% [0.80; 1.84] in women. The incidence of proximal colon cancer increased in both sexes (men: AAPC 3.26 [2.00; 4.53]; women: AAPC 2.99 [2.17; 3.83]), while the incidence of distal colon cancer remained unchanged.Conclusion: The incidence of EO-CRC in Germany is rising. The reasons are prob-ably multifactorial, reflecting the changing prevalence of risk and protective factors to which one is exposed in the early years of life.