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Mayo Clin Proc. 2014 Feb;89(2):216-24. doi: 10.1016/j.mayocp.2013.09.006. Epub 2014 Jan 4.

The increasing incidence of young-onset colorectal cancer: a call to action.

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Department of Veterans Affairs, Eastern Colorado Healthcare System, and Division of Gastroenterology, University of Colorado School of Medicine, Denver. Electronic address:
Wade Outcomes Research and Consulting, Salt Lake City, UT.
University of Louisville School of Medicine, and Colon Cancer Prevention Project, Louisville, KY.
Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
Colon Cancer Alliance, Washington, DC.
Clinical Cancer Genetics & Prevention, The Johns Hopkins Hospital, Baltimore, MD.
Global Colon Cancer Alliance, Bala Cynwyd, PA.
University of Texas, MD Anderson Cancer Center, Houston.


In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.


APC; CRC; FAP; FDR; HR; MSS; PCP; SEER; Surveillance, Epidemiology, and End Results; annual percent change; colorectal cancer; familial adenomatous polyposis; first-degree relative; hazard ratio; microsatellite stable; primary care physician

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