A recent study by the American Cancer Society and published in the journal The Lancet Oncology shows that early-onset (i.e. diagnosed in adults between younger than 49 years old) colon & rectal cancer incidence rates are rising in 27 of 50 countries and territories worldwide. Notably, 20 of these countries exhibit either exclusive or faster increases for early-onset disease. In 14 countries, including the United States, rates are increasing in young adults while stabilising in those aged 50 years and older. This research emphasises the alarming global surge in this killer disease in younger people and points to the need for colorectal cancer screening even for those under age 50.
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The Global Phenomenon Of Early-Onset Colon & Rectal Cancer
The primary objective of the study was to examine contemporary colon & rectal cancer incidence trends in young versus older adults using data through 2017 from 50 countries and territories. The data were compiled using the Cancer Incidence in Five Continents Plus, and trends were examined for age-standardized incidence rates of colon & rectal cancer ranging from 1943 to 2017. Temporal trends were visualised and quantified by age at diagnosis (25-49 years and 50-74 years). Average annual percentage changes were estimated for the last 10 years of data.
“The increase in early-onset colorectal cancer is a global phenomenon,” said Dr. Hyuna Sung, senior principal scientist, cancer surveillance research at the American Cancer Society and lead author of the study. Previous studies have documented this rise predominantly in high-income Western countries, but the current study reveals its presence across various economies and regions worldwide.
Trends In Early-Onset Colon & Rectal Cancer
Over the past decade, incidence rates of early-onset colon & rectal cancer (ages 25-49) were stable in 23 countries but increased in 27 countries. The greatest annual increases were observed in New Zealand (4.0%), Chile (4.0%), and Puerto Rico (3.8%). Fourteen of the 27 countries and territories showed either stable (Puerto Rico, Argentina, Norway, France, Ireland) or decreasing rates (Israel, Canada, the U.S., England, Germany, Scotland, Slovenia, Australia, and New Zealand) in older adults. Singapore was not covered in this survey. However, MOH data shows that overall colon & rectal cancer incidence in Singapore has been on the increase as well. MOH notes that from the period of 1968-1972 to 2018-2022, there was a notable rise in the Age-Standardised Incidence Rate of colorectal cancer – from 19.4 to 37.9 per 100,000 population for men. For women, there was also an increase, from 15.4 to 27.0 per 100,000 population over the same period. Singapore has similar lifestyle and demographic trends as many of the countries covered in the American Cancer Society survey, and it would not be surprising that the same trend of early-onset colorectal cancer applies in Singapore too.
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Contact UsGender Differences And Regional Variations
The rise in early-onset colon & rectal cancer was faster among men than women in countries such as Chile, Puerto Rico, Argentina, Ecuador, Thailand, Sweden, Israel, and Croatia. In contrast, young women experienced faster increases in countries like England, Norway, Australia, Türkiye, Costa Rica, and Scotland. For the remaining 13 countries with increasing trends in both age groups, the annual percentage increase in young compared to older adults varied.
Highest And Lowest Incidence Rates
For the past five years, the incidence rate of early-onset colon & rectal cancer was highest in Australia, Puerto Rico, New Zealand, the U.S., and the Republic of Korea (14 to 17 per 100,000), and lowest in Uganda and India (4 per 100,000).
The Need For Prevention And Awareness
“The global scope of this concerning trend highlights the need for innovative tools to prevent and control cancers linked to dietary habits, physical inactivity, and excess body weight,” added Dr. Sung. Ongoing efforts are essential to identify additional factors behind these trends and to develop effective prevention strategies tailored to younger generations and local resources worldwide.
Raising awareness of the trend and the distinct symptoms of early-onset colon & rectal cancer (e.g., rectal bleeding, abdominal pain, altered bowel habits, and unexplained weight loss) among young people and primary care providers can help reduce delays in diagnosis and decrease mortality. Regular colorectal cancer screening (e.g. FIT stool test, colonoscopy) is particularly important as colon & rectal cancer is a “silent killer” and is often without symptoms in the early stages.
By understanding these global trends in colon & rectal cancer, we can take proactive steps to promote early detection, encourage healthy lifestyle choices, and develop targeted prevention strategies to combat this growing health concern.
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Patient Story In Straits Times – Singapore Stage 3 Colorectal Cancer Patient Just 36 Years Old, No Typical Symptoms Experienced
- A case reported by The Straits Times on 10 April highlights the alarming rise of colorectal cancer in younger adults. It involved a patient, Mr Ambrose Lee, who was diagnosed at just 36 years old.
- Mr Lee initially experienced heart palpitations and shortness of breath in July 2022, which he believed were after-effects of a Covid-19 infection.
- A GP found no immediate cause for concern but referred him to Ng Teng Fong General Hospital, where blood tests revealed critically low red blood cell levels.
- Thalassaemia was first suspected, and iron infusions were administered, but persistently low iron levels led to further investigation.
- Despite normal scans showing no internal bleeding, a colonoscopy and upper endoscopy revealed a tumour in the colon, leading to an initial diagnosis of Stage 2 colon cancer.
- Unusually, Mr Lee displayed none of the common colorectal cancer symptoms like bowel habit changes or abdominal discomfort; his only sign was a long-standing sensation of incomplete bowel evacuation.
- During surgery, the cancer was found to have spread to the lymph nodes, resulting in a revised diagnosis of Stage 3 and the removal of half his colon.
- The patient subsequently underwent eight cycles of chemotherapy across six months.
- His case underscores the importance of seeking second opinions and comprehensive testing, even in the absence of classic symptoms and at a young age.
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