• Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145–64. https://doi.org/10.3322/caac.21601This study highlights the increasing incidence of early-onset colorectal cancer in the Unites States' population.

Loomans-Kropp HA, Umar A. Increasing incidence of colorectal cancer in young adults. J Cancer Epidemiol. 2019;2019:9841295.

PubMed  PubMed Central  Google Scholar 

Murphy CC, Singal AG, Baron JA, Sandler RS. Decrease in Incidence of young-onset colorectal cancer before recent increase. Gastroenterology. 2018;155(6):1716–9 e4.

PubMed  PubMed Central  Google Scholar 

Pearlman R, Frankel WL, Swanson B, Zhao W, Yilmaz A, Miller K, et al. Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncol. 2017;3(4):464–71.

PubMed  PubMed Central  Google Scholar 

Brenner DR, Heer E, Sutherland RL, Ruan Y, Tinmouth J, Heitman SJ, et al. National trends in colorectal cancer incidence among older and younger adults in Canada. JAMA Netw Open. 2019;2(7):e198090.

PubMed  PubMed Central  Google Scholar 

Araghi M, Soerjomataram I, Bardot A, Ferlay J, Cabasag CJ, Morrison DS, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol. 2019;4(7):511–8.

PubMed  Google Scholar 

Chambers AC, Dixon SW, White P, Williams AC, Thomas MG, Messenger DE. Demographic trends in the incidence of young-onset colorectal cancer: a population-based study. Br J Surg. 2020;107(5):595–605.

CAS  PubMed  PubMed Central  Google Scholar 

Vuik FE, Nieuwenburg SA, Bardou M, Lansdorp-Vogelaar I, Dinis-Ribeiro M, Bento MJ, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut. 2019;68(10):1820–6.

PubMed  PubMed Central  Google Scholar 

Chung RY, Tsoi KKF, Kyaw MH, Lui AR, Lai FTT, Sung JJ. A population-based age-period-cohort study of colorectal cancer incidence comparing Asia against the West. Cancer Epidemiol. 2019;59:29–36.

PubMed  Google Scholar 

Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar R. The shifting epidemiology of colorectal cancer in sub-Saharan Africa. Lancet Gastroenterol Hepatol. 2017;2(5):377–83.

Gabriel E, Attwood K, Al-Sukhni E, Erwin D, Boland P, Nurkin S. Age-related rates of colorectal cancer and the factors associated with overall survival. J Gastrointest Oncol. 2018;9(1):96–110.

PubMed  PubMed Central  Google Scholar 

Alvaro E, Cano JM, Garcia JL, Brandariz L, Olmedillas-Lopez S, Arriba M, et al. Clinical and molecular comparative study of colorectal cancer based on age-of-onset and tumor location: two main criteria for subclassifying colorectal cancer. Int J Mol Sci. 2019;20(4):968.

CAS  PubMed Central  Google Scholar 

Yeo H, Betel D, Abelson JS, Zheng XE, Yantiss R, Shah MA. Early-onset colorectal cancer is distinct from traditional colorectal cancer. Clin Colorectal Cancer. 2017;16(4):293–9 e6.

PubMed  Google Scholar 

Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal cancer in the young: epidemiology, prevention, management. Am Soc Clin Oncol Educ Book. 2020;40(40):1–14.

PubMed  Google Scholar 

Pan HY, Walker GV, Grant SR, Allen PK, Jiang J, Guadagnolo BA, et al. Insurance status and racial disparities in cancer-specific mortality in the United States: a population-based analysis. Cancer Epidemiol Biomark Prev. 2017;26(6):869–75.

Google Scholar 

Sineshaw HM, Ng K, Flanders WD, Brawley OW, Jemal A. Factors that contribute to differences in survival of black vs white patients with colorectal cancer. Gastroenterology. 2018;154(4):906–15 e7.

PubMed  Google Scholar 

Murphy CC, Wallace K, Sandler RS, Baron JA. Racial disparities in incidence of young-onset colorectal cancer and patient survival. Gastroenterology. 2019;156(4):958–65.

PubMed  Google Scholar 

Fass OZ, Poels KE, Qian Y, Zhong H, Liang PS. Demographics predict stage III/IV colorectal cancer in individuals under age 50. J Clin Gastroenterol. 2020;54:714–9.

PubMed  Google Scholar 

• Holowatyj AN, Ruterbusch JJ, Rozek LS, Cote ML, Stoffel EM. Racial/ethnic disparities in survival among patients with young-onset colorectal cancer. J Clin Oncol. 2016;34(18):2148–56. https://doi.org/10.1200/JCO.2015.65.0994This observational study highlights the racial disparities that exist in the age and stage of diagnosis and cancer-specific survival.

Lowery JT, Ahnen DJ, Schroy PC 3rd, Hampel H, Baxter N, Boland CR, et al. Understanding the contribution of family history to colorectal cancer risk and its clinical implications: a state-of-the-science review. Cancer. 2016;122(17):2633–45.

PubMed  PubMed Central  Google Scholar 

Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;153(1):307–23.

PubMed  Google Scholar 

Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–81.

PubMed  Google Scholar 

Meester RGS, Peterse EFP, Knudsen AB, de Weerdt AC, Chen JC, Lietz AP, et al. Optimizing colorectal cancer screening by race and sex: microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018;124(14):2974–85.

PubMed  PubMed Central  Google Scholar 

Peterse EFP, Meester RGS, Siegel RL, Chen JC, Dwyer A, Ahnen DJ, et al. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018;124(14):2964–73.

PubMed  PubMed Central  Google Scholar 

Richman I, Asch SM, Bhattacharya J, Owens DK. Colorectal cancer screening in the era of the affordable care act. J Gen Intern Med. 2016;31(3):315–20.

PubMed  Google Scholar 

Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322.

PubMed Central  Google Scholar 

Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003;57(10):778–83.

Abar L, Vieira AR, Aune D, Sobiecki JG, Vingeliene S, Polemiti E, et al. Height and body fatness and colorectal cancer risk: an update of the WCRF-AICR systematic review of published prospective studies. Eur J Nutr. 2018;57(5):1701–20.

PubMed  Google Scholar 

Park SY, Boushey CJ, Wilkens LR, Haiman CA, Le Marchand L. High-quality diets associate with reduced risk of colorectal cancer: analyses of diet quality indexes in the multiethnic cohort. Gastroenterology. 2017;153(2):386–94 e2.

PubMed  PubMed Central  Google Scholar 

Ma Y, Yang W, Song M, Smith-Warner SA, Yang J, Li Y, et al. Type 2 diabetes and risk of colorectal cancer in two large U.S. prospective cohorts. Br J Cancer. 2018;119(11):1436–42.

CAS  PubMed  PubMed Central  Google Scholar 

de Kort S, Masclee AAM, Sanduleanu S, Weijenberg MP, van Herk-Sukel MPP, Oldenhof NJJ, et al. Higher risk of colorectal cancer in patients with newly diagnosed diabetes mellitus before the age of colorectal cancer screening initiation. Sci Rep. 2017;7:46527.

PubMed  PubMed Central  Google Scholar 

Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300(23):2765–78.

CAS  PubMed  Google Scholar 

Parajuli R, Bjerkaas E, Tverdal A, Le Marchand L, Weiderpass E, Gram IT. Smoking increases rectal cancer risk to the same extent in women as in men: results from a Norwegian cohort study. BMC Cancer. 2014;14:321.

PubMed  PubMed Central  Google Scholar 

Keum N, Cao Y, Oh H, Smith-Warner SA, Orav J, Wu K, et al. Sedentary behaviors and light-intensity activities in relation to colorectal cancer risk. Int J Cancer. 2016;138(9):2109–17.

CAS  PubMed  Google Scholar 

Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18(8):e457–e71.

PubMed  PubMed Central  Google Scholar 

(NCD-RisC) NRFC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.

Google Scholar 

Dai Z, Xu YC, Niu L. Obesity and colorectal cancer risk: a meta-analysis of cohort studies. World J Gastroenterol. 2007;13(31):4199–206.

PubMed  PubMed Central  Google Scholar 

Nimptsch K, Giovannucci E, Willett WC, Fuchs CS, Wei EK, Wu K. Body fatness during childhood and adolescence, adult height, and risk of colorectal adenoma in women. Cancer Prev Res (Phila). 2011;4(10):1710–8.

Google Scholar 

Zhang X, Wu K, Giovannucci EL, Ma J, Colditz GA, Fuchs CS, et al. Early life body fatness and risk of colorectal cancer in u.s. Women and men-results from two large cohort studies. Cancer Epidemiol Biomark Prev. 2015;24(4):690–7.

Google Scholar 

Hidayat K, Yang CM, Shi BM. Body fatness at an early age and risk of colorectal cancer. Int J Cancer. 2018;142(4):729–40.

CAS  PubMed  Google Scholar 

•• Liu PH, Wu K, Ng K, Zauber AG, Nguyen LH, Song M, et al. Association of obesity with risk of early-onset colorectal cancer among women. JAMA Oncol. 2019;5(1):37–44. https://doi.org/10.1001/jamaoncol.2018.4280This is one of the largest prospective cohort studies that demonstrated that mid- and early adulthood obesity was independently associated with early-onset colorectal cancer in women.

Jung YS, Ryu S, Chang Y, Yun KE, Park JH, Kim HJ, et al. Risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years. Gastrointest Endosc. 2015;81(3):637–45 e7.

PubMed  Google Scholar 

Kim JY, Jung YS, Park JH, Kim HJ, Cho YK, Sohn CI, et al. Different risk factors for advanced colorectal neoplasm in young adults. World J Gastroenterol. 2016;22(13):3611–20.

CAS  PubMed  PubMed Central  Google Scholar 

Sanford NN, Giovannucci EL, Ahn C, Dee EC, Mahal BA. Obesity and younger versus older onset colorectal cancer in the United States, 1998-2017. J Gastrointest Oncol. 2020;11(1):121–6.

PubMed  PubMed Central  Google Scholar 

Syed AR, Thakkar P, Horne ZD, Abdul-Baki H, Kochhar G, Farah K, et al. Old vs new: risk factors predicting early onset colorectal cancer. World J Gastrointest Oncol. 2019;11(11):1011–20.

PubMed  PubMed Central  Google Scholar 

Hussan H, Patel A, Le Roux M, Cruz-Monserrate Z, Porter K, Clinton SK, et al. Rising incidence of colorectal cancer in young adults corresponds with increasing surgical resections in obese patients. Clin Transl Gastroenterol. 2020;11(4):e00160.

PubMed  PubMed Central  Google Scholar