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. 2024 Jun 1;154(11):1930-1939.
doi: 10.1002/ijc.34887. Epub 2024 Feb 10.

Environmental drivers of the rising incidence of early-onset colorectal cancer in the United States

Jianjiu Chen  1 , Mary Beth Terry  1   2 , Piero Dalerba  2   3   4   5   6 , Chin Hur  2   7 , Jianhua Hu  2   8 , Wan Yang  1   2
Affiliations

Environmental drivers of the rising incidence of early-onset colorectal cancer in the United States

Jianjiu Chen et al. Int J Cancer. .

Abstract

Incidence of early-onset (diagnosed before age 50) colorectal cancer (EOCRC) has increased alarmingly since the 1990s in the United States. This study investigated what environmental exposures may have driven this increase. We obtained EOCRC incidence data from the Surveillance, Epidemiology, and End Results Program, and data for 11 exposures, for example, body mass index (BMI), from long-term national surveys. We aggregated these data for 30 to 49-year-olds during 1992 to 2016 by population subgroups defined by calendar period, age, race and sex, and used negative binomial regression models to identify and estimate associations of EOCRC with multiple exposures. Furthermore, we used counterfactual modeling to quantify contributions of identified risk factors to EOCRC incidence. The top models (with lowest Bayesian Information Criteria) consistently identified excess body weight, represented by overweight and obesity (BMI ≥25) or obesity alone (BMI ≥30), as the strongest risk factor. The best-performing model estimated increased EOCRC incidence due to overweight and obesity, with an incidence rate ratio (95% confidence interval) of 1.20 (1.17-1.22) for white men, 1.04 (1.00-1.08) for black men, 1.17 (1.15-1.21) for white women and 1.03 (0.97-1.08) for black women. Increases in overweight and obesity prevalence contributed to an estimated 30% (standard error: 1%) for men and 28% (standard error: 2%) for women of ECORC incidence during 1992 to 2016. These findings suggest excess body weight substantially contributed to and is likely a primary driver of the rising incidence of EOCRC in the United States. Prevention of excess weight gain may help lower colorectal cancer risk early in life.

Keywords: alcohol drinking; early‐onset colorectal cancer; obesity; overweight; thyroid diseases.

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Conflict of interest statement

Conflicts of interest: The authors declare no potential conflicts of interest.

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References

    1. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8). - PMC - PubMed
    1. Kehm RD, Lima SM, Swett K, et al. Age-specific Trends in Colorectal Cancer Incidence for Women and Men, 1935-2017. Gastroenterology. 2021;161(3):1060–1062 e1063. - PubMed
    1. Yang W, Kehm RD, Terry MB. Survival model methods for analyses of cancer incidence trends in young adults. Stat Med. 2020;39(7):1011–1024. - PMC - PubMed
    1. Vuik FE, Nieuwenburg SA, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut. 2019;68(10):1820–1826. - PMC - PubMed
    1. Sung JJY, Chiu HM, Jung KW, et al. Increasing Trend in Young-Onset Colorectal Cancer in Asia: More Cancers in Men and More Rectal Cancers. Am J Gastroenterol. 2019;114(2):322–329. - PubMed

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