Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3602–3609 | Cite as

Epidemiology of Colorectal Cancer in Average Risk Adults 20–39 Years of Age: A Population-Based National Study

  • Michael Glover
  • Emad Mansoor
  • Muhammed Panhwar
  • Sravanthi Parasa
  • Gregory S. CooperEmail author
Original Article



While overall rates of colorectal cancer (CRC) have declined in individuals aged above 50 years of age, this decline has not been seen in younger individuals who do not benefit from current screening guidelines. We sought to describe the prevalence of CRC in adults 20–39 years of age without family history of CRC or inflammatory bowel disease as early-onset CRC (EoCRC), evaluate associated signs and symptoms and medical comorbidities in EoCRC, and compare them with individuals aged 20–39 years without CRC (NoCRC). Our secondary aim was to compare EoCRC with individuals aged 40 years and above with CRC (LoCRC).


Utilizing a commercial database (Explorys Inc, Cleveland, OH), we identified a cohort of patients aged 20–39 years with first ever diagnosis of CRC between 2013 and 2018 based on the Systematized Nomenclature of Medicine-Clinical Terms. We calculated the overall prevalence rate of EoCRC, described age, race, and gender-based prevalence rates of EoCRC, and identified associated symptoms and medical comorbidities associated with EoCRC.


The overall rate of EoCRC was 18.9/100,000. Compared to NoCRC, EoCRC patients were more likely to be Caucasian and female, with predominant symptoms of hematochezia, anemia, and decreased appetite. EoCRC group had higher prevalence rates of medical comorbidities such as diabetes, smoking, and obesity. Compared to LoCRC, EoCRC group presented more frequently with left-sided CRC and rectal cancers.


This is one of the largest studies to date to describe the epidemiology of EoCRC in USA. We found EoCRC to occur predominantly in the Caucasian and female population. EoCRC presented more frequently with left-sided and rectal CRC. We also identified signs/symptoms as well as comorbidities associated with EoCRC. Patients with these features may benefit from earlier screening.


Colon cancer Early-onset colon cancer Cancer epidemiology Cancer screening 


Author contributions

MG, EM, SP and GSC contributed to study conception and design. MG contributed to acquisition of data. MG, EM, SP and GSC contributed to analysis and interpretation of data. MG, EM, SP and GSC contributed to drafting of manuscript. EM, SP and GSC contributed to critical revision. MG, MP contributed to statistical analysis. GSC obtained funding. SP and GSC contributed to study supervision.

Compliance with Ethical Standards

Conflicts of interest

Glover, Mansoor, Panhwar, Parasa, and Cooper deny any relevant personal or financial conflicts of interest related to the material in this manuscript.


  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2018;68:7–30.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Marley AR, Nan H. Epidemiology of colorectal cancer. Int J Mol Epidemiol Genet. 2016;7:105–114.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Yang Y-X, Hennessy S, Lewis JD. Type 2 diabetes mellitus and the risk of colorectal cancer. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2005;3:587–594.Google Scholar
  4. 4.
    Giovannucci E, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Willett WC. Alcohol, low-methionine—low-folate diets, and risk of colon cancer in men. J Natl Cancer Inst. 1995;87:265–273.CrossRefGoogle Scholar
  5. 5.
    Singh KE, Taylor TH, Pan C-JG, Stamos MJ, Zell JA. Colorectal cancer incidence among young adults in California. J Adolesc Young Adult Oncol. 2014;3:176–184.CrossRefGoogle Scholar
  6. 6.
    Ahnen DJ, Wade SW, Jones WF, et al. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc. 2014;89:216–224.CrossRefGoogle Scholar
  7. 7.
    Stoffel EM, Koeppe E, Everett J, et al. Germline genetic features of young individuals with colorectal cancer. Gastroenterology. 2018;154:897–905.e1.CrossRefGoogle Scholar
  8. 8.
    Dozois EJ, Boardman LA, Suwanthanma W, et al. Young-onset colorectal cancer in patients with no known genetic predisposition. Medicine (Baltimore). 2008;87:259–263.CrossRefGoogle Scholar
  9. 9.
    American Cancer Society Guideline for Colorectal Cancer Screening [cited 2018 Jul 8]. Available from:
  10. 10.
    Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. JNCI J Natl Cancer Inst. 2017;. Scholar
  11. 11.
    Myers EA, Feingold DL, Forde KA, Arnell T, Jang JH, Whelan RL. Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions’ experience. World J Gastroenterol WJG. 2013;19:5651–5657.CrossRefGoogle Scholar
  12. 12.
    O’Connell JB, Maggard MA, Livingston EH, Yo CK. Colorectal cancer in the young. Am J Surg. 2004;187:343–348.CrossRefGoogle Scholar
  13. 13.
    IBM Explorys—IBM Watson Health 2017 [cited 2018 Dec 19]. Available from: undefined.Google Scholar
  14. 14.
    Chouhan V, Mansoor E, Parasa S, Cooper GS. Rates of prevalent colorectal cancer occurrence in persons 75 Years of age and older: a population-based national study. Dig Dis Sci. 2018;63:1929–1936. Scholar
  15. 15.
    Al-Kindi SG, Oliveira GH. Prevalence of preexisting cardiovascular disease in patients with different types of cancer: the unmet need for onco-cardiology. Mayo Clin Proc. 2016;91:81–83.CrossRefGoogle Scholar
  16. 16.
    Panhwar MS, Mansoor E, Al-Kindi SG, et al. Risk of myocardial infarction in inflammatory bowel disease: a population-based national study. Inflamm Bowel Dis. 2018. Scholar
  17. 17.
    Jarvinen HJ, Turunen MJ. Colorectal carcinoma before 40 years of age: prognosis and predisposing conditions. Scand J Gastroenterol. 1984;19:634–638.CrossRefGoogle Scholar
  18. 18.
    Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med. 2015;372:1441–1452.CrossRefGoogle Scholar
  19. 19.
    Jess T, Simonsen J, Jørgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology. 2012;143:375–381.e1.CrossRefGoogle Scholar
  20. 20.
    Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300:2765–2778.CrossRefGoogle Scholar
  21. 21.
    Doubeni CA, Major JM, Laiyemo AO, et al. Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence. J Natl Cancer Inst. 2012;104:1353–1362.CrossRefGoogle Scholar
  22. 22.
    Practical Statistics for Medical Research. CRC Press 1990 [cited 2018 Jul 10]. Available from:
  23. 23.
    Schoonjans F: MedCalc’s odds ratio calculator. MedCalc [cited 2018 Jul 10]. Available from:
  24. 24.
    Rabin RC: Colon and rectal cancers rising in young people. N Y Times 2017 [cited 2019 Apr 21]. Available from:
  25. 25.
    Cancer Statistics Review, 1975–2015—SEER Statistics [cited 2018 Jul 11]. Available from:
  26. 26.
    O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Rates of colon and rectal cancers are increasing in young adults. Am Surg. 2003;69:866–872.PubMedGoogle Scholar
  27. 27.
    Mik M, Berut M, Dziki L, Trzcinski R, Dziki A. Right- and left-sided colon cancer—clinical and pathological differences of the disease entity in one organ. Arch Med Sci AMS. 2017;13:157–162.CrossRefGoogle Scholar
  28. 28.
    Singh H, Nugent Z, Demers AA, Bernstein CN. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol. 2010;105:2588–2596.CrossRefGoogle Scholar
  29. 29.
    Adult Obesity Facts |Overweight & Obesity| CDC 2018 [cited 2018 Dec 20]. Available from:
  30. 30.
    Nadkarni PM, Darer JA. Migrating existing clinical content from ICD-9 to SNOMED. J Am Med Inform Assoc JAMIA. 2010;17:602–607.CrossRefGoogle Scholar
  31. 31.
    Kaelber DC, Foster W, Gilder J, Love TE, Jain AK. Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data. J Am Med Inform Assoc JAMIA. 2012;19:965–972.CrossRefGoogle Scholar
  32. 32.
    Adkins RB, DeLozier JB, McKnight WG, Waterhouse G. Carcinoma of the colon in patients 35 years of age and younger. Am Surg. 1987;53:141–145.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Michael Glover
    • 1
  • Emad Mansoor
    • 2
  • Muhammed Panhwar
    • 1
  • Sravanthi Parasa
    • 2
    • 3
  • Gregory S. Cooper
    • 2
    Email author
  1. 1.Department of Internal Medicine, University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandUSA
  2. 2.Department of Internal Medicine and Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandUSA
  3. 3.Swedish Medical CenterSeattleUSA

Personalised recommendations