Epidemiology and Risk Factors of Early-Onset Colorectal Cancer

Early-onset colorectal cancer, defined as diagnosis before age 50, has exhibited a striking rise in incidence across high-income and emerging economies over the past three decades. Age-standardised incidence rates have doubled in many regions, notably among those aged 20–49, while mortality trends have remained stable or declined only modestly. This divergence underscores a shifting burden towards younger cohorts and reflects complex interactions between genetic predisposition, lifestyle, and environmental exposures. Familial clustering and inflammatory bowel disease account for a minority of cases, whereas modifiable factors—obesity, physical inactivity, Western dietary patterns, alcohol consumption, smoking and high intake of processed and red meats—contribute substantially at a population level. Emerging evidence also implicates high consumption of sugar-sweetened beverages and prolonged sedentary time. Socio-demographic variation is pronounced, with high-middle Socio-demographic Index countries bearing the greatest increase in age-standardised incidence, and low- and middle-income regions experiencing rapidly accelerating burdens. Disparities by sex, race and geography are evident, and the steep rise at screening age thresholds suggests that undetected preclinical disease in those under 50 may only be unmasked by later screening. These findings have prompted calls to reassess screening guidelines, develop risk-tailored prevention strategies and enhance public awareness of early-onset disease.

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Epidemiology and Risk Factors of Early-Onset Colorectal Cancer publication trend

The graph below shows the total number of articles in epidemiology and risk factors of early-onset colorectal cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Early-Onset Colorectal Cancer: Colorectal carcinoma diagnosed in individuals younger than 50 years.

Age-Standardised Rate: Incidence or mortality rate adjusted to a standard population to allow comparisons across regions and time.

Disability-Adjusted Life Year (DALY): A metric combining years of life lost and years lived with disability to quantify overall disease burden.

Socio-demographic Index (SDI): A composite measure of income per capita, educational attainment and fertility used to categorise country development levels.

Sedentary Behaviour: Waking activities with low energy expenditure, such as sitting or reclining.

Western Dietary Pattern: Dietary profile characterised by high consumption of red and processed meats, refined grains, sugars and saturated fats.

References

1. The global, regional, and national early-onset colorectal cancer burden and trends from 1990 to 2019: results from the Global Burden of Disease Study 2019. BMC Public Health (2022).
2. Risk factors for early-onset colorectal cancer: systematic review and meta-analysis. Frontiers in Oncology (2023).
3. Risk factors for early-onset colorectal cancer: a population-based case–control study in Ontario, Canada. Cancer Causes & Control (2021).
4. Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age. JAMA Network Open (2020).
5. Racial Disparities and Sex Differences in Early- and Late-Onset Colorectal Cancer Incidence, 2001–2018. Frontiers in Oncology (2021).