Abstract
Background: The incidence rate of Colorectal cancer (CRC) is ranking fourth both in Florida and the U.S. as of 2020. There has been a recent increase in early-onset cases, under the age of 50. Previous studies on factors relating to this trend have conflicting outcomes. A state-level research to inform targeted screening strategies is needed. We aimed to explore the early-onset CRC trends in Florida.
Methods: We analyzed the Florida Cancer Data System from 1981 to 2020. The CRC patients were categorized by tumor location, tumor stage, age, race, ethnicity, and gender. Statistical analyses were conducted using Statistical Analysis Software and the Joinpoint Regression Program. Mean diagnosis age differences, trends of average diagnosis age, and age-specific incidence rates were analyzed. The significance for all tests was set at α=0.05.
Results: The majority of the 293,366 CRC patients were White (92%), non-Hispanic (90%), and male (52%). Blacks (mean age 64.3 vs 70.4 in Whites), Hispanics (67.3 vs 70.2 in non-Hispanics), and males (69.1 vs 70.8 in females) showed earlier diagnosis age. In trend analysis, the average age at diagnosis declined more in rectal cancers (5-year percent change (5PC) -0.36% vs -0.20% in colon cancers), Whites (5PC -0.28% vs -0.15% in Blacks), non-Hispanics (5PC -0.28% vs -0.21% in Hispanics), females (5PC -0.28% vs -0.25% in males), and advanced stages (5PC -0.29% vs -0.17% in early stages). Age-specific incidence trends showed increases in younger ages for Whites, non-Hispanics, males, and patients with advanced stages (2.61% in distant vs. 0.79% in local in aged 30-39).
Conclusions: The rising trend of early-onset CRC in Florida mirrors national patterns. The decreasing trend in diagnosis ages and the increasing rates in younger ages support the recommendations to expand CRC screening to all adults starting from age 45, regardless of race, ethnicity, and other risk factors. Because of the complex nature of cancer etiology and prognosis, more detailed studies can reveal the causality and associations of the risk factors with these early-onset CRC trends.