Bowel cancer, also known as colorectal cancer, is an aggressive cancer with a high incidence in developed countries. Only half of the newly diagnosed cases survive for more than five years. Bowel cancer is most common in the elderly population. However, in recent years the number of cases has risen in those under 50, whereas it has either declined or stabilised in older adults in multiple high-income countries. The rise of bowel cancer cases in younger adults is concerning and the factors driving this trend need to be identified to help facilitate early detection and treatment.
The review study conducted by Sung and colleagues and published in Lancet Oncology this month analysed the trend of bowel cancer incidence in a population. The authors analysed bowel cancer incidence data for 50 countries from the International Agency for Research on Cancer Incidence in Five Continents Plus database. Age-standardised incidence rates of early-onset (diagnosed from ages 25-49 years) and late-onset (diagnosed between ages 50-74 years) bowel cancer diagnosed between 1943-2017, were examined for bowel cancer incidence trends in younger adults versus older adults. In the most recent ten years (2007-2017), incidence rates of early-onset colorectal cancer were stable in 23 countries but increased in 27 countries. Out of these 27 countries, 14 had a stable incidence trend in late-onset cancer whereas in 13 countries it increased in both early- and late-onset cancer. The greatest annual increase in early-onset cancer was seen in New Zealand (3.97%) and England (3.59%).
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Bowel cancer is a significant health burden and is growing steadily across the world. Leading data and analytics company GlobalData‘s epidemiologists forecast that the diagnosed incident cases of bowel cancer in the 16 major markets (US, France, Germany, Italy, Spain, UK, Japan, China, Australia, Canada, Brazil, India, Mexico, Russia, South Africa, and South Korea) will grow from approximately 1.45 million cases in 2024 to 1.74 million cases in 2031 at an annual growth rate of 3%. The increase in the number of cases can be attributed to the projected increase in the population, as well as the higher incidence trend, especially in the younger population. According to Cancer Research UK, despite the increase in cases of cancer in the younger population, the risk of early-onset bowel cancer is relatively low. Approximately one in 20 bowel cancer cases is diagnosed under the age of 50. However, the increase in incidence should still be a concern and close monitoring is required to identify the causes. The current assumption for the rise is lifestyle factors, diet, and alcohol consumption.
Routine screening for this disease makes early detection feasible. In the UK, the National Health Service (NHS) sends home testing kits to the population ages 60-74 to screen for bowel cancer every year. The uptake of this home testing kit is improving over time. There are also plans to lower the screening age to 50 years by 2025, which will be a significant increase in screening coverage. Depending on the incidence trend, the screening age could be lowered further.
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