Incidence Rates of CRC Increasing Among White, Not Black Patients Aged 40 to 49 Years in the US

Computer illustration of a malignant (cancerous) tumour (red) in the colon. Risk factors for colorectal cancer are smoking, obesity and lack of physical activity.
Investigators analyzed trends stratified by race and sex in colorectal cancer incidence rates in the United States among patients aged 40 to 49 years.

There were differential, race- and sex-related trends in incidence rates (IRs) of colorectal adenocarcinoma between 2000 and 2017 in the United States, according to findings published in JAMA Network Open.

Researchers from Tulane University sourced data from the National Cancer Institute Surveillance, Epidemiology, and End Result Program. Data collected between 2000 and 2017 about annual age-adjusted colorectal cancer (CRC) IRs among individuals aged 40 to 49 years in the United States were assessed for race and ethnicity-based trends.

A total of 46,728 cases of CRC were identified among 45,429 individuals. The patients were 14.2% Black, 60.4% White, were aged mean 45.5 (SD, 2.8) years, and more cases were identified among men than women.

Among White individuals, IRs of colorectal adenocarcinoma increased from 19.6 in 2000 to 25.2 per 100,000 person-years in 2017 (annual percent change [APC], 1.6; 95% CI, 1.3-1.9). During the same time period, IRs remained stable among the Black population (APC, -0.03; 95% CI, -0.5 to 0.5). Prior to 2013, colorectal adenocarcinoma IRs were significantly higher among Black individuals. After 2013, there was no significant difference.

A similar pattern was observed for colon adenocarcinoma, in which there was a significant increase among White individuals (APC, 1.2; 95% CI, 0.8-1.6) but not Black individuals (APC, 0.5; 95% CI, -0.3 to 1.3).

Rectal adenocarcinoma had a differing pattern. As of 2017, the rate was decreasing among the Black population (APC, -1.4; 95% CI, -2.6 to -0.1) while IRs were 39.3% higher among White individuals, increasing at an APC of 2.2 (95% CI, 1.6-2.8).

Stratified by sex, colorectal adenocarcinoma was increasing among White men (APC, 1.7; 95% CI, 1.3-2.1) and White women (APC, 1.5; 95% CI, 1.1-1.9) but not Black men (APC, 0.0; 95% CI, -0.6 to 0.7) or Black women (APC, -0.1; 95% CI, -1.1 to 0.8).

This study was limited by its population-based observational design and no mechanisms for observed patterns could be assessed.

The study authors concluded that CRC rates have been increasing in the United States among the White population aged 40 to 49 years and have remained stable among the Black population. These data should be used to guide cancer screening programs.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Montminy EM, Zhou M, Maniscalco L, et al. Trends in the incidence of early-onset colorectal adenocarcinoma among black and white US residents aged 40 to 49 years, 2000-2017. JAMA Netw Open. 2021;4(11):e2130433. doi:10.1001/jamanetworkopen.2021.30433