The Increased Early Onset Colorectal Cancer in South East Scotland Is Indicative of a Wider UK Problem

Background and Aims: Colorectal cancer (CRC) in those younger than age 50 (early onset colorectal cancer: EOCRC) is reported to be increasing. We aimed to determine whether trends in incidence regionally were being reproduced across the UK. We investigate clinically important differences between CRC cases older (LOCRC) and younger than 50 years of age. 

Methods: The South East Scotland Cancer Network (SCAN) database was interrogated for CRC within NHS Lothian (2002–2019). Public Health Scotland and the Office for National Statistics (ONS) publish cancer data for Scotland, England, and Wales (1993–2019). Population figures were gathered from National Records of Scotland and ONS data. Joinpoint analysis was performed to assess significant Annual Percentage Change (APC) in CRC incidence trends. 

Results: In NHS Lothian, there has been a steady significant increase in EOCRC with an APC of 2.87 (p < 0.05) cumulating with an incidence rate of 10.5/100,000 in 2019. This was most evident in males and those aged 30–39. Across Scotland, England, and Wales, there have been similarly significant increasing trends of EOCRC. EOCRC was more likely to be referred as routine priority (23.2% vs. 4.0%, p < 0.001) and diagnosed at a later stage (AJCC stage 3/4), with 62.8% compared with 52.5% in the LOCRC, p < 0.001. There was better overall 5-year survival for EOCRC (p = 0.005). Conclusions: The incidence of EOCRC is increasing within NHS Lothian and across the UK. Awareness of EOCRC is essential to improve the current problems with delayed diagnosis and advanced stage disease.