How does the incidence of colon cancer vary by age?

Updated: Apr 15, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Age is a well-known risk factor for colorectal cancer, as it is for many other solid tumors. The timeline for progression from early premalignant lesion to malignant cancer ranges from 10-20 years. Median age at diagnosis is 68 years. [23]

However, in contrast to the decline in colon cancer incidence rates in persons age 55 and older, which began in the mid-1980s, rates of colon cancer in younger persons have been increasing. In adults age 20 to 39 years, colon cancer incidence rates have increased by 1.0% to 2.4% annually since the mid-1980s; in those age 40 to 54 years, the incidence has increased by 0.5% to 1.3% annually since the mid-1990s. Currently, adults born circa 1990 have double the risk of colon cancer compared with those born circa 1950.Increased obesity is a likely factor. [25]

From 2011 through 2016, the incidence of colorectal cancer continued to decline in those aged 65 years and older, by 3.3% annually. Rates increased by 1% annually in those aged 50 to 64 years, and rose approximately 2% annually in those younger than 50 years. The American Cancer Society estimates that 17,930 of the 147,950 individuals expected to be diagnosed with colon and rectal cancer in 2020, and 3640 of the 53,200 expected to die from the disease, will be younger than 50 years of age.  [31]  

Tumor site tends to vary by patient age. From 2012 to 2016, the proximal colon was the site of colon cancer in 23% of those under 50 years of age, 31% of those 50-64 years, and 49% of those 65 and older. Incidence trends varied by race/ethnicity: in those 50-64 years old, rates increased in whites by 1.3% per year but decreased in blacks by 1.6% per year, and were stable in Hispanics. In those younger than 50, rates rose by 2% annually in whites and by 0.5% annually in blacks. [31]

A review of Surveillance, Epidemiology and End Results (SEER) data found that US cases of colorectal cancer in persons aged 40-49 years have increased significantly since 1995, with the greatest average annual percentage increase for distant cancers, at 2.9%, while localized and regional disease each increased < 1.5% per year. In addition, the proportion of distant colorectal cancers in this age group increased significantly from 1990-1994 to 2011–2015, from 22% to 27%, while the proportion of localized cases did not change, and the proportion of regional cases decreased. These authors point out that these results indicate a true increase in risk, because if the increase had reflected earlier detection due to wider use of colonoscopy, earlier stage at diagnosis would be expected. [32]

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