Do Cross-National Differences in Increasing Early-Onset Colorectal Cancer Incidence Rates Reflect Inequities in Diagnosis and Surveillance
1
International Health, Maastricht University, Maastricht, Netherlands
2
School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel
3
School of Public Health, University of Haifa, Haifa, Israel
Popul. Med. 2026;8(Supplement Supplement 1):A132
ABSTRACT
BACKGROUND:
Colorectal cancer (CRC) incidence rates is increasing among young adults in several high-income countries, while remaining stable or declining s at older ages. Whether similar trends are occurring in high- and middle-income countries is less clear. Cross-national comparisons of CRC incidence rates can help clarify whether observed differences reflect true risk patterns or inequities in risk exposure, detection or surveillance. these trends.
OBJECTIVES:
To compare temporal trends in age-adjusted CRC incidence rates among young adults in high- and middle-income countries.
METHODS:
We analysed age-specific CRC incidence rates from the IARC database. High-income countries included Norway, the United Kingdom, Sweden, Israel, the United States, and Canada. Middle-income countries included Turkey, Croatia, Belarus, and India. Analyses focused on adults aged 20–49 years. Sex-specific trends were assessed using Joinpoint regression, estimating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs).
RESULTS:
High-income countries showed consistent and sustained increases in early-onset CRC incidence rates in both sexes, often accelerating from the mid-2000s or early-2010s. In contrast, middle-income countries demonstrated greater heterogeneity. Turkey and Belarus exhibited clear recent increases, Croatia showed marked sex-specific divergence with a pronounced late increase among females, and India displayed substantially lower incidence with more variable and often non-significant trends.
CONCLUSIONS:
Increasing early-onset CRC age-adjusted incidence rates in low-income countries are not identical to the trends in low-income countries. This may reflect broader global inequities in exposure risk, detection, and surveillance. Uniform increases in high-income countries may reflect earlier exposure to modifiable risk factors, alongside stronger cancer registry systems. In middle-income countries, heterogeneous patterns likely reflect later epidemiological transitions, uneven diagnostic access, and variable registry capacity. Comparative analyses across income settings are essential to inform equitable prevention and risk-adapted screening strategies.
Colorectal cancer (CRC) incidence rates is increasing among young adults in several high-income countries, while remaining stable or declining s at older ages. Whether similar trends are occurring in high- and middle-income countries is less clear. Cross-national comparisons of CRC incidence rates can help clarify whether observed differences reflect true risk patterns or inequities in risk exposure, detection or surveillance. these trends.
OBJECTIVES:
To compare temporal trends in age-adjusted CRC incidence rates among young adults in high- and middle-income countries.
METHODS:
We analysed age-specific CRC incidence rates from the IARC database. High-income countries included Norway, the United Kingdom, Sweden, Israel, the United States, and Canada. Middle-income countries included Turkey, Croatia, Belarus, and India. Analyses focused on adults aged 20–49 years. Sex-specific trends were assessed using Joinpoint regression, estimating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs).
RESULTS:
High-income countries showed consistent and sustained increases in early-onset CRC incidence rates in both sexes, often accelerating from the mid-2000s or early-2010s. In contrast, middle-income countries demonstrated greater heterogeneity. Turkey and Belarus exhibited clear recent increases, Croatia showed marked sex-specific divergence with a pronounced late increase among females, and India displayed substantially lower incidence with more variable and often non-significant trends.
CONCLUSIONS:
Increasing early-onset CRC age-adjusted incidence rates in low-income countries are not identical to the trends in low-income countries. This may reflect broader global inequities in exposure risk, detection, and surveillance. Uniform increases in high-income countries may reflect earlier exposure to modifiable risk factors, alongside stronger cancer registry systems. In middle-income countries, heterogeneous patterns likely reflect later epidemiological transitions, uneven diagnostic access, and variable registry capacity. Comparative analyses across income settings are essential to inform equitable prevention and risk-adapted screening strategies.
| eISSN: | 2654-1459 |
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