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Pancreatic, Colorectal Cancer Rates Rising in Young Adults, Nationwide Study Warns
The increase in pancreatic cancer among Americans aged 15 to 34 is particularly alarming and should alert clinicians to heed relevant GI symptoms as suspicious.
The incidence of pancreatic and colorectal adenocarcinoma is increasing among younger adults in the US, particularly among those aged 15 to 34 years, according to new findings from a large national cohort study published in JAMA Network Open. While colorectal cancer rates continue to decline in older adults, researchers observed an alarming upward trend among those under age 55. Pancreatic adenocarcinoma incidence, meanwhile, has increased across all age groups.1
The retrospective cohort study analyzed Surveillance, Epidemiology, and End Results (SEER) registry data from 2000 to 2021, including more than 275,000 cases of pancreatic adenocarcinoma and more than 1.2 million cases of colorectal adenocarcinoma. The most striking finding was the rate of increase in young adults for both neoplasms, authors wrote.
Among individuals aged 15 to 34 years, the annual percentage change (APC) for pancreatic adenocarcinoma was 4.35% (95% CI, 2.03–6.73), significantly higher than that for older age groups (P <.01), according to the study. For colorectal adenocarcinoma, the APC in the younger group was 1.75% (95% CI, 1.08–2.42), compared with a decline of –3.31% (95% CI, –3.54 to –3.08) in adults aged 55 and older.1
Pancreatic Adenocarcinoma
The rise in pancreatic cancer in younger populations is of significant concern, as it has historically been considered a disease of the elderly, lead author Arvind Bussetty, MD, an internal medicine resident at Robert Wood Johnson Medical School , and colleagues wrote. The updated evidence provided by this study, through 2021, suggests a sustained trend rather than a statistical anomaly, they added.
The researchers said the findings have direct clinical implications for both gastroenterologists and primary care clinicians. “Clinicians should be aware of this trend when evaluating younger patients with relevant [gastrointestinal] symptoms,” Bussetty et al wrote, particularly because younger adults may not meet traditional screening criteria.1
Despite being relatively rare in younger patients, the authors cite evidence that pancreatic adenocarcinoma is highly lethal, with a 5-year survival rate of just 10%. It remains the seventh leading cause of cancer-related death globally. The steady rise in cases among those under age 35 is particularly troubling given the challenges in early detection, Bussetty et al said. “It is unclear what factors are driving the increased incidence in this age group,” but hypotheses include lifestyle trends such as smoking and use of alcohol, consumption of processed foods, stress and environmental factors.1
Colorectal Cancer
In contrast, the overall incidence of colorectal cancer has declined, a trend the authors largely attribute to widespread screening in older adults. However, increases in younger cohorts persist. In individuals aged 35 to 54, the APC was 0.78% (95% CI, 0.51–1.06; P =.002). These patterns echo previous findings, the team wrote, and support recent updates to colorectal cancer screening guidelines from the United States Preventive Services Task Force.2 “With the recent lowering of age qualification for colorectal cancer screening to age 45 years, it is likely we will see a decline in colorectal adenocarcinoma incidence for the group aged 35 to 54 years.”1
The study also examined trends by sex and race. Pancreatic cancer incidence increased in all racial groups. Though the APC was slightly higher in men (1.87%) than women (1.57%), the difference was not statistically significant (P =.13). For colorectal cancer, incidence declined across all racial groups, with the steepest declines seen among White individuals (–2.96%) and Black individuals (–2.87%).1
Bussetty et al used Joinpoint regression analysis to assess APCs over the 21-year period. The SEER database includes data from 22 registries and covers approximately 47.9% of the US population. The study focused exclusively on adenocarcinomas, excluding other subtypes such as neuroendocrine tumors, in order to maintain a homogenous dataset and focus on the most clinically significant form of these cancers. Although SEER does not provide national coverage, the authors note that it is widely accepted as a reliable source for analyzing cancer incidence trends.1
“The takeaway from this research is that symptoms such as upper abdominal pain in younger age groups should not be dismissed as benign without a complete gastrointestinal workup,” senior author Arvind Trindade, MD, chief of endoscopy at RWJ University Hospital said in a statement.3 “And, of course, if [individuals have] high-risk genetics, a family history of pancreatic cancer, or a history of pancreas cysts, they need to be medically evaluated. Finally, patients who are at average risk should undergo guideline-recommended screening colonoscopy at age 45,” Trindade concluded.3
