Trends and characteristics of early-onset colorectal cancer in the state of Florida, 2002-2021

Authors

Young-Rock Hong, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States; Cancer Prevention and Control Research Program, Emory Winship Cancer Institute, Atlanta, GA, United States; Department of Health Services Research Management and Policy, University of Florida, Gainesville, FL, United States. Electronic address: youngrock.hong@emory.edu.
Lee Revere, Department of Health Services Research Management and Policy, University of Florida, Gainesville, FL, United States.
Kathryn M. Ross, Advocate Health - MidwestFollow
Peihua Qiu, Department of Biostatistics, University of Florida, Gainesville, FL, United States.
Mattia Prosperi, Department of Epidemiology, University of Florida, Gainesville, FL, United States.
Thomas J. George, Division of Hematology and Oncology, University of Florida, Gainesville, FL, United States; UF Health Cancer Center, Gainesville, FL, United States.
Beth A. Virnig, Department of Health Services Research Management and Policy, University of Florida, Gainesville, FL, United States; UF Health Cancer Center, Gainesville, FL, United States.

Recommended Citation

Hong YR, Revere L, Ross KM, et al. Trends and characteristics of early-onset colorectal cancer in the state of Florida, 2002-2021. Cancer Epidemiol. 2025;99:102932. doi:10.1016/j.canep.2025.102932

Abstract

Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is a growing public health concern. Despite increasing national incidence among younger adults, state-specific analyses for Florida remain limited. Florida's large and demographically unique population necessitates investigation into EOCRC trends and patient characteristics.

Methods: This population-based study utilized colorectal cancer incidence data for Florida residents aged 25-49 diagnosed between 2002 and 2021, from the Florida Cancer Data System and National Program of Cancer Registries. Joinpoint regression evaluated age-adjusted incidence trends across demographic and clinical factors. Age-period-cohort analysis explored generational effects, while multivariate logistic regression identified factors associated with advanced-stage diagnosis (regional or distant).

Results: Among 16,318 EOCRC cases identified during 2002-2021, overall incidence increased significantly (AAPC=1.48 %, P < .001), driven primarily by colon cancers (AAPC=1.53 %, P < .001), while rectal cancers showed non-significant increase (AAPC=0.53 %, P = 0.185). A concerning shift toward advanced stages at diagnosis emerged (P < 0.001), with localized disease decreasing from 32.8 % to 26.2 %, while regional (34.6-41.0 %) and distant metastases (21.9-26.8 %) increased substantially. This stage migration was confirmed by significant increases in regional (AAPC=2.10 %, P < .001) and distant disease (AAPC=2.71 %, P < .001) incidence. Strong birth cohort effects, indicating increasing risk with rate ratios exceeding 2.0 for recent cohorts, were evident predominantly in non-Hispanic White individuals. Conversely, Hispanic and non-Hispanic Black patients showed no significant cohort effects but consistently presented with higher odds of advanced-stage disease compared to non-Hispanic Whites (AOR=1.13 and AOR=1.11, respectively). Uninsured (AOR=1.23) and Medicaid-covered patients (AOR=1.52) faced significantly higher odds of advanced presentation compared to privately insured individuals.

Conclusion: Florida experienced sustained EOCRC incidence increases from 2002 to 2021, accompanied by advanced-stage diagnosis increases and notable disparities. Birth cohort effects primarily drove increased risk in non-Hispanic White populations, while barriers to timely care, including insurance status, likely contributed to delayed diagnoses in minority communities, underscoring urgent needs for targeted interventions.

Document Type

Article

PubMed ID

40946599