Colorectal cancer presenting in young adults in Kamrup Urban District cancer registry (2007–2016)

Debanjana Barman; Arpita Sharma; Chinmoy Misra; Ranjan Lahon; Barsha Roy Deka; Manoj Kalita

doi:10.4103/aort.aort_25_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 2 | Issue : 2 | Page : 77-81

Colorectal cancer presenting in young adults in Kamrup Urban District cancer registry (2007–2016)

Debanjana Barman, Arpita Sharma, Chinmoy Misra, Ranjan Lahon, Barsha Roy Deka, Manoj Kalita
Department of Population Based Cancer Registry Kamrup (Indian Council of Medical Research), Guwahati, Assam, India

Date of Submission	26-Sep-2022
Date of Decision	03-Oct-2022
Date of Acceptance	06-Oct-2022
Date of Web Publication	18-Nov-2022

Correspondence Address:
Mr. Manoj Kalita
Department of Population Based Cancer Registry Kamrup (Indian Council of Medical Research), Guwahati, Assam
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aort.aort_25_22

Abstract

INTRODUCTION: According to the GLOBOCAN 2020 report, colorectal cancers (CRC) comprise 10.6% of all cancers worldwide. Globally, colon cancers are the fourth-most common cancers, and the rectum is the 7^th among all cancers in both sexes. However, the recent reports have shown that the incidence rates of CRC are rising in the younger age group.
MATERIALS AND METHODS: Population-based cancer registry (PBCR) – Kamrup was established in 2003 under the network of the National Cancer Registry Program of the Indian Council of Medical Research. The data sources for the study have been used from the urban component of PBCR – Kamrup only. The data collected over the 10-year period of 2007–2016 are presented here.
RESULTS: A total of 831 cases were diagnosed with CRC cases, of which 434 (52.2%) were colon cancers and 397 (47.8%) were rectal cancers. Of the total 831 cases, 132 cases (15.9%) were below 40 years of age, of which 60 (13.8%) were colon cancers and 72 (18.1%) were rectal cancers. The age-standardized rates of colorectal cancer in India have been estimated to be 6.0 in males and 3.7/100,000 in females. For colon cancers, the Aizawl district had the highest age-adjusted rate (7.2), followed by Mizoram state (5.5) and Kamrup Urban (5.4) in males.
CONCLUSIONS: Colorectal cancer, though a disease of the elderly, is seen in younger age groups with increased incidence in the recent years.

Keywords: Age-adjusted rate, colorectal, crude rate, incidence, mortality

How to cite this article:
Barman D, Sharma A, Misra C, Lahon R, Deka BR, Kalita M. Colorectal cancer presenting in young adults in Kamrup Urban District cancer registry (2007–2016). Ann Oncol Res Ther 2022;2:77-81

How to cite this URL:
Barman D, Sharma A, Misra C, Lahon R, Deka BR, Kalita M. Colorectal cancer presenting in young adults in Kamrup Urban District cancer registry (2007–2016). Ann Oncol Res Ther [serial online] 2022 [cited 2023 Mar 29];2:77-81. Available from: http://www.aort.info/text.asp?2022/2/2/77/361496

Introduction

According to the GLOBOCAN 2020 report, colorectal cancers (CRC) comprise 10.6% of all cancers worldwide. Globally, colon cancers are the fourth-most common cancers, and the rectum is the 7^th among all cancers in both sexes.^[1] Considering the age group, the occurrence is more common in the older population, especially after the fifth decade of life and is considered a disease of the elderly. However, the recent reports have shown that the incidence rates of CRC are rising in the younger age group.^[2] Some of the factors associated with it are lack of physical activity, obesity, and consumption of red and processed meat. Increased intake of dietary fiber, vitamins, and minerals may be a protective factor against it. In the Indian scenario, the cancers of the colon and rectum are not among the top ten leading sites of cancer.^[3],[4],[5] Colon cancer is in the 13^th position, and rectal cancers occupy the 16^th position in both sexes. The recent data reveal a rise in the incidence of CRC among the youths. This is considered a major public health problem.^[6]

Aims and objectives

Our aim was to highlight the rising incidence of rectal cancers in young patients in the resident population of Kamrup Urban District (KUD) for the years 2007–2016

Materials and Methods

Population-based cancer registry (PBCR) – Kamrup was established in 2003 under the network of the National Cancer Registry Program of the Indian Council of Medical Research. The data sources for the study have been used from the urban component of PBCR – Kamrup only. KUD covered a total population of 1,179,405, of which 608,844 were male and 570,561 were female in 2011. KUD covered 701 km², and population density was 581 per km².

To study the rise of CRC in young adults, we conducted a retrospective analysis of patients below 40 years diagnosed with histologically confirmed colon and rectal cancers. The data collected over the 10-year period of 2007–2016 are presented here.

Data collection is active from various sources within the registry area. Coding is done as per the International Classification of Diseases for Oncology, 3^rd Edition. The crude rate, age-adjusted rate (AAR), and truncated incidence rates per 100,000 populations were calculated by the direct method using the world standard population. The data were entered into PBCR online software developed by NCDIR. The cases which were detected by the software as “unlikely” in terms of primary site and age at diagnosis were reviewed further for verification. The verified cases were included in the study. It is seen that there is a rising incidence in the age group <40 years.

Results

A total of 831 cases were diagnosed with CRC cases, of which 434 (52.2%) were colon cancers and 397 (47.8%) were rectal cancers. Of the total 831 cases, 132 cases (15.9%) were below 40 years of age, of which 60 (13.8%) were colon cancers and 72 (18.1%) were rectal cancers. In individuals above 40 years, the total number of cases was 699 (84.1%). Three hundred and seventy-four (86.2%) were colon cancers, and 325 (81.9%) were rectal cancers. Gender wise comparison of the incidence of CRC was observed to be higher in males with 59.3% compared to their female counterpart with 40.7% [Table 1] and [Table 2]; [Figure 1].

Figure 1: Age-wise case distribution for the year 2007–2016

Click here to view

Table 1: Age- and gender-wise distribution of cases for the year 2007-2016

Click here to view

Table 2: Year-wise distribution of colon and rectum cancer

Click here to view

The age standardized rates of colorectal cancer in India have been estimated to be 6.0 in males and 3.7/100,000 in females. For colon cancers, the Aizawl district had the highest AAR (7.2), followed AQ9 by Mizoram state (5.5) and Kamrup Urban (5.4) in males. In females, Aizawl district had the highest AAR (5.7), followed by Kamrup Urban (4.1) and Mizoram state (4.0).

For CRC in both males and females, Aizawl district leads the list of PBCRs with an AAR of males: 15.9 and females: 11.4. Mizoram state had the second-highest AAR (males: 12.2 and females: 8.6), KUD has AAR of 10.9 in males and is the third highest, and in females, AAR of 7.9 has the fourth position [Figure 2] and [Figure 3].

Figure 2: National comparison of age-adjusted incidence rate (males)

Click here to view

Figure 3: National comparison of age-adjusted incidence rate (females)

Click here to view

Discussion

CRC is commonly seen in the older population. Increased incidence in young adults, mostly <40 years of age, has made researchers to think about the probable cause behind this.^[8],[9] Gender differences have also been observed for the incidence of the colon and rectum. Males have a higher incidence than females. The main priority should be given to identify the risk factors associated with it. Various studies have tried to find out a correlation between CRC and the consumption of unhealthy diets like processed meat, low intake of vegetables and fruits in the younger generation.^[10] Changes in lifestyle and environmental factors or association with genetic diseases need to be evaluated. The presence of gut bacteria and inflammation might be another etiological factor associated with it. Some studies also revealed the association of CRC in young age groups with genetic susceptibility and hereditary factors.

Other studies have shown that the consumption of fruits and vegetables rich in fibers, antioxidants, vitamins, and minerals may reduce the incidence of CRC.^[11] Young patients presenting with rectal symptoms should be examined by sigmoidoscopy or colonoscopy, as there is no routine screening program available. This has led to delays in diagnosis and late presentation.^[12]

There exists a difference of opinion relating to the age at diagnosis and aggressiveness of tumor. Some studies have shown that young patients usually present at the advanced stage with poorly differentiated cancers and have a relatively poor prognosis. Identification of high-risk young adults has been a serious medical problem.^[13],[14]

Conclusions

Colorectal cancer, though a disease of the elderly, is seen in younger age groups with increased incidence in recent years. Efforts should be made to identify the high-risk young adults by giving importance to early symptoms and followed by screening for colorectal cancer for its timely diagnosis. The reporting of colorectal cancer cases in youths is of utmost importance for public health benefits.

Acknowledgment

The authors would like to thank Dr. Prashanth Mathur, Director, National Centre for Disease Informatics and Research, Bangalore. All the staffs of population-based cancer registry – Kamrup District.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Kellokumpu I, Kairaluoma M, Mecklin JP, Kellokumpu H, Väyrynen V, Wirta EV, et al. Impact of age and comorbidity on multimodal management and survival from colorectal cancer: A population-based study. J Clin Med 2021;10:1751.
2.	Connell LC, Mota JM, Braghiroli MI, Hoff PM. The rising incidence of younger patients with colorectal cancer: Questions about screening, biology, and treatment. Curr Treat Options Oncol 2017;18:23.
3.	Slattery ML, Edwards SL, Boucher KM, Anderson K, Caan BJ. Lifestyle and colon cancer: An assessment of factors associated with risk. Am J Epidemiol 1999;150:869-77.
4.	Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: The role of patient factors and physician counseling. Prev Med 2005;41:23-9.
5.	Rasool S, Kadla SA, Rasool V, Ganai BA. A comparative overview of general risk factors associated with the incidence of colorectal cancer. Tumour Biol 2013;34:2469-76.
6.	Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; 2020. Available from: https://gco.iarc.fr/today. [Last accessed on 2022 Sep 12].
7.	Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: Report from national cancer registry programme, India. JCO Glob Oncol 2020;6:1063-75.
8.	Young JP, Win AK, Rosty C, Flight I, Roder D, Young GP, et al. Rising incidence of early-onset colorectal cancer in Australia over two decades: Report and review. J Gastroenterol Hepatol 2015;30:6-13.
9.	Haggar FA, Boushey RP. Colorectal cancer epidemiology: Incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009;22:191-7.
10.	Giovannucci E. Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 2002;31:925-43.
11.	Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for prevention of gastrointestinal cancers: A systematic review and meta-analysis. Lancet 2004;364:1219-28.
12.	Myers EA, Feingold DL, Forde KA, Arnell T, Jang JH, Whelan RL. Colorectal cancer in patients under 50 years of age: A retrospective analysis of two institutions' experience. World J Gastroenterol 2013;19:5651-7.
13.	Campos FG. Colorectal cancer in young adults: A difficult challenge. World J Gastroenterol 2017;23:5041-4.
14.	Mokarram P, Kumar K, Brim H, Naghibalhossaini F, Saberi-firoozi M, Nouraie M, et al. Distinct high-profile methylated genes in colorectal cancer. PLoS One 2009;4:e7012.