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  • Review Article
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Changing epidemiology of colorectal cancer — birth cohort effects and emerging risk factors

Nature Reviews Gastroenterology & Hepatology volume 21, pages 25–34 (2024)Cite this article

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Abstract

Incidence and mortality of colorectal cancer (CRC) are increasing worldwide, suggesting broad changes in the epidemiology of CRC. In this Review, we discuss the changes that are becoming evident, including trends in CRC incidence and mortality by age and birth cohort, and consider the contributions of early-life exposures and emerging risk factors to these changes. Importantly, incidence of CRC has increased among people born since the early 1950s in nearly all regions of the world. These so-called birth cohort effects imply the involvement of factors that influence the earliest stages of carcinogenesis and have effects across the life course. Accumulating evidence supports the idea that early-life exposures are important risk factors for CRC, including exposures during fetal development, childhood, adolescence and young adulthood. Environmental chemicals could also have a role because the introduction of many in the 1950s and 1960s coincides with increasing incidence of CRC among people born during those years. To reverse the expected increases in the global burden of CRC, participation in average-risk screening programmes needs to be increased by scaling up and implementing evidence-based screening strategies, and emerging risk factors responsible for these increases need to be identified.

Key points

  • Incidence and mortality of colorectal cancer (CRC) are increasing worldwide, suggesting broad changes in the epidemiology of CRC.

  • The incidence of CRC has increased among people born since the early 1950s in nearly all regions of the world; so-called birth cohort effects.

  • Birth cohort effects implicate factors that influence the earliest stages of carcinogenesis and have effects across the life course.

  • Accumulating evidence supports the idea that early-life exposures, including those during fetal development, childhood, adolescence and young adulthood, are important risk factors for CRC.

  • Environmental chemicals could have a role in birth cohort effects because the introduction of many in the 1950s and 1960s coincides with increasing incidence of CRC among people born during those years.

  • To prevent expected increases in the global burden of CRC, participation in average-risk screening programmes needs to be increased, and emerging risk factors responsible for the increases need to be identified.

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Fig. 1: Incidence of and mortality associated with colorectal cancer by age group and world region over time.
Fig. 2: Incidence rate ratios of colorectal cancer by birth cohort and world region.

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Authors and Affiliations

  1. Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA

    Caitlin C. Murphy

  2. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Timothy A. Zaki

  3. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Timothy A. Zaki

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Murphy, C.C., Zaki, T.A. Changing epidemiology of colorectal cancer — birth cohort effects and emerging risk factors. Nat Rev Gastroenterol Hepatol 21, 25–34 (2024). https://doi.org/10.1038/s41575-023-00841-9

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