Epidemiology of Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis of Incidence, Temporal Trends, and Associated Factors
Abstract
Early-onset colorectal cancer (EOCRC) refers to colorectal cancer (CRC) diagnosed in adults younger than 50 years. We conducted this systematic review and meta-analysis to estimate EOCRC incidence, evaluate temporal trends from 1990 to 2021, identify factors associated with increased EOCRC risk, and project the anticipated burden through 2030. PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through December 31, 2025. Population-based registry studies, cohort studies, and case-control studies reporting EOCRC incidence, temporal trends, or associated factors were included. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261345410). Two reviewers independently screened records, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for the primary incidence estimate and the leading modifiable associated factors. Incidence rates and adjusted association estimates were pooled using random-effects meta-analysis, with analyses stratified by study design where appropriate. Prespecified subgroups included geographic region, sex, tumor subsite, Human Development Index stratum, calendar period, and age group; temporal trends were examined using meta-regression. Fifty-two studies from 52…
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