Rising Incidence of Colorectal Cancer in Patients Younger than Age 50 in Hawai'i.

Colorectal cancer is the third most common cancer in the United States in both men and women, and the second leading cause of cancer-related deaths. Whereas the overall incidence of colon and rectal cancer has been decreasing over the past two decades, due in large part to improved colorectal screening and surveillance of patients who are at risk, incidence rates of colorectal cancer in young adults ages 20 to 50 have actually been increasing. Recently, the American Cancer Society updated their guidelines with recommendations that everyone, not just African Americans or those with a strong family history of colon cancer, should begin colorectal screening at age 45 rather than age 50. However, the United States Multi-Society Task Force on Colorectal Cancer, which is comprised of the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, felt that there is still insufficient evidence to support early screening in the absence of known risk factors. Previous authors have examined the epidemiology and natural history of early onset colorectal cancer but none of these studies are specific to the state of Hawai'i, which has a unique ethnic profile. The purpose of this article is to review the most recently reported incidence rate and demographics of early onset colorectal cancer in Hawai'i and to discuss our own experience with colon cancer in patients younger than age 50. If we can determine specific characteristics of young patients with early onset colorectal cancer in Hawai'i, we can better identify those patients who would benefit most from earlier screening.