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      Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years

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          The incidence of colorectal cancer (CRC) declines among subjects aged 50 years and above. An opposite trend appears among younger adults. In Europe, data on CRC incidence among younger adults are lacking. We therefore aimed to analyse European trends in CRC incidence and mortality in subjects younger than 50 years.


          Data on age-related CRC incidence and mortality between 1990 and 2016 were retrieved from national and regional cancer registries. Trends were analysed by Joinpoint regression and expressed as annual percent change.


          We retrieved data on 143.7 million people aged 20–49 years from 20 European countries. Of them, 187 918 (0.13%) were diagnosed with CRC. On average, CRC incidence increased with 7.9% per year among subjects aged 20–29 years from 2004 to 2016. The increase in the age group of 30–39 years was 4.9% per year from 2005 to 2016, the increase in the age group of 40–49 years was 1.6% per year from 2004 to 2016. This increase started earliest in subjects aged 20–29 years, and 10–20 years later in those aged 30–39 and 40–49 years. This is consistent with an age-cohort phenomenon. Although in most European countries the CRC incidence had risen, some heterogeneity was found between countries. CRC mortality did not significantly change among the youngest adults, but decreased with 1.1%per year between 1990 and 2016 and 2.4% per year between 1990 and 2009 among those aged 30–39 years and 40–49 years, respectively.


          CRC incidence rises among young adults in Europe. The cause for this trend needs to be elucidated. Clinicians should be aware of this trend. If the trend continues, screening guidelines may need to be reconsidered.

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          Most cited references 20

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          Inflammatory mechanisms in obesity.

          The modern rise in obesity and its strong association with insulin resistance and type 2 diabetes have elicited interest in the underlying mechanisms of these pathologies. The discovery that obesity itself results in an inflammatory state in metabolic tissues ushered in a research field that examines the inflammatory mechanisms in obesity. Here, we summarize the unique features of this metabolic inflammatory state, termed metaflammation and defined as low-grade, chronic inflammation orchestrated by metabolic cells in response to excess nutrients and energy. We explore the effects of such inflammation in metabolic tissues including adipose, liver, muscle, pancreas, and brain and its contribution to insulin resistance and metabolic dysfunction. Another area in which many unknowns still exist is the origin or mechanism of initiation of inflammatory signaling in obesity. We discuss signals or triggers to the inflammatory response, including the possibility of endoplasmic reticulum stress as an important contributor to metaflammation. Finally, we examine anti-inflammatory therapies for their potential in the treatment of obesity-related insulin resistance and glucose intolerance.
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            Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.
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              Global patterns and trends in colorectal cancer incidence and mortality.

              The global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. In this study, we aim to describe the recent CRC incidence and mortality patterns and trends linking the findings to the prospects of reducing the burden through cancer prevention and care.

                Author and article information

                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                October 2019
                16 May 2019
                : 68
                : 10
                : 1820-1826
                [1 ] departmentGastroenterology and Hepatology , Erasmus MC University Medical Center , Rotterdam, The Netherlands
                [2 ] departmentPublic Health , Erasmus MC University Medical Center , Rotterdam, The Netherlands
                [3 ] departmentCentre d’investigations Clinique INSERM 1432 , CHU Dijon-Bourgogne , Dijon, France
                [4 ] departmentGastroenterology , Portuguese Oncology Institute of Porto , Porto, Portugal
                [5 ] departmentCINTESIS , Porto Faculty of Medicine, University of Porto , Porto, Portugal
                [6 ] departmentNorth Region Cancer Registry (RORENO), Department of Epidemiology , Portuguese Oncology Institute of Porto , Porto, Portugal
                [7 ] departmentEpidemiology and Cancer Registry , Institute of Oncology , Ljubljana, Slovenia
                [8 ] departmentGastroenterology Department , Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona , Barcelona, Spain
                [9 ] departmentCatalan Cancer Plan , Catalan Institute of Oncology, L’Hospitalet del Llobregat , Barcelona, Spain
                [10 ] departmentCancer Prevention , The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw, Poland
                [11 ] departmentGastroenterology, Hepatology and Clinical Oncology , Medical Centre for Postgraduate Education , Warsaw, Poland
                [12 ] departmentDepartment of Health Management and Health Economics , University of Oslo , Oslo, Norway
                [13 ] departmentInternal Medicine , 1st Faculty of Medicine, Charles University, Military University Hospital , Prague, Czech Republic
                [14 ] departmentFaculty of Medicine, Masaryk University , Institute of Biostatistics and Analyses , Brno, Czech Republic
                [15 ] Institute of Health Information and Statistics of the Czech Republic , Prague, Czech Republic
                [16 ] departmentInstitute of Clinical and Preventive Medicine & Faculty of Medicine , University of Latvia , Riga, Latvia
                Author notes
                [Correspondence to ] Dr Manon CW Spaander, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam 3015CE, The Netherlands ; v.spaander@
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

                Original article
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                Gastroenterology & Hepatology

                screening, epidemiology, colorectal cancer


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