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Cancer Research and Treatment > Volume 55(3); 2023 > Article
Shin, Jung, and Jeong: Right Then, Wrong Now: Early-Onset Colorectal Cancer in Korea
The rising incidence of early-onset colorectal cancer (EOCRC), which is defined as a diagnosis of colorectal cancer (CRC) before the age of 50, has been a hot issue in the oncology field. Generally, this is explained by the starting age of cancer screening in most countries being 50, which limits access to screening of younger adults, and the transition of lifestyle and metabolic risk factors such as obesity.
There is the notion in the media and academic communities that the incidence and the increase in EOCRC are the highest in Korea. This notion is based on two articles. The first paper by Sung et al. [1] was published in 2019 and compared the incidence of EOCRC in 4 Asian countries/regions, including Korea. The abstract presented the average annual percent change (AAPC) between 1999 and 2014, and Korean patients showed the highest AAPC of 6% for male rectal cancer [1]. The second paper by Patel et al. published in 2022 [2] referred to an article by Siegel et al. [3] in the figure; the incidence (12.9/100,000) as well as the AAPC (4.2%) between 2008 and 2012 was the highest in South Korea among 42 countries [2].
The data used for both articles were Korea Central Cancer Registry (KCCR) data, which are of very high quality. Notably, the study periods were limited to 1999 to 2014 (Sung et al. [1]) and 2008–2012 (Patel et al. [2]) when the incidence of CRC sharply increased [4]. Since 2011, CRC in most age groups among both men and women has started to decrease [4,5]. Fig. 1 shows the incidence of colon, rectal, and colorectal cancer among population aged 20–49 years from the KCCR between 1999 and 2019. The incidence of CRC significantly increased until 2011 among men and 2012 among women and then significantly decreased among men between 2011 and 2016. Although there were fluctuations for both men and women, the trends were not statistically significant. Similar trends were observed for colon and rectal cancers, respectively. Even in the most recent estimates from the International Agency for Research on Cancer (IARC), the Republic of Korea ranked 8th, 17th, and 9th for CRC incidence among men, women, and both sexes aged 20–49, respectively (https://gco.iarc.fr/today/home).
The National Cancer Screening Program (NCSP) for CRC starts at age 50 for both men and women; however, the NCSP for gastric cancer starts at age 40 for both sexes and that for breast cancer starts at age 40 for women. Apart from the NCSP, opportunistic screening for CRC among those aged 40 years was 48% according to the 2022 National Cancer Screening Survey (personal communication), which could explain the different patterns of EOCRC in Korea compared to other countries.
In conclusion, EOCRC in Korea reached its peak in 2011 and has decreased since then. EOCRC in Korea showed one of the highest incidences worldwide; however, the notion that the incidence and the increase in EOCRC are the highest in Korea does not appropriately describe the current situation.


Author Contributions

Conceived and designed the analysis: Shin A, Jung KW, Jeong SY.

Collected the data: Shin A, Jung KW.

Contributed data or analysis tools: Jung KW.

Performed the analysis: Jung KW.

Wrote the paper: Shin A, Jung KW, Jeong SY.

Conflicts of Interest

Conflict of interest relevant to this article was not reported.

Fig. 1
The incidence of colorectal (A), colon (B), and rectal cancer (C) among population aged 20–49 years from the Korea Central Cancer Registry (KCCR) between 1999 and 2019. a)Annual percent change (APC) is significantly different from zero at α=0.05.


1. Sung JJY, Chiu HM, Jung KW, Jun JK, Sekiguchi M, Matsuda T, et al. Increasing trend in young-onset colorectal cancer in Asia: more cancers in men and more rectal cancers. Am J Gastroenterol. 2019;114:322–9.
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2. Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol. 2022;7:262–74.
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3. Siegel RL, Torre LA, Soerjomataram I, Hayes RB, Bray F, Weber TK, et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019;68:2179–85.
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4. Shin A, Jang D, Choe S, Won YJ, Jung KW, Park JW, et al. Colorectal cancer epidemiology in Korea. J Korean Med Assoc. 2019;62:407–15.
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5. Kang MJ, Won YJ, Lee JJ, Jung KW, Kim HJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019. Cancer Res Treat. 2022;54:330–44.
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