pISSN 1598-2998, eISSN 2005-9256

https://doi.org/10.4143/crt.2022.1612 Cancer Res Treat. 2023;55(3):1058-1060

Correspondence

Right Then, Wrong Now: Early-Onset Colorectal Cancer in Korea

Aesun Shin , Kyu-Won Jung5,6, Seung-Yong Jeong2,7
1,2,3,4

1
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 2Cancer Research Institute, Seoul National University,
Seoul, 3Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, 4Integrated Major in Innovative
Medical Science, Seoul National University Graduate School, Seoul, 5Korea Central Cancer Registry, National Cancer Center, Goyang, 6Division of
Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, 7Department of Surgery, Seoul National
University College of Medicine, Seoul, 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

A
Trends in incidence of colorectal cancer,
20-49 yr, 1999-2019
20 APC
Male
Age-standardized rate per 100,000

Female Male
Total 1999-2011: 5.19a)
15 2011-2016: –5.59a)
2016-2019: 2.29
Female
1999-2011: 4.01a)
10 2011-2016: –6.90a)
2016-2019: 2.95
Total
5 1999-2011: 4.80a)
2011-2016: –4.80a)
2016-2019: 3.14

0
1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
Year of diagnosis
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. (Continued to the
next page)

Correspondence: Aesun Shin

Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: 82-2-740-8331 Fax: 82-2-747-4830 E-mail: shinaesun@snu.ac.kr
Received December 12, 2022 Accepted February 3, 2023 Published Online February 6, 2023

1058 Copyright 2023­­by the Korean Cancer Association │ https://www.e-crt.org │

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Aesun Shin, Early-Onset Colorectal Cancer in Korea

B
Trends in incidence of colon cancer,
20-49 yr, 1999-2019
20 APC
Male

Age-standardized rate per 100,000

Female Male
Total 1999-2011: 8.94a)
15 2011-2019: –0.76
Female
1999-2013: 7.33a)
2013-2019: –1.67
10
Total
1999-2012: 7.94a)
2012-2019: –1.04
5

0
1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
Year of diagnosis

C
Trends in incidence of rectal cancer,
20-49 yr, 1999-2019
20 APC
Male
Age-standardized rate per 100,000

Female Male
Total 1999-2011: 4.97a)
15 2011-2016: –5.91a)
2016-2019: 2.38
Female
1999-2012: 3.79a)
10 2012-2015: –7.73a)
2015-2019: 3.52a)
Total
5 1999-2011: 4.58a)
2011-2016: –5.21a)
2016-2019: 3.49

0
1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
Year of diagnosis
Fig. 1. (Continued from the previous page)

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.

VOLUME 55 NUMBER 3 JULY 2023 1059

Cancer Res Treat. 2023;55(3):1058-1060

ORCID iDs
Aesun Shin : https://orcid.org/0000-0002-6426-1969

Conflicts of Interest
Conflict of interest relevant to this article was not reported.

References
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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 epidemiol-
ogy, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol. 2022;7:262-74.
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.
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.
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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