Burden and Forecast of Early-Onset Colorectal Cancer (1990-2038) in Five East Asian Populations: A Systematic...

Early-onset colorectal cancer (EO-CRC) is increasing globally with substantial regional variation. We assessed epidemiological changes in EO-CRC in five East Asian populations.

Using GBD 2023 data, we calculated age-standardized incidence, prevalence, mortality, and DALY rates (ASIR, ASPR, ASMR, ASDR), counts, and average annual percent changes (AAPC). Decomposition, age-period-cohort (APC), and forecast analyses assessed trends and risk factor contributions to mortality.

In 2023, these populations accounted for 25%-31% of global EO-CRC cases. China had the highest absolute burden, and Taiwan (Province of China) had the highest ASR. From 1990 to 2023, North Korea had the highest ASIR increase (AAPC = 1.34%), while South Korea's ASMR declined most (AAPC = -2.58%). Males had a higher burden than females. Decomposition analysis showed epidemiological changes increased incidence outside China but generally reduced mortality except in North Korea, with effects stronger for deaths than incidence. APC analysis revealed accelerated risk with age; period effects varied: North Korea showed the largest relative risk increase (RR 0.93 → 1.32), and China showed a post-2014 rebound. Projections to 2038 suggest continued rises in incidence and DALYs. Risk analysis identified low calcium intake as the main mortality driver in North Korea, and low milk, low whole grains, and high red meat intake in the other populations; high BMI and processed meat-related deaths also increased markedly.

EO-CRC incidence is rising in East Asia, with China highest in absolute numbers and Taiwan in ASR; men are disproportionately affected. Burden and risk analyses reveal population-specific effects. Interventions should target diet, screening, and sex- and population-specific risk factors.