Consumption of red meat, alcohol intake, and other nongenetic risk factors are associated with early-onset colorectal cancer (CRC), according to a study published in JNCI Cancer Spectrum.

The prevalence of early-onset CRC (in adults younger than 50 years of age) has been on the rise in recent years, the study authors noted. The incidence of early-onset CRC in the United States nearly doubled between 1992 and 2013 (8.6 to 13.1 per 100,000 people).

However, risk factors contributing to early-onset CRC are not well established. The authors sought to determine whether the pharmacologic, dietary, lifestyle, and anthropometric-related risk factors that are traditionally associated with late-onset CRC are also linked to early-onset CRC and whether the association patterns are different based on anatomic subsites.

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The researchers pooled data from 13 population-based studies. They analyzed 3767 CRC patients and 4049 control individuals younger than 50 years of age as well as 23,437 CRC patients and 35,311 control individuals age 50 and older.

In the younger cohort, men and women were equally distributed between the CRC and control groups. Patients with early-onset CRC and control individuals were similar according to age (mean, 45.0 years and 44.7 years, respectively).

In a multivariate analysis, early-onset CRC was significantly associated with the following factors:

  • Greater red meat intake (treated as a continuous variable) — odds ratio (OR) of 1.10 (95% CI, 1.04-1.16; P <.001)
  • No regular use of nonsteroidal anti-inflammatory drugs — OR of 1.43 (95% CI,  1.21-1.68; P <.001)
  • Lower educational attainment (less than a college graduate) — OR of 1.10 (95% CI, 1.04-1.16; P <.001)
  • Alcohol intake greater than 28 g/day — OR of 1.25 (95% CI, 1.04-1.50; P =.02)
  • Abstinence from alcohol — OR of 1.23 (95% CI, 1.08-1.39; P =.001).

None of these risk factors had a greater excess in effect size for early-onset CRC compared with late-onset CRC.

However, a few factors were associated with late-onset CRC but not early-onset CRC — body mass index, smoking history, and lack of aspirin use.

An evaluation of risk factors for early-onset CRC by anatomic subsite revealed that lower intake of dietary fiber was more strongly linked to rectal cancer than to colon cancer (OR, 1.30 vs 1.14; P =.04).

“These results present key insights concerning risk factors that contribute to CRC manifestation in younger individuals, providing a basis for identification of those most at risk, which is imperative in mitigating the rising burden of this disease,” the study authors concluded.

Disclosures: This research was supported by the National Cancer Institute and other organizations. Please see the original reference for a full list of funding sources. The study authors declared no competing interests.


Archambault AN, Lin Y, Jihyoun J, et al. Nongenetic determinants of risk for early-onset colorectal cancer. JNCI Cancer Spectrum. 2021; 5(3):pkab029. doi:10.1093/jncics/pkab029