{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:10:12Z","timestamp":1772989812256,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute\u2019s Surveillance, Epidemiology, and End Results Program","doi-asserted-by":"publisher","award":["HHSN261201800011I"],"award-info":[{"award-number":["HHSN261201800011I"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute\u2019s Surveillance, Epidemiology, and End Results Program","doi-asserted-by":"publisher","award":["CA071789-15"],"award-info":[{"award-number":["CA071789-15"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute P30 award","doi-asserted-by":"publisher","award":["HHSN261201800011I"],"award-info":[{"award-number":["HHSN261201800011I"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute P30 award","doi-asserted-by":"publisher","award":["CA071789-15"],"award-info":[{"award-number":["CA071789-15"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Current characteristics of early onset colorectal cancer (EOCRC) in the United States have been mainly studied in Whites, African Americans, and Hispanics, but little is known in regard to EOCRC in Asians and Native Hawaiians in the US. EOCRC was examined in Hawaii\u2019s multiethnic population. Data from the Hawaii Tumor Registry was used to analyze colorectal cancer (CRC) cases diagnosed in Hawaii from 2000\u20132019 by subsite, age, gender, ethnicity, and stage. Ethnicity analyses were limited to 3524 CRC cases, diagnosed between 2015\u20132019. Average annual 5-year age-adjusted incidence and mortality rates, average annual percent change over time, and 5-year survival were evaluated. Group comparisons utilized Chi-square and binomial proportion tests. Overall CRC incidence and mortality declined and were more pronounced for colon than rectal\/rectosigmoid junction cancers. Colon cancer incidence rates significantly increased 1.46-fold for cases diagnosed under 45 years of age and rectal\/rectosigmoid cancers significantly increased 1.54-fold for cases 45\u201354 years of age. CRC incidence increased sharply for females aged 45\u201354 years from 2000\u20132009 to 2010\u20132019, and increases in colon and rectal\/rectosigmoid cancer among individuals aged 45\u201354 were higher for females. Among both sexes, the increase in rectal\/rectosigmoid cancer incidence for individuals under 55 years was highest for stage I cancers. Overall, the mean (SD) age of CRC diagnosis was 5\u201310 years earlier for Native Hawaiians (60.6 [13.3] years) compared with Japanese, Chinese, Filipinos, Whites, and Other Asians (p &lt; 0.001). Native Hawaiians constituted a greater proportion of CRC diagnosed under age 55 years and, conversely, a smaller proportion of cases 55 years and older compared with Japanese, Chinese, Filipinos, Whites, and Other Asians. Native Hawaiians had a significantly higher CRC-related mortality rate (14.5 per 100,000 [95% CI: 12.4, 16.8]) compared with Japanese (10.7 per 100,000 [95% CI: 9.3, 12.3]) and a significantly lower CRC survival rate (62.2% [95% CI: 59.1, 65.2]) compared with Japanese (71.9% [95% CI: 69.9, 73.8]), Filipinos (71.9% [95% CI: 69.2, 74.4]), Chinese (70.2% [95% CI: 65.5, 74.4]), Whites (69.3% [95% CI: 67.1, 71.4]), and Other Asians (71.7% [95% CI: 66.2, 76.5]). In our diverse US population, Native Hawaiians contribute disproportionately to EOCRC and present 5\u201310 years earlier than Whites, Japanese, Chinese, and Filipinos. EOCRCs are increasing faster in females than males in Hawaii, which differs from trends in the general US population. Emerging ethnic disparities in EOCRC in the US speak to the need for studies on targeted interventions and ethnic-specific risk factors for EOCRC.<\/jats:p>","DOI":"10.3390\/cancers16020398","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T07:41:28Z","timestamp":1705477288000},"page":"398","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Multiethnic Trends in Early Onset Colorectal Cancer"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0168-5008","authenticated-orcid":false,"given":"Michelle","family":"Nagata","sequence":"first","affiliation":[{"name":"Population Sciences in the Pacific Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohei","family":"Miyagi","sequence":"additional","affiliation":[{"name":"Population Sciences in the Pacific Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda Y.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Population Sciences in the Pacific Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott K.","family":"Kuwada","sequence":"additional","affiliation":[{"name":"Cancer Biology Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA"},{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA"},{"name":"Gastroenterology, The Queen\u2019s Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.canlet.2021.09.034","article-title":"Incidence, mortality, survival, risk factor and screening of colorectal cancer: A comparison among China, Europe, and northern America","volume":"522","author":"Li","year":"2021","journal-title":"Cancer Lett."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMra2200869","article-title":"Increasing Incidence of Early-Onset Colorectal Cancer","volume":"386","author":"Sinicrope","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_3","unstructured":"International Agency for Research on Cancer (2023, May 01). Colorectal Cancer. Available online: https:\/\/gco.iarc.fr\/today\/fact-sheets-cancers."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"317","DOI":"10.5217\/ir.2019.00021","article-title":"Prevalence and risk factors of colorectal cancer in Asia","volume":"17","author":"Wong","year":"2019","journal-title":"Intest. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/S0140-6736(19)32319-0","article-title":"Colorectal cancer","volume":"394","author":"Dekker","year":"2019","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3322\/caac.21772","article-title":"Colorectal cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/1878-0261.12417","article-title":"Early-onset colorectal cancer in young individuals","volume":"13","author":"Mauri","year":"2019","journal-title":"Mol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1038\/s41571-020-00445-1","article-title":"Rising incidence of early-onset colorectal cancer\u2014A call to action","volume":"18","author":"Akimoto","year":"2021","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.cgh.2021.01.037","article-title":"Risk Factors for Early-Onset Colorectal Cancer: A Systematic Review and Meta-analysis","volume":"20","author":"Sutherland","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12885-022-09238-4","article-title":"A risk scoring system to predict the individual incidence of early-onset colorectal cancer","volume":"22","author":"Gu","year":"2022","journal-title":"BMC Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1132306","DOI":"10.3389\/fonc.2023.1132306","article-title":"Risk factors for early-onset colorectal cancer: Systematic review and meta-analysis","volume":"13","author":"Hua","year":"2023","journal-title":"Front. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2752","DOI":"10.1016\/j.cgh.2019.10.009","article-title":"Risk Factors Associated With Early-Onset Colorectal Cancer","volume":"18","author":"Gausman","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6629","DOI":"10.1007\/s00464-021-08929-6","article-title":"Colorectal cancer in the 45-to-50 age group in the United States: A National Cancer Database (NCDB) analysis","volume":"36","author":"Haas","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Muller, C., Ihionkhan, E., Stoffel, E.M., and Kupfer, S.S. (2021). Disparities in Early-Onset Colorectal Cancer. Cells, 10.","DOI":"10.3390\/cells10051018"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"734998","DOI":"10.3389\/fonc.2021.734998","article-title":"Racial Disparities and Sex Differences in Early- and Late-Onset Colorectal Cancer Incidence, 2001\u20132018","volume":"11","author":"Petrick","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1002\/ijc.25822","article-title":"Racial\/ethnic differences in colorectal cancer risk: The multiethnic cohort study","volume":"129","author":"Ollberding","year":"2011","journal-title":"Int. J. Cancer"},{"key":"ref_18","unstructured":"National Cancer Institute (2023, May 17). Quick Profile: Hawaii. National Cancer Institute State Cancer Profiles, Available online: https:\/\/statecancerprofiles.cancer.gov\/quick-profiles\/index.php?tabSelected=2&statename=hawaii."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/aje\/kwy208","article-title":"Alcohol Intake and Colorectal Cancer Risk in the Multiethnic Cohort Study","volume":"188","author":"Park","year":"2019","journal-title":"Am. J. Epidemiol."},{"key":"ref_20","unstructured":"National Cancer Institute (2023, July 11). Surveillance, Epidemiology, and End Results Program, Available online: https:\/\/seer.cancer.gov\/."},{"key":"ref_21","unstructured":"World Health Organization (2013). International Classification of Diseases for Oncology (ICD-O), World Health Organization. [3rd ed.]. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/96612."},{"key":"ref_22","unstructured":"Adamo, M., Groves, C., Dickie, L., and Ruhl, J. (2023, June 26). SEER Program Coding and Staging Manual 2023. Natl. Cancer Inst. 2022, Available online: https:\/\/seer.cancer.gov\/manuals\/2023\/SPCSM_2023_MainDoc.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Statist Med."},{"key":"ref_24","unstructured":"Surveillance, Epidemiology, and End Results Program (2023, December 13). U.S. Census Tract Population Data, Available online: https:\/\/seer.cancer.gov\/censustract-pops\/."},{"key":"ref_25","unstructured":"American Community Survey (2023, August 18). Public Use Microdata Sample, Available online: https:\/\/www.census.gov\/programs-surveys\/acs\/microdata\/access.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1365","DOI":"10.1016\/j.cgh.2021.07.035","article-title":"Trends in Early-onset vs Late-onset Colorectal Cancer Incidence by Race\/Ethnicity in the United States Cancer Statistics Database","volume":"20","author":"Chang","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00384-010-1049-8","article-title":"Human papillomavirus and colorectal cancer: Evidences and pitfalls of published literature","volume":"26","author":"Lorenzon","year":"2011","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.ejca.2014.01.019","article-title":"The prevalence of human papillomavirus in colorectal adenomas and adenocarcinomas: A systematic review and meta-analysis","volume":"50","author":"Baandrup","year":"2014","journal-title":"Eur. J. Cancer."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1111\/codi.12257","article-title":"Human papillomavirus infection and colorectal cancer risk: A meta-analysis","volume":"15","author":"Damin","year":"2013","journal-title":"Colorectal Dis."},{"key":"ref_30","unstructured":"National Cancer Institute (2023, November 24). State Cancer Profiles. State Cancer Profiles, Available online: https:\/\/statecancerprofiles.cancer.gov\/historicaltrend\/index.php?0&2115&999&7599&001&057&00&2&0&0&1&0&1&1#results."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/jnci\/djac215","article-title":"Body mass index and molecular subtypes of colorectal cancer","volume":"115","author":"Murphy","year":"2023","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wele, P., Wu, X., and Shi, H. (2022). Sex-Dependent Differences in Colorectal Cancer: With a Focus on Obesity. Cells, 11.","DOI":"10.3390\/cells11223688"},{"key":"ref_33","unstructured":"Hawai\u2018i Health Data Warehouse (2023, November 24). Overweight and Obesity. Hawai\u2018i Health Data Warehouse. Available online: https:\/\/hhdw.org\/health-topics\/obesity-2\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1053\/j.gastro.2020.01.004","article-title":"Risk Factors for Early-Onset Colorectal Cancer","volume":"159","author":"Low","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.cgh.2022.05.035","article-title":"Racial and Ethnic Disparities in Early-Onset Colorectal Cancer Survival","volume":"21","author":"Zaki","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1002\/cam4.560","article-title":"Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States","volume":"4","author":"Rahman","year":"2015","journal-title":"Cancer Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1158\/1055-9965.EPI-20-1528","article-title":"Cancer Mortality Disparities among Asian American and Native Hawaiian\/Pacific Islander Populations in California","volume":"30","author":"Medina","year":"2021","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1309\/AJCPNOC55IOLXFUD","article-title":"Left-Sided Early-Onset vs Late-Onset Colorectal Carcinoma","volume":"143","author":"Pilozzi","year":"2015","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3393\/ac.2021.00976.0139","article-title":"Clinicopathologic characteristics of early-onset colorectal cancer","volume":"38","author":"Park","year":"2022","journal-title":"Ann. Coloproctol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e75","DOI":"10.1200\/EDBK_279901","article-title":"Colorectal Cancer in the Young: Epidemiology, Prevention, Management","volume":"40","author":"Siegel","year":"2020","journal-title":"Am. Soc. Clin. Oncol. Educ. Book."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/cncr.29716","article-title":"Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening","volume":"122","author":"Abdelsattar","year":"2016","journal-title":"Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/s41575-019-0189-8","article-title":"Global burden of colorectal cancer: Emerging trends, risk factors and prevention strategies","volume":"16","author":"Keum","year":"2019","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1038\/sj.bjc.6605721","article-title":"The association of diabetes with colorectal cancer risk: The Multiethnic Cohort","volume":"103","author":"He","year":"2010","journal-title":"Br. J. Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/398\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:51Z","timestamp":1760104131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,17]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["cancers16020398"],"URL":"https:\/\/doi.org\/10.3390\/cancers16020398","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,17]]}}}