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’s multiethnic population. Data from the Hawaii Tumor Registry was used to analyze colorectal cancer (CRC) cases diagnosed in Hawaii from 2000–2019 by subsite, age, gender, ethnicity, and stage. Ethnicity analyses were limited to 3524 CRC cases, diagnosed between 2015–2019. 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 45–54 years of age. CRC incidence increased sharply for females aged 45–54 years from 2000–2009 to 2010–2019, and increases in colon and rectal/rectosigmoid cancer among individuals aged 45–54 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 5–10 years earlier for Native Hawaiians (60.6 [13.3] years) compared with Japanese, Chinese, Filipinos, Whites, and Other Asians (p< 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 5–10 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.
目前美国早发性结直肠癌（EOCRC）的特征研究主要集中于白人、非裔美国人和西班牙裔人群，而针对美国亚裔及夏威夷原住民的EOCRC情况了解甚少。本研究在夏威夷多民族人群中考察了EOCRC的流行病学特征。通过夏威夷肿瘤登记处2000-2019年确诊的结直肠癌（CRC）病例数据，按解剖亚位、年龄、性别、种族和分期进行分析。种族分析限定于2015-2019年间确诊的3524例CRC病例。研究评估了五年平均年龄标化发病率与死亡率、年均变化百分比及五年生存率，采用卡方检验和二项比例检验进行组间比较。 总体CRC发病率与死亡率呈下降趋势，其中结肠癌的下降幅度显著大于直肠/直肠乙状结肠交界处癌。45岁以下人群结肠癌发病率显著上升1.46倍，45-54岁人群直肠/直肠乙状结肠癌发病率显著上升1.54倍。2000-2009年至2010-2019年间，45-54岁女性CRC发病率急剧上升，且该年龄段女性结肠癌与直肠/直肠乙状结肠癌的增幅均高于男性。在55岁以下人群中，两性I期直肠/直肠乙状结肠癌的发病率增幅最为显著。 总体而言，夏威夷原住民的CRC确诊平均年龄（60.6±13.3岁）较日裔、华裔、菲律宾裔、白人及其他亚裔人群早5-10年（p<0.001）。与日裔、华裔、菲律宾裔、白人及其他亚裔相比，夏威夷原住民在55岁以下CRC病例中占比更高，而在55岁及以上病例中占比更低。夏威夷原住民的CRC相关死亡率（14.5/10万[95% CI: 12.4, 16.8]）显著高于日裔人群（10.7/10万[95% CI: 9.3, 12.3]），其CRC生存率（62.2%[95% CI: 59.1, 65.2]）则显著低于日裔（71.9%[95% CI: 69.9, 73.8]）、菲律宾裔（71.9%[95% CI: 69.2, 74.4]）、华裔（70.2%[95% CI: 65.5, 74.4]）、白人（69.3%[95% CI: 67.1, 71.4]）及其他亚裔人群（71.7%[95% CI: 66.2, 76.5]）。 在美国多元化人群中，夏威夷原住民在EOCRC疾病负担中呈现不成比例的高负担，其发病时间较白人、日裔、华裔和菲律宾裔早5-10年。夏威夷地区女性EOCRC增速高于男性，这一趋势与美国总体人群存在差异。美国EOCRC中显现的种族差异提示，亟需开展针对特定干预措施及种族特异性风险因素的深入研究。
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