Epidemiology of early-onset colorectal cancer in the WHO Eastern Mediterranean Region: Regional and global comparisons.

3660 Background: Early onset colorectal cancer (EO-CRC) is increasing globally, yet studies from the WHO Eastern Mediterranean Region (EMRO) are limited. We quantified the burden, temporal trends, and future projections of EO-CRC in EMRO and compared patterns with regional and global estimates. Methods: We conducted a population based study using GLOBOCAN 2022 data. EO-CRC outcomes included age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and 1-, 3-, and 5-year prevalence per 100000 population. Age-specific analyses were conducted. Temporal trends were assessed using Estimated Annual Percentage Change (EAPC). Associations between Human Development Index (HDI) and EO-CRC outcomes were evaluated using Pearson correlation coefficients (r). Results: In 2022, EMRO recorded 53941 new CRC cases (ASIR = 8.9), including 15381 EO-CRC cases (ASIR = 2.5), and 29918 CRC deaths (ASMR = 5.1), including 6965 EO-CRC deaths (ASMR = 1.1). EO-CRC incidence was lowest among individuals aged 0–19 years (ASIR = 0.17), increased in those aged 20–34 years (ASIR = 1.9), and peaked among adults aged 35–49 years (ASIR = 8.4), who accounted for most EO-CRC cases and deaths. Marked inter-country heterogeneity was observed. Jordan had the highest EO-CRC incidence (ASIR = 4.2), followed by Libya (ASIR = 3.5) and Iran (ASIR = 3.3), while EO-CRC mortality was highest in Jordan (ASMR = 1.9), followed by Oman and Somalia (ASMR = 1.8 each). Five-year EO-CRC prevalence was highest in Saudi Arabia (14.7 per 100,000), Oman (13.5), and Iran (13.3), but remained below 3 per 100000 in Afghanistan and Somalia. Males exhibited higher EO-CRC incidence (ASIR = 2.6) and mortality (ASMR = 1.2) than females (ASIR = 2.4; ASMR = 1.1), although several countries demonstrated a higher female burden. Compared with other WHO regions, EMRO demonstrated one of the highest EO-CRC mortality rates globally (ASMR = 1.1), exceeding Europe (ASMR = 1.0), South-East Asia (ASMR = 0.68), and the Western Pacific (ASMR = 0.98), despite having lower overall CRC incidence. Temporal trend analyses revealed concerning increases in EO-CRC incidence, with significant rises in Israel (EAPC = +2.58%). EO-CRC mortality was inversely correlated with HDI (r = −0.45; p = 0.034), indicating a disproportionate mortality burden in lower HDI countries. Projections indicate that annual EO-CRC cases will increase from 15381 in 2022 to 24396 by 2050, and annual deaths from 6965 to 11005, underscoring a rapidly escalating regional burden. Incidence and mortality are projected to rise faster in females across EMRO by 2050. Conclusions: EO-CRC is a rapidly growing, inequitable burden in EMRO, with high mortality and marked inter-country differences. Its disproportionate impact on lower HDI countries and younger populations highlights the urgent need for targeted interventions, including early detection and awareness campaigns.