The burden of early-onset colorectal cancer in the WHO Eastern Mediterranean Region: an analysis of GLOBOCAN 2022 data

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Background Early-onset colorectal cancer (EO-CRC), defined as colorectal cancer (CRC) diagnosed before age 50 years, is increasing globally. However, population-based studies from the World Health Organization (WHO) Eastern Mediterranean Region (EMRO) remain limited, masking regional disparities. To address this gap, we conducted a comprehensive assessment of the burden, temporal trends, and future projections of EO-CRC across the EMRO, comparing patterns with other WHO regions and global estimates. Methods We conducted a population-based study using GLOBOCAN 2022 surveillance data for EMRO. EO-CRC outcomes included age-standardised incidence rates (ASIRs), age-standardised mortality rates (ASMRs), and 1-, 3-, and 5-year prevalence per 100,000 population. Temporal trends were assessed using estimated annual percentage change (EAPC), while future burden to 2050 was projected using the Cancer Tomorrow tool. Associations between the Human Development Index (HDI) and EO-CRC outcomes were evaluated using Pearson and Spearman correlation analyses. CRC across all ages was analysed for comparative purposes. Findings In 2022, EMRO recorded 53,941 new CRC cases (ASIR = 8.9), including 15,381 EO-CRC cases (ASIR = 2.5 per 100,000), and 29,918 CRC deaths (ASMR = 5.1 per 100,000), including 6965 EO-CRC deaths (ASMR = 1.1 per 100,000). EO-CRC incidence peaked among adults aged 35–49 years (ASIR = 8.4 per 100,000) and demonstrated substantial inter-country heterogeneity. Jordan had the highest EO-CRC incidence (ASIR = 4.2 per 100,000), while Jordan, Oman, and Somalia had the highest EO-CRC mortality rates. Males exhibited higher EO-CRC incidence and mortality than females, although several EMRO countries demonstrated a greater female burden, such as Bahrain, Kuwait, Libya, and Jordan. Compared with other WHO regions, EMRO had one of the highest EO-CRC mortality rates despite having intermediate CRC incidence, compared to other countries. Temporal trends showed significant increases in EO-CRC incidence especially in Kuwait and Qatar. Across EMRO, EO-CRC incidence and mortality are projected to increase substantially by 2050, with females expected to experience greater relative increases. Exploratory analyses suggested an inverse association between HDI and EO-CRC mortality (Pearson r=−0.45; Spearman ρ = −0.37), although the findings were sensitive to the method of estimation, indicating a disproportionate mortality burden in lower HDI countries. Interpretation EO-CRC represents a rapidly expanding burden in EMRO, characterised by high and inequitable cancer mortality, substantial inter-country heterogeneity in both EO-CRC incidence and mortality, and marked projected increases. The observed socioeconomic disparities highlight the need for tailored public health strategies, including earlier detection, increased public awareness, and improved access to high-quality cancer care, particularly across EMRO and other low- and middle-income countries.