This population-based nested case-control study examined whether demographic, birth, and parental characteristics are associated with early-onset colorectal cancer (EOCRC, diagnosed before age 50) among 1,221 cases (ages 0–39) and 61,050 matched controls born in California between 1982–2021 and diagnosed during 1988–2021.
In multivariable analysis, male sex (OR 1.34; 95% CI 1.20–1.51) and Hispanic ethnicity vs. non-Hispanic White (OR 1.34; 95% CI 1.20–1.51) were independent risk factors. Foreign-born mother was protective (OR 0.85; 95% CI 0.73–0.97). Among females only: each 500-g birthweight increase raised EOCRC risk 10% (OR 1.10; 95% CI 1.01–1.21), and paternal age ≥35 years conferred 56% higher risk (OR 1.56; 95% CI 1.08–2.25).
- The 0–19 age subgroup had only 76 cases, leaving it likely underpowered. - ~70% of cases and controls had missing parental education data, limiting that variable's interpretability. - Maternal obesity—a known CRC risk factor—was not captured in the birth records, representing potential residual confounding. - Findings apply only to ages 0–39 and may not generalize to the full EOCRC spectrum (ages 40–49).
Clinicians should recognize Hispanic individuals and males as higher-risk groups for EOCRC even before age 40, supporting heightened clinical suspicion and earlier symptom evaluation in these groups. Foreign-born maternal origin appears protective, possibly through diet and lifestyle, but does not reduce individual vigilance.
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