Rising early-onset and declining late-onset gastrointestinal cancers in Spain, 1999-2023.

[INTRODUCTION] Gastrointestinal cancers (GICs) constitute a major and evolving public health challenge. Global trends indicate a decline in infection-related malignancies and a rise in cancers associated with metabolic risk factors. This study analysed long-term incidence trends of early- and late-onset GICs in Spain between 1999 and 2023.

[METHODS] A retrospective, ecological time-trend analysis was performed using incidence data from the Global Burden of Disease (GBD) 2023 database. Age-standardised incidence rates (ASIRs) for oesophageal, gastric, colorectal, liver, pancreatic, and gallbladder/biliary tract cancers were calculated by sex and age group (<50 years, ≥50 years), using the 2013 European standard population. Temporal trends were assessed with Joinpoint regression to estimate annual (APC) and average annual percentage change (AAPC).

[RESULTS] Among adults aged ≥50 years, marked declines were observed for gastric and oesophageal cancers, whereas pancreatic and liver cancers increased steadily in both sexes. Colorectal cancer incidence stabilised in women and rose slightly in men. In individuals <50 years, overall GIC incidence decreased, most notably for oesophageal (-3.7%) and colorectal (-0.8%) cancers, although a plateau emerged from 2016-2017 onwards. Pancreatic and liver cancers in young women showed early signs of stabilisation or mild increase.

[CONCLUSIONS] From 1999 to 2023, Spain achieved substantial reductions in infection- and tobacco-related GICs, reflecting effective prevention strategies. However, the rising incidence of metabolic-related malignancies, particularly pancreatic and liver cancers, and the recent stagnation in early-onset colorectal cancer trends highlight the need to strengthen metabolic health policies and optimise national screening programmes.