Colon, colorectal, and all cancer incidence increase in the young due to appendix reclassification
Bibliographic record
Abstract
BACKGROUND: Increases in colon and colorectal cancer incidence among adolescents and young adults have been reported progressively. Most of the increase may be because of an artifact caused by reclassifying appendiceal carcinoids and neuroendocrine tumor (NET) as malignant. METHODS: Age-adjusted incidence and survival data were obtained from the Surveillance, Epidemiology, and End Results SEER22 database. RESULTS: In adolescents and young adults during 2000-2020, appendix cancer had an average annual percent change in incidence increase that in males was 3.7 times greater than the next most increasing cancer (average annual percent change = 12.8, 95% confidence interval CI] = 10.9% to 14.6% vs average annual percent change = 3.4 [kidney], 95% CI = 2.7% to 3.5%) and correspondingly in females 2.9-fold greater (average annual percent change = 14.6,95% CI = 11.9% to 17.3% vs average annual percent change = 4.2 [pancreas], 95% CI = 3.6% to 4.8%). From 2000-2009 to 2015-2020, appendix cancer incidence increased 17-, 6.5-, and 2.5-fold in children aged 0-14 years, adolescents and young adults aged 15-39 years, and adults aged 40-49 years, respectively. NET accounted for 95%, 90%, and 80% of appendix cancer increase in the 3 age groups, respectively. In 3446 adolescents and young adults diagnosed during 2010-2020 with malignant appendix NET, the 6-year cancer-specific survival was 99.4% (95% CI = 99.0% to 99.6%). From 2000-2009 to 2015-2020, colon carcinoma incidence in adolescents and young adults increased 61% with the appendix included and only 11% with the appendix excluded. CONCLUSIONS: Reclassification of appendix NET/carcinoids as malignant has artifactually increased the incidence of colon, colorectum, and all cancer in children and adolescents and young adults. Appendix NET/carcinoids are rarely fatal in those aged younger than 40 years and should not be considered as cancer and included in colorectal cancer analyses. To the extent that the appendix artifact occurs in adults aged 40-49 years, recommendations for starting colorectal cancer screening earlier may be affected.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".