Global patterns and trends in colorectal cancer incidence and mortality

Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study.

To understand the incidence and mortality of colorectal cancer in China. The data from GLOBOCAN 2012, Chinese Cancer Registry Annual Report 2012, Cancer Incidence in Five Continents (CI5), the Three National Death Cause Surveys in China and WHO Mortality Database were used to learn about the incidence and mortality of colorectal cancer and related trends in China. It was estimated by GLOBOCAN 2012 that in 2012 the age-standardized incidence of colorectal cancer in China was 16.9 per 100 000 in males and 11.6 per 100 000 in females, and the age-standardized mortality was 9.0 per 100 000 in males and 6.1 per 100 000 in females. GLOBOCAN 2012 estimated that colorectal cancer incidence and mortality would increase with the level of human development index. China's human development level was high, suggesting that the burden of colorectal cancer would be more serious in China with the development of social economy. The data from CI5 Volume IV and GLOBOCAN 2012 indicated that the incidence of colorectal cancer began to increase obviously at age of 50 years in China. Chinese Cancer Registry Annual Report 2012 showed that the incidence and mortality of colorectal cancer in urban population were two times higher than those in rural population in 2009, the proportions of colon cancer among colorectal and anus cancers, which was 49.0% in males and 54.2% in females, 53.4% in urban population and 41.7% in rural population. CI5 Volumes IV-X showed that colon cancer and rectum and anus cancer incidence in Shanghai for both males and females were increasing during the period 1973-2007. The percentage change in colon cancer and rectum and anus cancer incidence between 1973-1977 and 2003-2007 increased by 138.8% and 31.1% in males, 146.7% and 49.1% in females, respectively. The data from the Three National Death Cause Surveys showed that the crude mortality of colorectal cancer increased by 77.9% form mid 1970's (1973-1975) to mid 2000's (2004-2005). WHO Mortality Database showed that average annual percentage change (AAPC) of age-standardized colorectal cancer mortality increased by 0.7% (P < 0.05) from 1987 to 2000. More attention should be paid to the prevention and control of colorectal cancer in urban area and in male population in China. Similar to the western countries, the burden of colorectal cancer in China would continue to become serious if no population based prevention and control programs are conducted.

INTRODUCTION:Several reports have highlighted increasing colorectal cancer (CRC) incidence among younger individuals. However, little is known about variations in CRC incidence or mortality across age subgroups in different geographical locations. We aimed to examine time trends in CRC incidence and mortality in Canada by age group and geography in this population-based, retrospective cohort study.METHODS:Individuals diagnosed with CRC from 1992 to 2016 or who died of CRC from 1980 to 2018 in Canada were studied. Geography was determined using an individual's postal code at diagnosis from the Canadian Cancer Registry or province or territory of death from the Canadian Vital Statistics Death Database. Geography was categorized into Atlantic, Central, Prairies, West, and Territories. Canadian Cancer Registry data were used to determine CRC incidence from 1992 to 2016. Canadian Vital Statistics Death data were used to determine CRC mortality from 1980 to 2018.RESULTS:Among all age groups, CRC incidence was highest in Atlantic Canada, was lowest in Western Canada, and increased with age. CRC incidence increased over time for individuals aged 20–44 years and was stable or decreased for other age groups in all regions. CRC mortality was highest in Atlantic Canada and lowest in the Prairies and Western Canada. CRC mortality decreased for individuals in all age groups and regions except among individuals aged 20–49 years in the Territories.DISCUSSION:Most of Canada has not yet seen an increase in CRC burden in the age group of 45–49 years, which is a reason to not lower the start age for CRC screening in Canada. Targeted CRC screening should be considered for individuals younger than 50 years who live in the Territories.

Differences in Incidence and Mortality Trends of Colorectal Cancer Worldwide Based on Sex, Age, and Anatomic Location

Lower Endoscopy and Prevention of Colon Cancer

e15699 Background: Colorectal cancer (CRC) is the third most diagnosed cancer and the second leading cause of cancer-related deaths worldwide. However, there is a lack of direct comparisons between global CRC trends and those in the U.S. This study examines data from the Global Burden of Disease (GBD 2021) and Surveillance, Epidemiology, and End Results (SEER) databases to analyze trends in CRC incidence, mortality, and Disability-Adjusted Life Years (DALYs) over the last twenty years. Methods: We utilized the GBD 2021 database to extract data on global trends in CRC and the SEER Research Data, 17 Registries Nov 2023 Sub (2000–2021) for CRC trends in the U.S. Global CRC incidence, mortality, and DALYs were assessed using the GBD 2021 database. U.S. incidence trends were examined with SEER*Stat software. Annual Percent Change (APC) was determined using Joinpoint regression to evaluate age-specific trends, with APCs calculated through the weighted least squares method. Results: Globally, the APC in CRC incidence increases with age, starting at –0.38 in younger individuals (15–19 years) and reaching a peak of 3.86 in those aged 85 and older. Likewise, the APC for DALYs and mortality shows an age-dependent increase, indicating a growing health burden among older populations. The lowest mortality APC is found in the 15–19 age group (–1.51), while the highest is observed in those aged 85+ (3.5). Similarly, the DALY APC follows this trend, with the lowest in the 15–19 age group (–1.49) and the highest in the 85+ group (3.47). In contrast, SEER data from the U.S. highlights a different trend. Younger age groups, like those aged 15–19, exhibit a significantly high APC in CRC incidence of 11.5 (95% CI: 8.9–14.3), signaling a concerning rise in diagnoses. This pattern differs from global data, where APCs in younger populations are either stable or declining. For older U.S. populations, the APC consistently decreases with age, turning negative in individuals aged 70 and above. The most significant APC reductions are seen in the 75–79 and 80–84 age groups showing a value of –2.6(95% CI: -3.0 to -2.2) and -2.6(95% CI: -2.9 to -2.3) respectively. Conclusions: The global rates of CRC incidence, mortality, and overall impact are increasing, especially among older populations. However, CRC rates are rising significantly in younger people in the U.S., which is concerning. The factors behind this shift in younger populations need more exploration. Healthcare professionals should be mindful of these age-related differences. If the trend persists, it may be necessary to reevaluate existing CRC screening guidelines to better address the growing impact on younger individuals.

Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men.

This study aimed to investigate the trends in colorectal cancer (CRC) incidence and mortality rates among the Western Australian (WA) population. This study further compared the trends with the timing of the implementation and rollout of the National Bowel Cancer Screening Program (NBCSP) and examined the survival predictors in CRC cases. This study was a whole-population, retrospective longitudinal study and included all individuals with a confirmed histological diagnosis of primary invasive CRC diagnosed in WA from 1990 to 2014 (n = 25,932). The temporal trends were assessed by Joinpoint regression models and Kaplan-Meier survival curves were used to asses 5-year survival. Predictors of survival were examined using multivariable Cox proportional hazard regression models, adjusting for age of diagnosis. The overall CRC incidence showed an upward trend between 1990 and 2010 (annual percent change (APC) = 1.1%); then, there was a downward trend from 2010 to 2014 (APC = - 5.0%). In younger people (< 50 years), the incidence rate increased steadily (APC = 0.9%) over the study period. The overall CRC mortality trend increased from 1990 to 1999 (APC = 1.6%), decreasing after that (APC = - 2.1%). Younger people had better CRC-related 5-year survival than older people (HR = 0.81, 95%CI 0.75-0.87, p = < 0.001). This study found that CRC incidence and mortality rates decreased among older people over the last 10 years in Western Australia. However, incidence continues to rise for younger people. Hence, more widespread adoption of the screening program, and potential preventive and early diagnostic strategies should become key priorities for the CRC control in WA.

Incidence and mortality of colorectal cancer (CRC) are increasing worldwide, suggesting broad changes in the epidemiology of CRC. In this Review, we discuss the changes that are becoming evident, including trends in CRC incidence and mortality by age and birth cohort, and consider the contributions of early-life exposures and emerging risk factors to these changes. Importantly, incidence of CRC has increased among people born since the early 1950s in nearly all regions of the world. These so-called birth cohort effects imply the involvement of factors that influence the earliest stages of carcinogenesis and have effects across the life course. Accumulating evidence supports the idea that early-life exposures are important risk factors for CRC, including exposures during fetal development, childhood, adolescence and young adulthood. Environmental chemicals could also have a role because the introduction of many in the 1950s and 1960s coincides with increasing incidence of CRC among people born during those years. To reverse the expected increases in the global burden of CRC, participation in average-risk screening programmes needs to be increased by scaling up and implementing evidence-based screening strategies, and emerging risk factors responsible for these increases need to be identified.

Novel, Emerging Risk Factors for Colorectal Cancer Remain Understudied

Colorectal cancer has declined markedly in California for all major racial/ethnic groups, including Asian/Pacific Islanders as a whole. Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist between individual Asian subgroups. This study examines secular, sex-, age-, and socioeconomic-specific trends in colorectal cancer incidence among six Asian subgroups-Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian-to determine whether these groups experienced a decline in colorectal cancer incidence and to assess possible differences in colorectal cancer incidence trends among these groups. Cases of invasive colorectal cancer diagnosed among Japanese, Chinese, Filipinos, Koreans, Vietnamese, and South Asians between 1988 and 2007 were identified using the California Cancer Registry database. Secular, sex-, age-, and socioeconomic-specific trends in the age-adjusted colorectal cancer incidence rates for each Asian subgroup were examined using joinpoint analysis to estimate the annual percent change (APC). Among males, Koreans (APC, 3.6%) were the only group that experienced a significant increase in colorectal cancer incidence. Among females, Koreans (APC, 2.7%), South Asians (APC, 2.8%), and Filipinos (APC, 1.6%) experienced significant increases. Stratification by age at diagnosis revealed that Korean males (APC, 3.4%) and females (APC, 2.9%) as well as Filipino females (APC, 1.8%) aged 50years and older experienced a significant increase in colorectal cancer incidence. Korean males aged less than 50years (APC, 3.4%) also experienced a significant increase. Japanese (APC, -1.2%) and Chinese (APC, -1.6%) males aged 50years and older experienced a significant decrease in colorectal cancer incidence. Stratification by socioeconomic status (SES) revealed that Korean males (APC, 2.5%) and females (APC, 2.9%) as well as Filipino females (APC, 2.1%) in the lowest SES category experienced a significant increase in colorectal cancer incidence. Korean males (APC, 5.2%) and females (APC, 3.1%) as well as Filipino males (APC, 1.5%) in the highest SES category also experienced a significant increase. Japanese males (APC, -2.5%) and females (APC, -2.0%) as well as Chinese males (APC, -2.8%) and females (APC, -2.9%) in the lowest SES category experienced a significant decrease. Chinese males in the middle (APC, -3.4%) and highest (APC, -3.5%) SES categories also experienced significant decreases in colorectal cancer incidence. In contrast to the decreasing trends in colorectal cancer incidence reported among all major racial/ethnic groups including Asian/Pacific Islanders, colorectal cancer is actually increasing among some Asian subgroups in California including Korean males and females, as well as South Asian and Filipino females. Furthermore, the colorectal cancer incidence trends for these Asian subgroups differ with respect to age at diagnosis and socioeconomic status. These findings suggest that more efforts need to be made to target these populations with culturally sensitive cancer prevention and screening programs. More research is needed to examine the differences in the colorectal cancer burden among these populations.

To evaluate the trends of colorectal cancer (CRC) incidence and mortality rates from 2003 to 2014 in Italy by age groups and regions. We used the data of 48 cancer registries from 17 Italian regions to estimate standardized incidence and mortality rates overall and by sex, age groups (<50, 50-69, 70+ years), and geographic area (northwest, northeast, center, south, and islands). Time trends were expressed as annual percent change in rates (APC) with 95% confidence intervals (95% CI). Incidence rates decreased from 104.3 (2003) to 89.9 × 100,000 (2014) in men and from 64.3 to 58.4 × 100,000 in women. Among men, incidence decreased during 2007-2010 (APC -4.0, 95% CI -6.0 to -1.9) and 2010-2014 (APC -0.7, 95% CI -1.4 to 0.0), while in women it linearly decreased during the whole period (APC -1.1, 95% CI -1.4 to -0.8). Mortality rates showed a linear reduction both in men (APC -0.7, 95% CI -1.0 to -0.3) and women (APC -0.9, 95% CI -1.2 to -0.6) and decreased respectively from 41.1 to 39.2 × 100,000 and from 24.6 to 23.1 × 100,000. In the 50- to 69-year-old range (screening target age), incidence showed a prescreening increase, followed by a peak after screening started, and a decline thereafter. Incidence and mortality rates significantly decreased in all areas but in the south and islands, where incidence increased and mortality remained stable. A renewed commitment by all regional health systems to invest in primary (i.e., lifestyle) and secondary (i.e., screening programs) prevention is of utmost importance.

OBJECTIVESWe evaluated changes in colorectal cancer (CRC) incidence and mortality by anatomic site since 1975 to assess the possible impact of CRC screening.METHODSUsing data from 9 Surveillance, Epidemiology, and End Results cancer registries, we estimated trends in CRC incidence from 1975–2007 and incidence-based mortality from 1985–2007. We evaluated trends separately for proximal and distal CRC, overall and by stage, tumor site, and race.RESULTSBetween 1975–2007, 323,237 adults in the study area were diagnosed with CRC. For most tumor and population subgroups, incidence rates increased between 1975–1985 and subsequently declined markedly. Declines were most rapid between 1999–2007, and were greater for distal than proximal CRC. Declines in incidence were also greater for white adults than black adults, and greatest for regional-stage disease. There was little difference in trends across subsites within the proximal and distal colorectum. Declines in incidence-based mortality mirrored those for incidence.CONCLUSIONSRecent declines in CRC incidence and mortality are greater for distal than proximal CRC. Differing trends across populations may reflect variation in screening prevalence; distinct trends by tumor characteristics likely reflect differences in screening efficacy.

To examine trends in colorectal cancer (CRC) incidence and colonoscopy history in adolescents and young adults (AYAs) aged 15-39 years in Western Australia (WA) from 1982 to 2007. Descriptive cohort study using population-based linked hospital and cancer registry data. Five-year age-standardized and age-specific incidence rates of CRC were calculated for all AYAs and by sex. Temporal trends in CRC incidence were investigated using Joinpoint regression analysis. The annual percentage change (APC) in CRC incidence was calculated to identify significant time trends. Colonoscopy history relative to incident CRC diagnosis was examined and age and tumor grade at diagnosis compared for AYAs with and without pre-diagnosis colonoscopy. CRC-related mortality within 5 and 10 years of incident diagnosis were compared for AYAs with and without pre-diagnosis colonoscopy using mortality rate ratios (MRRs) derived from negative binomial regression. Age-standardized CRC incidence among AYAs significantly increased in WA between 1982 and 2007, APC = 3.0 (95% CI 0.7-5.5). Pre-diagnosis colonoscopy was uncommon among AYAs (6.0%, 33/483) and 71% of AYAs were diagnosed after index (first ever) colonoscopy. AYAs with pre-diagnosis colonoscopy were older at CRC diagnosis (mean 36.7 ± 0.7 years) compared to those with no prior colonoscopy (32.6 ± 0.2 years), p < 0.001. At CRC diagnosis, a significantly greater proportion of AYAs with pre-diagnosis colonoscopy had well-differentiated tumors (21.2%) compared to those without (5.6%), p = 0.001. CRC-related mortality was significantly lower for AYAs with pre-diagnosis colonoscopy compared to those without, for both 5-year [MRR = 0.44 (95% CI 0.27-0.75), p = 0.045] and 10-year morality [MRR = 0.43 (95% CI 0.24-0.83), p = 0.043]. CRC incidence among AYAs in WA has significantly increased over the 25-year study period. Pre-diagnosis colonoscopy is associated with lower tumor grade at CRC diagnosis as well as significant reduction in both 5- and 10-year CRC-related mortality rates. These findings warrant further research into the balance in benefits and harms of targeted screening for AYA at highest risk.

Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: A population-based study