Impact of colorectal cancer screening on the incidence of advanced stages of the disease in the United States: An analysis of 181,442 patients.

Abstract

10524 Background: Routine cancer screening, in addition to identifying early-stage cancers, aim to delay the time of diagnosis of the advanced stage. The impact of screening on the incidence of advanced colorectal cancer (aCC) in real-world settings is unknown. Methods: Data of adults aged 50–74 years with regional/distant stage (advanced) colorectal cancer diagnosed between 2004 and 2020 was obtained from the Surveillance, Epidemiology, and End Results Plus Data, 17 Research Plus Registries. The age-standardized incidence rates (ASIR) and annual percentage change (APC) were used to compare incidence trends stratified by sex, race/ethnicity, area of residence, and tumor site. Results: Among 181,442 cases of aCC, 56.6% were male, 117 847 (65%) were Non-Hispanic White (NHW), 23 419 (12.9%) were Non-Hispanic Black (NHB), 22 402 (12.4%) were Hispanics, 15 787 (8.7%) were Non-Hispanic Asian or Pacific Islander (NHAPI), 1564 (0.9%) were Non-Hispanic American Indian/Alaska Native (NHAIA), and 423 (0.2%) were of unknown race, respectively. In 123 609 cases (68.1%), the tumor site was in the colon, in the rectum in 41 395 cases (22.8%), and in the recto-sigmoid junction in 16 438 cases (9.1%). From 2004 to 2020, overall ASIR of aCC decreased (APC, -1.87%: -2.37 to -1.40), especially in females (APC, -2.05%: -2.53 to -1.55 vs. male: APC, -1.84%: -2.36 to -1.29), and metropolitan residents (APC, -2.01%: -2.57 to -1.43 vs. non-metropolitan: APC, -1.36%: -1.78 to -0.92). Notably, NHB showed the greatest decrease (APC, -2.56%: -3.01 to -2.06) followed by NHW (APC, -1.95%: -2.44 to -1.47), NHAPI (APC, -1.80%: -2.25 to -1.32) and Hispanics (APC, -1.29%: -1.85 to -0.64). There was no significant change in the ASIR among NHAIA. Furthermore, the ASIR of advanced colonic (APC, -2.66%: -3.18 to -2.14) and recto-sigmoid cancers (APC, -2.35%: -2.91 to -1.65) declined, but advanced rectal cancer increased (APC, 0.58%: 0.18 to 0.98) over the same period. Conclusions: This study highlights the positive impact of colorectal cancer screening in reducing aCC incidence rates in across genders, residential areas, and racial groups/ethnicities including minority populations. While there may be other contributing factors, increased awareness and use of screening may account for the overall declining aCC incidence rates over the almost 20-year study period. Further research is essential to identify factors contributing to the screening program's limited impact on the NHAIA population and advanced rectal cancers. [Table: see text]