In 2010, experts predict that 4,400 fewer Americans will be diagnosed with colon and rectal cancer than in 2009.

According to new American Cancer Society statistics for 2010, 142,570 people will hear the difficult words, “You have colorectal cancer”, down from 146,970 in 2009.

Still, 51,370 families will get painful news when loved ones die from colorectal cancer.

Continuing this year, African Americans are more likely to develop colorectal cancer than whites and other races, to die of it, and to have poorer survival at every stage of the disease.

Each year the American Cancer Society estimates the number of new cases and deaths from cancer expected in the United States in that year.  They study trends in cancer rates and look at the impact of various types of cancer.

In 2010 colorectal cancer will again be the third most commonly diagnosed cancer in men and women and the second most common cause of cancer death.

2010 Colon and Rectal Cancer

Incidence

• In 2010, 102,900 new cases of colon cancer and 39,670 cases of rectal cancer will be diagnosed for a total of 142,570.
• This is a reduction of 4,400 new cases over last year’s estimate of 146,970.
• 72,090 men will be diagnosed with colorectal cancer (9 percent of all cancers) and 70,480 women (10 percent of the total).
• Incidence rates are projected at 59.0 per 100,000 men and 43.6 per 100,000 women – a decrease from 61.2 for men and 44.8 for women in 2009.
• Over a lifetime, 1 in 19 men and 1 in 20 women will develop colon or rectal cancer.

Deaths

Although the number of deaths from colorectal cancer are expected to increase in 2010, rates for both new cases and deaths continue to go down. As the American population grows and ages, more people are vulnerable to colorectal cancer.

• 51,370 deaths from colorectal cancer are expected in 2010, up 1,450 from 49,920 in 2009.
• 26,580 men and 24,790 women will die.
• After all cancer rates peaked for men in 1990, colorectal cancer death rates dropped by 10.27  per 100,000 men from 30.77  to 20.51, accounting for a third of the decrease in all cancers.
• For women, cancer rates peaked in 1991.  Since then women’s colorectal cancer death rates have dropped from 20.30 to 14.53, accounting for about 30 percent of the overall cancer death rate decrease.

Five year survival

• In the years between 1975 and 1977, just over half of people with colorectal cancer lived five years past diagnosis (52 percent).
• By 1999 through 2005, two out of three would live those five years (66 percent).

African American Disparities

Incidence Rates Per 100,000 by Race and Ethnicity

Five-Year Survival Percentages by Race

2010 Overall Cancer Burden

• 1,529,560 new cases of cancer are expected in 2010.
• 569,490 people will die of cancer.
• Incidence rates (rates per 100,000 people) have been going down 1.3 percent each year for men in the years 2000 through 2006.
• For women, incidence decreased by 0.5 percent each year from 1998 through 2006.

Although the rates of new cancers and cancer deaths are going down, cancer remains the leading killer of people under the age of 85 in the United States.

One in four deaths is due to cancer.

In 2010, 1,529,560 people will be diagnosed with cancer and 569,490 will die.

In reporting cancers statistics for 2010, the ACS team wrote,

Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment.

SOURCE: Jemal et al., Cancer Statistics, 2010, CA: A Cancer Journal for Clinicians, published online July 7, 2010.

For comparisons to 2009, see Jemal et al., Cancer Statistics 2009, CA: A Cancer Journal for Clinicians, Volume 59, Number 4, July/August 2009.

Image: Figure #3: Jemal, Cancer Statistics 2009,  CA Cancer J Clin 2010, online July 7, 2010.

Although new diagnoses of colon and rectal cancer are decreasing in the United States, the benefit does not reach everyone.

No matter where they lived, incidence of colorectal cancer dropped significantly between 1995 and 2004 for white Americans aged 65 and over, most of whom have Medicare that covers colonoscopy screening.  However, colorectal cancer rates for whites from 50 to 64 did not fall if they lived in rural areas or counties where there was poverty, lack of insurance, or few primary care providers.

African Americans only benefited from reduced incidence if they were over 64 and living in an affluent community.

Researchers from the American Cancer Society in Atlanta reviewed colorectal cancer incidence rates in metropolitan and rural counties across the United States looking at poverty, age, race, and ethnicity. They also measured access to health care by the supply of primary care physicians and amount of insurance coverage.

Medicare made a difference for older people.  Colorectal cancer fell for whites over 64 in all areas, including those with poverty or few primary care physicians.  However, for Hispanics and African Americans eligible for Medicare, only those living in more affluent counties without poverty and with a good supply of primary care saw colorectal cancer rates decrease.

For younger whites from 50 to 64, not covered by Medicare, rates did not decrease if they lived in a county with high poverty, many uninsured, lack of primary care physicians, or in a rural area.

Hispanics and African Americans under 65 saw no reduction in incidence rates in general, no matter where they lived.  If they were 65, rates did not decrease in counties with poverty, lack of insurance, and few primary care physicians.  African Americans also did worse in rural communities.

Colonoscopy screening increased significantly for whites in both age groups.  However, screening with colonoscopy didn’t improve for Hispanics below Medicare age at all, nor for Hispanics over 64 who lived in areas with high poverty.

Likewise African Americans from 50 to 64 saw no increase in colonoscopies if they lived where there were high rates of uninsured.  Colonoscopy screening for African Americans old enough for Medicare didn’t improve where there was poverty or a poor supply of primary care physicians.

Writing in Cancer Causes and Control, Yong Ping Hao and colleagues concluded,

Individuals residing in poorer communities with lower access to medical care have not experienced the reduction in colorectal cancer incidence rates that have benefited more affluent communities, and that this is likely explained in part by lower utilization of colorectal endoscopic screening even in older populations with coverage through Medicare. Further research is needed on factors that explain the disparities and potential interventions to address them.

As nations develop economically and adopt more Western diet and lifestyle, colorectal cancer increases.  In fact, the United States is the only nation in the world where colorectal cancer incidence rates are falling for both men and women.

Over the past 20 years, colorectal cancer rates have risen in 27 of 51 countries including Eastern Europe, most of Asia, and some South American countries.  Rates for men are rising faster than those for women.

Information for the study was obtained from the Cancer Incidence in Five Continents databased developed by the International Agency for Research on Cancer (IARC).  It compared new cases of colorectal cancer from 1983 through 2002.

Among dramatic increases was a 70 percent male and 28 percent female rise in colorectal cancer in Slovenia. In Mijagi, Japan male rates nearly doubled, while female rates increased 47 percent.  In some countries, like Israel, there are significant differences in incidence among different ethnic groups,

Rates for men in Japan, Slovakia, and the Czech Republic have now surpassed peak US rates and are still rising.

Researchers attribute the growth in new cases of colon and rectal cancer to the adoption of Western lifestyles including obesity, physical inactivity, smoking, heavy use of alcohol, and diets with lots of red or processed meats and fewer fruits and vegetables.

Writing for colleagues at the American Cancer Society in Atlanta, Melissa M. Center concluded,

Colorectal cancer incidence rates continue to increase in economically transitioning countries, with incidence rates among men in the Czech Republic and Slovakia exceeding the peak incidence observed in the United States and other long-standing developed nations. Targeted prevention and early detection programs could help reverse the trend in these countries.

SOURCE: Center et al., Cancer Epidemiology, Biomarkers, and Prevention, Volume 18, Number 6, June 2009.

Although the numbers of new colon and rectal cancers have been steadily declining in people over 50, the rate of newly diagnosed cancer is increasing in young adults from 20 to 49  in the United States.

The increase is primarily driven by rectal cancer in non-Hispanic whites where there was an average annual increase of 3.5 percent in men and 2.9 percent in women from 1992 through 2005.  Overall, incidence of colorectal cancer in young adults rose during that time 1.5 percent in men and 1.6 percent in women each year, almost all of the new cancers diagnosed in the left colon (distal colon) or rectum.

Information about increasing rates of colon and rectal cancer were obtained by studying  data from 13 Surveillance, Epidemiology, and End Results cancer registries from 1992 through 2006.  Researchers analyzed information by sex, race and ethnicity, age, site of cancer, and stage at diagnosis.

In attempting to find a reason for increasing colorectal cancer rates in the younger group, who are not part of screening programs, the researchers looked at risk factors for colorectal cancer.  Obesity is a major risk factor for colorectal cancer, and it is increasing in all age groups in the United States, as is Type 2 diabetes, which also increases chances for colon and rectal cancer.

Eating red meat increases colorectal cancer risk in the left colon and rectum, while consumption of calcium-rich foods decreases risk.  Young adults’ consumption of fast food increased three-fold between the late 1970′s and the mid 1990′s.  During that time calories from hamburgers and cheeseburgers increased by 30 percent while milk consumption  went down by 42 percent.  Young adults are eating more red meat, more calories, and less calcium-rich foods.

Two other risk factors, alcohol use and smoking, have been declining in young adults.

The study authors point out young people who may have inherited a gene for colon cancer or have inflammatory bowel disease should begin screening earlier than age 50 and that physicians need to know and follow the guidelines.

Clinical practice guidelines suggest that patients with inflammatory bowel disease, polyposis syndromes,a known genetic predisposition, or a personal or family history of adenomatous polyps or CRC begin screening before age 50 years. Early recognition of CRC in patients under age 50 without these risk factors requires clinical awareness and aggressive pursuit of symptoms.

Almost 9 out of 10 young adults had symptoms of colon or rectal cancer at the time of diagnosis.  Half had rectal bleeding and a third had abdominal pain.  Among those without symptoms, 14 percent had anemia.

Our findings of a recent increase in CRC among those under age 50 years suggests the importance of timely evaluation of the distal colorectum, at a minimum, in young adults who present with symptoms consistent with possible underlying cancer.

In conclusion, Rebecca L. Siegel and her team at the American Cancer Society wrote,

The increasing incidence of CRC in young adults is in contrast with the rapidly declining incidence among older individuals. The disparate increase in left-sided CRC suggests that particular attention be given to studies to elucidate the behavioral and environmental risk factors responsible for this trend and potential prevention and early detection strategies.

SOURCE: Siegel et al., Cancer Epidemiology, Biomarkers, and Prevention, Volume 18, Number 6, June 2009.