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Colorectal cancer: Epidemiology, risk factors, and protective factors

Author
Finlay A Macrae, MD
Section Editors
Richard M Goldberg, MD
Timothy O Lipman, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Colorectal cancer (CRC) is a common and lethal disease. The risk of developing CRC is influenced by both environmental and genetic factors. The epidemiology of CRC and risk factors for its development will be discussed here. Colorectal screening, clinical presentation, prognostic determinants, and treatment of colon and rectal cancer are discussed elsewhere. (See "Screening for colorectal cancer in patients with a family history of colorectal cancer" and "Tests for screening for colorectal cancer: Stool tests, radiologic imaging and endoscopy" and "Screening for colorectal cancer: Strategies in patients at average risk" and "Clinical presentation, diagnosis, and staging of colorectal cancer" and "Pretreatment local staging evaluation for rectal cancer" and "Overview of the management of primary colon cancer" and "Adjuvant chemotherapy for resected stage II colon cancer" and "Rectal cancer: Surgical principles" and "Rectal cancer: Surgical techniques" and "Adjuvant therapy for resected rectal adenocarcinoma".)

EPIDEMIOLOGY

CRC incidence and mortality rates vary markedly around the world. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, with 1.4 million new cases and almost 694,000 deaths estimated to have occurred in 2012 [1]. Rates are substantially higher in males than in females. Global, country-specific incidence and mortality rates are available in the World Health Organization GLOBOCAN database.

In the United States, both the incidence and mortality have been slowly but steadily decreasing [2]. Annually, approximately 134,490 new cases of large bowel cancer are diagnosed, of which 95,270 are colon and the remainder rectal cancers [3]. Annually, approximately 49,190 Americans die of CRC, accounting for approximately 8 percent of all cancer deaths.

Incidence — Globally, the incidence of CRC varies over 10-fold. In the latest data from 2012 from the Globocan database, the highest incidence rates are in Australia and New Zealand, Europe, and North America, and the lowest rates are found in Africa and South-Central Asia [4]. These geographic differences appear to be attributable to differences in dietary and environmental exposures that are imposed upon a background of genetically determined susceptibility.

Low socioeconomic status (SES) is also associated with an increased risk for the development of colorectal cancer; one study estimated the CRC risk to be about 30 percent increased in the lowest as compared with the highest SES quintile [5]. Potentially modifiable behaviors such as physical inactivity, unhealthy diet, smoking, and obesity are thought to account for a substantial proportion (estimates of one-third to one-half) of the socioeconomic disparity in risk of new onset colorectal cancer [5-7]. Other factors, particularly lower rates of CRC screening, also contribute substantively to SES differences in CRC risk [8].

                                                

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