Decrease in Incidence of Colorectal Cancer Among Individuals 50 Years or Older After Recommendations for Population-based Screening

Abstract

Background & aims: The incidence of colorectal cancer (CRC) in the United States is increasing among adults younger than 50 years, but incidence has decreased among older populations after population-based screening was recommended in the late 1980s. Blacks have higher incidence than whites. These patterns have prompted suggestions to lower the screening age for average-risk populations or in blacks. At the same time, there has been controversy over whether reductions in CRC incidence can be attributed to screening. We examined age-related and race-related differences in CRC incidence during a 40-year time period.

Methods: We determined the age-standardized incidence of CRC from 1975 through 2013 by using the population-based Surveillance, Epidemiology, and End Results (SEER) program of cancer registries. We calculated incidence for 5-year age categories (20-24 years through 80-84 years and 85 years or older) for different time periods (1975-1979, 1980-1984, 1985-1989, 1990-1994, 1995-1999, 2000-2004, 2005-2009, and 2010-2013), tumor subsite (proximal colon, descending colon, and rectum), and stages at diagnosis (localized, regional, and distant). Analyses were stratified by race (white vs black).

Results: There were 450,682 incident cases of CRC reported to the SEER registries during the entire period (1975-2013). Overall incidence was 75.5/100,000 white persons and 83.6/100,000 black persons. CRC incidence peaked during 1980 through 1989 and began to decrease in 1990. In whites and blacks, the decreases in incidence between the time periods of 1980-1984 and 2010-2013 were limited to the screening-age population (ages 50 years or older). Between these time periods, there was 40% decrease in incidence among whites compared with 26% decrease in incidence among blacks. Decreases in incidence were greater for cancers of the distal colon and rectum, and reductions in these cancers were greater among whites than blacks. CRC incidence among persons younger than 50 years decreased slightly between 1975-1979 and 1990. However, among persons 20-49 years old, CRC incidence increased from 8.3/100,000 persons in 1990-1994 to 11.4/100,000 persons in 2010-2013; incidence rates in younger adults were similar for whites and blacks.

Conclusions: On the basis of an analysis of the SEER cancer registries from 1975 through 2013, CRC incidence decreased only among individuals 50 years or older between the time periods of 1980-1984 and 2010-2013. Incidence increased modestly among individuals 20-49 years old between the time periods of 1990-1994 and 2010-2013. The decision of whether to recommend screening for younger populations requires a formal analysis of risks and benefits. Our observed trends provide compelling evidence that screening has had an important role in reducing CRC incidence.

Keywords: Colon Cancer; Early Detection; Endoscopy; Epidemiology; Tumor.

Figure 1. Age-adjusted (2000 U.S. standard population) incidence of colorectal cancer by age group and time period (1980–84 vs. 2010–13a) for whites and blacks, SEER 9, 1975–2013

^aWe chose to compare incidence rates from the most recent time period (2010–13) to 1980–84 in the figure because incidence peaked in 1980–84 and subsequently declined through to 2013 Shaded regions in figure denote 95% confidence intervals

Figure 2. Age-adjusted (2000 U.S. standard population) incidence of proximal colon, descending colon, and rectal cancer by age group and time period (1980–84 vs. 2010–13) for whites and blacks, SEER 9, 1975–2013

Proximal colon includes the cecum, ascending colon, hepatic flexure, and transverse colon; descending colon includes the splenic flexure, descending colon, and sigmoid colon; rectum includes the rectosigmoid junction and rectum. Shaded regions in figure denote 95% confidence intervals