Available online 23 May 2023, 101839

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Colorectal Cancer (CRC) is the third most commonly diagnosed form of cancer and accounts for approximately 1.9 million cancer cases each year (10% of all new cancer cases globally). Incidence strongly increases with age and has been traditionally highest in Western, affluent countries, but it is rapidly increasing in many less developed countries and in younger generations in both developed and developing countries. With demographic aging, CRC will pose a rapidly increasing challenge for many societies, which underlines the need for major efforts on primary and secondary prevention. A number of effective screening options are available, and implementation of well-organized screening programs could have a major impact on lowering the future burden of the disease.

Section snippetsPractice points•

CRC incidence is the third most common cancer and the second most common cancer-related cause of death globally.

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Global numbers of cases and deaths are projected to almost double (from 1.9 to 3.2 million and from 0.9 to 1.6 million, respectively) between 2020 and 2040.

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The total economic burden of CRC amounts to approximately 19 billion EUR per year for Europe alone, and is expected to strongly increase in the years to come.

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Major efforts in primary and secondary prevention are paramount to reduce

Research agenda•

Research is needed on better implementation of effective primary and secondary prevention measures, and to develop, implement and evaluate novel cost-effective risk-adapted screening strategies

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Particular research efforts are needed to better understand reasons for and cope with the increase in incidence of early-onset CRC among younger generations

Incidence and prevalence

CRC is the third most commonly diagnosed form of cancer and accounts for approximately 10% of all new cancer cases globally [1]. In 2020, approximately 1.9 million people were diagnosed with colorectal cancer, and the global five-year prevalence (i.e., a diagnosis within the last five years) was estimated at 5.25 million people [1,7]. Incidence strongly increases with age (Fig. 1), approximately 80% of all new cases are diagnosed in individuals aged 55 or older, and the median age at diagnosis

Survival

Prognosis of CRC patients strongly depends on the stage at diagnosis. Prospects of cure are high for patients diagnosed with locally confined cancers, with five-year relative survival being close to 90% (Fig. 3). In case of locally advanced (i.e. spread to lymph nodes) cancers, relative five-year survival rates drop to approximately 70%, respectively. Despite recent progress in therapeutic options, such as the advent of immunotherapies for specific subtypes of CRC, the survival prospects of

Mortality

About one in ten cancer deaths is directly attributed to CRC, making it rank second in cancer mortality among both women and men, only surpassed by breast cancer in women and lung cancer in men [1]. Worldwide, the absolute number of deaths due to CRC was estimated at 935.000 in 2020, with approximately half of these occurring between ages 50 and 74 [22]. Fig. 4 shows the trend in the age-standardized CRC mortality rates and the total number of deaths from 1980 to 2016 for Germany, the U.K, and

Disability Adjusted Life Years

Globally, CRC accounted for close to 24.3 million Disability Adjusted Life Years (DALYs, one DALY represents the loss of the equivalent of one year of full health) in 2019, doubling the numbers as compared to 1990 and making it rank second out of all cancers (only lung cancer accounts for more DALYs) [25,26]. Low- and middle-income regions, especially in East Asia, now comprise approximately 75% of all global DALYs. However, even though the absolute burden of disease by CRC has substantially

Treatment costs

Once clinically manifest, CRC causes substantial treatment costs over time, which depend on the stage of disease, cancer subtype, country, and individual patient preferences [21]. Unfortunately, detailed cost data are not available on a global scale, and varying purchasing power as well as differences in healthcare systems make country-by-country healthcare costs comparisons difficult.

However, population-based studies consistently indicate that the highest costs for CRC arise in the first and

Effectiveness and cost-effectiveness of screening

Due to the slow progression from adenomatous polyps to invasive cancers, which typically takes many years, chances for early detection and removal of CRC precursor lesions or early-stage carcinomas through screening are much higher than for most other forms of cancer [35]. Randomized trials and observational studies have demonstrated a large potential of screening by fecal occult blood tests, flexible sigmoidoscopy or colonoscopy in reducing CRC incidence and mortality [[36], [37], [38]].

Conclusion

CRC presents a significant global health challenge. CRC is the third most commonly diagnosed form of cancer globally and current trends in risk factors like obesity, physical inactivity and Western dietary habits are likely to increase CRC incidence in the future. However, effective screening options are available and can have a major impact on reducing the burden of CRC while being cost-effective. Given the projected demographic changes, it is crucial that countries enhance their primary and

Declaration of competing interest

None.

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