ACS Reports Shift in Colorectal Cancer to Advanced Stage and Younger Age at Diagnosis

A new report released by the American Cancer Society (ACS) shows that the incidence of colorectal cancer (CRC) is rapidly increasing among younger individuals, and the disease is also being diagnosed at more advanced stages in people of all ages. The report, Colorectal Cancer Statistics 2023, was published in CA: A Cancer Journal for Clinicians,¹ along with a patient-friendly version, Colorectal Cancer Facts & Figures 2023-2025, which is available on cancer.org.²

According to statistics cited in the report, the percentage of CRC cases diagnosed among individuals aged ≤55 years doubled from 11% (1 in 10) in 1995 to 20% (1 in 5) in 2019. In addition, the percentage of individuals diagnosed with advanced-stage disease increased from 52% in the mid-2000s to 60% in 2019, despite increased screening.¹

In a press release, Rebecca L. Siegel, MPH, Senior Scientific Director, ACS, and the lead investigator of the report, said, “We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population. The trend toward more advanced disease in people of all ages is also surprising and should motivate everyone 45 and older to get screened.”³

Past Progress and Current Trends

CRC is the third most frequently diagnosed cancer and the third leading cause of cancer death in both men and women in the United States.¹ It is estimated that 153,020 people will be diagnosed with CRC in the United States and 52,550 individuals will die from the disease.¹

The incidence of CRC decreased rapidly during the 2000s among individuals aged ≥50 years, due in large part to an increase in cancer screening with colonoscopy, which has been shown to help prevent the disease by removing premalignant polyps. However, this progress has slowed during the past decade, and currently the trend toward declining incidence is largely confined to those aged ≥65 years.

The investigators of the report noted that more than 50% of all CRC cases and deaths are associated with modifiable risk factors, including smoking, an unhealthy diet, high alcohol consumption, physical inactivity, and excess body weight. A significant proportion of incidence and mortality is preventable through recommended screening, surveillance, and high-quality treatment.

It remains unclear why incidence rates are increasing among younger individuals and why there is a trend toward the disease being initially diagnosed at more advanced stages.

“We have to address why the rates in young adults continue to trend in the wrong direction,” said Ahmedin Jemal, DVM, PhD, Senior Vice President, Surveillance & Health Equity Science, ACS, and senior investigator of the study. “We need to invest more in research to uncover the causes of the rising trends and to discover new treatment for advanced-stage diseases to reduce the morbidity and mortality associated with this disease in this young population, who are raising families and supporting other family members.”

“These highly concerning data illustrate the urgent need to invest in targeted cancer research studies dedicated to understanding and preventing early-onset colorectal cancer,” said Karen E. Knudsen, MBA, PhD, Chief Executive Officer, ACS. “The shift to diagnosis of more advanced disease also underscores the importance of screening and early detection, which saves lives.”

Additional Findings

Other key findings from the report included the following:

• Progress against CRC slowed from declines in incidence and mortality of 3% to 4% per year during the 2000s to 1% per year for incidence and 2% per year for mortality during the past 10 years.
• From 2015 to 2019, men had a 33% higher rate of CRC than women, likely reflecting differences in risk factor prevalence, such as excess body weight, consumption of processed meats, and historic smoking.
• CRC incidence and mortality rates were highest in individuals who were Alaska Native, American Indian, or Black.
• Mortality rates from CRC declined by 2% to 3% annually for all racial groups.
• Up-to-date screening for CRC reached 59% in 2021 among individuals aged ≥45 years.

Efforts to Reduce Barriers and Expand Coverage for CRC Screening

In November 2022, the Centers for Medicare & Medicaid Services finalized its rule for Medicare to cover, as a preventive service, a follow-on screening colonoscopy after a noninvasive stool-based test returns a positive result, which means that beneficiaries will not incur out-of-pocket costs for both tests.⁴ The agency also reduced the minimum age for CRC screening from 50 years to 45 years, in alignment with recently revised policy recommendations by the US Preventative Services Task Force and professional society recommendations.⁴ To date, 11 states have passed such laws that would eliminate cost-sharing and lower the screening age to 45 years.

The ACS asserts that its nonprofit, nonpartisan advocacy affiliate, the American Cancer Society Cancer Action Network, which supports policy and legislative solutions designed to eliminate healthcare barriers for patients, will continue to advocate for the implementation of these policies at the state level.

References

1. Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics. 2023. CA Cancer J Clin. 2023;1-22.
2. American Cancer Society. Colorectal cancer facts & figures 2023-2025. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf. Accessed March 22, 2023.
3. American Cancer Society. American Cancer Society releases new colorectal cancer statistics; rapid shifts to more advanced disease and young people. March 1, 2023. https://pressroom.cancer.org/CRCFactsFigures2023. Accessed March 21, 2023.
4. Fact sheet Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule. CMS. Updated November 1, 2022. Accessed December 8, 2022. www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule. Accessed April 4, 2023.