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Overview of CRC (1/3)

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Colorectal Cancer Overview 

Colorectal cancer (CRC) is the third most common cancer among men and women in the United States, with about 154,000 cases occurring each year and affecting 1:17 men and 1:19 women over their lifetime. It is the third leading cause of cancer death in both men and women.1 Despite the intensive efforts of medical professionals and CRC advocacy groups to educate the public about screening and early detection, CRC continues to be disproportionately diagnosed at an advanced stage. According to Surveillance, Epidemiology, and End Results (SEER) data from 1995-2003, less than 40% of CRC diagnoses involved localized disease. Nearly 20% of diagnoses were stage IV, distant metastatic disease.1,2

 

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US Estimated 2007: Cancer Incidence and Mortality

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Male
Cases
Deaths
Female
Cases
Deaths
Prostate
218,890
27,050
Breast
178,480
40,460
Lung and bronchus
114,760
89,510
Lung and bronchus
98,620
70,880
Colon and rectum
79,130
26,000
Colon and rectum
74,630
26,180
Urinary bladder
50,040
9,630
Uterine Corpus
39,080
7,400
Non-Hodgkin's lymphoma
34,200
9,600
Non-Hodgkin's lymphoma
28,990
9,060
Melanoma
33,910
5,220
Melanoma
26,030
2,890
Ovary
22,430
15,280
Kidney and renal pelvis
31,590
8,080
 Kidney and renal pelvis
19,600
4,810
Leukemia
24,800
12,320
Leukemia
19,440
9,470
Esophagus
12,130
10,900
Esophagus
3,430
3,040
All sites
766,860
289,550
All sites
678,060
270,100

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Nonmodifiable Risk Factors

Researchers have identified some factors that increase an individual's risk of developing colorectal polyps or CRC. Some of these risk factors cannot be changed, such as having a first-degree relative who has had CRC, especially one who was under age 60 at diagnosis.3

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Family History Personal History
  • 1 first degree relative
  • 2 or more other relatives
  • Inherited genetics
  • History of CRC, especially if first CRC ≤ 60 years
  • 1 or more adenomatous polyps, especially if large
  • Chronic inflammatory bowel disease for 8-10 years

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About 5% to 10% of people with CRC have familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC.) People with FAP generally develop large numbers (hundreds) of colorectal polyps before age 40. Cancer may develop in FAP individuals as young as age 20, and by age 40 nearly all those with FAP will develop CRC if prophylactic colectomy is not performed.3 HNPCC accounts for 3% to 4% of CRC cases.4 Eastern European Jews (Ashkenazi) have higher rates of CRC due to a genetic mutation.4 Other risk factors include a personal history of chronic inflammatory bowel disease, ulcerative colitis, and Crohn's disease. As with many cancers, the chance of developing CRC greatly increases after age 50; more than 90% of CRC diagnoses are made in persons over age 50.1,3

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Modifiable Risk Factors

Risk factors that can be modified include:

  • Consuming a diet primarily from high-fat animal sources (eg, red and processed meats)
  • Sedentary lifestyle
  • High caloric and/or carbohydrate intake leading to insulin resistance5-6
  • Sedentary lifestyle
  • Diabetes
  • Excessive alcohol consumption, probably in combination with low micronutrients such as folate and methionine6
  • Obesity remains under study as a risk for developing CRC7
  • Obesity and smoking are more likely to cause those with CRC to die of the disease1

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Ethnic Variations in Cancer Site

A recent study suggests ethnic differences in the site of colon cancers. A sigmoidoscopy was performed on 2,207 patients to screen for cancer in the distal colon. Of these, 290 had positive findings and underwent a colonoscopy to examine the proximal colon. Ethnic variations may suggest the need for different screening strategies.8

Prevalence of Colon Cancer, %

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Ethnicity		 Sigmoidoscopy:
Distal Colon
(N=2,207)		 Colonoscopy:
Proximal Colon
(n=290)
Caucasians 12.6 63.9
African Americans 11.2 59.3*
Hispanics 15.9 66.7
Asians 24.7 (P = .002) 26.3* (P = .01)

*Advanced cancers in the proximal colon were found to be highest in African Americans (34.9%) and lowest in Asians (10.5%)

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This page was last modified on 2/9/2007, at 12:17:27 pm ET.