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Colorectal Cancer in the U.S., 1999-2021: Declining Rates, Rising Concerns, and Persistent Disparities.

Qais Bin Abdul Ghaffar1, Sayed Maisum Mehdi Naqvi1, Garrett Shields2

  • 1Department of Medicine, Dow International Medical College, Karachi 75280, Pakistan.

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|December 24, 2025
PubMed
Summary
This summary is machine-generated.

Colorectal cancer (CRC) incidence and mortality decreased in the US, but the mortality-to-incidence ratio (AAMIR) shows persistent disparities. Targeted interventions are needed for men, minorities, young adults, and high-burden regions to improve CRC outcomes.

Keywords:
SEER programcolorectal neoplasmsearly-onset colorectal cancerhealth disparitiesincidencejoinpoint regressionmortalitymortality-to-incidence ratio

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Area of Science:

  • Epidemiology
  • Public Health
  • Cancer Research

Background:

  • Colorectal cancer (CRC) incidence and mortality have declined in the US over the past two decades.
  • Significant disparities in CRC outcomes persist across age, sex, race/ethnicity, and geographic location.

Purpose of the Study:

  • To examine trends in age-adjusted incidence rates (AAIR), mortality rates (AAMR), and the mortality-to-incidence ratio (AAMIR) of CRC from 1999 to 2021.
  • To characterize population-level survival signals and identify disparities stratified by key demographic and geographic subgroups.

Main Methods:

  • Retrospective analysis of de-identified data from the CDC WONDER United States Cancer Statistics database (1999-2021).
  • Inclusion of incident CRC cases and deaths in adults aged 20 years and older.
  • Calculation of age-adjusted rates and AAMIR using Stata 17.0, with joinpoint regression to identify trends (APC/AAPC, p < 0.05).

Main Results:

  • Overall AAIR decreased by 2.20% and AAMR by 2.33% annually.
  • AAMIR showed a marginal decrease of 0.08% annually (p=0.669), with significant declines observed in women but not men.
  • Young adults (20-39 years) experienced rising incidence and mortality but improving AAMIR. Non-Hispanic Black individuals had the highest AAMIR.

Conclusions:

  • Despite overall declines, CRC incidence and mortality trends reveal persistent and uneven survival signals across various subgroups.
  • The mortality-to-incidence ratio (AAMIR) improved only marginally and remains uneven, highlighting disparities.
  • Targeted interventions focusing on screening and treatment access for underserved populations (men, racial/ethnic minorities, young adults, high-burden regions) are crucial for achieving equitable CRC outcomes.