Rebecca L. Siegel, MPH
In a research letter to JAMA, Rebecca L. Siegel, MPH, of the American Cancer Society, and colleagues reported that overall colorectal cancer mortality rates have declined in the United States between 1970 and 2004 in patients aged 20 to 54 years. Between 2004 and 2014, colorectal cancer mortality rates in black individuals aged 20 to 54 years continued to decline, whereas in white individuals aged 20 to 54 years colorectal cancer mortality rates increased annually during this period. In the study, colorectal cancer mortality rates per 100,000 population, age-adjusted to the 2000 U.S. standard population, from 1970 through 2014 were obtained from SEER*Stat (version 8.3.4) for decedents who were aged 20 to 54 years, as reported by the National Center for Health Statistics.
Overall, colorectal cancer mortality per 100,000 population among individuals aged 20 to 54 years declined from 6.3 in 1970 to 3.9 in 2004. Colorectal cancer mortality then increased in white persons only reaching 4.1 in 2014. Mortality rates in black individuals decreased by 0.4% annually from 8.1 in 1970 to 6.1 in 2014. Mortality rates decreased in persons of other races combined between 1970 and 2006 and did not significantly change thereafter.
In an analysis by age, rates in white persons during the most recent trend period defined by Joinpoint regression were stable among those aged 20 to 29 years between 1988 and 2014, increased by 1.6% annually in those aged 30 to 39 years between 1995 and 2014, and increased by 1.9% annually in those aged 40 to 49 and by 0.9% annually in those aged 50 to 54 years between 2005 and 2014. Rates in black persons decreased between 1970 and 2014 by 2.1% annually in those aged 20 to 29 years and by 1.1% annually since 1993 in those aged 50 to 54 years.
The investigators noted that the identified mortality trends are consistent with reported colorectal cancer incidence between 1998 and 2009 among patients aged < 50 years, which was stable in black persons but increased in white persons by 1.5% annually for local-stage and regional-stage disease and by 3% annually for distant-stage disease, and that the disparate racial patterns observed are in conflict with trends in colorectal cancer risk factors such as obesity, which are similar in white and black individuals.
They concluded: “Escalating mortality rates in young and middle-aged adults highlight the need for earlier colorectal cancer detection through age-appropriate screening and more timely follow-up of symptoms.”
Siegel RL, et al: JAMA 318:572-574, 2017