The US has seen a steady decline in the overall incidence of colorectal cancer (CRC) during the past several decades. In 1975, 60 people per 100,000 were diagnosed with colorectal cancer; by 2018, that number had fallen to 34. But overall trends in CRC incidence and outcomes often differ among racial groups and geographic locations. Black Americans are more likely to be diagnosed with CRC than White Americans and more likely to die from it. CRC mortality rates in American Indian and Alaska Native populations have stubbornly stayed put.
Although March is recognized as National Colorectal Cancer Awareness Month, the persistence and highly variable outcomes of this disease call for year-round awareness. In the US, colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women. In 2021, CRC accounted for an estimated 52,980 deaths and nearly 8% of all newly diagnosed cancers in the US.
Improvements for Some
The US has seen a steady decline in the overall incidence of colorectal cancer during the past several decades. In 1975, 60 people per 100,000 were diagnosed with colorectal cancer; by 2018, that number had fallen to 34. From 2013 to 2017, incidence rates for CRC dropped by approximately 1% each year. Researchers attribute this positive trend to improving screening rates and encouraging lifestyle changes to reduce associated risk factors, including obesity, poor diet, smoking, alcohol use, and inactivity.
But overall trends in CRC incidence and outcomes often differ among racial groups and geographic locations. Black Americans are more likely to be diagnosed with CRC than White Americans and more likely to die from it. CRC mortality rates in American Indian and Alaska Native populations have stubbornly stayed put.
Another concerning trend is the increase in colorectal cancer in younger adults. The American Cancer Society reports that from 2012 to 2016, there was a 2% increase in CRC among people age 50 and below and a 1% increase in people age 50 to 64. Today, the US Preventive Services Task Force (USPSTF) estimates that 10.5% of new colorectal cancer cases occur in persons younger than age 50.
New Screening Guidelines
In 2016, only 26% of eligible adults in the US had never been screened for colorectal cancer; in 2018, 31% were not up to date with their screening. To encourage more people at possible risk for CRC to be screened, in 2021 the US Preventive Services Task Force (USPSTF) issued a final recommendation that lowered the recommended age for initial colorectal cancer screening from 50 to 45 years for individuals at normal risk. The task force now “strongly” recommends screening for those age 50 to 75 years. After age 75, the decision of whether screening is needed should be made by providers on an individual basis. In its updated recommendation, USPSTF asserts that it “strongly encourages clinicians to ensure their Black patients receive recommended colorectal cancer screening, follow-up, and treatment.”
Treatment Advancements
During the past 15 years, colorectal cancer treatment options have benefited from medical advances on many fronts. Improvements include surgical innovation and technological advances; growing understanding of the molecular biology of the disease; and more therapeutic options, including targeted therapy, combination therapy, and immunotherapy.
The study and identification of actionable biomarkers in CRC are areas of particularly active research. Colorectal cancer is a highly heterogeneous disease. As research continues to unravel more clues about the molecular-level activity driving CRC, biomarker testing can provide information about the characteristics of a patient’s tumor—information that may help in treatment planning. Biomarker testing is especially important for patients with metastatic CRC.
The increasing number of targeted therapies for CRC, along with changing biomarker testing recommendations, has challenged community clinicians to keep abreast of and adopt new advancements in CRC treatment. Participants from previous ACCC education programs have indicated that the overwhelming amount of new and evolving clinical information about cancer therapies constitutes a significant knowledge gap in community cancer centers.
In response to this, in 2021, ACCC joined Pfizer Global Medical Grants to award $1.5 million in grants to five community cancer centers for quality improvement (QI) projects aimed at improving the integration of biomarker testing in personalized treatment selection for patients with metastatic CRC. The chosen programs are currently developing initiatives focused on improving the timing, access, and proper use of biomarker testing by addressing issues that include reimbursement, workflow and staffing, patient and provider education, and care team coordination.
These projects aim to innovate new processes to bring best practices to larger patient populations, including underserved racial and socioeconomic groups. Stay tuned for updates on the progress of these initiatives.
Understanding both the benefits to be had from offering BsAb therapy to its community and the scope of this undertaking, Vanderbilt-Ingram Cancer Center took a novel approach with its APP-led BsAb step-up dosing clinic, which won the program a 2026 ACCC Innovator Award.
