A Snapshot of Colorectal Cancer
Incidence and Mortality
Colorectal cancer is the third most common non-skin cancer in both men and women. It is the second leading cause of cancer-related mortality in the United States. Over the past decade, colorectal cancer incidence and mortality rates have decreased in all racial/ethnic populations except American Indians/Alaska Natives. Men and women have similar incidence rates through age 39; at and above age 40, rates are higher in men.
Differences exist between racial/ethnic groups in both incidence and mortality. African Americans have higher mortality rates than all other racial/ethnic groups and higher incidence rates than all except American Indians/Alaska Natives. Incidence and mortality rates are lowest among Hispanics and Asians/Pacific Islanders. Overall colorectal cancer incidence and mortality rates have been declining over the past two decades; these declines have been attributed largely to increased use of screening tests.
Risk factors for colorectal cancer include increasing age, colorectal polyps, a family history of colorectal cancer, certain genetic mutations, excessive alcohol use, obesity, being physically inactive, cigarette smoking, and a history of inflammatory bowel disease. Effective colorectal cancer screening tests include the fecal occult blood test, sigmoidoscopy, and colonoscopy. Standard treatments for colorectal cancer include surgery, chemotherapy, radiation therapy, cryosurgery, radiofrequency ablation, and targeted therapy.
Assuming that incidence and survival rates follow recent trends, it is estimated that $13.8 billion1 will be spent on colorectal cancer care in the United States in 2014.
Examples of NCI Activities Relevant to Colorectal Cancer
- The Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) program is supporting multisite, coordinated, transdisciplinary research on cancer screening to better understand how to improve the screening process, including recruitment, diagnosis, and referral for treatment. Three sites are focusing on colorectal cancer screening.
- The PREVENT Cancer Preclinical Drug Development Program is supporting efforts to move cancer preventive chemical and biological agents and biomarkers from preclinical development toward clinical trial testing. Several projects are studying colon cancer prevention through preclinical development of small molecule inhibitors, identification of biomarkers of cancer, and vaccine development.
- NCI is supporting Preventing Adenomas of the Colon with Eflornithine and Sulindac (PACES), a phase III trial that is investigating whether treatment with sulindac (a nonsteroidal anti-inflammatory drug) and/or eflornithine (an experimental agent) reduces the risk of developing an adenoma or a second primary colorectal cancer in patients previously treated for colon cancer.
- The Division of Cancer Epidemiology and Genetics is conducting population and multidisciplinary research to discover the genetic and environmental causes of cancer and new approaches to cancer prevention, including several studies on colorectal cancer.
- The Clinical Proteomic Tumor Analysis Consortium is characterizing the entire set of proteins expressed by various cancer types, including colorectal tumors, and integrating this information with genomic data from The Cancer Genome Atlas program. The results of this research will provide a better understanding of cancer biology and facilitate the discovery of protein targets with diagnostic and therapeutic utility.
- Five gastrointestinal-cancer-specific Specialized Programs of Research Excellence (SPOREs) are conducting translational research on gastrointestinal system cancers, including colorectal cancer.
Selected Advances in Colorectal Cancer Research
- A preclinical study has shown that gut microflora can influence the treatment response of tumors formed by colon carcinoma cells. Published November 2013. [PubMed Abstract]
- In a study comparing the gut microflora of colorectal cancer patients and noncancer controls, colorectal cancer risk was associated with decreased bacterial diversity. Published December 2013. [PubMed Abstract]
- Overexpression of PLAC8, a protein whose levels are elevated in colon cancer, shifts the normal cells lining the colon into a state that encourages metastasis. Published April 2014. [PubMed Abstract]
- The integration of proteomic and genomic data from colorectal cancer studies identified five colon cancer subtypes (three of which were unique to this combined analysis) and demonstrated the value of using proteomics to understand the mutations that drive cancer. Published July 2014. [PubMed Abstract]
Trends in NCI Funding for Colorectal Cancer Research
NCI’s investment2 in colorectal cancer research was $238.3 million in fiscal year (FY) 2013. In addition to the funding described in the graph, NCI supported $58.6 million in colorectal cancer research in FYs 2009 and 2010 using funding from the American Recovery and Reinvestment Act.
Additional Resources for Colorectal Cancer
- Colon and Rectal Cancer Home Page
NCI's gateway for information about colon and rectal cancer.
- Test to Detect Colorectal Cancer and Polyps
A fact sheet that discusses the advantages and disadvantages of several colorectal cancer screening tests.
- Colorectal Cancer Risk Assessment Tool
An interactive tool to help health providers estimate a patient’s risk of developing colorectal cancer.
- Gut Check
A resource for exploring colon cancer screening choices.
- Colon Cancer Treatment (PDQ®)
Expert-reviewed information summary about the treatment of colon cancer.
- Rectal Cancer Treatment (PDQ®)
Expert-reviewed information summary about the treatment of rectal cancer.
- Clinical Trials for Colon Cancer
- Clinical Trials for Rectal Cancer
- 1 Cancer Prevalence and Cost of Care Projections, in 2010 dollars.
- 2 The estimated NCI investment is based on funding associated with a broad range of peer-reviewed scientific activities. For additional information on research planning and budgeting at the National Institutes of Health (NIH), see About NIH.