CA CANCER J CLIN 2017;67:177–193
Colorectal Cancer Statistics, 2017
Rebecca L. Siegel, MPH1; Kimberly D. Miller, MPH2; Stacey A. Fedewa, PhD3; Dennis J. Ahnen, MD4;
Reinier G. S. Meester, PhD5; Afsaneh Barzi, MD, PhD6; Ahmedin Jemal, DVM, PhD7
1
Strategic Director, Surveillance Information
Services, Surveillance and Health Services
Research, American Cancer Society, Atlanta,
GA; 2Epidemiologist, Surveillance and Health
Services Research, American Cancer Society,
Atlanta, GA; 3Director, Screening and Risk
Factor Surveillance, Surveillance and
Health Services Research, American Can-
cer Society, Atlanta, GA; 4Professor, Division
of Gastroenterology, School of Medicine, Uni-
versity of Colorado, Aurora, CO; 5Epidemiolo-
gist, Department of Public Health, Erasmus
University, Rotterdam, the Netherlands;
6 declined by 32%, with the drop largest for distal tumors in people aged 65 years
Assistant Professor of Clinical Medicine,
Department of Medicine, Norris Comprehen-
sive Cancer Center, University of Southern Cal-
ifornia, Los Angeles, CA; 7Vice President,
Surveillance and Health Services Research,
American Cancer Society, Atlanta, GA
Corresponding author: Rebecca L. Siegel,
MPH, Surveillance Research, American Can-
cer Society, 250 Williams Street NW, Atlanta,
GA 30303; rebecca.siegel@cancer.org
DISCLOSURES: Dennis J. Ahnen serves on
the Speakers Bureau for Ambry Genetics and
is a Scientific Advisory Board member of
EXACT Sciences and Cancer Prevention Phar-
maceuticals, all outside the submitted work.
Reinier G.S. Meester reports grants from the
US National Cancer Institute during the con-
duct of this study. All other authors report
no conflicts of interest.
doi: 10.3322/caac.21395. Available online
at cacancerjournal.com
Abstract: Colorectal cancer (CRC) is one of the most common malignancies in the
United States. Every 3 years, the American Cancer Society provides an update of
CRC incidence, survival, and mortality rates and trends. Incidence data through
2013 were provided by the Surveillance, Epidemiology, and End Results program,
the National Program of Cancer Registries, and the North American Association of
Central Cancer Registries. Mortality data through 2014 were provided by the Nation-
al Center for Health Statistics. CRC incidence rates are highest in Alaska Natives
and blacks and lowest in Asian/Pacific Islanders, and they are 30% to 40% higher in
men than in women. Recent temporal patterns are generally similar by race and sex,
but differ by age. Between 2000 and 2013, incidence rates in adults aged 50 years
(incidence rate ratio [IRR], 0.50; 95% confidence interval [95% CI], 0.48-0.52) and
smallest for rectal tumors in ages 50 to 64 years (male IRR, 0.91; 95% CI, 0.85-0.96;
female IRR, 1.00; 95% CI, 0.93-1.08). Overall CRC incidence in individuals ages 50
years declined from 2009 to 2013 in every state except Arkansas, with the decrease
exceeding 5% annually in 7 states; however, rectal tumor incidence in those ages 50
to 64 years was stable in most states. Among adults aged <50 years, CRC incidence
rates increased by 22% from 2000 to 2013, driven solely by tumors in the distal
colon (IRR, 1.24; 95% CI, 1.13-1.35) and rectum (IRR, 1.22; 95% CI, 1.13-1.31). Simi-
lar to incidence patterns, CRC death rates decreased by 34% among individuals
aged 50 years during 2000 through 2014, but increased by 13% in those aged
<50 years. Progress against CRC can be accelerated by increasing initiation of
screening at age 50 years (average risk) or earlier (eg, family history of CRC/
advanced adenomas) and eliminating disparities in high-quality treatment. In
addition, research is needed to elucidate causes for increasing CRC in young adults.
CA Cancer J Clin 2017;67:177-193. V C 2017 American Cancer Society.
Keywords: colon and rectum neoplasms, epidemiology, health disparities, screen-
ing and early detection
Introduction
Colorectal cancer (CRC) is the third most commonly diagnosed cancer among both
men and women in the United States. Incidence and mortality rates have been declin-
ing for several decades because of historical changes in risk factors (eg, decreased
smoking and red meat consumption and increased use of aspirin), the introduction
and dissemination of screening tests, and improvements in treatment (mortality).1,2 In
this article, we provide a comprehensive overview of current CRC statistics in the
United States, including the estimated numbers of new cases and deaths among
men and women in 2017 by age; incidence rates and trends by age, race/ethnicity, and
anatomic subsite through 2013; survival for cases diagnosed from 1975 to 2012; and
mortality rates and trends through 2014. CRC screening prevalence for adults aged
50 years and older are also presented nationally for 2015 and by state for 2014.
Materials and Methods
Data Sources
US mortality data from 1930 to 2014 were obtained from the Centers for Disease
Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS).3,4
Population-based cancer incidence data in the United States are collected by the
VOLUME 67 _ NUMBER 3 _ MAY/JUNE 2017 177
 Colorectal Cancer Statistics, 2017

FIGURE 1. Colorectal Cancer Incidence (2009-2013) and Mortality (2010-2014) Rates by Race/Ethnicity and Sex, United
States.
AI/AN indicates American Indian/Alaska Native; API, Asian American/Pacific Islander; NHB, non-Hispanic black; NHW, non-Hispanic white. Rates are age adjust-
ed to the 2000 US standard population.
*Rates for AI/ANs are based on Contract Health Service Delivery Area (CHSDA) counties; incidence rates exclude data from Kansas.
Sources: Incidence: NAACCR, 2016. Alaska Natives only: SEER program, 2016. Mortality: NCHS, CDC, 2016.

National Cancer Institute’s (NCI’s) Surveillance, Epidemiolo-
gy, and End Results (SEER) program and the CDC’s
National Program of Cancer Registries. Long-term incidence
and relative survival trends dating back to 1975 were based on
data from the 9 oldest SEER registries (Connecticut, Iowa,
Hawaii, New Mexico, Utah, and the metropolitan areas
of Atlanta, Detroit, San Francisco-Oakland, and Seattle-
Puget Sound), representing approximately 9% of the US
population.5 The entire SEER catchment area (SEER 9 plus
registries for Alaska Natives, Georgia, California, Kentucky,
Louisiana, and New Jersey) achieves 28% population coverage
and was the source for cancer stage distribution, 5-year rela-
tive survival by stage, 5-year cause-specific survival by race/
ethnicity, and incidence trends from 2000 through 2013.6
Incidence and mortality rates for Alaska Natives separate
from American Indians were based on cases collected by the

TABLE 1. Estimated Numbers of New Colorectal Cancer Cases and Deaths by Age, United States, 2017*

NEW CASES DEATHS

MALE FEMALE MALE FEMALE

AGE, YEARS Count % Count % Count % Count %

Birth to 49 7,550 11 6,650 10 2,000 7 1,490 6

50-64 24,410 34 18,030 28 7,600 28 4,840 21
65-79 26,950 38 22,230 35 10,120 37 7,480 32
80 12,510 18 17,100 27 7,430 27 9,300 40
All ages 71,420 100 64,010 100 27,150 100 23,110 100
*Estimates are rounded to the nearest 10.

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 CA CANCER J CLIN 2017;67:177–193

TABLE 2. Colorectal Cancer Incidence (2009-2013) and Mortality (2010-2014) Rates by Race/Ethnicity and State,
United States

INCIDENCE MORTALITY

MALE FEMALE MALE FEMALE

NHW NHB HISPANIC NHW NHB HISPANIC NHW NHB HISPANIC NHW NHB HISPANIC

Alabama 50.6 65.2 20.4 35.5 44.8 20.0 19.1 29.2 * 12.1 18.7 *
Alaska 41.2 * * 33.5 * * 14.2 * * 11.5 * *
Arizona 38.6 41.6 43.1 30.4 38.1 28.9 15.5 21.0 16.2 11.5 18.6 9.2
Arkansas 49.1 58.5 64.7 35.6 45.2 49.1 21.2 31.0 * 14.4 18.0 *
California 43.9 57.6 40.4 34.7 45.6 28.3 16.1 25.0 14.8 12.3 18.1 8.7
Colorado 37.3 47.9 45.8 30.7 34.1 32.0 14.2 21.5 16.2 11.1 12.6 10.6
Connecticut 45.0 57.8 55.6 34.3 40.9 34.7 13.7 19.6 11.9 10.4 12.6 7.8
Delaware 44.5 48.8 33.0 33.7 35.8 * 17.2 16.3 * 10.5 14.8 *
Dist. Of Columbia 24.0 63.0 30.8 25.9 49.1 * 7.0 26.5 * 9.5 19.3 *
Florida 41.9 52.3 47.3 32.3 37.2 34.4 16.0 21.7 15.9 11.3 14.8 10.3
Georgia 46.9 60.4 31.0 34.4 43.6 26.0 18.1 27.1 10.4 11.7 16.2 3.5
Hawaii 42.7 * 48.0 33.3 * 44.4 14.7 * 21.0 12.2 * *
Idaho 41.8 * 38.5 31.9 * 24.7 16.2 * * 11.2 * *
Illinois 52.9 69.4 37.6 38.3 49.4 28.8 18.6 29.8 12.6 13.0 19.5 7.5
Indiana 49.4 55.7 33.0 39.0 45.5 30.3 19.1 26.4 11.4 13.3 18.6 *
Iowa 52.4 53.2 31.4 40.0 46.8 21.9 19.3 20.0 * 14.0 21.2 *
Kansas 47.9 64.5 44.2 35.5 43.6 28.1 18.2 29.8 15.1 12.2 21.0 10.9
Kentucky 59.6 64.3 26.5 43.5 51.9 * 20.9 23.3 * 14.1 18.2 *
Louisiana 54.3 70.3 30.1 38.9 51.3 33.5 19.8 29.7 * 13.7 19.2 *
Maine 44.9 * * 35.6 * * 16.6 * * 11.8 * *
Maryland 41.5 49.9 28.0 32.8 38.6 23.5 16.3 25.3 6.9 11.2 15.9 5.4
Massachusetts 43.6 49.6 35.5 34.9 36.8 26.8 16.2 17.4 10.6 11.2 14.2 9.4
Michigan 43.1 58.1 47.4 33.4 43.8 27.1 16.9 25.3 15.3 12.1 17.2 10.5
Minnesota† 43.7 43.5 33.9 34.3 39.9 33.0 15.2 12.8 * 11.4 10.6 *
Mississippi 54.2 74.4 * 38.0 54.0 * 21.0 33.2 * 13.9 21.4 *
Missouri 49.7 62.9 36.7 36.8 45.2 26.0 18.6 27.4 * 12.9 17.6 *
Montana 44.5 * * 32.9 * * 15.5 * * 10.9 * *
Nebraska 49.3 71.6 32.7 38.5 52.1 27.9 18.4 36.9 * 14.3 19.7 *
Nevada†,‡ 52.0 60.1 36.0 34.7 47.2 34.8 21.1 24.4 13.2 14.7 16.4 9.6
New Hampshire 41.4 * * 34.6 * * 14.3 * * 13.6 * *
New Jersey 49.9 57.7 45.1 39.2 43.1 35.5 18.4 28.0 11.9 13.2 15.8 8.7
New Mexico†,§ 36.3 * 48.0 29.3 * 32.9 15.5 * 20.1 10.5 * 12.1
New York 47.4 55.0 47.0 37.2 39.6 31.4 16.5 21.4 15.3 12.1 14.6 10.0
North Carolina 43.3 55.9 27.3 32.2 39.9 22.9 16.2 26.3 6.9 10.8 16.3 3.5
North Dakota 54.4 * * 39.6 * * 18.3 * * 12.9 * *
Ohio 48.4 53.3 29.6 35.7 38.1 23.8 19.5 25.3 13.2 13.5 15.9 6.0
Oklahoma 47.6 56.2 41.3 35.8 42.9 35.5 20.1 29.0 14.1 13.2 17.8 9.0
Oregon 41.6 58.6 39.6 32.3 38.8 28.5 16.7 27.7 12.5 12.3 18.7 8.7
Pennsylvania 50.8 58.5 46.5 38.2 43.0 29.9 18.4 27.0 14.0 13.3 16.5 7.7
Rhode Island 42.6 36.1 37.4 35.3 30.9 22.7 16.3 * * 13.6 * *
South Carolina 43.3 56.1 26.4 33.0 38.4 26.6 17.3 26.1 * 12.1 16.3 *
South Dakota 50.2 * * 39.4 * * 19.4 * * 12.5 * *
Tennessee 46.9 59.8 21.3 35.8 43.7 20.1 19.2 31.1 * 13.3 19.9 *
Texas 46.3 60.5 46.8 33.0 43.7 28.1 17.6 28.4 17.8 12.0 17.8 9.6
Utah 36.0 68.6 37.8 27.9 * 29.6 12.6 * 15.0 9.6 * 9.5
Vermont 41.4 * * 33.6 * * 15.8 * * 12.7 * *
Virginia 40.9 53.2 30.4 32.4 40.6 25.8 16.1 25.1 8.4 11.3 16.4 8.2
Washington 41.6 47.3 29.5 34.2 32.7 28.0 15.4 20.5 7.6 11.5 12.4 6.9
West Virginia 54.5 54.5 * 40.9 42.3 * 22.2 30.9 * 15.2 13.4 *
Wisconsin 43.6 68.6 36.7 33.7 41.0 30.4 16.2 29.3 * 11.9 17.1 8.4
Wyoming 44.0 * 41.4 32.2 * * 17.0 * * 10.5 * *
United States 46.1 58.3 42.8 35.2 42.7 29.8 17.3 25.9 15.0 12.3 16.9 9.2
NHB indicates non-Hispanic black; NHW, non-Hispanic white. Rates are per 100,000 and age adjusted to the 2000 US standard population.
*Statistics are not displayed because there were fewer than 25 cases or deaths.
†This state’s incidence data are not included in US combined rates, because they did not meet NAACCR’s high-quality standards for 1 or more years during
2009 through 2013.
‡Incidence rates are based on data for 2009 through 2010.
§Incidence rates are based on data for 2009 through 2012.
Sources: Incidence: NAACCR, 2016. Mortality: NCHS, CDC, 2016.

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 Colorectal Cancer Statistics, 2017

TABLE 3. Colorectal Cancer Incidence Rates and Proportions of Cases by Tumor Subsite, United States, 2009 to 2013

ALL PERSONS MALE FEMALE

RATE % RATE % RATE %

Proximal colon 16.9 41 17.9 37 16.1 46

Distal colon 9.0 22 10.9 24 7.5 21
Rectum 11.5 28 14.5 32 8.9 25
Other 3.2 8 3.6 7 3.0 8
Total colorectum 40.7 100 46.9 100 35.6 100
Rates are per 100,000 and are age adjusted to the 2000 US standard population.
Source: NAACCR, 2016.

SEER program’s Alaska Native Tumor Registry and deaths
occurring in American Indians/Alaska Natives (AI/AN) in
Contract Health Service Delivery Area counties in Alaska, as
reported by the NCHS. Because of data limitations, there
may be some cross-contamination between rates for Alaska
Natives and American Indians provided separately (Fig. 1),
particularly for mortality.
Some of the data presented herein were previously pub-
lished in the NCI’s SEER Cancer Statistics Review, 1975-
2013.7 Combined SEER and National Program of Cancer
Registries data, as provided by the North American Associ-
ation of Central Cancer Registries (NAACCR), were the
source for the projection of new CRC diagnoses in 2017,
age and subsite distributions, 5-year (2009-2013) average
annual incidence rates by race/ethnicity and state, and
trends by state from 2004 through 2013.8
CRC screening prevalence data at the state level were
obtained from 2014 Behavioral Risk Factor Surveillance
System (BRFSS) public use data.9 The BRFSS is a survey
coordinated by the CDC and conducted by individual state
health departments that is designed to provide state preva-
lence estimates of health behaviors. Data are collected from
computer-assisted telephone interviews with adults aged 18
years and older. In 2011, the CDC modified the BRFSS
weighting procedures and expanded reach to include house-
holds without landline telephone service (ie, cellular service
only).10 Therefore, BRFSS estimates for 2011 and later
should not be compared with earlier estimates.

FIGURE 2. Distribution of Colorectal Tumor Location by Age, United States, 2009-2013.

Source: NAACCR, 2016.

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 CA CANCER J CLIN 2017;67:177–193

TABLE 4. Stage Distribution and 5-Year Relative Survival Rates by Race for Colon and Rectal Cancer, United States,
2006 to 2012*

ALL RACES COMBINED WHITE BLACK

STAGE DISTRIBUTION, % SURVIVAL, % STAGE DISTRIBUTION, % SURVIVAL, % STAGE DISTRIBUTION, % SURVIVAL, %

Colon
Localized 38 91.1 38 91.8 35 86.7
Regional 36 71.7 37 72.4 34 66.1
Distant 22 13.3 21 14.0 27 9.4
Unstaged 4 27.5 4 25.3 4 30.1
All stages 100 64.4 100 65.4 100 56.6
Rectum
Localized 43 88.2 42 87.8 46 86.4
Regional 33 70.0 34 70.9 27 60.9
Distant 18 14.0 18 14.4 20 11.7
Unstaged 6 48.9 5 44.7 7 53.7
All stages 100 66.6 100 66.5 100 62.2
*Cases were diagnosed from 2006 to 2012, and all were followed through 2013.
Source: Howlader N, et al.7

FIGURE 3. Colorectal Cancer Stage Distribution and 5-Year Cause-Specific Survival* by Race/Ethnicity, United States,
2006-2012.
AI/AN indicates American Indian/Alaska Native; API, Asian American/Pacific Islander; NHB, non-Hispanic black; NHW, non-Hispanic white.
*Cause-specific survival rates are the probability of not dying from colorectal cancer within 5 years of diagnosis. Patients were followed through 2013.
†Data are based on cases diagnosed in CHSDA counties. Rates for AI/ANs are based on small case numbers, particularly for distant stage disease.
Source: SEER program, 2016.

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 Colorectal Cancer Statistics, 2017
FIGURE 4. Trends in Colorectal Cancer Incidence (1975-2013)
and Mortality (1930-2014) Rates by Sex, United States.
Rates are age adjusted to the 2000 US standard population and incidence
rates are adjusted for reporting delays. Due to improvements in International
Classification of Diseases (ICD) coding over time, numerator data for colorec-
tal cancer mortality differ slightly from those presented elsewhere.
Sources: Incidence: SEER program, 2016. Mortality: US Mortality Volumes
1930 to 1959, US Mortality Data 1960-2014, NCHS, CDC, 2016.
National CRC screening prevalence was obtained from
the NCHS 2015 National Health Interview Survey
(NHIS).11 The NHIS is a centralized survey conducted by
the US Census Bureau that is designed to provide national
prevalence estimates on health characteristics, such as cancer
screening behaviors. Data are collected through computer-
assisted, in-person interviews of adults aged 18 years and
older. The number of additional people screened from 2013
to 2015 was calculated using NHIS and US Census data
based on a methodology described elsewhere.12 The
MISCAN-colon model, which is a part of the Cancer Inter-
vention and Surveillance Modeling Network sponsored by
the National Cancer Institute (cisnet.cancer.gov/), was used
to predict the number of cases and deaths averted under sce-
narios of different screening rates.
Projected New Cases and Deaths in 2017
The most recent year for which incidence and mortality data
are available lags 2 to 4 years behind the current year because
of the time required for data collection, compilation, quality
control, and dissemination. Therefore, the American Cancer
Society projects the numbers of new cancer cases and deaths
in the United States for the current year to provide an esti-
mate of the contemporary cancer burden. These estimates
cannot be used for tracking cancer occurrence over time
because they are model-based and because the methodology
changes every few years to take advantage of improvements
in modeling techniques, increased cancer registration
182 CA: A Cancer Journal for Clinicians
coverage, and updated risk factor surveillance. The methods
for projecting the total number of new CRC cases and deaths
that will occur in 2017 is described in detail elsewhere.13,14
The proportions of cases and deaths by age were calculated
by applying the age distributions for NAACCR incidence
data and NCHS mortality data during the most recent data
year to the overall estimates.
Statistical Analysis
CRC cases were classified according to the International
Classification of Diseases for Oncology as colon (codes
C18.0-C18.9 and C26.0) or rectum (codes C19.9 and
C20.9).15 Colon tumors were further designated by loca-
tion as proximal (codes C18.0 and C18.2-C18.5), distal
(codes C18.6-C18.7), or other (codes C18.1, C18.8,
C18.9, and C26.0). Because of the large number of rectal
cancer deaths that are misclassified as colon,16 colon and
rectal cancer deaths were combined in all analyses. This
misclassification does not affect the calculation of relative
survival rates presented herein. All incidence and death
rates were age-standardized to the 2000 US standard popu-
lation and expressed per 100,000 persons, as calculated by
the NCI’s SEER*Stat software (version 8.3.2).17 SEER
incidence trends were based on rates adjusted for delays in
reporting based on SEER delay factors, except for AI/AN
rates, which were based on NAACCR combined registries
delay factors (Eric J. Feuer, personal communication,
2017). Delay adjustment accounts for the additional time
required for the complete registration of cases and more
accurately reflects cancer trends in the most recent time
period.18 The lifetime probability of developing cancer was
calculated using the NCI’s DevCan software (version
6.7.4).19
Selected Findings
Estimated Cases and Deaths in 2017
In the United States in 2017, there are projected to be
135,430 individuals newly diagnosed with CRC and
50,260 deaths from the disease.20 Although the majority
of new cases (58%) occur in people aged 65 years or
older, 45% of men and 39% of women are younger than
age 65 years at diagnosis (Table 1). Among women, 27%
of cases and 40% of deaths occur in those aged 80 years
and older, compared with 18% and 27%, respectively,
among men (Table 1).
Contemporary Incidence and Mortality
Overall
In the United States, the annual age-standardized inci-
dence rate for CRC during 2009 through 2013, the most
recent years for which data are available, was 40.7 per
100,000 persons, and the mortality rate (2010-2014) was

FIGURE 5. Colorectal Cancer Incidence and Mortality Trends by Age and Sex, United States, 1975-2014.
Please note: Axis scales are not uniform in order to highlight trends.
Rates are age adjusted to the 2000 standard population and incidence rates are adjusted for reporting delays.
Sources: Incidence: SEER program, 2016. Mortality: NCHS, CDC, 2016.
14.8 per 100,000 persons. Incidence and mortality rates are
30% and 40% higher in men than in women, respectively,20
although the lifetime risk of disease is similar (4.6% vs
4.2%) because women have longer life expectancy. In addi-
tion, the sex disparity differs by age. For example, incidence
is not significantly different in men and women younger
than age 40 years but is almost 50% higher in men than in
women ages 55 to 74 years (131.5 vs 90.7 per 100,000).
Reasons for higher rates in men are not completely under-
stood but to some extent likely reflect differences in expo-
sures to risk factors and sex hormones, as well as complex
interactions between these influences.21,22
Racial/ethnic disparities
CRC incidence and mortality rates vary substantially by race
and ethnicity. Among the 5 major racial/ethnic groups
depicted in Figure 1, rates are highest in non-Hispanic
CA CANCER J CLIN 2017;67:177–193
blacks (NHBs) and lowest in Asian Americans/Pacific
Islanders (APIs) (Fig. 1). During 2009 through 2013, inci-
dence rates in NHBs (49.2 per 100,000) were about 20%
higher than those in non-Hispanic whites (NHWs) (40.2
per 100,000) and 50% higher than those in APIs (32.2 per
100,000). Notably, the magnitude of the disparity for mor-
tality is double that for incidence. During 2010 through
2014, CRC death rates in NHBs (20.5 per 100,000) were
40% higher than those in NHWs (14.6 per 100,000) and
twice those in APIs (10.3 per 100,000). It is believed that the
higher rates in NHBs are largely driven by disproportionately
low socioeconomic status, which is associated with a higher
risk of CRC incidence and death.23,24 According to the US
Census Bureau, the poverty rate in 2015 was 24% in blacks
compared with 9% in NHWs and 11% in Asians.25 Approxi-
mately 40% of the socioeconomic disparity in CRC
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 Colorectal Cancer Statistics, 2017

TABLE 5. Trends in Colorectal Cancer Incidence Rates by Age and Subsite, United States, 2000 to 2013

TREND 1 TREND 2 TREND 3

2009-2013 2004-2013
YEARS APC YEARS APC YEARS APC AAPC AAPC

Proximal colon
Birth to 49 years 2000-2013 0.2 0.2 0.2
50-64 years 2000-2013 -2.0* -2.0* -2.0*
65 years 2000-2008 -2.4* 2008-2013 -4.4* -4.4* -3.5*
Distal colon
Birth to 49 years 2000-2013 1.7* 1.7* 1.7*
50-64 years 2000-2013 -2.2* -2.2* -2.2*
65 years 2000-2002 -1.0 2002-2013 -5.5* -5.5* -5.5*
Rectum
Birth to 49 years 2000-2003 -0.7 2003-2007 4.6* 2007-2013 0.7 0.7 2.0*
50-64 years 2000-2013 -0.5* -0.5* -0.5*
65 years 2000-2013 -3.7* -3.7* -3.7*
Appendix/unspecified subsite
Birth to 49 years 2000-2009 1.8* 2009-2013 11.8* 11.8* 6.1*
50-64 years 2000-2013 0.8* 0.8* 0.8*
65 years 2000-2013 -1.9* -1.9* -1.9*
Total colorectum
Birth to 49 years 2000-2013 1.6* 1.6* 1.6*
50-64 years 2000-2013 -1.4* -1.4* -1.4*
65 years 2000-2008 -3.1* 2008-2013 -4.6* -4.6* -4.0*
AAPC indicates average annual percent change over the most recent 5 data years; APC,: annual percent change based on incidence rates age adjusted to the
2000 US standard population.
*The APC or AAPC is significantly different from zero (p < .05).
Source: SEER program, 2016.
Note: Trends are based on incidence rates adjusted for delays in case reporting and were analyzed using the Joinpoint Regression Program, version 4.3.1.0,
allowing up to 2 joinpoints.

TABLE 6. Trends in Colorectal Cancer Incidence Rates by Age and Stage, United States, 2000 to 2013

TREND 1 TREND 2 TREND 3

2009-2013 2004-2013
YEARS APC YEARS APC YEARS APC AAPC AAPC

Localized
Birth to 49 years 2000-2013 1.3* 1.3* 1.3*
50-64 years 2000-2008 -0.5 2008-2013 -2.8* -2.8* -1.8*
65 years 2000-2008 -2.3* 2008-2011 -6.5* 2011-2013 -2.9 -4.7* -3.9*
Regional
Birth to 49 years 2000-2013 1.1* 1.1* 1.1*
50-64 years 2000-2013 -2.1* -2.1* -2.1*
65 years 2000-2013 -4.1* -4.1* -4.1*
Distant
Birth to 49 years 2000-2013 3.0* 3.0* 3.0*
50-64 years 2000-2013 -0.5* -0.5* -0.5*
65 years 2000-2002 0.4 2002-2013 -2.9* -2.9* -2.9*
Unknown stage
Birth to 49 years 2000-2013 0.3 0.3 0.3
50-64 years 2000-2005 -6.1* 2005-2013 0.9 0.9 0.1
65 years 2000-2004 -6.1* 2004-2013 -3.8* -3.8* -3.8*
AAPC indicates average annual percent change over the most recent 5 data years; APC, annual percent change based on incidence rates age adjusted to the
2000 US standard population.
*The APC or AAPC is significantly different from zero (p < 0.05).
Source: SEER program, 2016.
Trends are based on incidence rates adjusted for delays in case reporting and were analyzed using the Joinpoint Regression Program, version 4.3.1.0, allowing
up to 2 joinpoints.

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 CA CANCER J CLIN 2017;67:177–193

TABLE 7. Trends in Colorectal Cancer Incidence Rates by Age and Race/Ethnicity, United States, 2000 to 2013

TREND1 TREND 2
2009-2013 2004-2013
YEARS APC YEARS APC AAPC AAPC

Non-Hispanic white
All ages 2000-2013 -2.7* -2.7* -2.7*
Birth to 49 years 2000-2013 2.3* 2.3* 2.3*
50-64 years 2000-2011 -2.0* 2011-2013 0.4 -0.8 -1.5*
65 years 2000-2008 -3.2* 2008-2013 -4.7* -4.7* -4.1*
Non-Hispanic black
All ages 2000-2007 -1.2* 2007-2013 -3.0* -3.0* -2.4*
Birth to 49 years 2000-2013 1.0* 1.0* 1.0*
50-64 years 2000-2007 -0.3 2007-2013 -2.2* -2.2* -1.6*
65 years 2000-2006 -1.6* 2006-2013 -3.9* -3.9* -3.4*
Asian/Pacific Islander
All ages 2000-2013 -2.1* -2.1* -2.1*
Birth to 49 years 2000-2013 0.2 0.2 0.2
50-64 years 2000-2013 -0.2 -0.2 -0.2
65 years 2000-2013 -3.2* -3.2* -3.2*
American Indian/Alaska Native†
All ages 2000-2013 -0.3 -0.3 -0.3
Birth to 49 years 2000-2013 2.5 2.5 2.5
50-64 years 2000-2013 -0.9 -0.9 -0.9
65 years 2000-2013 -0.4 -0.4 -0.4
Hispanic
All ages 2000-2008 -1.1* 2008-2013 -3.0* -3.0* -2.2*
Birth to 49 years 2000-2013 1.2* 1.2* 1.2*
50-64 years 2000-2005 1.7 2005-2013 -1.2* -1.2* -0.9*
65 years 2000-2008 -1.9* 2008-2013 -4.4* -4.4* -3.3*
AAPC indicates average annual percent change over the most recent 5 data years; APC, annual percent change based on incidence rates age adjusted to the
2000 US standard population.
*The APC or AAPC is significantly different from zero (p < 0.05).
†Trends are based on cases diagnosed in CHSDA counties.
Source: SEER program, 2016.
Trends are based on incidence rates adjusted for delays in case reporting and were analyzed using the Joinpoint Regression Program, version 4.3.1.0, allowing
up to 2 joinpoints.

incidence is attributed to a higher prevalence of risk factors,
such as obesity, unhealthy diet, and smoking,26 while dif-
ferences in screening are estimated to account for 40% of
the racial disparity.27 The larger mortality disparity
reflects inequities in comorbidities, access to care and
treatment,28 and perhaps delayed follow-up of screen-
detected abnormalities.29
It is important to recognize that the burden of CRC
varies greatly within the broadly defined racial/ethnic
groups presented in Figure 1. For example, Alaska Natives
have CRC incidence (91.1 per 100,000) and mortality
(36.7 per 100,000) rates that are about 80% higher than
those in blacks and more than double those in other
Native American groups combined, among whom rates
are similar to NHWs.6 CRC has been the most commonly
diagnosed cancer in Alaska Natives since the early 1970s
for reasons that are not well understood but may include a
traditional diet high in animal fat and low in fruits and
vegetables; vitamin D deficiency; and a high prevalence of
smoking, obesity, and diabetes.30,31 Alaska Natives,
particularly rural residents, also have a high prevalence of
Helicobacter pylori,32 a bacterium primarily associated with
inflammation and malignancy in the stomach, but that has
also been associated with an increased risk of CRC in
some studies.33,34
Geographic disparities
The striking variation in CRC incidence globally reflects
the strong impact of lifestyle factors on the occurrence of
this cancer.35 Similarly, wide geographic disparities within
the United States have shifted in recent decades. CRC
death rates were highest across the Northeast and lowest
in the South in the 1970s and 1980s,36 whereas they are
currently highest in parts of the South and Midwest and
lowest in the West.37 Table 2 shows annual, age-
standardized CRC incidence and death rates by state and
race/ethnicity. Geographic variation is similar by sex, with
the highest rates for NHWs, NHBs, and Hispanics all in
Southern states. Geographic patterns of CRC within the
United States reflect differences in population demo-
graphics and the prevalence of risk factors, as well as the
use of screening.

VOLUME 67 _ NUMBER 3 _ MAY/JUNE 2017 185

 Colorectal Cancer Statistics, 2017

by sex and age (Fig. 2). Proximal tumor location is more

TABLE 8. Colorectal Cancer Screening (%), Adults Ages
50 Years or Older, United States, 2015 likely in women than in men and increases with age. For
example, 57% of CRCs in women aged 80 years and older
COMBINED occur in the proximal colon, versus just 26% in men youn-
FECAL FECAL/
CHARACTERISTIC TEST* ENDOSCOPY† ENDOSCOPY‡ ger than 50 years. Among men and women younger than
Sex 50 years, tumors are most commonly diagnosed in the rec-
Men 7.6 60.9 63.2 tum (41% and 36%, respectively).
Women 6.8 59.9 62.2
Age (years) Survival and stage distribution
50-64 6.0 55.3 57.8
65 8.6 66.1 68.3 CRC survival rates are presented for men and women com-
Race/ethnicity bined because they do not vary substantially by sex. The 5-
Non-Hispanic white 6.9 63.3 65.4
Non-Hispanic black 8.0 59.3 61.8 year relative survival rate for patients diagnosed from 2006
Hispanic 7.3 47.6 49.9 to 2012 (all followed through 2013) was 65%.7 Survival
Non-Hispanic American Indian/ # 49.6 54.3
Alaska Native
declines to 58% at 10 years after diagnosis, although this
Non-Hispanic Asian§ 9.2 44.8 49.4 estimate does not reflect the most recent improvements in
Education detection and treatment because it is based on the experi-
Some high school or less 6.3 45.3 47.4
High school diploma or GED 7.1 56.4 58.6 ence of patients diagnosed as far back as 2000. Overall five-
Some college/associates degree 7.2 61.6 64.3 year survival is slightly higher for patients with rectal
College graduate 7.7 68.9 71.3
Sexual orientation tumors (67%) than for those with colon tumors (64%),
Gay/lesbian # 68.0 71.8 despite generally higher stage-specific survival for colon
Straight 7.2 60.3 62.7
Bisexual # 52.0 53.2 tumors, because rectal cancer is more often diagnosed at a
Insurance status, ages 50-64 years localized stage (43% vs 38%) (Table 4).7 Survival also varies
Uninsured 4.0 24.0 25.1
Insured 6.2 56.8 59.6
based on tumor location within the colon; 5-year survival is
Immigration status higher for patients with distal tumors (69%) than for those
Born in US 7.1 62.4 64.7
Born in US territory¶ # 62.5 63.4
with proximal tumors (65%).6 Tumors in the proximal
In US fewer than 10 years # 25.6 33.7 colon are associated with a higher risk of death, even after
In US 101 years 8.0 48.8 51.8 controlling for stage at diagnosis and treatment.42 Survival
Region
Northeast 5.0 64.5 65.5 is also higher in younger patients; 5-year survival is 69% in
Midwest 4.5 62.6 64.0 those younger than 65 years versus 62% in those aged 65
South 6.7 59.3 61.0
West 12.6 55.8 61.3 years and older. This age advantage is larger for those who
Overall 7.2 60.3 62.6 have rectal tumors (72% vs 60%) than for those who have
GED indicates General Education Development high school equivalency. colon tumors (68% vs 62%).
*A fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) within Localized stage CRC is diagnosed in 39% of patients,
the past year.
for which the 5-year survival rate is 90%. The survival rate
†Sigmoidoscopy within the past 5 years or a colonoscopy within the past 10
years. declines to 71% and 14% for patients diagnosed with
‡An FOBT or FIT within the past year, or sigmoidoscopy within the past 5 regional and distant-stage disease, respectively.7 Black and
years, or a colonoscopy within the past 10 years. AI/AN patients are most likely to be diagnosed with distant-
§Excludes Native Hawaiians or other Pacific Islanders. stage disease and have the lowest survival rates for every stage
¶Individuals who had been in the United States for any length of time. (Fig. 3). Disparities in CRC survival are largely driven by
#An estimate was not provided because of instability. socioeconomic inequalities that result in differences in access
Note: These estimates include diagnostic examinations. Estimates are age to early detection tests and the receipt of timely, high-quality
adjusted to the 2000 US standard population.
treatment.43-46 Although black patients are less likely than
Source: CDC. National Health Interview Survey, 2015. Public use data file.
others to receive appropriate surgery, adjuvant chemotherapy,
and radiation treatments,47-49 survival is lower in black than
in white patients even when treatment is equal.50 A recent
study found that tumor presentation at diagnosis played a
Subsite distribution larger role in survival differences than treatment, estimating
Clinical and biologic characteristics, drug response and that 40% of the racial disparity in colon cancer survival is
prognosis differ based on tumor location within the color- because of the combined effects of later stage at diagnosis, a
ectum, suggesting distinct etiologic mechanisms.38-41 As higher likelihood of unfavorable tumor characteristics, and
Table 3 indicates, the most common tumor location is the more comorbidities among black patients.51 Survival dispar-
proximal colon (41%), followed by the rectum (28%).8 ities are also evident within racial and ethnic groups. For
However, there is striking variation in subsite distribution example, blacks who are privately insured are 46% more likely

186 CA: A Cancer Journal for Clinicians

 CA CANCER J CLIN 2017;67:177–193

TABLE 9. State-Level Colorectal Cancer Incidence Rates and Trends (2004-2013) and Screening Prevalence (2014),
Adults Ages 50 Years or Older, United States

INCIDENCE

TREND 1 TREND 2 SCREENING

INCIDENCE
RATE (2009-2013) YEARS APC YEARS APC 2004-2013 AAPC 2009-2013 AAPC RANK % 6 95% CI

Alabama 137.6 2004-2013 -2.7* -2.7* -2.7* 32 65.9 1.7

Alaska 139.1 2004-2013 -4.1* -4.1* -4.1* 49 61.2 2.8
Arizona 110.2 2004-2013 -3.1* -3.1* -3.1* 35 65.6 1.5
Arkansas 135.4 2004-2011 -3.1* 2011-2013 1.2 -2.2* -1.0 46 62.1 2.3
California 122.4 2004-2008 -0.8 2008-2013 -5.2* -3.2* -5.2* 21 68.6 2.0
Colorado 110.4 2004-2010 -5.5* 2010-2013 -1.9 -4.3* -2.8* 25 67.7 1.3
Connecticut 126.1 2004-2013 -4.7* -4.7* -4.7* 5 73.8 1.7
Delaware 120.6 2004-2013 -5.6* -5.6* -5.6* 7 73.2 2.2
District of Columbia 137.0 2004-2013 -3.5* -3.5* -3.5* 16 69.5 3.0
Florida 119.0 2004-2013 -4.1* -4.1* -4.1* 19 69.2 1.6
Georgia 131.1 2004-2013 -3.0* -3.0* -3.0* 26 67.6 2.0
Hawaii 137.5 2004-2013 -2.2* -2.2* -2.2* 18 69.3 2.1
Idaho 117.7 2004-2013 -3.3* -3.3* -3.3* 44 62.5 2.3
Illinois 146.1 2004-2013 -3.7* -3.7* -3.7* 44 62.5 2.3
Indiana 139.8 2004-2013 -3.5* -3.5* -3.5* 42 62.5 1.5
Iowa 146.0 2004-2013 -3.6* -3.6* -3.6* 23 68.2 1.6
Kansas 131.2 Data unavailable 32 65.9 1.2
Kentucky 161.4 2004-2013 -2.6* -2.6* -2.6* 24 68.1 1.8
Louisiana 153.8 2004-2013 -2.5* -2.5* -2.5* 34 65.8 1.8
Maine 125.5 2004-2013 -5.7* -5.7* -5.7* 3 75.2 1.5
Maryland 118.3 2004-2013 -4.1* -4.1* -4.1* 9 72.1 1.7
Massachusetts 122.2 2004-2013 -5.4* -5.4* -5.4* 1 76.0 1.4
Michigan 124.8 2004-2006 -1.3 2006-2013 -4.9* -4.1* -4.9* 8 72.1 1.5
Minnesota 126.2 Data unavailable 11 71.7 1.1
Mississippi 156.4 2004-2013 -1.7* -1.7* -1.7* 47 62.0 2.5
Missouri 137.3 2004-2013 -3.3* -3.3* -3.3* 39 63.5 2.0
Montana 127.9 2004-2013 -3.3* -3.3* -3.3* 40 63.4 1.9
Nebraska 139.3 2004-2006 1.8 2006-2013 -6.0* -4.3* -6.0* 37 65.0 1.2
Nevada† 137.3 Data unavailable 48 61.6 3.4
New Hampshire 119.0 2004-2013 -4.6* -4.6* -4.6* 4 74.2 1.9
New Jersey 138.2 2004-2013 -3.8* -3.8* -3.8* 30 66.4 1.7
New Mexico‡ 110.6 Data unavailable 43 62.5 1.8
New York 131.4 2004-2013 -4.0* -4.0* -4.0* 17 69.4 1.9
North Carolina 118.8 2004-2013 -4.5* -4.5* -4.5* 10 71.8 1.6
North Dakota 150.6 2004-2013 -2.7* -2.7* -2.7* 38 63.6 1.9
Ohio 132.7 2004-2013 -4.1* -4.1* -4.1* 31 66.2 1.7
Oklahoma 136.3 2004-2013 -2.7* -2.7* -2.7* 50 59.4 1.6
Oregon 116.7 2004-2013 -4.2* -4.2* -4.2* 22 68.3 2.1
Pennsylvania 140.7 2004-2013 -3.9* -3.9* -3.9* 28 67.4 1.5
Rhode Island 121.6 2004-2013 -5.7* -5.7* -5.7* 2 75.5 1.7
South Carolina 122.8 2004-2013 -4.6* -4.6* -4.6* 20 69.0 1.5
South Dakota 144.2 2004-2010 -0.9 2010-2013 -6.8* -2.9* -5.4* 27 67.5 2.5
Tennessee 129.1 2004-2013 -3.8* -3.8* -3.8* 29 66.6 2.3
Texas 124.1 2004-2013 -3.6* -3.6* -3.6* 41 62.7 1.9
Utah 99.3 2004-2013 -3.6* -3.6* -3.6* 13 70.7 1.3
Vermont 119.9 2004-2013 -3.7* -3.7* -3.7* 12 71.0 1.7
Virginia 118.1 2004-2013 -4.3* -4.3* -4.3* 15 70.0 1.6
Washington 118.4 2004-2013 -3.8* -3.8* -3.8* 14 70.1 1.6
West Virginia 149.3 2004-2013 -3.1* -3.1* -3.1* 36 65.4 1.7
Wisconsin 124.0 2004-2013 -3.9* -3.9* -3.9* 6 73.8 1.8
Wyoming 119.3 2004-2013 -3.9* -3.9* -3.9* 51 58.0 2.2
95% CI indicates 95% confidence interval; AAPC, average annual percent change over the most recent 5 data years; APC, annual percent change based on
incidence rates age adjusted to the 2000 US standard population.
Note: These trends are based on rates that were not adjusted for delays in case reporting, in contrast to Surveillance, Epidemiology, and End Results (SEER)-
based trends. Trends were analyzed using the Joinpoint Regression Program, version 4.3.1.0, allowing up to 1 joinpoint.
Incidence rates are per 100,000 and are age adjusted to the 2000 US standard population. Trends are unavailable for states that did not meet NAACCR high
quality data standards for one or more years from 2004 to 2013.
Screening prevalence reflects a fecal occult blood test within the past year, or sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years.
*The trend is statistically significantly different from zero (p < .05)
†The incidence rate is for 2009 through 2010.
‡These incidence rates are for 2009 through 2012.
Sources: Incidence: NAACCR, 2016. Screening: Behavioral Risk Factor Surveillance System Public Use Data Tapes 2014, National Center for Disease Preven-
tion and Health Promotion, Centers for Disease Control and Prevention.

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 Colorectal Cancer Statistics, 2017
FIGURE 6. Trend in Colorectal Cancer Mortality: Age-Standardized Rate Versus Number of Deaths, United States, 1975-
2014.
Rates are age adjusted to the 2000 standard population.
Source: NCHS, CDC, 2016.
to survive 5 years after a CRC diagnosis than blacks who are
uninsured.52
Temporal Trends
Incidence
CRC incidence rates increased from 1975 through the mid-
1980s in both men and women but have since decreased
with the exception of a slight, unexplained interruption from
1996 to 1998 (Fig. 4).5 Some researchers have attributed the
short-term increase, which also occurred in Canada, to
the sudden rise in folate levels during the late 1990s after
mandatory folic acid fortification of uncooked cereal grains
was introduced to reduce the incidence of neural tube
defects.53,54 Folic acid appears to have a complex, paradoxical
relation with CRC, in that it is associated with both preven-
tion of new colonic neoplasia and promotion of existing neo-
plastic lesions.55,56 Although prospective cohort studies find
an inverse association between total dietary folate and
CRC,57,58 randomized controlled trials of folic acid supple-
ments have shown an increased, although not statistically
significant, risk of colorectal adenomas59 and no effect on
cancer occurrence.60
Trends in CRC incidence are similar by sex but vary by
age (Fig. 5). Incidence rates among individuals aged 50
years have dropped from a peak of 225.6 (per 100,000) in
1985 to 119.3 in 2013.5 The rate of decline accelerated
188 CA: A Cancer Journal for Clinicians
around the year 2000, particularly in people aged 65 years,
among whom rates plummeted from 298.3 (per 100,000) in
2000 to 186.8 in 2013 (incidence rate ratio [IRR], 0.63; 95%
confidence interval [95% CI], 0.61-0.64). During this time
period, incidence in individuals aged 50 years declined by
32%, with reductions largest for distal tumors in those aged
65 years (IRR, 0.50; 95% CI, 0.48-0.52) and smallest for
rectal tumors in those ages 50 to 64 years (IRR, 0.91; 95%
CI, 0.85-0.96 in men; IRR, 1.00; 95% CI, 0.93-1.08 in
women).6 This compares to 40% declines in rectal tumor
incidence in ages 65 years (IRR, 0.62; 95% CI, 0.59-0.65
in men; IRR, 0.59; 95% CI, 0.55-0.62 in women).
The age-specific annual percent change in incidence rates
from 2000 to 2013 based on SEER data adjusted for delays
in case reporting are shown by tumor location, stage at
diagnosis, and race/ethnicity in Tables 5, 6, and 7, respec-
tively. Over the past decade of data (2004-2013), incidence
rates decreased by an average of 1.4% per year among indi-
viduals ages 50 to 64 years and by 4.0% per year among
those ages 65 years and older (Table 5). Among individuals
ages 65 years and older, the rate of decline was similar
regardless of tumor subsite, stage, or race/ethnicity (with
the exception of AI/ANs). However, among people ages 50
to 64 years, declines were much slower for those with rectal
tumors (Table 5), for distant-stage disease (Table 6), and
for APIs and AI/ANs, among whom incidence rates were
stable from 2000 through 2013 (Table 7).
 CA CANCER J CLIN 2017;67:177–193

FIGURE 7. Trends in Colorectal Cancer Mortality Rates by Race/Ethnicity, United States, 1990-2014.
*The APC or AAPC is significantly different from zero (p < 0.05).
†Trends for American Indian/Alaska Natives are based on mortality data from Contract Health Service Delivery Area counties.
Source: NCHS, CDC, 2016.
Trends were analyzed using the Joinpoint Regression Program, version 4.3.1.0, allowing up to 4 joinpoints. Trends by Hispanic ethnicity exclude deaths from
Louisiana, New Hampshire, and Oklahoma.

Differences in contemporary trends in individuals aged
50 years probably partly reflect differences in the
uptake of screening.61 NHIS data indicate that receipt of
a colonoscopy in the past 10 years increased from 14% in
2000 to 41% in 2013 among individuals ages 50 to 54
years, from 16% to 52% in those ages 55 to 59 years, and
from 25% to 63% in those ages 65 years and older.62
From 2013 to 2015, screening with any guideline-
recommended test increased from 53% to 58% in individ-
uals ages 50 to 64 years, from 65% to 68% in those ages
65 years and older, and from 59% to 63% in those ages 50
years and older combined (Table 8). This rise, which fol-
lowed a plateau in screening from 2010 to 2013, trans-
lates into an additional 3,785,600 adults (ages 50 years
and older) screened in 2015. If screening prevalence
remains at the 2015 rather than the 2013 level, an esti-
mated 39,700 additional CRC cases and 37,200 deaths
will be prevented through 2030.
CRC incidence in adults ages 50 years and older is
declining rapidly in every state, although the rate appears to
have stabilized in Arkansas in the most recent data years
(Table 9). During 2009 through 2013, the average rate of
decline exceeded 5% annually in 7 states (Nebraska, Maine,
Rhode Island, Delaware, Massachusetts, South Dakota,
and California). Notably, states with the highest incidence
rates (Kentucky, Mississippi, and Louisiana) have among
the slowest declines. Declines are also slow for rectal tumor
incidence in individuals ages 50 to 64 years, among whom
rates were stable in 31 of 46 states (with available data) and
the District of Columbia.63 The reported CRC screening
prevalence in 2014 ranged from 76% in Massachusetts to
58% in Wyoming.
In contrast to the downturns among screening-aged
individuals, CRC incidence rates in adults aged <50 years
rose by 1.6% from 2000 to 2013 (Table 5), for an overall
increase of 22% (from 5.9 to 7.2 per 100,000; IRR, 1.22; 95%

VOLUME 67 _ NUMBER 3 _ MAY/JUNE 2017 189

 Colorectal Cancer Statistics, 2017
FIGURE 8. Trends in 5-year Relative Survival Rates for Colorectal Cancer by Stage and Subsite, United States, 1975-
2012.
Legend indicates diagnosis years. All patients followed through 2013.
Source: SEER Program, SEER 9 registries, 2016.
CI, 1.17-1.28). The increase was driven solely by tumors in
the distal colon (IRR, 1.24; 95% CI, 1.13-1.35) and rectum
(IRR, 1.22; 95% CI, 1.13-1.31).6 Incidence increased most
rapidly for distant-stage disease, which rose by 3% per year
during this time period (Table 6). The rise in early onset CRC
occurred in all racial/ethnic groups except APIs (although the
increase was not statistically significant in AI/ANs, likely
because of small numbers); was largest among NHWs (2.3%
per year from 2000 to 2013) (Table 7); and has also been
reported in other high-income countries, including Norway,64
Australia,65 and Canada.66 Although causes for this increase
have yet to be elucidated, factors thought to have contributed
include increased prevalence of excess body weight, as well as
changes in lifestyle patterns that precipitated the obesity epi-
demic, including unhealthy dietary patterns and a sedentary
lifestyle.61,67-70
Mortality
The declining trend in CRC mortality is more long-
standing than that for incidence, particularly in women,
among whom death rates have been decreasing since the
mid-1940s (Fig. 4). In men and women combined, the
death rate has dropped 51% from its peak of 28.6 (per
100,000) in 1976 to 14.1 in 2014. Mortality reductions
through 2000 are attributed to improvements in treatment
(12%), changing patterns in CRC risk factors (35%), and
screening uptake (53%).1 Similar to incidence, the decline
in death rates accelerated beginning around 2000 and nota-
bly has been of sufficient magnitude to overcome the aging
and growth of the population, such that the reported num-
ber of CRC deaths dropped from a peak of 57,644 in 1995
to 51,651 in 2014 (Fig. 6). From 2000 to 2014, CRC death
190 CA: A Cancer Journal for Clinicians
rates decreased by 34% in individuals aged 50 years but
increased by 13% in those aged <50 years (Fig. 5).
CRC death rates have been decreasing since at least
1990 in whites, blacks, and APIs and since 2002 in His-
panics, with a similar pace of decline across these groups
over the past decade of data. In contrast, death rates have
remained stable in AI/ANs (Fig. 7). Progress in reducing
CRC death rates has also lagged in the highest poverty
areas of the United States, including the lower Mississippi
Delta and parts of Appalachia.36,71
Survival
As of January 1, 2016, almost 1.5 million Americans were
alive with a history of CRC.72 Figure 8 depicts trends in
survival for colon and rectal cancers separately since the
mid-1970s based on data from the 9 oldest SEER regis-
tries. (Survival rates and stage distribution presented for the
most current time period in this section differ slightly from
those presented in Table 4, because they are based on a
subset of SEER data with historical coverage.) From the
mid-1970s to the most recent time period (2006-2012), the
5-year relative survival rate for all stages combined
increased from 51% to 66% for colon cancer and from 48%
to 68% for rectal cancer.7 These gains reflect improvements
in treatment and earlier detection.73-75 In the SEER 9
areas, the proportion of cases diagnosed at a localized stage
increased from 30% during 1975-1977 to 40% during
2006-2012 for colon cancer and from 37% to 44% for rectal
cancer.76 Progress in survival may also reflect the increased
use of advanced imaging techniques, such as positron emis-
sion tomography, which can improve the accuracy of stag-
ing and influence treatment decisions.77-79
 CA CANCER J CLIN 2017;67:177–193

The largest improvement in survival has been for
regional- and distant-stage disease. For example, the 5-year
relative survival rate for regional-stage disease increased from
55% during 1975-1977 to 74% during 2006-2012 for
patients with colon cancer and from 45% to 70% for those
with rectal cancer (Fig. 8). This progress reflects important
improvements in treatment, including adjuvant therapy for
resectable stage III colon cancer,80-82 preoperative chemora-
diation for locally advanced rectal cancer,83,84 and cancer-
directed surgery for advanced CRC.85 Advances in the treat-
ment of liver metastases,86,87 new therapies (eg, antiepider-
mal growth factor receptor antibody therapy and
bevacizumab),88,89 and the use of imaging to improve detec-
tion of metastatic lesions90 have particularly influenced the
survival of patients with distant-stage disease. Between
1989-1992 and 2009-2012, the 2-year relative survival rate
for patients diagnosed with distant-stage tumors increased
from 21% to 35% for colon cancer and from 22% to 39% for
rectal cancer.76 However, strides in the treatment of meta-
static disease have been slower for black, Hispanic, and older
patients91,92; for certain molecular subtypes (eg, microsatel-
lite instability-high and KRAS wild type)93,94; and for
progress can be achieved by ensuring access to high-quality
health care for all patients and incentivizing healthier life-
styles to prevent cancer occurrence. Healthy behaviors like
achieving a normal body weight being physically active, and
not consuming excessive alcohol or smoking can cut the risk
of CRC by at least one-third.95-97 Many more CRC cases
and deaths could be prevented through increased screening.
Meester and colleagues estimated that achieving the Nation-
al Colorectal Cancer Roundtable’s goal of increasing screen-
ing prevalence to 80% by 2018 would prevent 277,000 CRC
cases and 203,000 deaths by 2030.98 Screening rates 75%
in some states (Massachusetts, Rhode Island, and Maine) in
2014 and the increase nationally from 59% in 2013 to 63%
in 2015 demonstrate real headway toward achieving the 80%
goal. Finally, more research is needed to elucidate causes for
the increasing burden of CRC in young adults and to
advance treatments for tumor subtypes with low response
rates to current therapies. 䊏
Acknowledgments: We thank Iris Lansdorp for her technical assistance in
estimating the additional cancer cases and deaths prevented as a result of the
increase in screening prevalence.

patients with right-sided tumors.41
Conclusions
Despite dramatic reductions in CRC incidence and mortality
overall, striking disparities by age, race, and tumor subsite
remain. Reducing these inequalities and accelerating
Author Contributions: Rebecca L. Siegel: Conceptualization, formal analysis,
investigation, methodology, writing–original draft, writing–review and editing.
Kimberly D. Miller: Formal analysis, investigation, methodology, and
writing–review and editing. Stacey A. Fedewa: Formal analysis, methodology,
and writing–review and editing. Dennis J. Ahnen: Writing–review and edit-
ing. Reinier G.S. Meester: Formal analysis, methodology, and writing–review
and editing. Afsaneh Barzi: Writing–review and editing. Ahmedin Jemal:
Writing–review and editing and supervision.

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