Chapter 8: Cancer of the Colon and Rectum

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

For this report, cancers of the colon and rectum were combined (see Appendix 1 for ICD codes). Together, these cancers were responsible for an estimated 55 percent of all digestive system cancers diagnosed in 2004. In 72.5 percent of cases, the colon was the anatomical site. By themselves, colon cancer would be the most common digestive system cancer, and rectal cancer the second most common. Therefore, trends in colorectal cancer largely determine trends in digestive system cancers as a whole.

Two-thirds of new cases of colorectal cancer were among those age 65 years or older (Table 1). Among the major racial-ethnic groups, non-Hispanic blacks had the highest rate, followed by non-Hispanic whites. American Indians had the lowest rates, with Hispanics and Asians intermediate. Age-adjusted rates were about one-third higher among males than females. Colorectal cancer incidence has been falling for the past 20 years, declining by 27.1 percent from 1985 to 2004 (Figure 1). The proportion of newly diagnosed patients who survived for at least 5 years has climbed steadily since 1979.

Colorectal cancer is the digestive system malignancy with the most reliable data on medical care (Table 2). In 2004, there were an estimated 2.6 million ambulatory care visits for persons with colorectal cancer. Most visits were among persons age 65 years and older and among women. Blacks had two-thirds the age-adjusted rate of whites. Visit rates were similar for males and females. For hospitalizations, colorectal cancer was more often listed as a first-listed diagnosis than as a secondary diagnosis. Hospitalization rates were disproportionately higher among the 65 years and older group. Age-adjusted rates were higher for blacks than for whites and for males than for females. Hospitalization rates declined from the early 1980s through 1995, and subsequently increased slightly (Figure 2).

Colorectal cancer was the leading cause of death related to the digestive system, accounting for 22.5 percent of deaths (Table 3). Because the median age of death for colorectal cancer was 75 years (PDF, 28KB) , colorectal cancer accounted for a smaller proportion of YPLL to digestive diseases (16.6 percent), second to liver disease. Because of declining incidence and improved survival, death rates declined 34.8 percent between 1979 and 2004. This decline accelerated during the latter part of that period (Figure 3).

Table 1. Colorectal Cancer: Number of Cases and Incidence Rates by Age, Race/Ethnicity, and Sex, 2004

Source: Surveillance, Epidemiology, and End Results (SEER) Program

Demographic Characteristics Number of Cases Incidence per 100,000 Unadjusted Incidence per 100,000 Age-Adjusted
AGE (Years)
Under 15
AGE (Years)
15–44
6,019 5.0
AGE (Years)
45–64
41,467 59.2
AGE (Years)
65+
87,872 256.9
RACE/ETHNICITY
Non-Hispanic White
111,509 58.0 48.5
RACE/ETHNICITY
Non-Hispanic Black
14,251 41.7 58.6
RACE/ETHNICITY
Hispanic
7,370 18.2 38.1
RACE/ETHNICITY
Asian/Pacific Islander
4,089 33.2 38.6
RACE/ETHNICITY
American Indian/Alaska Native
477 25.8 35.8
Sex
Female
64,080 43.9 41.1
Sex
Male
65,069 46.5 55.7
Total 129,189 45.2 47.5

Figure 1. Colorectal Cancer: Age-Adjusted Incidence Rates and 5-Year Survival Rates, 1979–2004

Incidence per 100,000 was 62.4 in 1979; between 1985 and 2004 it declined from 66.3 to 48.3. Five-year survival climbed steadily from 40.5 percent in 1979 to 48.8 percent in 1999, the last year for which it could be calculated.
Source: Surveillance, Epidemiology, and End Results (SEER) Program

Table 2. Colorectal Cancer: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS)

Demographic Characteristics Ambulatory Care Visits First-Listed Diagnosis Number in Thousands Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000 Ambulatory Care Visits All-Listed Diagnosis Number in Thousands Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000 Hospital Discharges First-Listed Diagnosis Number in Thousands Hospital Discharges First-Listed Diagnosis Rate per 100,000 Hospital Discharges All-Listed Diagnosis Number in Thousands Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years)
Under 15
AGE (Years)
15–44
56 45 83 66 7 6 14 11
AGE (Years)
45–64
721 1,021 875 1,238 47 66 80 113
AGE (Years)
65+
1,321 3,636 1,627 4,477 97 268 160 441
Race
White
1,892 747 2,323 915 118 45 195 76
Race
Black
127 426 177 601 17 59 30 107
Sex
Female
1,134 705 1,456 902 76 45 127 75
Sex
Male
969 736 1,133 856 76 58 127 98
Total 2,103 716 2,589 882 151 52 255 87

Figure 2. Colorectal Cancer: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004

The rate of ambulatory care visits over time (age-adjusted to the 2000 U.S. population) is shown by 3-year periods (except for the first period which is 2 years), between 1992 and 2005 (beginning with 1992–1993 and ending with 2003–2005). Ambulatory care visits per 100,000 have been relatively stable during the period at 791 in 1992-1993 and 880 in 2003-2005. Hospitalization rates per 100,000 declined from 118 in 1979 to 72.3 in 1995, and subsequently increased slightly to 82.8 in 2004.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

Table 3. Colorectal Cancer: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States

Demographic Characteristics Underlying Cause Number of Deaths Underlying Cause Rate per 100,000 Underlying Cause Years of Potential Life Lost in Thousands Underlying or Other Cause Number of Deaths Underlying or Other Cause Rate per 100,000
AGE (Years)
Under 15
1 0.0 0.1 2 0.0
AGE (Years)
15–44
1,608 1.3 58.3 1,654 1.3
AGE (Years)
45–64
12,262 17.3 219.9 13,056 18.5
AGE (Years)
65+
39,355 108.3 54.9 48,188 132.6
Race
White
45,340 17.3 263.0 53,979 20.6
Race
Black
6,592 24.7 57.7 7,446 28.2
Sex
Female
26,512 15.1 142.8 31,153 17.5
Sex
Male
26,714 21.5 190.2 31,747 25.9
Total 53,226 18.1 333.0 62,900 21.4

Figure 3. Colorectal Cancer: Age-Adjusted Rates of Death in the United States, 1979–2004

Death rates declined between 1979 and 2004. This decline accelerated during the latter part of that period. Underlying-cause mortality per 100,000 decreased from 27.3 in 1979 to 17.8 in 2004. All-cause mortality per 100,000 decreased from 32.1 in 1979 to 21.0 in 2004.
Source: Vital Statistics of the United States
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