Progress in Colorectal Cancer Mortality Across 48 Countries: The Impact of Screening and Early Detection.

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer mortality globally. We estimate where and how much progress has been made in the reduction of CRC mortality across 48 countries with varying background risks, epidemiologic risk factors, and screening practices. We used age-specific population counts and CRC mortality rates from 1950 to 2019 from 48 countries from the WHO's Global Cancer Observatory web-based platform and standardized mortality to the WHO (2000-2025) Standard Population. The expected number of CRC deaths following the peak mortality years was estimated using the peak-year age-specific mortality rates and population counts for the index year. Avoided deaths were estimated as the difference between the expected and observed number of CRC deaths. There has been a notable reduction (standardized mortality ratio < 0.70) in CRC deaths in 7 of 41 (17.1%) countries for males and only 2 of 41 (4.9%) countries for females. In countries where screening is widely used, notable reductions have been observed. In many countries, CRC peak mortality has not been reached. Across these 48 countries, there have been 2.87 million avoided CRC deaths, with the greatest reductions observed in the United States, the United Kingdom, and Germany. This study shows the diverging trends in CRC mortality across 48 countries. In countries where CRC screening has been implemented, considerable numbers of CRC cancer deaths have been avoided since mortality rates peaked. The reduction in CRC mortality has not been observed equally for males and females. For many countries, CRC peak mortality has not been reached, highlighting the importance of primary and secondary prevention in addition to treatment advances.