What is the epidemiology of rectal cancer in the US?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Colon and rectal cancer is the third most common cancer in both females and males. The American Cancer Society (ACS) estimates that 104,270 new cases of colon cancer and 45,230 new cases of rectal cancer will occur in 2021; 26,930 cases of rectal cancer are expected in men and 18,300 in women. For estimates of deaths, the ACS combines colon and rectal cancers; approximately 52,980 deaths from colorectal cancer are expected to occur in 2020. [2]

The incidence of colorectal cancer has generally declined since the mid-1980s. The decrease has accelerated since 2000, with incidence rates falling by about 1% per year from 2013 to 2017, thanks largely to greater use of screening. However, the overall trend is driven by older adults (who have the highest rates) and masks the situation in younger adults, who have experienced rising incidence rates since at least the mid-1990s. One study showed that from 2012 through 2016, the annual incidence rose 2% in individuals younger than 50 years and 1% in those 50-64 years. [2]  Currently, adults born circa 1990 have quadruple the risk of rectal cancer compared with those born circa 1950. [10]  

The overall death rate from colorectal cancer has also been falling, decreasing 55% from 1970 to 2018—from 29.2 to 13.1 per 100,000, respectively—because of changing patterns in risk factors, increased screening, and improvements in treatment. From 2014 to 2018, the death rate declined by almost 2% per year. As with incidence rates, however, the decrease in overall mortality masks the rise in death rates in adults younger than 55 years. [2]

Tumor site tends to vary by patient age. In those aged younger than 65 years, the rectum is the most common site of colorectal cancer, accounting for 37% of cases in those under age 50 years and 36% in those 50 to 64 years of age. In individuals age 65 and older, rectal cancer accounts for 23% of colorectal cancer cases; the proximal colon is the most common site, accounting for 49% of cases. [11]

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