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An examination of colorectal cancer burden by socioeconomic status: evidence from GLOBOCAN 2018

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Abstract

Aim and background

Colon and rectum (colorectal) cancer cause substantial mortality and morbidity worldwide. The management and control of a complex disease such as cancer cannot rely on the old strategy of “one disease one medicine” and must make a transition into new-age practices involving predictive, preventive, and personalized medicine (PPPM) at its core. Adoption of PPPM approach to cancer management at the policy level requires quantification of cancer burden at the country level. For this purpose, we examine the burden of colorectal cancer in 185 countries in 2018. Based on results, we discuss the opportunities presented by PPPM and challenges to be encountered while adopting PPPM for the treatment and prevention of colorectal cancer.

Data and methods

Age- and sex-wise estimates of colorectal cancer were procured from the GLOBOCAN 2018. The country- and region-wise burden of colorectal cancer in 185 countries was examined using all-age and age-standardized incidence and mortality estimates. Human development index (HDI) was employed as the indicator of socioeconomic status of a country. Mortality-to-incidence ratio (MIR) was employed as the proxy of 5-year survival rate.

Results

Globally, colorectal cancer claimed an estimated 880,792 lives (males 484,224; females 396,568) with 1.85 million new cases (males 1.03 million; females 823,303) were estimated to be diagnosed in 2018. Globally, the age-standardized incidence rate (ASIR) was 19.7/100,000, whereas age-standardized mortality rate (ASMR) recorded to be 16.3/100,000 in 2018. Age-standardized rates were the highest in developed countries led by Hungary with ASIR of 51.2/100,000 followed by South Korea with ASIR of 44.5/100,000. ASMR followed the patterns of ASIR with the highest ASMR recorded by Hungary (21.5 per 100,000) and Slovakia (20.4 per 100,000). Globally, MIR stood at 0.48, and among the countries recording more than 1000 cases, Nepal registered the highest MIR of 0.83 and the lowest was recorded by South Korea (0.27). The age-standardized rates exhibited nonlinear association with HDI, whereas MIR was negatively associated with HDI.

Conclusion

Colorectal cancer causes a substantial burden worldwide and exhibit a positive association with the socioeconomic status. With the aid of improving screening modalities, preventable nature of the disease (due to dietary and lifestyle risk factors) and improving treatment procedures, the burden of CRC can largely be curtailed. The high burden of CRC in developing countries, therefore, calls for effective prevention strategies, cost-effective screening, and early-stage detection, cost-effective predictive, and personalized treatment regime.

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Notes

  1. UNDP defines mean number of years of schooling as the number of years of schooling received by people ages 25 and older, and expected years of schooling s defined as number of years of schooling that a child of school entrance age can expect to receive if prevailing patterns of age-specific enrolment rates persist throughout life [12].

  2. US Preventive Services Task Force (US PSTF) recommends the use of low-dose aspirin for the prevention of colorectal cancer in high-risk patients [45].

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Acknowledgments

The authors thank the International Agency for Research on Cancer (IARC) for making available GLOBOCAN 2018 estimates in the public domain.

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  1. University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar- Phase II, Delhi, 110095, India

    Rajesh Sharma

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Correspondence to Rajesh Sharma.

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Appendix

Appendix

Table 4 Country-wise probability of incidence and death due to colorectal cancer
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Table 5 Country-wise availability of screening modalities
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Sharma, R. An examination of colorectal cancer burden by socioeconomic status: evidence from GLOBOCAN 2018. EPMA Journal 11, 95–117 (2020). https://doi.org/10.1007/s13167-019-00185-y

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