Colorectal cancer is among the top three causes of cancer incidence and cancer deaths in the United States (U.S.), and the lifetime risk of a person being diagnosed with colorectal cancer is 6%.1, 2 This supplement on colorectal cancer represents the diligent efforts of over 60 investigators from the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), population-based cancer registries, academic institutions, ORC Macro, and the American Cancer Society. The articles are based mainly on cancer incidence data from population-based cancer registries that participate in the CDC's National Program of Cancer Registries (NPCR) and/or the NCI's Surveillance, Epidemiology, and End Results (SEER) Program.1 The NPCR Program, which was established through the Cancer Registries Amendment Act passed by the U.S. Congress in 1992, began providing financial support and technical assistance to population-based cancer registries in 1994. This program currently supports such registries in 45 states, the District of Columbia, and three U.S. territories, covering 96% of the U.S. population. The SEER Program, which was established as a result of the National Cancer Act of 1971, currently supports 14 such registries and three supplemental registries, covering 26% of the U.S. population. Together, the two programs cover 100% of the U.S. population.1 Both the NPCR and SEER data are collected and reported with the use of uniform data items and codes as documented by the North American Association of Central Cancer Registries.3 The Institute of Medicine has recognized the importance of these two programs as valuable resources for studies on cancer.4
Approximately 90% of all colorectal cancer cases and deaths are thought to be preventable.5 Screening can prevent colorectal cancer by detecting precancerous polyps, and it can improve survival by detecting cancers at an early stage. Screening is recommended beginning at age of 50 years for persons at average risk and at an earlier age for individuals at higher than average risk because of family history of colorectal cancer or other factors.6 Options for screening include fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema. Unfortunately, colorectal cancer screening lags far behind screening for other cancers even though routine screening can reduce the number of persons who die of the disease by at least 60%.7 National objectives for colorectal cancer prevention and control include increasing the proportion of adults who receive colorectal cancer screening, increasing the proportion of cancer survivors who are living 5 years or longer after diagnosis, and reducing the colorectal cancer death rate.8 A related national objective is to reduce the prevalence of modifiable risk factors.8 Physical inactivity, obesity, and tobacco use are known risk factors for colorectal cancer.9 Probable risk factors include alcohol consumption, consumption of large amounts of red meat, and inadequate intake of fruits and vegetables.9 Physical inactivity and excess body weight account for one fourth of colon cancer cases.10
Data from the NPCR and SEER programs are used to monitor the burden of cancer and to facilitate the planning and implementation of intervention programs. Summary data on cancer incidence and mortality can be accessed at the web portals www.cdc.gov/cancer/npcr/uscs and http://statecancerprofiles.cancer.gov/. Queries on the NPCR data can be run from CDC's Wide-ranging OnLine Data for Epidemiologic Research (WONDER) system.11 Data from registries in the SEER Program are available through public-use data files.12 Local cancer registry data are used to support cancer prevention and control activities at the state level.
This supplement includes an in-depth analysis of cancer incidence data from registries with high-quality data. This analysis highlights the burden of colorectal cancer in the U.S. population and among vulnerable population subgroups. The findings are likely to be an important resource for enhancing strategies for the prevention and control of colorectal cancer.