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Cancers
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Colorectal Cancer: Epidemiology and Prevention
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Colorectal Cancer: Epidemiology and Prevention

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: 10 October 2024 | Viewed by 6878

Special Issue Editor

Prof. Dr. Eero Pukkala

E-Mail Website
Guest Editor
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, FI-00130 Helsinki, Finland
Interests: registry-based epidemiology; cancer etiology

Special Issue Information

Dear Colleagues,

Colorectal cancer is one of the most common cancers worldwide, and its incidence is increasing. However, its etiology is still poorly understood and the tools for primary but also secondary prevention are limited. In this situation—when the cancer cannot be avoided and screening only catches a small fraction of cases—tertiary prevention has a central role.

The aim of the Special Issue is to provide insight into the current state of knowledge on colorectal cancer epidemiology and prevention. It will include articles on a variety of topics, including studies on the complex pattern of risk factors of colorectal cancer, and the use of new technologies in cancer prevention and treatment. The importance of this Special Issue is that it has the potential to improve our understanding of colorectal cancer, which can lead to the prevention of cancers, making diagnoses at an earlier stage, better treatment, and ultimately improved patient outcomes. This set of articles is a valuable resource for clinicians and researchers interested in advancing our knowledge of colorectal cancer.

Prof. Dr. Eero Pukkala
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • colorectal cancer
  • etiology
  • causes
  • epidemiology
  • screening
  • prevention

Published Papers (7 papers)

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Research

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19 pages, 4452 KiB  
Article
Non-Curative Treatment Choices in Colorectal Cancer: Predictors and Between-Hospital Variations in Denmark: A Population-Based Register Study
by Søren Rattenborg, Torben Frøstrup Hansen, Sören Möller, Erik Frostberg and Hans Bjarke Rahr
Cancers 2024, 16(2), 366; https://doi.org/10.3390/cancers16020366 - 15 Jan 2024
Viewed by 762
Abstract
Background: Variations in treatment choices have been reported in colorectal cancer (CRC). In the context of national recommendations, we aimed to elucidate predictors and between-hospital variations in refraining from curatively intended surgery and adjuvant chemotherapy in potentially curable colorectal cancer. Methods: A total [...] Read more.
Background: Variations in treatment choices have been reported in colorectal cancer (CRC). In the context of national recommendations, we aimed to elucidate predictors and between-hospital variations in refraining from curatively intended surgery and adjuvant chemotherapy in potentially curable colorectal cancer. Methods: A total of 34,116 patients diagnosed with CRC from 2009 to 2018 were included for analyses on non-curative treatment in this register-based study. Subsequently 8006 patients were included in analyses on adjuvant treatment. Possible predictors included patient-, disease-, socioeconomic- and perioperative-related factors. Logistic regressions were utilized to examine the predictors of a non-curative aim of treatment and no adjuvant chemotherapy. Results: The predictors of non-curative treatment were high age, poor performance, distant metastases and being underweight. Predictors for no adjuvant treatment were high age, poor performance, kidney disease, postoperative complications and living alone. For both outcomes we found between-hospital variations to be present. Conclusions: Non-curative overall treatment and refraining from adjuvant chemotherapy were associated with well-known risk factors, but the former was also associated with being underweight and the latter was also associated with living alone. Marked between-hospital variations were found and should be examined further. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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11 pages, 1204 KiB  
Article
Gout and Colorectal Cancer Likelihood: Insights from a Nested Case-Control Study of the Korean Population Utilizing the Korean National Health Insurance Service-National Sample Cohort
by Mi Jung Kwon, Kyeong Min Han, Joo-Hee Kim, Ji Hee Kim, Min-Jeong Kim, Nan Young Kim, Hyo Geun Choi and Ho Suk Kang
Cancers 2023, 15(23), 5602; https://doi.org/10.3390/cancers15235602 - 27 Nov 2023
Cited by 2 | Viewed by 837
Abstract
Considering the global importance of both gout and colorectal cancer (CRC) as significant health issues with mutual relevance, we aimed to examine the risk of colorectal cancer in Korean patients with gout. In this nested case-control study, we used data from 9920 CRC [...] Read more.
Considering the global importance of both gout and colorectal cancer (CRC) as significant health issues with mutual relevance, we aimed to examine the risk of colorectal cancer in Korean patients with gout. In this nested case-control study, we used data from 9920 CRC patients and 39,680 controls the Korean National Health Insurance Service-National Sample Cohort database. Propensity score overlap-weighted multivariate logistic regression analyses, adjusted for confounders, were used to assess the odds ratio (OR) and 95% confidence interval (CI) of the association between gout and CRC. Adjusted OR for CRC were similar between patients with gout and the control group (0.95; 95% CI, 0.86–1.04; p = 0.282). However, after adjustment, subgroup analysis revealed an 18% reduction in the probability of CRC among patients younger than 65 years with gout (95% CI, 0.70–0.95; p = 0.009). Conversely, absence of an association between gout and subsequent CRC persisted regardless of sex, income, residence, and Charlson Comorbidity Index score, even among individuals aged 65 years or older. These results imply that gout may not be a significant independent risk factor for CRC among the general population. However, in patients younger than 65 years with gout, a slightly reduced likelihood of CRC was observed. Further research is necessary to establish a causal relationship between gout and CRC and to generalize these findings to other populations. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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12 pages, 1331 KiB  
Article
Long-Term Usage of Proton Pump Inhibitors Associated with Prognosis in Patients with Colorectal Cancer
by Chin-Chia Wu, Chuan-Yin Fang, Ben-Hui Yu, Chun-Ming Chang, Ta-Wen Hsu, Chung-Lin Hung, Shih-Kai Hung, Wen-Yen Chiou and Jui-Hsiu Tsai
Cancers 2023, 15(21), 5304; https://doi.org/10.3390/cancers15215304 - 06 Nov 2023
Cited by 1 | Viewed by 1082
Abstract
The dose–response effect of proton pump inhibitors on colorectal cancer prognosis is still under exploration. This population-based study in Taiwan was designed to examine the effect of proton pump inhibitors on overall death, colorectal cancer-specific death, and recurrence in colorectal cancer patients with [...] Read more.
The dose–response effect of proton pump inhibitors on colorectal cancer prognosis is still under exploration. This population-based study in Taiwan was designed to examine the effect of proton pump inhibitors on overall death, colorectal cancer-specific death, and recurrence in colorectal cancer patients with different cumulative proton pump inhibitor dose levels. This cohort study was based on the Taiwan Cancer Registry and Taiwan National Health Insurance Research Database from 2005 to 2020. After frequency matching with a 1:1 ratio, a total of 20,889 users with proton pump inhibitors and 20,889 without proton pump inhibitors were analyzed. The cumulative defined daily dose level of proton pump inhibitor was stratified to explore the dose–response relationship. A proton pump inhibitor exposure cumulative defined daily dose > 60 after colorectal cancer diagnosis had higher risk of all-cause death than non-proton pump inhibitor users with adjusted hazard ratios of 1.10 (95% CIs: 1.04–1.18). For recurrence, a proton pump inhibitor exposure cumulative defined daily dose > 60 had reduced recurrence risk with an adjusted hazard ratio of 0.84 (95% CIs: 0.76–0.93). This study demonstrated that the long-term use of proton pump inhibitors in patients with colorectal cancer was associated with an increased risk of death that related to the proton pump inhibitor exposure cumulative defined daily dose > 60 and had different dose–response effect in various dose level. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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12 pages, 1975 KiB  
Article
Clinico-Pathological Features, Outcomes and Impacts of COVID-19 Pandemic on Patients with Early-Onset Colorectal Cancer: A Single-Institution Experience
by Daniel Martinez-Perez, David Viñal, Jesús Peña-Lopez, Diego Jimenez-Bou, Iciar Ruiz-Gutierrez, Sergio Martinez-Recio, María Alameda-Guijarro, Antonio Rueda-Lara, Gema Martin-Montalvo, Ismael Ghanem, Ana Belén Custodio, Lucia Trilla-Fuertes, Angelo Gamez-Pozo, Antonio Barbachano, Javier Rodriguez-Cobos, Pilar Bustamante-Madrid, Asuncion Fernandez-Barral, Aurora Burgos, Maria Isabel Prieto-Nieto, Laura Guerra Pastrian, José Manuel González-Sancho, Alberto Muñoz, Jaime Feliu and Nuria Rodríguez-Salasadd Show full author list remove Hide full author list
Cancers 2023, 15(17), 4242; https://doi.org/10.3390/cancers15174242 - 24 Aug 2023
Viewed by 950
Abstract
Background: The rising incidence of colorectal cancer (CRC) among young patients is alarming. We aim to characterize the clinico-pathological features and outcomes of patients with early-onset CRC (EOCRC), as well as the impacts of COVID-19 pandemic. Methods: We included all patients with pathologically [...] Read more.
Background: The rising incidence of colorectal cancer (CRC) among young patients is alarming. We aim to characterize the clinico-pathological features and outcomes of patients with early-onset CRC (EOCRC), as well as the impacts of COVID-19 pandemic. Methods: We included all patients with pathologically confirmed diagnoses of CRC at Hospital Universitario La Paz from October 2016 to December 2021. The EOCRC cut-off age was 50 years old. Results: A total of 1475 patients diagnosed with CRC were included, eighty (5.4%) of whom had EOCRC. Significant differences were found between EOCRC and later-onset patients regarding T, N stage and metastatic presentation at diagnosis; perineural invasion; tumor budding; high-grade tumors; and signet ring cell histology, with all issues having higher prevalence in the early-onset group. More EOCRC patients had the RAS/ BRAF wild type. Chemotherapy was administered more frequently to patients with EOCRC. In the metastatic setting, the EOCRC group presented a significantly longer median OS. Regarding the COVID-19 pandemic, more patients with COVID-19 were diagnosed with metastatic disease (61%) in the year after the lockdown (14 March 2020) than in the pre-pandemic EOCRC group (29%). Conclusions: EOCRC is diagnosed at a more advanced stage and with worse survival features in localized patients. More patients with EOCRC were diagnosed with metastatic disease in the year after the COVID-19 pandemic lockdown. The long-term consequences of COVID-19 are yet to be determined. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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17 pages, 5373 KiB  
Article
Evaluation of Intratumoral Response Heterogeneity in Metastatic Colorectal Cancer and Its Impact on Patient Overall Survival: Findings from 10,551 Patients in the ARCAD Database
by Fang-Shu Ou, Daniel H. Ahn, Jesse G. Dixon, Axel Grothey, Yiyue Lou, Pashtoon M. Kasi, Joleen M. Hubbard, Eric Van Cutsem, Leonard B. Saltz, Hans-Joachim Schmoll, Richard M. Goldberg, Alan P. Venook, Paulo Hoff, Jean-Yves Douillard, J. Randolph Hecht, Herbert Hurwitz, Cornelis J. A. Punt, Miriam Koopman, Carsten Bokemeyer, Charles S. Fuchs, Eduardo Diaz-Rubio, Niall C. Tebbutt, Chiara Cremolini, Fairooz F. Kabbinavar, Tanios Bekaii-Saab, Benoist Chibaudel, Takayuki Yoshino, John Zalcberg, Richard A. Adams, Aimery de Gramont and Qian Shiadd Show full author list remove Hide full author list
Cancers 2023, 15(16), 4117; https://doi.org/10.3390/cancers15164117 - 15 Aug 2023
Viewed by 1479
Abstract
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement [...] Read more.
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement response criteria to evaluate their prognostic effect on overall survival (OS). Patients and Methods: Patients enrolled in 17 first-line clinical trials, who had mCRC with ≥ 2 lesions at baseline, and a restaging scan by 12 weeks were included. For each patient, lesions were categorized as a progressing lesion (PL: > 20% increase in the longest diameter (LD)), responding lesion (RL: > 30% decrease in LD), or stable lesion (SL: neither PL nor RL) based on the 12-week scan. Lesion-based response criteria were defined for each patient as follows: PL only, SL only, RL only, and varied responses (mixture of RL, SL, and PL). Lesion-based response criteria and OS were correlated using stratified multivariable Cox models. The concordance between OS and classifications was measured using the C statistic. Results: Among 10,551 patients with mCRC from 17 first-line studies, varied responses were noted in 51.6% of patients, among whom, 3.3% had RL/PL at 12 weeks. Among patients with RL/SL, 52% had stable disease (SD) by RECIST 1.1, and they had a longer OS (median OS (mOS) = 19.9 months) than those with SL only (mOS = 16.8 months, HR (95% CI) = 0.81 (0.76, 0.85), p < 0.001), although a shorter OS than those with RL only (mOS = 25.8 months, HR (95% CI) = 1.42 (1.32, 1.53), p < 0.001). Among patients with SL/PL, 74% had SD by RECIST 1.1, and they had a longer OS (mOS = 9.0 months) than those with PL only (mOS = 8.0 months, HR (95% CI) = 0.75 (0.57, 0.98), p = 0.040), yet a shorter OS than those with SL only (mOS = 16.8 months, HR (95% CI) = 1.98 (1.80, 2.18), p < 0.001). These associations were consistent across treatment regimen subgroups. The lesion-based response criteria showed slightly higher concordance than RECIST 1.1, although it was not statistically significant. Conclusion: Varied responses at first restaging are common among patients receiving first-line therapy for mCRC. Our lesion-based measurement criteria allowed for better mortality discrimination, which could potentially be informative for treatment decision-making and influence patient outcomes. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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Review

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22 pages, 2899 KiB  
Review
Colorectal Cancer: Epidemiology, Risk Factors, and Prevention
by Gholamreza Roshandel, Fatemeh Ghasemi-Kebria and Reza Malekzadeh
Cancers 2024, 16(8), 1530; https://doi.org/10.3390/cancers16081530 - 17 Apr 2024
Viewed by 557
Abstract
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer mortality worldwide. There are disparities in the epidemiology of CRC across different populations, most probably due to differences in exposure to lifestyle and environmental factors related [...] Read more.
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer mortality worldwide. There are disparities in the epidemiology of CRC across different populations, most probably due to differences in exposure to lifestyle and environmental factors related to CRC. Prevention is the most effective method for controlling CRC. Primary prevention includes determining and avoiding modifiable risk factors (e.g., alcohol consumption, smoking, and dietary factors) as well as increasing protective factors (e.g., physical activity, aspirin). Further studies, especially randomized, controlled trials, are needed to clarify the association between CRC incidence and exposure to different risk factors or protective factors. Detection and removal of precancerous colorectal lesions is also an effective strategy for controlling CRC. Multiple factors, both at the individual and community levels (e.g., patient preferences, availability of screening modalities, costs, benefits, and adverse events), should be taken into account in designing and implementing CRC screening programs. Health policymakers should consider the best decision in identifying the starting age and selection of the most effective screening strategies for the target population. This review aims to present updated evidence on the epidemiology, risk factors, and prevention of CRC. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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13 pages, 1278 KiB  
Review
Obesity and Inflammatory Factors in the Progression of Early-Onset Colorectal Cancer
by Alexandra N. Jones, Katharina M. Scheurlen, Anne Macleod, Hillary L. Simon and Susan Galandiuk
Cancers 2024, 16(7), 1403; https://doi.org/10.3390/cancers16071403 - 03 Apr 2024
Viewed by 750
Abstract
Metabolic dysfunction associated with obesity leads to a chronic pro-inflammatory state with systemic effects, including the alteration of macrophage metabolism. Tumor-associated macrophages have been linked to the formation of cancer through the production of metabolites such as itaconate. Itaconate downregulates peroxisome proliferator-activated receptor [...] Read more.
Metabolic dysfunction associated with obesity leads to a chronic pro-inflammatory state with systemic effects, including the alteration of macrophage metabolism. Tumor-associated macrophages have been linked to the formation of cancer through the production of metabolites such as itaconate. Itaconate downregulates peroxisome proliferator-activated receptor gamma as a tumor-suppressing factor and upregulates anti-inflammatory cytokines in M2-like macrophages. Similarly, leptin and adiponectin also influence macrophage cytokine expression and contribute to the progression of colorectal cancer via changes in gene expression within the PI3K/AKT pathway. This pathway influences cell proliferation, differentiation, and tumorigenesis. This work provides a review of obesity-related hormones and inflammatory mechanisms leading to the development and progression of early-onset colorectal cancer (EOCRC). A literature search was performed using the PubMed and Cochrane databases to identify studies related to obesity and EOCRC, with keywords including ‘EOCRC’, ‘obesity’, ‘obesity-related hormones’, ‘itaconate’, ‘adiponectin’, ‘leptin’, ‘M2a macrophage’, and ‘microbiome’. With this concept of pro-inflammatory markers contributing to EOCRC, increased use of chemo-preventative agents such as aspirin may have a protective effect. Elucidating this association between obesity-related, hormone/cytokine-driven inflammatory effects with EOCRC may help lead to new therapeutic targets in preventing and treating EOCRC. Full article
(This article belongs to the Special Issue Colorectal Cancer: Epidemiology and Prevention)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Obesity and Inflammatory Factors in the Development of Early Onset Colorectal Cancer
Authors: Susan Galandiuk
Affiliation: University of Louisville School of Medicine

Title: Challenges and solutions to colorectal cancer prevention in young patients
Authors: Melio Anna; Mankaney Gautam; Simianu Vladamir
Affiliation: Department of Surgery, Virginia Mason Medical Center, Seattle, WA. United States; Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA. United States.
Abstract: There has been a well-documented increase in the incidence of colorectal cancer in patients under 50 years of age, with patients presenting with later stage cancer at diagnosis compared to their over-50 counterparts. However, there is limited consensus on how the impact of this changing epidemiology should affect existing prevention and screening tools. Recently proposed strategies include increased genetic testing, improved young patient awareness through targeted media campaigns, and initiatives to increase clinical suspicion in primary care providers, among others. There also exists significant challenges regarding the impact of colorectal cancer treatment on the younger population, with underexplored concerns regarding fertility, sexual health, financial impact, and extended post-treatment surveillance. This review aims to summarize the changing epidemiology of colorectal cancer in young patients, and discuss challenges and proposed solutions surrounding prevention of early-onset colon cancer.

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