Progress in Chronic Disease Prevention Chronic Disease Reports: Deaths from Colorectal Cancer -- United States, 1986

In 1986, 55,811 persons died with an underlying diagnosis of cancer of the colon, rectum, or anus (i.e., colorectal cancer) (International Classification of Diseases, Ninth Revision (ICD-9), codes 153.0-154.8), accounting for 12% of cancer deaths in the United States. Colorectal cancer followed lung cancer as the second leading cause of cancer death among males and followed breast and lung cancer as the third leading cause of cancer death among females (1).

In 1986, 41% of deaths from colorectal cancer occurred in persons aged 60-74 years, and 44% in persons aged greater than or equal to 75 years. When adjusted for age, colorectal cancer mortality was 44% higher in males than in females and 15% higher in blacks than in whites (1).

The highest rates of colorectal cancer mortality in 1986 (age adjusted to the 1986 U.S. population) occurred in the northeastern and east north central states and in the District of Columbia, Maryland, and Iowa (Tables 1 and 2, Figure 1). Wyoming had the lowest rate (16.2 per 100,000), and the District of Columbia the highest (32.1 per 100,000). Reported by: Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office; Div of Nutrition, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: From 1979 to 1986, age-adjusted rates of colorectal cancer death declined by 7% (2). In contrast, since the early 1970s, the incidence of colorectal cancer has increased (1). Between 1974 and 1985, overall 5-year survival with colorectal cancer was 54% (1); survival was estimated at 83% for disease diagnosed at the localized stage and 52% at the regional stage but only 6% at the distant stage (1). At each stage, survival was higher among whites than among blacks (1).

Several risk factors for colorectal cancer have been investigated, although few have been firmly established. Potential nutritional risk factors that have been examined include high consumption of calories, total fat, animal fat, and unsaturated fat (3-6); low consumption of vitamin D and calcium (7), fruit, vegetables, cruciferous vegetables (3), and dietary fiber (3,8); and both low and high levels of serum cholesterol (9,10). Evidence supports a role for high dietary fat intake in the development of colorectal cancer and suggests a protective role for fruits and vegetables, although the particular nutrients or food substances responsible for this effect are uncertain. Obesity and high caloric intake may increase the risk for colorectal cancer (3), and occupational or recreational exercise may lower risk (11,12).

References

1. National Cancer Institute. Cancer statistics review

1973-1986, including a report on the status of cancer control. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1989; NIH publication no. 89-2789.

2. CDC. Chronic disease reports: mortality trends--United States, 1979-1986. MMWR 1989; 38:189-91. 3. National Research Council. Diet and health: implications for reducing chronic disease risk. Washington, DC: National Academy Press, 1989.

4. Graham S, Marshall J, Haughey B, et al. Dietary epidemiology of cancer of the colon in western New York. Am J Epidemiol 1988;128:490-503.

5. Kolonel LN. Fat and colon cancer: how firm is the epidemiologic evidence? Am J Clin Nutr 1987;45:336-41.

6. Byers T. Diet and cancer: any progress in the interim? Cancer 1988;62:1713-24.

7. Garland C, Shekelle RB, Barrett-Connor E, Criqui MH, Rossof AH, Paul O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet 1985; 1:307-9.

8. Greenwald P, Lanza E, Eddy GA. Dietary fiber in the reduction of colon cancer risk. J Am Diet Assoc 1987;87:1178-88.

9. McMichael AJ, Jensen OM, Parkin DM, Zaridze DG. Dietary and endogenous cholesterol and human cancer. Epidemiol Rev 1984;6:192-216. 10. Broitman SA. Dietary cholesterol, serum cholesterol, and colon cancer: a review. Adv Exp Med Biol 1986;206:137-52. 11. Garabrant DH, Peters JM, Mack TM, Bernstein L. Job activity and colon cancer risk. Am J Epidemiol 1984;119:1005-14. 12. Powell KE, Caspersen CJ, Koplan JP, et al. Physical activity and chronic diseases. Am J Clin Nutr 1989;49:999-1006.

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