Increasing burden of colorectal cancer in China

The burden of colorectal cancer is on the rise globally due to increasing prevalence. According to the Article by the Global Burden of Disease (GBD) 2019 Colorectal Cancer Collaborators, east Asia—especially China—has been greatly affected, with the highest all-age incidence (607 900 [95% uncertainty interval 521 805–708 420]) in mainland China, and the highest age-standardised incidence rates (62·0 [95% uncertainty interval 48·9–80·0] per 100 000) in Taiwan (province of China).1GBD 2019 Colorectal Cancer CollaboratorsGlobal, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Gastroenterol Hepatol. 2022; (published online April 7.)https://doi.org/10.1016/S2468-1253(22)00044-9Google Scholar We believe there are a number of questions that could entail challenges and opportunities regarding colorectal cancer treatment in China. Disease patterns and treatment methods of colorectal cancer differ between anatomical subsites (usually distinguished as proximal colon, distal colon, and rectum). The locations of colorectal tumours—along with clinical features—also differ between patients in China and patients from other countries. For example, in Chinese patients, nearly half of tumours are located in the rectum.2Qu R Ma Y Tao L et al.Features of colorectal cancer in China stratified by anatomic sites: a hospital-based study conducted in university-affiliated hospitals from 2014 to 2018.Chin J Cancer Res. 2021; 33: 500-511Crossref PubMed Google Scholar Unique and distinctive treatment methods should be further explored, focusing on Chinese patients. A large increase of incident colorectal cancer cases was observed in young individuals (ie, those younger than 50 years) in the GBD study,1GBD 2019 Colorectal Cancer CollaboratorsGlobal, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Gastroenterol Hepatol. 2022; (published online April 7.)https://doi.org/10.1016/S2468-1253(22)00044-9Google Scholar which has also been noted in Chinese patients.3Shi JF Wang L Ran JC et al.Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: overall design and results from a multicenter retrospective epidemiologic survey.Cancer. 2021; 127: 1880-1893Crossref PubMed Scopus (11) Google Scholar However, most guidelines in China still recommend that screening for colorectal cancer starts from age 50 years. Despite the potential downsides of over-screening, under-screening could lead to preventable deaths. The increasing evidence for a trend in younger-onset colorectal cancer in China urges us to rethink the recommended age at which people should be screened. What is the cause behind the growing trend in early-onset colorectal cancer in China? Popularisation of the meat-sweet diet (a hypercaloric diet high in processed sugar and red meat) among Chinese people, especially those younger than 40 years, has been proposed to be a causative factor, due to its detrimental metabolic consequences and effects on the progression of colorectal cancer.4Keum N Giovannucci E Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies.Nat Rev Gastroenterol Hepatol. 2019; 16: 713-732Crossref PubMed Scopus (775) Google Scholar However, detailed research among Chinese patients regarding the relation between colorectal cancer and risk factors remains scarce. Further research is needed to develop more thorough regional prevention strategies. The annual increase in incidence of—and mortality due to—colorectal cancer, increasing attention to quality of life, and the trend in early-onset disease suggest a need to revolutionise treatment methods. Surgery has long been considered the ultimate and most effective path for colorectal cancer treatment, but the long-term postoperative complications (including anal dysfunction) can affect quality of life (especially for Chinese patients, a higher proportion of whom have rectal cancer when compared with elsewhere in the world). Neoadjuvant chemotherapy has been increasingly accepted as a colorectal cancer treatment due to its potential benefits in long-term survival and quality of life.5O'Neill BD Brown G Heald RJ Cunningham D Tait DM Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer.Lancet Oncol. 2007; 8: 625-633Summary Full Text Full Text PDF PubMed Scopus (175) Google Scholar However, use of neoadjuvant chemotherapy is not popular in China, and together with controversies in indication and scarcity of precise radiotherapy technology, represent challenges that need to be conquered in the future. We declare no competing interests. WF and ZZ have received funding from the National Natural Science Foundation of China (81972702 and 91959110 for WF and 62173005 for ZZ). ZZ and WF contributed equally. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published text and institutional affiliations. Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. Full-Text PDF Open Access