Screening and trends: A Global Burden of Disease 2023 assessment of colorectal cancer mortality across G7 nations.

Abstract

3656 Background: Historically, the adoption of screening techniques has led to a steady decline in colorectal carcinoma (CRC) mortality in high-income countries. However, recent epidemiological data points towards a potential saturation of screening benefits and a rising burden of early-onset disease. Using Global Burden of Disease (GBD) 2023 data, we were able to identify points of stagnation and trend reversals in CRC mortality rates for G7 nations and hypothesize a systemic screening saturation in the post-pandemic era. Methods: The Global Burden of Disease 2023 study was used to retrieve data that included age-standardized death rates (ASDR) for G7 nations (2000-2023). Trends were analyzed using the Joinpoint regression Program, Version 5.4.0.0. We employed a log-linear model to estimate Annual Percent Change (APC). Pairwise comparison tests assessed parallelism between national trajectories to identify statistically distinct trend patterns. Results: From 2000 to 2023, epidemiological data shows an overall decline in the age standardized death rates (ASDR) for colorectal carcinoma in the USA. The ASDR in 2000 was 18.54 (95% UI: 16.80-19.87) and in 2023 it decreased to 12.64 (AAPC: -1.66: 95% CI: -1.83 to -1.49). Upon further analysis, three individual trajectory phenotypes were detected across the G7. The USA and Canada displayed a stagnation phenotype, in which mortality rates plateaued in the more modern years after initial rapid declines. In USA 2018-2023 APC was -0.48 (95% CI: -1.03 to 0.08) and in Canada 2020-2023 APC was 0.26 (95% CI: -0.94 to 1.47). The UK, Japan and France exhibited a rather alarming reversal phenotype, where mortality rates significantly accelerated in recent years. In UK 2021-2023 APC was 2.87 (95% CI: 0.74 to 5.06) while Japan 2021-2023 APC was 2.68 (95% CI: 1.45 to 3.93) and France 2021-2023 APC was 2.56 (95% CI: -2.06 to 7.40). Italy, however, has maintained a sustained decline phenotype, which sharply contrasts with that of the aforementioned nations. In Italy 2003-2023 APC was -1.65 (95% CI: -1.74 to -1.56) with no evidence of saturation. Pairwise comparison confirmed that the USA trajectory was significantly non-parallel to Italy (p <0.05). Conclusions: For the majority of G7 nations, the era of universal CRC mortality decline has come to an end. While the USA and Canada show halted progress, the UK, Japan and France show early signs of slope inversion. On the contrary, Italy’s clear lead in maintenance of declining mortality suggests a policy-based limitation as opposed to unavoidable biological circumstances. Urgent implementation of revolutionized screening techniques and interventions, focusing on hard-to screen populations as well as early onset cohorts, are required to avert a global deterioration in CRC outcomes.