Capstone Case C: Colorectal Cancer Screening By Steven T.

Fleming and Bryan Boling Colorectal cancer

(CRC) is the second most common cancer diagnosed in industrialized nations (Benson et al. 2008).
Worldwide, colon can- cer is the fourth leading cause of cancer deaths, and it is the second leading cause of
cancer deaths in the United States (Janout & Kol- larova 2001). Risk of developing colon cancer increases with
age; more than 90 percent of cases occur after age 50 (American Cancer Society 2005). A family history of
colon cancer is another major risk factor. Individuals with one first-degree relative diagnosed after age 50 have
a relative risk of 1.6. That increases to 2.6 if the relative was diagnosed before age 50. The presence of two
first-degree relatives diagnosed with colon cancer increases risk further. Relative risk is 3.5 if both rela- tives
were diagnosed after age 50, 5.6 if either or both were diagnosed before age 50 (Wilschut et al. 2011). You are
a primary care provider and one of your patients, Mr. Jones, is a 50-year-old male with no history of colon
cancer. He has heard about the recommendations for colon cancer screening and has some questions for you.
How commonly is colon cancer diagnosed in the United States? Is Mr. Jones at increased risk? The latest
statistics from the Centers for Disease Control and Prevention (CDC 2013) report that 136,717 cases of colon
cancer are diagnosed annually. Mr. Jones is curious as to whether his gender places him at increased risk. Of
those 136,717 cases of CRC, 70,223 were male and 66,494 were female. Of the US population, 148,640,424
are male and 152,711,352 are female. Mr. Jones is also curious about whether his older age places him at
increased risk for CRC. Exhibit C.1 reports the cases and population size among males for various age
categories (CDC 2013).
Questions
1. Assume a total US population of 301,351,776; calculate the overall incidence rate per 100,000 of
colon cancer in the United States.

2. By calculating the ratio of incidence rates we can derive the relative risk of getting CRC (males
compared to females), or the number of times more likely males are to get CRC than females.
Calculate the incidence rate for males and females and the relative risk (males versus females).

Age Cases Population Rate/100,000

<1 0 2,141,127
1–4 0 8,559,824
5–9 0 10,353,968
10–14 0 10,039,911
15–19 26 10,844,290
20–24 97 10,881,353
25–29 223 10,922,914
30–34 510 9,936,086
35–39 900 10,173,758
40–44 1,851 10,307,818
45–49 3,678 11,072,321
50–54 6,673 10,462,503
55–59 7,534 9,017,505
60–64 8,740 7,430,412
65–69 9,487 5,406,398
70–74 8,986 4,002,885
75–79 8,362 3,087,390
80–84 7,023 2,252,255
 85+ 6,129 1,747,706
<50 7,285 105,233,370
50+ 62,934 43,407,054

3. Calculate the incidence of colon cancer for each age category and for males older and
younger than age 50 in Exhibit C.1.
4. Calculate and interpret the relative risk for males aged 50 and older as compared to males
younger than 50.
5. Assume that there are 538,584 males 50 and older alive with CRC, and 31,346 males younger than 50
alive with CRC. What are the prevalence rates (per 100,000) for each age group?