Testing and Colorectal cancer: Critical appraisal/ Epidemiology

Critical Appraisal
Student’s Name
Institution
Critical Appraisal
Epidemiology of Colorectal Cancer
In the United States (US), colorectal cancer is the third most common cancer and also the third leading cause of cancer-specific deaths (Centers for Disease Control and Prevention (CDC), 2020). The estimated new cases and deaths resulting from colorectal cancer in 2020 alone are 147, 950, and 53,200 respectively, according to the National Cancer Institute (2020). Colorectal cancer accounts for about 8% of the total new cases of cancer among men and women. It also accounts for about the same percentage of all cancer-specific deaths. However, the prevalence of colorectal cancer in the US has been on a gradual decline from 1992-2017, except for three consecutive years in 1996, 1997, and 1998 where it rose slightly and then started declining again (National Cancer Institute, 2020). The incidence rates among older adults have dropped to 3% per year. This decline has been attributed to increased screening, a decrease in colorectal cancer risk, and changes in the occurrence of colorectal cancer risk factors (Siegel, et al., 2017). Additionally, five-year survival rates have improved. The National Cancer Institute ( 2020) indicates that the five-year survival rate( from 2010-2016) was at 64.6%. While this decline is true for middle and older adults, the situation is different for younger adults. Siegel, et al. (2017) indicates that the incidence of colorectal cancer has, surprisingly, gone up among young adults. Also, despite the decline in prevalence rates, many men and women are still at the risk of developing colorectal cancer. It is estimated that about 4.2% of American men and women will, at some point in their life, be diagnosed with colorectal cancer (National Cancer Institute, 2020). The main risk factors for colorectal cancer are obesity, alcohol consumption, and tobacco smoking (Marley & Nan, 2016). Also, race, age, and certain genes predispose an individual to colorectal cancer.
Figure 1: Trends in New Cases and Death Rates, 1992-2017
Source: National Cancer Institute, 2020
Effects of Race, Age, Gender, and other Factors on the Epidemiology of Colorectal Cancer
Race determines the risk of colorectal cancer. People from certain racial backgrounds are more likely to develop colorectal cancer than others. According to the American Cancer Society (2017), the incidence rates among black Americans are approximately 20% higher than the rates among non-Hispanic whites. Also, non-Hispanic blacks have the highest incidence as well as death rates arising from colorectal cancer. Asians/Pacific Islanders have the lowest incidence and death rates. Age also increases the risk of colorectal cancer. The American Cancer Society (2017) reveals that the median age at the time of colon cancer diagnosis in men and women is 68 and 72 years, respectively. The median age for rectal cancer is the same for men and women, which is 63 years. However, the recent increase in the incidence rates of colorectal cancer among young adults suggests that the median age at diagnosis for the condition may be lower than 63 years. Further, men are at a higher risk of developing colorectal cancer than women. The incidence and death rates are higher in men than women by about 30% and 40%, respectively. These gender differences have been partially attributed to a higher rate of smoking among men. Socio-economic status also affects the incidence rates of colorectal cancer and has even been considered a cause of the racial differences in incidence rates. As indicated earlier, black Americans have a higher incidence and death rate than non-Hispanic whites. In terms of socio-economic status, blacks also have the highest levels of poverty when compared to Asians and non-Hispanic whites. For instance, in 2015, only 9% and 11% of non-Hispanic whites and Asians, respectively, lived in poverty in comparison to 24% of blacks. Geographically, the incidence rates of colorectal cancer are higher in the deep South and Midwest, although this is a shift from the 1970s when the rates were higher in the Northeast. This shift has been attributed to changes in the racial and socioeconomic composition in those regions (American Cancer Society, 2017).
Figure 2: Trends in Incidence and Death Rates by Gender, 1975-2013 and 1930-2014 Respectively
Source: American Cancer Society, 2017
Figure 3: Trends in Incidence and Death Rates by Race, 1975-2013 and 1970-2014, Respectively
Source: American Cancer Society, 2017
Strategies to Modify the Risk of Developing Colorectal Cancer
As revealed earlier, incidence rates for colorectal cancer, as well as the colorectal cancer-specific death rates have declined in the last couple of decades because of increased screening (Siegel, et al., 2017). Thus, an even further increase in screening can further reduce incidence and death rates. Strategies that can modify the risk of colorectal cancer should be aimed at improving screening among Americans.
Strategies to Improve Healthcare Infrastructure
* Establish partnerships between Accountable Care Organizations and cancer screening clinics. According to Davis, et al. (2019), such partnerships have been effective in increasing colorectal cancer screening. Through such partnerships, vulnerable populations from low socio-economic status can access screening services faster since the partnerships are put in place to maximize screening.
* Provide practitioners with training and resources. Practitioners need access to training and resources that will enable them to not only review patient data but to also apply evidence-based strategies when dealing with patients who are at risk of developing colorectal cancer, thus decreasing colorectal cancer occurrences (Davis, et al., 2019). This would ensure that the public health infrastructure is strong enough to identify at-risk patients and offer them the necessary medical assistance.
* Organize nationwide educational campaigns. The public needs to understand the importance of timely follow-ups and screening for colorectal cancer. A national campaign is one way of increasing the number of people participating in colorectal cancer screening (Durkin, Broun, Spittal, & Wakefield, 2019). These educational campaigns will also enlighten the public about the need for physical activities as well as dietary improvement. This will reduce their risk of developing obesity and encourage them to abandon a sedentary lifestyle. Obesity and sedentary lifestyles are some of the risk factors for colorectal cancer (Marley & Nan, 2016). Addressing these risk factors will help reduce the population risk of developing colorectal cancer.
Strategies for Clinicians
* C...