Age-adjusted risk-factor prevalence, screening dissemination, and treatment use for colorectal cancer in the MISCAN-Colon model for years 1965 to 2020

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Years 1965 to 2000 (Past Trends)

  1965 1970 1975 1980 1985 1990 1995 2000
Risk factors* Smoking (% adults current smokers) 42 37 36 33 30 26 25 23
Obesity (% adults obese) 13 13 14 14 17 21 25 31
Red meat (% adults consuming >2 times per week) 97 97 95 93 89 85 81 78
Physical activity (% adults adhering to guidelines) 25 25 25 25 25 24 25 26
Multivitamin (% adult-users) 0 0 5 12 20 27 34 38
Aspirin (% adult-users) 5 5 5 5 6 8 9 10
Screening Home-based FOBT (% adults age >50 years in past two years) 0 0 0 5 14 18 21 24
Endoscopy (% adults age >50 years ever had endoscopy) 0 0 0 8 21 30 35 39
Treatment
(% of patients)		 Overall rate of adjuvant chemotherapy for Stage III 0 0 1 12 37 69 73 73
By regimen type:
5-FU based regimens without other agents 0 0 1 12 37 69 73 73
Infusional 5-FU and oxaliplatin 0 0 0 0 0 0 0 0
Overall rate of chemotherapy for metastatic disease 0 13 25 27 49 59 66 66
By regimen type:
5-FU based regimens 0 13 25 27 49 59 20 20
5-FU and irinotecan 0 0 0 0 0 0 46 46
5-FU, irinotecan and oxaliplatin 0 0 0 0 0 0 0 0
5-FU irinotecan, oxaliplatin, and the biologics 0 0 0 0 0 0 0 0

Years 2000 to 2020

  Frozen trends** Continued trends*** Optimistic trends****
  2000-2020 2000 2005 2010 2015 2020 2000 2005 2010 2015 2020
Risk factors* Smoking (% adults current smokers) 23 23 22 20 19 17 23 21 17 14 11
Obesity (% adults obese) 31 31 34 38 41 45 31 34 34 34 34
Red meat (% adults consuming >2 times per week) 78 78 76 74 71 69 78 76 62 51 41
Physical activity (% adults adhering to guidelines) 26 26 28 30 32 34 26 28 34 42 51
Multivitamin (% adult-users) 38 38 42 46 50 55 38 42 51 62 76
Aspirin (% adult-users) 10 10 11 13 14 15 10 11 13 14 15
Screening Home-based FOBT (% adults age >50 years in past two years) 24 24 26 29 32 35 24 28 38 38 38
Endoscopy (% adults age >50 years ever had endoscopy) 39 39 43 48 52 56 39 46 61 61 61
Treatment
(% of patients)		 Overall rate of adjuvant chemotherapy for Stage III 73 73 77 77 77 77 73 77 84 84 84
By regimen type:
5-FU based regimens without other agents 73 73 56 27 27 27 73 56 0 0 0
Infusional 5-FU and oxaliplatin 0 0 21 49 49 49 0 21 84 84 84
Overall rate of chemotherapy for metastatic disease 66 66 70 70 70 70 66 70 83 83 83
By regimen type:
5-FU based regimens 20 20 6 6 6 6 20 6 0 0 0
5-FU and irinotecan 46 46 31 1 1 1 46 31 0 0 0
5-FU, irinotecan and oxaliplatin 0 0 27 18 18 18 0 27 0 0 0
5-FU irinotecan, oxaliplatin, and the biologics 0 0 8 45 45 45 0 8 83 83 83

Footnotes

*Risk factor data were obtained primarily from the Cancer Progress Report (Cancer Progress Report - 2003 Update, 2004) {, 2004 #28;, 2004 #1}. Additional age-specific data were directly obtained from the National Health Interview Survey (NHIS) ("National Center for Health Statistics. Data File Documentation, National Health Interview Survey, 2003 (machine-readable data file and documentation)," 2003), the National Health and Nutrition Examination Survey (NHANES) (CDC), and the Behavioral Risk Factors Surveillance System (BRFSS).

**Frozen at 2000—Risk factor prevalence and use of screening and treatment remain at the levels observed for the year 2000.

***Continued trends—Observed trends in risk factors and screening during 1995–2000 continue at the average rate for that period until 2020. Recently approved treatment strategies are adopted rapidly.

****Optimistic trends—This scenario considers continued trends (during 1995-2000) from 2000–2004; from 2005 onwards, risk factor prevalence in the U.S. population is assumed to improve by 4% per year (assuming that obesity stabilizes at the 2005 level and aspirin stays at the level of continued trends but is not a possible intervention because of adverse effects of bleeding (Imperiale, 2003). CRC screening rates reach current levels of breast cancer screening (70%) by 2010 and stay at this level until 2020. All patients eligible for chemotherapy (i.e., those without significant comorbidities) receive the currently best available chemotherapy from 2005 onwards.