Incidence, prevalence, and survival of colorectal cancer in the United Kingdom from 2000-2021: a population-based cohort study

Background: The management of colorectal cancer (CRC) is evolving, with advances in screening and treatment. We leveraged population-based data to generate up-to-date UK estimates of age and sex-specific incidence and prevalence and overall survival for the period 2000-2021. Methods: We analysed nationally representative primary care records from Clinical Practice Research Datalink (CPRD) GOLD, and replicated in CPRD Aurum. We calculated incidence rates, prevalence, and short- and long-term survival stratified by age, sex, and diagnosis year. Results: Unadjusted prevalence increased in the study period, from 15.6 to 46.4/10,000. Overall incidence was 61.5/100,000 person years, increasing in 2000-2011 to drop slightly in 2011-2014, and then plateauing. In contrast, early-onset CRC raised uninterruptedly throughout the study period, from 8.33 to 19.07/100,000 person-years. Overall survival was 78.3%, 51.4% and 38.5% at 1-, 5-, and 10-years respectively, lower in men compared to women. Modest improvements in survival were observed over the study period, particularly for 60-69 year old patients. Conclusion: The overall prevalence of CRC in the UK has tripled in the last 20 years, leading to increased healthcare resource needs and with slight survival improvements. A worrying increasing trend of early-onset CRC is observed, warranting further research into its diagnosis and management. ### Competing Interest Statement Professor Daniel Prieto-Alhambra research group has received research grants from the European Medicines Agency, from the Innovative Medicines Initiative, from Amgen, Chiesi, and from UCB Biopharma; and consultancy or speaker fees (paid to his department) from Astellas, Amgen, Astra Zeneca, and UCB Biopharma. All other authors declare no conflicts of interest. ### Funding Statement This activity under the European Health Data & Evidence Network (EHDEN) has received funding from the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement No 806968. IMI2 receives support from the European Union's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations (EFPIA). The sponsors of the study did not have any involvement in the writing of the manuscript or the decision to submit it for publication. Additionally, there was partial support from the Oxford NIHR Biomedical Research Centre. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The use of CPRD data for this study was approved by the Independent Scientific Advisory Committee (22_001843). Informed consent was waived by competent authorities due to the anonymized nature of patient data. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Patient level data used in this study was obtained through an approved application to the CPRD (application number 22_001843) and is only available following an approval process to safeguard the confidentiality of patient data. Details on how to apply for data access can be found at https://cprd.com/data-access.