CRC Lifetime Risk Highest in More Developed Nations

A person's lifetime risk of developing or dying from colorectal cancer (CRC) varies more than 10-fold worldwide, with the highest incidence and mortality risks concentrated in highly developed countries, according to a population-based analysis recently published in Cancer Biology & Medicine.¹

Global Differences in Lifetime CRC Risk

CRC is among the most common and deadly malignancies worldwide. In 2022, it accounted for over 900,000 deaths of the 9.7 million cancer deaths recorded globally. Although age-adjusted CRC mortality has declined overall, incidence patterns vary widely by geography and correlate with socioeconomic development and dietary shifts. As a result, transitional economies face rising CRC rates among younger populations, straining health care resources.

To better quantify this burden, researchers use "lifetime risk,” the cumulative probability of developing or dying from a disease over a person's remaining life, accounting for competing mortality risks. Because individuals can develop multiple primary cancers, they explained that the adjusted for multiple primaries (AMP) method has emerged as a more accurate way to estimate this risk; it combines incidence data with cancer-free survival probabilities rather than relying on registry figures alone.

Using GLOBOCAN 2022 data combined with United Nations population and mortality statistics, the researchers conducted a study using the AMP method to examine how the global lifetime risk of developing and dying from CRC varies by cancer subtype, sex, Human Development Index (HDI), region, and age to generate evidence to guide more targeted, population-specific screening and prevention strategies.

CRC Risk, Mortality Vary by Development, Region, and Country

The lifetime risk of developing CRC globally was 2.69% (95% CI, 2.68%-2.70%), and the risk of dying from it was 1.39% (95% CI, 1.39%-1.40%), with men facing a higher risk than women (2.81% vs 2.55%). The starkest divide was seen by HDI, with countries classified as having very high HDI reporting a lifetime CRC incidence risk of 5.17% compared with just 0.57% in low-HDI countries. Mortality risk followed the same pattern, ranging from 2.48% in very high-HDI nations down to 0.41% in low-HDI nations.

Of the high-HDI nations, Norway had the greatest national lifetime incidence risk at 10.32% (95% CI, 10.00%-10.63%), meaning roughly 1 in 10 residents will develop CRC in their lifetime, followed by Denmark, New Zealand, Japan, the Netherlands, and Singapore, all above 8%. By region, Australia/New Zealand had the highest incidence risk (7.41%; 95% CI, 7.30%-7.52%), whereas West Africa had the lowest (0.51%; 95% CI, 0.49%-0.54%). The researchers linked the pattern to longer life expectancy and aging populations in wealthier countries, alongside Western diets, obesity, and rising early-onset CRC among adults aged younger than 50.

Regarding survival, the researchers found that the mortality-to-incidence (MI) ratio was lowest in Northern and Western Europe (0.45-0.49) but climbed as high as 0.62 to 0.76 across parts of Africa. In South Africa, the MI ratio for colon cancer reached 0.95, meaning nearly every diagnosis proved fatal, compared with 0.39 for rectal cancer. Singapore had the highest national mortality risk (5.52%; 95% CI, 5.24%-5.80%), followed by Norway, New Zealand, and Croatia, all above 4%.

Between 2003 and 2017, lifetime risk trends diverged sharply by country. Thailand, Belarus, and Estonia posted the largest increases, a pattern the researchers tied in part to rising obesity and diabetes prevalence alongside expanding diagnostic capacity. By contrast, the US and Austria were among the few countries with statistically significant declines, which they attributed to strengthened screening programs, falling smoking rates, and improved treatment outcomes. A sensitivity analysis projecting these trends to 2030 found that country rankings and regional patterns remained largely stable.

Global CRC Differences Reinforce Need for Targeted Prevention

The findings add global context to domestic research on geographic CRC disparities. One recent study found that limited broadband access, higher smoking prevalence, and rurality were independently associated with higher CRC mortality in the US, with higher screening uptake linked to lower mortality and incidence.² A separate analysis similarly reported that rural residents had lower CRC screening rates than urban residents, with more than 70% of that gap unexplained by measurable sociodemographic or access factors.³ Building on this research, the new analysis reinforces that CRC control strategies cannot be one-size-fits-all.¹

Still, the author acknowledged their limitations, one being that the study's estimates are limited by inconsistent global cancer registry data, with about 23% of the world's population lacking effective data and requiring extrapolation from neighboring regions. Because the analysis relies on cross-sectional 2022 data rather than projected trends, it may also underestimate risk in countries with rising CRC rates and overestimate it in countries with declining rates; it reflects national averages that obscure regional disparities within large, populous countries. Despite these limitations, they emphasized the importance of their findings.

“The findings of this study should have substantial value to policymakers seeking to advance cancer-specific prevention initiatives, control strategies, therapeutic interventions, and resource allocation planning, as well as to researchers seeking to design and implement appropriate CRC prevention strategies, early detection programs, and clinical treatment protocols,” the authors concluded.

References

1. Li L, Sun K, Li X, et al. Global landscape and temporal trends in lifetime risk of colorectal cancer in 185 countries: a population-based study. Cancer Biol Med. 2026;23(7):1004-1015. doi:10.20892/j.issn.2095-3941.2025.0851
2. McCormick B. County-level CRC mortality disparities linked to broadband gaps, smoking, and rurality. AJMC^®. August 19, 2026. Accessed August 24, 2026. https://www.ajmc.com/view/county-level-crc-mortality-disparities-linked-to-broadband-gaps-smoking-and-rurality
3. Steinzor P. Rural-urban disparities in colorectal cancer screening persist. AJMC. September 21, 2025. Accessed August 24, 2026. https://www.ajmc.com/view/rural-urban-disparities-in-colorectal-cancer-screening-persist