Colon and Rectum Cancer
Disease Overview
Colon and Rectum Cancer (CRC) usually develops from an early stage precancerous polyps, this has allowed for screening and detection of benign tumors before they become invasive. Early screening for CRC has reduced the incidence and mortality of colon and rectum cancer. In GBD 2019 summary, there were 2.17 million (95% UI 2.00–2.34) incident cases and 1.09 million (1.00–1.15) deaths, due to colon and rectum cancer globally. Several risk factors are associated with an increased risk for developing CRC. Some of them are modifable and modeled in GBD, such as diet, high-BMI, and alcohol use. Other risk factors are non-modifable, such as family history of CRC or personal history of adenoma polyps. For more information of CRC development and advances in screening, please read this article
ICD 10 |
ICD 9 |
|---|---|
C18-C19.0, C20, C21-C21.8, Z12.1-Z12.13 (Z*=screening) |
153-154.9, V76.41, V76.5-V76.52 (V*=screening) |
GBD 2017 Modeling Strategy
See [GBD-2017-CoD-Appendix] and [GBD-2017-YLD-Appendix] for GBD 2017 fatal and non-fatal modeling methods.
Cause Hierarchy
Restrictions
The following table describes any restrictions on the effects of this cause (such as being only fatal or only nonfatal), as well as restrictions on the age and sex of simulants to which different aspects of the cause model applies.
Restriction Type |
Value |
Notes |
|---|---|---|
Male only |
False |
|
Female only |
False |
|
YLL only |
False |
|
YLD only |
False |
|
YLL age group start |
15 to 19 |
GBD age group id 8 |
YLL age group end |
95 plus |
GBD age group id 235 |
YLD age group start |
15 to 19 |
GBD age group id 8 |
YLD age group end |
95 plus |
GBD age group id 235 |
Vivarium Modeling Strategy
Scope
The Vivarium cause model is designed to include both preclinical screening-detecable (asymptomatic) state of colorectal cancer and clinical (symptomatic) state of colorectal cancer. This design intends to allow for colorectal cancer diagnosis through symptomatic presentation. This model will use GBD forecasts of cancer incidence, prevalence, and cause-specific mortality from 2020 to 2040 as disease input.
Assumptions and Limitations
To avoid overestimate deaths due to colorectal cancer after 10 years stay in clinical state, we will model a “recovered” state and use 10 years for duration of remission from clinical colorectal cancer to its recovery.
We might consider exlude sequalae stoma from colon and rectum cancer beyond ten years when calculating YLDs contributable to colon and rectum cancer.
We assume that GBD forecasted incidence of colorectal cancer corresponds to the incidence of preclinical colorectal cancer rather than clinical colorectal cancer. The incidence of clinical colorectal cancer will lag behind forecasted incidence by a interval of mean sojourn time (MST).
The precancerous state Adenoma will not be modeled in Vivarium due to lack of transitional rates for regression, persistence, and progression. Alternatively, we will model it as a risk factor for colorectal cancer.
Compartmental Diagram
State and Transition Data Tables
State |
State name |
Definition |
|---|---|---|
S |
Susceptible |
Healthy OR with asymptomatic condition, but not screen-detectable |
PC |
Pre-clinical screen-detectable colon and rectum cancer |
with asymptomatic condition and screen-detectable |
C |
Clinical colon and rectum cancer |
With symptomatic condition |
R |
Recovered |
Recovered from clinical colon and rectum cancer, not susceptible |
State |
Measure |
Value |
Notes |
|---|---|---|---|
S |
prevalence |
(1 - prev_PC - prev_C - prev_R) |
|
S |
excess mortality rate |
0 |
|
S |
disabilty weights |
0 |
|
PC |
prevalence |
\(\frac{\text{i\_PC} \times MST}{1 - \text{prev\_c441}}\) |
We scale the prevalence of PC state by (1 - prev_c441) to account for zero prev_C at initialization. Formula used to calculate i_PC is specified in Transition Data table. |
PC |
excess mortality rate |
0 |
|
PC |
disabilty weights |
0 |
|
C |
prevalence |
0 |
Assume zero clinical cases for insured population at initialization |
C |
excess mortality rate |
\(\frac{\text{csmr\_c441}}{\text{prev\_c441}}\) |
|
C |
disabilty weights |
\(\frac{\displaystyle{\sum_{s\in\text{s\_c441}}}\scriptstyle{\text{disability\_weight}_s\,\times\,\text{prev}_s}}{\displaystyle{\sum_{s\in\text{s\_c441}}}\scriptstyle{\text{prev}_s}}\) |
weighted average of colon and rectum cancer disability weight over all sequelae including ids s_296, s_298, s_299, s_5519, s_5522, s_5525 |
R |
prevalence |
0 |
No initialization in R state |
R |
excess mortality rate |
0 |
|
R |
disabilty weights |
0 |
Transition |
Source state |
Sink state |
Value |
Notes |
|---|---|---|---|---|
i_pc |
S |
PC |
\(\frac{\text{incidence\_c441(age + MST)}}{1-\text{prev\_c441}}\) |
incidence of PC state among susceptible population |
i_c |
PC |
C |
1 / MST |
|
r |
C |
R |
0.1 per person-year for all ages and sexes |
Measure |
Sources |
Notes |
|---|---|---|
prev_c441 |
forecasted for future years 2020-2040 |
forcasted data filepath: /ihme/csu/swiss_re/forecast/441_prevalence_12_29_ng_smooth_13.csv |
incidence_c441 |
forecasted for future years 2020-2040 |
forcasted data filepath: /ihme/csu/swiss_re/forecast/441_incidence_12_29_ng_smooth_13.csv |
csmr_c441 |
forecasted for future years 2020-2040 |
forcasted data filepath: /ihme/csu/swiss_re/forecast/441_deaths_12_29_ng_smooth_13.csv |
remission_c441 |
GBD 2017 |
remission rate of cervical cancer = 0.1 per person-years for all ages and sexes |
Disability weights for colon and rectum cancer |
weighted average of colon and rectum cancer disability weight over all sequelae with ids s_296, s_298, s_299, s_5519, s_5522, s_5525 |
|
ACMR |
forecasted for future years 2020-2040 |
forcasted data filepath: /ihme/csu/swiss_re/forecast/294_deaths_12_29_ng_smooth_13.csv |
Population |
demography for 2017 |
mid-year population |
MST |
4.5-5.8 years (Brenner et al.) |
Let’s use 5 years as age-standardized value. |
Validation Criteria
- Fatal outcomes
- Deaths
EMR_PC = 0
ACMR = CSMR_c441 + CSMR_other
- YLLs
YLLs_PC = 0
YLLs_total = YLLs_c441 + YLLs_other
- Non-fatal outcomes
- YLDs
YLDs_PC = YLDs_other = 0
YLDs_total = YLDs_c441
Todo
Compare forecast data in 2020 against GBD 2019 results.
Compare prevalence, incidence, CSMR of colon and rectum cancer, and ACMR over year with GBD age-/sex- stratification that calculated from simulation baseline to forecast data.
Check outcomes such as YLDs and YLLs in 2020 yield from simulation baseline against GBD 2019 all causes and colon and rectum cancer results.
References
Supplement to: GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789–858 (pp. 310-317)
Supplement to: GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88. (pp. 180-186)