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Question: When will we reach the Healthy People 2010 colorectal cancer mortality objective of 13.7 deaths per 100,000?
Answer: We used our simulation models to determine whether we are on track to meet the Healthy People 2010 objective for CRC mortality for the general population. Our models predict that given projected trends in risk factors, screening and chemotherapy, the mortality rate will be 15.1 per 100,000 for the general population. Even if those interventions are stepped up to a level we believe is optimistic but still realistic, the rate will be 14.5 in 2010. However, white women are likely to achieve the objective of 13.7 deaths per 100,000 before 2010, and white men and black women by 2020.
Detailed Discussion
Healthy People 2010 is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. It includes several objectives that apply to colorectal cancer (CRC), including one to reduce death due to CRC to 13.7 per 100,000 by 2010.
Healthy People 2010 (HP 2010) goals and objectives were set for the nation as a whole, and our simulations show that meeting the CRC mortality objective (the pink ‘+’ on the graph below) is unlikely by 2010. If current trends for risk factors, screening, and chemotherapy continue, we predict that mortality will be in the vicinity of 15.1 per 100,000 by 2010. If we are able to accelerate these interventions according to our Optimistic but Realistic scenario, the rate would be about 14.6 per 100,000. You can hold your cursor over the points on the graph below to see the projected numbers.
If we look at CRC mortality by race and sex groups, we find that white females are very likely to meet the objective; black women and white men might achieve the objective sometime before 2020, assuming current trends in risk factors, screening and chemotherapy continue.
According to our models, the Healthy People 2010 objective for colorectal cancer deaths for black males is not obtainable even by 2020, regardless of intervention use. In the graph below, the red line shows the effect on CRC mortality of meeting the Optimistic but Realistic goals for upstream objectives. In this scenario, CRC mortality for black males would decrease to about 19.5 deaths per 100,000 by 2020, down from 22.4 under Projected Trends (black line) but still well above the HP 2010 goal of 13.7.
There are Healthy People objectives for increasing screening and addressing various risk factors (the ‘upstream objectives’ in our models). Because these objectives are set for the population as a whole, many are more aggressive than the optimistic goals we set for black males in our models, especially for certain risk factors like smoking and use of multivitamins. If black males were to reach the Healthy People 2010 upstream objectives (blue line), it may be possible to further reduce CRC mortality to around 17.2 deaths per 100,000.
Similar graphs for white men and black women show that while pursuing interventions more aggressively WILL reduce mortality more quickly, in neither case is it sufficient to meet the HP 2010 mortality objective of 13.7 deaths per 100,000.
