By Ana Espino | Published on March 2nd, 2026 | 3 min read
Colorectal cancer (CRC) is the
third
most commonly diagnosed cancer worldwide and the second leading cause of
cancer-related mortality. In 2022, more than
1.9 million new cases and
881,984
deaths were recorded globally.
Traditionally viewed as a cancer of
Western countries, CRC is showing contrasting trends. High-income countries are
seeing stabilization—or even a decline—in overall incidence thanks to
screening.
In contrast, several middle-income countries, including India, are
reporting a
gradual increase in cases.
In India, CRC is the
fourth most
common cancer, with
64,863 new cases and 38,367 deaths in 2022. Although
incidence remains lower than in Western countries, the
proportionally high
mortality and limited 5-year survival (≈34–38%) reflect late diagnosis and
inequities in access to care.
This narrative review published in
the Indian Journal of Gastroenterology examines CRC epidemiology with a
specific focus on India, detailing trends, risk factors, and prevention
perspectives.
Urbanization and diet: the real
culprits?
This review draws on
GLOBOCAN 2022
data, Indian cancer registries, and more than
50 international studies
including cohorts, case–control studies, and meta-analyses. The analysis covers
incidence, mortality, survival, and both modifiable and non-modifiable risk
factors.
In India, the
age-adjusted incidence
rate (AAR) is
5.7 per 100,000 in men and
3.4 per 100,000 in women. Regional
disparities are marked, with incidence up to
two to five times higher in urban
areas compared with rural areas.
Unlike Western countries, India has
seen an
annual increase of 2–3% over the past two decades. Projections suggest
a
doubling of incidence and mortality by 2050. Dietary factors play a central role.
Consumption of
red and processed meats, fried foods, and sugar-sweetened
beverages significantly increases risk. Conversely, a diet rich in
fiber,
fruits, vegetables, dairy products, fish, legumes, and whole grains is
protective.
Behavioral factors include
smoking,
alcohol, physical inactivity, and
obesity, all strongly associated with tumor
risk. Comorbidities such as
diabetes,
metabolic syndrome, and
chronic
inflammatory bowel diseases also increase risk. Genetic and familial
factors—including Lynch syndrome, familial colorectal polyps, and BRCA
mutations—contribute to individual risk.
Finally, certain medications such as
metformin and
aspirin show a protective effect, whereas exposure to pesticides,
radiation, and industrial environments is associated with increased risk.
Act now to prevent a doubling
Colorectal cancer in India
illustrates an epidemiological transition linked to urbanization and dietary
change. Despite still-moderate incidence, the
steady rise and high mortality
are a warning signal.
This review aimed to synthesize
epidemiological data and identify priority prevention levers. The findings
confirm that
nearly three-quarters of the CRC burden is attributable to
modifiable factors.
However, Indian data rely largely on
hospital-based and case–control studies, which are prone to methodological
bias. The absence of national screening programs also limits early detection.
In a resource-limited context,
systematic mass screening is not currently recommended. A pragmatic strategy
relies on
targeted screening of high-risk populations, health education, and
modification of dietary and metabolic behaviors.
In the longer term, integrating
nutrition policies, combating obesity, and improving access to diagnosis could
slow the expected rise in CRC in India and sustainably reduce its public health
impact.
Read next: Cancer: when biotin becomes a therapeutic lever
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
