Methods: We used a previously-developed population-based microsimulation model of CRC that incorporates the effect of risk factors and screening on the adenoma-carcinoma sequence and the impact of screening and treatment on CRC mortality. We used the model to project CRC mortality rates in the year 2010 under three scenarios: (1) Continuing: risk factor and screening trends continue at their current pace; (2) HP 2010: HP 2010 goals for risk factors and screening are met; and (3) Optimistic: difficult yet realistic goals for CRC risk factors, screening, and treatment are achieved.
Results: If risk factor, screening, and treatment trends continue at their current pace (i.e., continuing scenario), the age-adjusted CRC mortality rate among white males is projected to fall from 21.5 deaths per 100,000 in 2004 to 17.5 in 2010. If the HP 2010 goals for risk factors and screening are met, the HP 2010 CRC mortality goal is not achievable in 2010 but would be reached by the year 2015. However, many of the HP 2010 risk factor goals are unrealistic (e.g., increase the proportion at a healthy weight from 22% of white males in 2004 to 60% in 2010 and the proportion engaging in regular physical activity from 32% to 50% over the same period); a similar reduction could be achieved in the year 2015 if more realistic goals are set for risk factors, more aggressive goals are set for CRC screening, and if all who are eligible for chemotherapy receive the best-available treatment (i.e., optimistic scenario).
Conclusions: The HP 2010 CRC mortality goal is not achievable given the goals specified for CRC risk factors and screening. Additional delivery and discovery of cancer control strategies are needed in order to reduce CRC mortality to the HP 2010 target. Modeling can be used to elucidate alternative pathways for achieving national mortality goals.