The results of our study demonstrate a rising global burden of LC with some significant but uneven trends based on geography, age, and socio-economic status. This information can be used to shape policy and aid strategic targeting of resources to areas with the highest burden.

Colorectal cancer is the 4th most common cancer in the world with 1.3 million new cases each year and a 5-year prevalence rate of 3.2 million [1,2]. There were an estimated 693,333 deaths due to colorectal cancer (CRC) in 2012. When looking at India and the United States, the incidence, mortality, and prevalence rates are all consistently higher in the US although the incidence is higher in males in both countries. [3] In the US, colorectal cancer falls behind prostate, breast, and lung as the fourth most common cancer. In India, it is the 5th most common cancer following breast, cervix/uteri, lip/oral cavity, and lung cancer [3].North America, Australia, and Europe have higher rates of CRC when compared to other parts of the world. It is thought that Bthe westernized lifestyle^of physical inactivity, poor diet, obesity, and increased alcohol consumption and longterm smoking attribute to this higher burden [4,5]. In contrast, registries in Asia, Africa and South America have some of the lowest rates of CRC [4]. A review of the 12 population based cancer registries from India (Benaguluru, Barshi, Bhopal, Chennai, Delhi, Mumbai, Ahmedabad, Karunagappally, Kolkata, Nagpur, Pune and Thiruvananthapuram) again demonstrated that the incidence of colon and rectal cancer is significantly lower in India for both genders when compared to the West. In these registries, colon and rectal cancer is ranked 10th among all cancers. It is thought that until recently there were fewer known risk factors for colorectal cancer in India. The typical diet in India is lower in calories and consists of more fruits and vegetables. This combined with a higher level of physical activity translate to a lower obesity rates [6,7]. India's low incidence rate is unfortunately also associated with a low 5-year survival rate [7].Even though the rates of colorectal cancer are much higher in the US, the incidence and mortality rates have been decreasing in the past 20 years. According to the American Cancer Society, this is likely due to colorectal cancer screening tests that allow for early detection and removal of polyps before progression to cancer. The incidence rates declined by 3.7% per year among those 50 and older from 2006 to 2010, however, the incidence increased by 1.8% per year among those younger than 50. Mortality rates have also declined, from 2005 to 2014, by 2.5% per year [5].Patients with colorectal cancer usually present with rectal bleeding, pain, or a change in bowel habits. Occasionally, patients will present with a malignant large bowel obstruction. The article by Patil et al. demonstrated that patients in India presented with the same symptoms as in the US, however, the patients were typically younger and presented at a later stage. In the article by Ashish et al, colorectal cancer data in the young (<45) was compared with the old (>45) and those <45 were found to have poor histology, node-positive disease, and more cases of rectal cancer. Nonetheless, there was no difference in overall survival at 3 years in these two groups ...

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To assess the familial risk of colorectal cancer among first-degree relatives of colorectal cancer patients, a tumour-related family history study was conducted in 1982-1988 on 184 patients (median age 60 [28-92] years). These family data were compared with the data recorded in the cancer register of the population of Basel. An enhanced risk among first-degree relatives was noted (relative risk: 1.8%; 95% confidence interval: 1.4-2.3). The enhanced risk was attributed exclusively to seven families involving 2-3 relatives each (the relative risk in these families being 34). In four of these seven families an autosomal dominant site-specific cancer of the colon (Lynch's syndrome I) was diagnosed. Hence, family case history of colorectal cancer patients enables the identification of relatives with a high risk for colorectal carcinoma.