incidence rates for those living in Alaska (approximately 95 per 100,000) were more than two-fold higher than those living in the East and Southwest regions (30 to 40 per 100,000) of the US during 2010-2015.58 Factors that may contribute to this disparity include differences in diet and the prevalence of obesity and smoking, as well as access to medical services, including screening. Among some more isolated groups (e.g., Alaska Natives), genetic differences may also play a role. (See page 5 and page 6 for more information about CRC in Alaska Natives.) K Mortality Nevada and the District of Columbia did not meet NAACCR high-quality incidence data standards for one or more years during 2012-2016. Incidence rates for the District of Columbia are based on data years 2012-2014. Rates are age adjusted to the 2000 standard population. Sources: Incidence – NAACCR, 2019. Mortality – NCHS, 2019. ©2020, American Cancer Society, Inc. Surveillance Research Colorectal Cancer Incidence (2012-2016) and Mortality (2013-2017) Rates* by Race/Ethnicity and State, US State Incidence Mortality Men Women Men Women NonHispanic white NonHispanic black Hispanic NonHispanic white NonHispanic black Hispanic NonHispanic white NonHispanic black Hispanic NonHispanic white NonHispanic black Hispanic Alabama and age adjusted to the 2000 US standard population. †Statistics not displayed due to fewer than 25 cases or deaths. ‡Incidence data for these states are not included in US combined incidence rates because data did not meet inclusion standards for all years during 2012-2016 according to the North American Association of Central Cancer Registries (NAACCR). §Rates are based on cases diagnosed during 2012-2014. Sources: Incidence – NAACCR, 2019. Mortality – NCHS, 2019. ©2020, American Cancer Society, Inc., Surveillance Research Colorectal Cancer Facts & Figures 2020-2022 11 Colorectal cancer survival The relative survival rate for CRC is 64% at 5 years following diagnosis and 58% at 10 years.59 The most important predictor of CRC survival is stage at diagnosis. The 5-year survival rate is 90% for the 39% of patients diagnosed with localized-stage disease, but declines to 71% and 14% for those diagnosed with regional and distant stages, respectively (Figure 10 and Figure 11). Rectal cancer is diagnosed at a localized stage slightly more often than colon cancer, 41% versus 38%, likely due to the earlier appearance of symptoms and partly explaining the higher overall 5-year relative survival (67% versus 63%). Factors associated with advanced-stage CRC diagnosis include low socioeconomic status, black race, and young age.60, 61 Factors associated with CRC survival in addition to stage include age at diagnosis, the presence of other illnesses, and other tumor and patient characteristics, such as race/ethnicity and socioeconomic status.62 For reasons that are not explained by tumor differences or other known factors, women are slightly more likely than men to survive after a CRC diagnosis.63 There is some evidence that patients with tumors located in the proximal colon have lower survival rates than those with tumors in the distal colon,64 but this association may be confined to distant-stage diagnoses.65 Age Although CRC patients younger than age 50 have higher 5-year relative survival rates than their older counterparts for every stage of diagnosis (Figure 10), overall survival among patients younger than age 50 (68%) is similar to that in ages 50-64 years (69%) because of a later stage at diagnosis. Approximately 26% of CRCs are diagnosed at a distant stage among patients younger than age 50, compared to 23% in ages 50-64 years and 19% among those ages 65 and older (Figure 11). Despite having the highest proportion of early-stage diagnoses, however, individuals ages 65 and older have the lowest overall 5-year relative survival (61%) because their stage advantage is outweighed by age-related disadvantages, such as additional health issues. *Cause-specific survival rates are the probability of not dying from colorectal cancer within 5 years of diagnosis. Rates are based on cases diagnosed from 2009 to 2015, all followed through 2016. Rates for American Indians/Alaska Natives are based on small case