Colorectal cancer (CRC) represents a substantial public health burden in Puerto Rico, both in terms of incidence and mortality. Most cases can be detected through routine screening before symptoms develop. This article, prepared by the Alliance for Clinical and Translational Research (ALLIANCE), presents current data and evidence-based recommendations.
The Burden of Colorectal Cancer in Puerto Rico
During 2018–2022, approximately 1 in every 9 men and 1 in every 10 women diagnosed with cancer in Puerto Rico had CRC, which also accounted for about 1 in 8 cancer deaths among both sexes, making it the leading cause of cancer-related death on the island.
On average, 936 men and 794 women were diagnosed with CRC annually, while deaths reached 364 among men and 287 among women each year. Men experience a 1.4 times higher incidence and 1.6 times higher mortality compared with women. The median age at diagnosis is 68 years for both sexes, while the median age at death is 72 years for men and 75 years for women.
Puerto Rico’s rate of new colorectal cancer cases is similar to the U.S. national average — about 37 cases per 100,000 people per year — and fewer cases are diagnosed at an advanced stage (18.2 vs. 22.0 per 100,000). Between 2000 and 2022, both incidence and mortality from CRC declined. New cases decreased by approximately 0.5% per year in women and at a lower rate in men, while deaths declined about 1.5% per year in both sexes, representing an overall reduction of roughly 25–30% over two decades. As of January 1, 2022, an estimated 14,502 people in Puerto Rico were living after a CRC diagnosis.
A study of CRC outcomes in Puerto Rico found that Puerto Ricans have the lowest 5-year survival rates for localized CRC (85.5%) and regional CRC (61.1%) among all racial and ethnic groups in the United States. For comparison, non-Hispanic Whites have a 91% survival rate for localized CRC. When CRC has spread to distant organs, fewer than 1 in 8 Puerto Ricans (11.8%) survive five years.
Colorectal Cancer in Adults Under 50: An Increasing Trend
In the United States, about 1 in 10 new CRC cases now occur in individuals under age 50. Among adults in their 40s, incidence has increased by nearly 15% in less than 15 years, a trend observed particularly among White and Hispanic/Latino populations. Local data from the UPR Comprehensive Cancer Center (CCCUPR) confirm a growing proportion of CRC diagnoses among Puerto Ricans under 50. A recent study found that early-onset CRC mortality on the island has increased steadily by 1.58% per year since 2000. Among Puerto Rican men under 50, mortality rose by 2.77% per year, the second highest among all racial and ethnic groups in the United States. Younger patients are often diagnosed at more advanced stages, partly because symptoms may not be promptly investigated when CRC is considered unlikely in this age group. Puerto Ricans have the lowest 1-year survival rate for early-onset CRC (86.9%) among all groups studied, which may reflect delays in diagnosis and access to treatment. CRC in adults under 50 is increasing and warrants clinical attention regardless of age.
Screening Recommendations
For average-risk adults, the Puerto Rico Department of Health (Administrative Order 334, 2015) recommends CRC screening starting at age 40, using the fecal immunochemical test (FIT) annually. The U.S. Preventive Services Task Force (2021) recommends CRC screening starting at age 45 for average-risk individuals. Individuals with a personal or family history of CRC or polyps, inflammatory bowel disease, or hereditary syndromes, such as Lynch syndrome or familial adenomatous polyposis (FAP), should consult their healthcare provider about starting screening earlier and undergoing it more frequently.
The following screening options are available (U.S. Preventive Services Task Force, 2021):
| Test* | Frequency | Notes |
|---|---|---|
| Fecal immunochemical test (FIT) | Annually | No bowel preparation; performed at home. Recommended by the PR Department of Health for average-risk adults starting at age 40. |
| High-sensitivity guaiac FOBT (HS-gFOBT) | Annually | Requires dietary restrictions prior to testing. |
| Multitarget stool DNA test (mt-sDNA) | Every 1–3 years | Detects DNA markers and hemoglobin associated with colorectal neoplasia. |
| Colonoscopy | Every 10 years | Allows visualization and removal of polyps during the same procedure. |
| CT colonography (CTC) | Every 5 years | Radiological test; no sedation required. Abnormal findings require follow-up colonoscopy. |
| Flexible sigmoidoscopy | Every 5 years | Examines only the lower colon. |
* PR Department of Health (Administrative Order 334, 2015): FIT annually starting at age 40 for average-risk adults. USPSTF (2021): any listed modality starting at age 45. Both recommendations apply to average-risk individuals; high-risk individuals should follow provider guidance regardless of age.
Important: A positive result on any non-colonoscopic test should be followed by a diagnostic colonoscopy.
Colorectal Cancer Screening Rates in Puerto Rico
Data from the Behavioral Risk Factor Surveillance System (BRFSS), provide insight into how CRC screening rates in Puerto Rico compare with those in the United States. Table 1 summarizes the use of colonoscopy or sigmoidoscopy and at-home stool test (FOBT) rates.
| CRC Screening Test (Population / Interval) | PR 2012 | PR 2022 | US 2012 | US 2022 |
|---|---|---|---|---|
| Colonoscopy / Sigmoidoscopy | 47.2% | 52.3%* | 67.3% | 66.2%* |
| Fecal Occult Blood Test (FOBT) — 45–75 yrs / last year | — | 27.3% | — | 5.7% |
Table 1. Colorectal cancer screening test utilization — colonoscopy/sigmoidoscopy and FOBT — Puerto Rico vs. United States, BRFSS. * 2018 data.
Source: Puerto Rico Comprehensive Cancer Control Plan 2025–2030, November 2024.
About 1 in 2 eligible Puerto Ricans (52.3%) had completed a colonoscopy or sigmoidoscopy as of 2018, roughly 14 percentage points lower than the U.S. prevalence (66.2%). In contrast, 27.3% of adults in Puerto Rico reported using at-home FOBT, compared with 5.7% nationally. These tests should be performed annually, and positive results require follow-up colonoscopy.
These differences in screening patterns may reflect underlying barriers to access and affordability. Puerto Rico’s median household income ($25,096) is less than one-third of the U.S. average ($78,538), and more than 4 in 10 residents live in poverty. For many families, the cost, logistics, and time required for a colonoscopy can limit access. Affordable, accessible options such as the at-home FOBT testing and community-based screening programs may help reduce these barriers (add reference).
When to Seek Medical Evaluation
CRC may not cause symptoms in its early stages. Medical evaluation is recommended for patients with any of the following:
- Rectal bleeding or blood in the stool (hematochezia or melena)
- Persistent changes in bowel habits for more than a few days, including diarrhea, constipation, or a change in stool caliber
- Sensation of incomplete bowel evacuation (tenesmus)
- Abdominal pain, cramping, or persistent discomfort
- Unexplained weight loss, fatigue, or anemia
These symptoms are not specific to colorectal cancer, but they should be evaluated to identify the underlying cause.
Modifiable Risk Factors and Prevention
Several lifestyle factors are associated with a reduced CRC risk:
- Diet rich in fruits, vegetables, and fiber, with limited intake of processed and red meats
- Regular physical activity (at least 150 minutes of moderate-intensity exercise per week)
- Maintaining a healthy body weight
- Avoiding tobacco use and limiting alcohol consumption
- Adequate management of metabolic conditions such as type 2 diabetes
Although hereditary syndromes such as Lynch syndrome and familial adenomatous polyposis (FAP) are well-established risk factors, they account for a small proportion of cases. In Puerto Rico, those in younger patients are attributed to identifiable hereditary causes. Most cases occur in individuals without a family history, underscoring the importance of routine screening for all adults, regardless of family background.
Recommendations for Action
Addressing CRC effectively requires coordinated efforts across individuals, healthcare systems, and public policy. The following actions are recommended:
- Adults aged 40 and older: Schedule a CRC screening test and do not wait for symptoms to develop.
- Clinical providers: Proactively recommend appropriate screening to all eligible patients and ensure timely follow-up of positive non-colonoscopic results.
- Public health programs: Expand community-based screening initiatives, particularly in underserved municipalities, and improve access to colonoscopy and follow-up care.
- Individuals and communities: Promote awareness of screening guidelines, including the recommendation to begin screening at age 40, among family members and peers.
Additional Resources
The following organizations provide information, screening services, and support related to CRC in Puerto Rico:
| Organization | Description | Website |
|---|---|---|
| Coalición de Cáncer Colorrectal de Puerto Rico | Prevención, educación y detección temprana | coloncancerpr.org |
| Centro Comprensivo de Cáncer de la Universidad de Puerto Rico (CCCUPR) | Specialized screening clinic, oncology services, and cancer research | cccupr.org |
| Registro Central de Cáncer de Puerto Rico (RCPR) | Cancer incidence and mortality statistics for Puerto Rico | rcpr.org |
| Puerto Rico Comprehensive Cancer Control Program | Cancer prevention and control planning | Program page |
| U.S. Preventive Services Task Force (USPSTF) | Evidence-based screening recommendations | uspreventiveservicestaskforce.org |
| American Cancer Society | Patient information, screening guidelines, and support resources | cancer.org |
| National Cancer Institute (NCI) | Cancer research, clinical trials, and patient education | cancer.gov |
| Asociación Puertorriqueña de Gastroenterología | Gastroenterology professionals in Puerto Rico; patient information on colorectal cancer and colonoscopy | prgastro.org |
Alliance’s Contribution to Colorectal Cancer Research
Supported by the National Institute of General Medical Sciences (NIGMS), National Institutes of Health
Award Number: 5P50GM133807
| Study Title | Principal Investigator | Institution | Research Areas |
|---|---|---|---|
| A Phase Ib/II Clinical Trial of Nous-209 for Recurrent Neoantigen Immunogenicity and Cancer Immune Interception in Lynch Syndrome | Ballester, Verushka | UPR Comprehensive Cancer Center | Cancer / Genetic Disorder / Cancer Prevention |
| Familiar Colorectal Cancer in Puerto Rico: A Feasibility Study | Cruz-Correa, Marcia R. | UPR-Medical Sciences Campus | Cancer |
| A Mixed Methods Study to Explore the Effect of Hurricanes Irma and Maria on Cancer Care in Puerto Rico | Colón-López, Vivian | UPR Comprehensive Cancer Center | Cancer |
| Implementing a Virtual Reality Distraction Experience for Hispanic Oncology Patients Undergoing Colonoscopy Procedures | Pereira-Morales, Sherily |
UPR-Medical Sciences Campus | Cancer |
| A Randomized and Placebo-Controlled Phase II Trial Targeting Dominant-Negative Missense Mutant p53 by Atorvastatin for Reducing the Risk of Longstanding Ulcerative Colitis-Associated Cancer | Carlo-Chevere, Victor L. | UPR-Medical Sciences Campus | Cancer / Cancer Prevention |
| Multimodal Analgesia with Ultrasound-Guided Transversus Abdominis Plane Block for Abdominal Surgery in Puerto Rico Oncology Patients | Pereira-Morales, Sherily | UPR-Medical Sciences Campus | Cancer |
| Deciphering the Risk Factors and Mechanisms Contributing to Early-Onset Gastrointestinal Cancer Disparities | González-Pons, María del Mar | UPR Comprehensive Cancer Center | Cancer |
REFERENCES
Centro Comprensivo de Cáncer de la Universidad de Puerto Rico. (2026, March 5). Llamado a la detección temprana del cáncer colorrectal. El Vocero de Puerto Rico. https://www.notiuno.com/noticias/ultimo-minuto/aumentan-casos-de-c-ncer-colorrectal-en-adultos-j-venes/article_0b17619e-1c6a-4c76-a3c2-2cf48f2be00f.html
Cruz Correa, M. (2023, April 3). Cáncer colorrectal en Puerto Rico: menos del 5% de los casos se debe a factores hereditarios. Medicina y Salud Pública. https://medicinaysaludpublica.com/noticias/oncologia-hematologia/cancer-colorrectal-en-puerto-rico-menos-del-5-de-los-casos-son-por-factores-hereditarios/18641
Departamento de Salud de Puerto Rico. (2015). Orden Administrativa Núm. 334: Ordenar la prueba de detección de sangre oculta en excreta como procedimiento de cernimiento de cáncer colorrectal. https://www.salud.pr.gov/CMS/DOWNLOAD/3481
Montalvo-Pacheco, C., Torres-Cintrón, C. R., Moró-Carrión, M., Centeno-Girona, H., Borrero-García, L. D., & González-Pons, M. (2025). Disparities in colorectal cancer mortality and survival trends among Hispanics living in Puerto Rico (2000–2021): A comparison between early-onset and average-onset disease. Life, 15, 1742. https://doi.org/10.3390/life15111742
National Cancer Institute & Centers for Disease Control and Prevention. (2024). State Cancer Profiles: Quick profiles — Puerto Rico. https://statecancerprofiles.cancer.gov
Puerto Rico Cancer Control Coalition & Puerto Rico Comprehensive Cancer Control Program. (2024). Puerto Rico Comprehensive Cancer Control Plan: 2025–2030. Puerto Rico Comprehensive Cancer Control Program. https://www.cccupr.org/cccupr-al-dia/programa-de-control-comprensivo-de-cancer-de-puerto-rico/
Torres-Cintrón, C. R., Ortiz-Ortiz, K. J., Moró-Carrión, M., Centeno-Girona, H., Borrero-García, L. D., Colón-Castillo, L., Mora-López, L. M., & González-Pons, M. (2025). Cancer in Puerto Rico 2018–2022: Incidence, mortality, and survival. Puerto Rico Central Cancer Registry. https://rcpr.org/Portals/0/informe%202018-2022%20-%20Ingles.pdf
U.S. Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965–1977. https://doi.org/10.1001/jama.2021.6238
