Global, regional, and Chinese disease burden and trends of colorectal cancer, 1990-2021: An update from the GBD 2021 study and implications for predictive, preventive, and personalized medicine.

Background: In the era of shifting healthcare, a "reactive" approach to colorectal cancer (CRC) management-that is, initiating treatment only after the onset of symptoms-remains a major global health challenge. This study uses the Global Burden of Disease (GBD) 2021 data to quantify CRC burden and provide a foundation for developing targeted Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies worldwide, especially in China. Methods: We conducted a comprehensive analysis using data from the Global Burden of Disease GBD 2021 study, obtained through VizHub and GBD Foresight Visualization tools. Statistical analyses were performed using R (4.4.2; available from: https://cloud.r-project.org/) and Biowinford (Available from: http://biowinford.site:3838/trial/), incorporating key parameters including age, sex, disease-specific factors, disability-adjusted life years (DALYs), and socio-demographic index (SDI) and modifiable risk factors, such as behavioral and dietary factors. This methodological framework is designed to identify high-risk populations and regions, thereby enabling predictive diagnostics and targeted prevention strategies as core tenets of the PPPM model. Results: From 1990 to 2021, the global age-standardized rate of CRC prevalence increased by 24.6%, with the number of prevalent cases rising from 4.26 million to 11.7 million. During the same period, China experienced an increase of 141.2% in its ASR, as its prevalent cases increased from 0.6 million to 3.6 million. While age-standardized death rates declined globally (-20.7%), regional disparities persisted, with men bearing a higher burden and DALYs rising in parts of Africa and Asia. For instance, the number of deaths in East Asia, North Africa and the Middle East was 287,900 and 37,400, respectively; the corresponding DALYs were 7,149,000 and 1,012,700. Major modifiable risks were high BMI, diet high in red meat, and low physical activity. Projections to 2050 indicate a continued rise in cases in China and Africa. Conclusion: Our study provides evidence to support the shift towards PPPM in CRC care. With rising urbanization, dietary shifts, and aging populations, predictive diagnostics using Artificial Intelligence and big data, targeted prevention of modifiable risks, and personalized treatments based on genetic and tumor data could be essential. Detailed burden mapping forms the foundation for this proactive approach, especially in high-burden regions like China. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-025-00431-6.