Burden of bowel cancer
Burden of disease analysis is used to assess and compare the impact of different diseases and injuries on a population. It involves determining their impact in terms of the following:
- the number of years of healthy life lost through living with an illness or injury (the non‑fatal burden, years lived with disability, or YLD)
- the number of years of life lost through dying prematurely from an illness or injury (the fatal burden, years of life lost, or YLL)
- the number of disability‑adjusted life years (DALYs), which combines the non-fatal and fatal burden (or the combined impact of dying early and living with illness). One DALY is equivalent to one healthy year of life lost.
Burden of disease estimates capture both the quantity and quality of life, and reflect the magnitude, severity, and impact of disease and injury within a population. Burden of disease studies can also estimate the contribution of specific risk factors to disease burden (known as the attributable burden) (AIHW 2024).
The AIHW report Australian Burden of Disease Study 2024 (hereafter referred to as the ABDS 2024) found that 97,903 years of healthy life were lost (from fatal and non-fatal outcomes) due to bowel cancer in 2024 (AIHW 2024). This meant bowel cancer accounted for 1.7% of the total disease burden in Australia, making it the 16th most burdensome disease overall (15th in males and 17th in females). Bowel cancer (97,903 DALYs) was the second most burdensome cancer in 2024 behind lung cancer (158,445 DALYs); Australians lost many more years of life due to dying from bowel cancer (92.8% of total bowel cancer burden) than healthy years lost from living with the impacts of the disease (7.2% of total bowel cancer burden) (AIHW 2024).
Changes in burden since 2003
The NBCSP was introduced in 2006; hence, comparisons of the health burden before and after this date, as well as during the full program rollout, are of interest. The ABDS 2024 provides burden of disease estimates best matched to the Australian public health context for the Australian population for 2024. Due to improvements in data sources and methodological changes, published estimates from previous Australian studies are not directly comparable with those for the ABDS 2024. However, estimates for 2018, 2015, 2011, and 2003, revised using the same methods as for 2024, were calculated to enable direct comparisons over time (Figure 2.6).
Between 2003 and 2024, the age-standardised rate (ASR) of total burden from bowel cancer fell 27%, from 4.9 to 3.6 DALYs per 1,000 people. This reduction was primarily due to a drop in fatal burden for all age groups, which lowered the general burden from 4.7 to 3.4 YLL per 1,000 people (AIHW 2024). The change in YLL ASRs was also driven by a shift towards people dying from bowel cancer at older ages. The age group with the highest fatal burden shifted from 75–79 in 2003 (22.2 YLL) to 80–84 and 85–59 (both 15.3 YLL) in 2024.
Figure 2.6: Change in fatal burden - years of life lost (YLL) from bowel cancer, age-specific rate (per 1,000 people), Australia, 2003, 2011, 2015, 2018 and 2024
This line chart shows the age-specific rate of years of life lost due to bowel cancer per 1,000 people for 2003, 2011, 2015, 2018 and 2024. It shows there has been a reduction in the years of life lost rates which was driven by a shift towards dying at older ages (85 and over). People aged 60 to 84 have had the greatest reduction (improvement) in the years of life lost rate.
| Age group (years) | 2003 | 2011 | 2015 | 2018 | 2024 |
|---|---|---|---|---|---|
| 30–34 | 0.7 | 0.5 | 1.2 | 0.9 | 0.9 |
| 35–39 | 0.9 | 1.1 | 1.1 | 1.4 | 1 |
| 40–44 | 2.2 | 1.7 | 2 | 2 | 1.5 |
| 45–49 | 4 | 2.9 | 3.3 | 2.7 | 2.5 |
| 50–54 | 5.8 | 4.2 | 5.3 | 4.8 | 3.9 |
| 55–59 | 9.2 | 6.5 | 6 | 6.5 | 5.2 |
| 60–64 | 14.6 | 10.1 | 8.8 | 8 | 7.3 |
| 65–69 | 17.3 | 12.6 | 11.2 | 10.1 | 9.1 |
| 70–74 | 20.7 | 15.4 | 12.5 | 11.2 | 10.9 |
| 75–79 | 22.2 | 19.1 | 17.3 | 14.8 | 14 |
| 80–84 | 21.2 | 19 | 18.6 | 16.2 | 15.3 |
| 85–89 | 19.6 | 18.5 | 18.7 | 17 | 15.3 |
| 90–94 | 17.2 | 17.3 | 16.2 | 16.2 | 14.2 |
| 95–99 | 12.6 | 12.2 | 14 | 11 | 11.5 |
| 100+ | 4.8 | 8 | 9.5 | 9 | 8.3 |
Sources: AIHW Australian Burden of Disease Database; Table A2.4.
Contribution of risk factors to bowel cancer burden
The ABDS 2024 calculated the proportion of the bowel cancer burden attributable to a number of behavioural, environmental, and metabolic risk factors. For the majority of this analysis, the risk factors were analysed independently, meaning that the estimates cannot be added together without further analysis to take into account that many risk factors are interrelated (AIHW 2021).
After analysis to adjust for interrelated risk factors, the study estimated that 53% of bowel cancer burden in 2024 was attributable to the combined impact of associated risk factors, referred to as the ‘joint effect’ (AIHW 2021). All dietary risk factors combined were responsible for 26% of bowel cancer burden.
When looking at the individual contribution of each risk factor, a low consumption of wholegrains and high-fibre cereals and overweight and obesity contributed the most individually to bowel cancer burden in 2024 (16% and 14%, respectively). A greater proportion of bowel cancer burden in males was due to overweight and obesity than in females (19% compared with 7%) (Table 2.2). Physical inactivity was responsible for around 11% of bowel cancer burden in 2024.
See Australian Burden of Disease Study 2024 (AIHW 2024) for more information on the methods used to quantify the impact of specific risk factors.
Risk factor | Males | Females | Persons | |||
|---|---|---|---|---|---|---|
Attributable DALY | Proportion of bowel cancer burden (%) | Attributable DALY | Proportion of bowel cancer burden (%) | Attributable DALY | Proportion of bowel cancer burden (%) | |
Alcohol use | 2,695 | 4.9 | 2,860 | 6.6 | 5,555 | 5.7 |
All dietary risks | 14,312 | 26.2 | 11,266 | 26.1 | 25,579 | 26.1 |
| 1,213 | 2.2 | 967 | 2.2 | 2,180 | 2.2 |
| 3,182 | 5.8 | 2,495 | 5.8 | 5,677 | 5.8 |
| 2,578 | 4.7 | 2,027 | 4.7 | 4,605 | 4.7 |
| 8,680 | 15.9 | 6,831 | 15.8 | 15,510 | 15.8 |
High blood plasma glucose | 4,003 | 7.3 | 2,287 | 5.3 | 6,290 | 6.4 |
Overweight and obesity | 10,574 | 19.3 | 2,891 | 6.7 | 13,465 | 13.8 |
Physical inactivity | 5,467 | 10.0 | 4,964 | 11.5 | 10,431 | 10.7 |
Tobacco use | 2,511 | 4.6 | 3,647 | 8.4 | 6,158 | 6.3 |
Joint effect | 30,026 | 54.9 | 21,801 | 50.5 | 51,826 | 52.9 |
Note: Attributable burden was analysed independently for each risk factor and only the ‘joint effect’ estimates take into account the complex pathways and interactions between risk factors. Therefore, attributable DALY and percentages for individual risk factors will not sum to the joint effect.
Source: AIHW Australian Burden of Disease Database.
AIHW (2021) Australian Burden of Disease Study: Methods and supplementary material 2018, AIHW, Australian Government, accessed 15 May 2025.
AIHW (2024) Australian Burden of Disease Study 2024, AIHW, Australian Government, accessed 15 May 2025.