The Evolving Burden of Colorectal Cancer in South Asia: A GBD-Based Analysis of Trends, Risk Factors, and Projections to 2035

Colorectal cancer (CRC) is the second leading cause of cancer deaths worldwide. In South Asia, demographic shifts, dietary changes, and healthcare disparities are influencing CRC trends. This study evaluated temporal patterns, projected future burden, and examined links between CRC indicators and key risk factors from 1990 to 2023, with forecasts to 2035. Globally, CRC DALYs declined from 364.57 to 287.69 per 100,000 between 1990 and 2023, while prevalence increased (111.15 to 133.78). In South Asia, all metrices increased, DALYs (115.40-144.21), mortality (4.31-5.55), incidence (4.71-7.02) and prevalence (14.74-25.00) rose. Afghanistan, Maldives, Pakistan and Sri Lanka showed the largest increases, with males consistently more affected. Forecasts indicate further increases in all metrices by 2035. Among risk factors of CRC, smoking showed declining trends but metabolic and dietary factors, particularly high body-mass index, high fasting plasma glucose, and unhealthy diets, showed increasing burden trend in South Asia. CRC burden in South Asia is increasing, driven by modifiable risks, aging populations, and socio-economic disparities. Despite modest mortality improvement, rising incidence and prevalence may strain healthcare systems. Prevention, early screening, and interventions targeting metabolic risks are critical to reducing future burden.