Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study - 29/06/21
Doi : 10.1016/S1470-2045(21)00199-6
Rafael Cardoso, MSc a, b, Feng Guo, PhD b, c, Thomas Heisser, MSc b, c, Monika Hackl, PhD e, Petra Ihle, BA e, Harlinde De Schutter, PhD f, Nancy Van Damme, PhD f, Zdravka Valerianova, ProfPhD g, Trajan Atanasov, PhD g, Ondřej Májek, PhD h, i, Jan Mužík, PhD h, i, Mef Christina Nilbert, ProfPhD j, k, Anne Julie Tybjerg, MSc j, Kaire Innos, PhD l, Margit Mägi, MD m, Nea Malila, PhD n, Anne-Marie Bouvier, PhD o, Véronique Bouvier, MD p, Guy Launoy, ProfPhD q, r, Anne-Sophie Woronoff, MD s, Mélanie Cariou, MSc t, Michel Robaszkiewicz, ProfPhD t, Patricia Delafosse, MD u, Florence Poncet, MD u, Alexander Katalinic, ProfMD v, Paul M Walsh, PhD w, Carlo Senore, MSc x, Stefano Rosso, MD y, Ieva Vincerževskienė, PhD z, Valery E P P Lemmens, ProfPhD aa, ab, Marloes A G Elferink, PhD aa, Tom Børge Johannesen, PhD ac, Hartwig Kørner, ProfPhD ad, ae, Frank Pfeffer, ProfPhD ae, af, Maria José Bento, PhD ag, ah, ai, Jessica Rodrigues, MSc ag, ah, Filipa Alves da Costa, PhD aj, Ana Miranda, MSc aj, Vesna Zadnik, ProfPhD ak, Tina Žagar, PhD ak, Arantza Lopez de Munain Marques, BSc al, Rafael Marcos-Gragera, PhD am, an, ao, Montse Puigdemont, BSN am, an, Jaume Galceran, PhD ap, Marià Carulla, MD ap, María-Dolores Chirlaque, PhD ao, ap, Monica Ballesta, BSc ao, aq, Kristina Sundquist, ProfMD ar, as, at, Jan Sundquist, ProfMD ar, as, at, Marco Weber au, Andrea Jordan au, Christian Herrmann, PhD av, aw, Mohsen Mousavi, MD av, aw, Anton Ryzhov, PhD ax, ay, Michael Hoffmeister, PhD c, Hermann Brenner, ProfMD a, c, d, ⁎ 
a Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
b Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
c Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
d German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
e Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
f Belgian Cancer Registry, Brussels, Belgium
g Bulgarian National Cancer Registry, University Hospital of Oncology, Sofia, Bulgaria
h Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
i Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
j Danish Cancer Society Research Center, Copenhagen, Denmark
k Department of Clinical Medicine, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
l Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
m Estonian Cancer Registry, National Institute for Health Development, Tallinn, Estonia
n Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
o Digestive Cancer Registry of Burgundy, University Hospital of Dijon, INSERM U1231, French Network of Cancer Registries (FRANCIM), Dijon, France
p Digestive Tumors Registry of Calvados, University Hospital of Caen, U1086 INSERM UCN—ANTICIPE, French Network of Cancer Registries (FRANCIM), Caen, France
q Interdisciplinary Research Unit for the Prevention and Treatment of Cancer, Normandy University, University of Caen Normandy, INSERM—ANTICIPE, Caen, France
r Department of Research, University Hospital of Caen, Caen, France
s Cancer Registry of Doubs, Centre Hospitalier Régional Universitaire Besançon, Besançon, France
t Digestive Tumors Registry of Finistère, Centre Hospitalier Régional Universitaire Morvan, French Network of Cancer Registries (FRANCIM), Brest, France
u Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France
v Cancer Registry of Schleswig-Holstein, Lübeck, Germany
w National Cancer Registry Ireland, Cork, Ireland
x University Hospital ‘Città della Salute e della Scienza’, SSD Epidemiologia Screening—CPO Piemonte, Turin, Italy
y Piedmont Cancer Registry, Turin, Italy
z Lithuanian Cancer Registry, National Cancer Institute, Vilnius, Lithuania
aa Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
ab Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
ac Cancer Registry of Norway, Oslo, Norway
ad Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
ae Department of Clinical Medicine, University of Bergen, Bergen, Norway
af Department of Surgery, Haukeland University Hospital, Bergen, Norway
ag Department of Epidemiology, North Region Cancer Registry of Portugal, Portuguese Oncology Institute of Porto, Porto, Portugal
ah IPO Porto Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal
ai Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
aj Portuguese National Cancer Registry, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
ak Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
al Basque Country Cancer Registry, Vitoria-Gasteiz, Spain
am Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
an Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain
ao Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
ap Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain
aq Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
ar Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden
as Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
at Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
au Cancer Registry Bern-Solothurn, Bern, Switzerland
av Cancer Registry of Eastern Switzerland and Liechtenstein, St Gallen, Switzerland
aw Graubünden and Glarus Cancer Registry, Chur, Switzerland
ax National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine
ay Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
* Correspondence to: Prof Hermann Brenner, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany Division of Clinical Epidemiology and Aging Research German Cancer Research Center (DKFZ) Heidelberg 69120 Germany
Summary |
Background |
Colorectal cancer screening programmes and uptake vary substantially across Europe. We aimed to compare changes over time in colorectal cancer incidence, mortality, and stage distribution in relation to colorectal cancer screening implementation in European countries.
Methods |
Data from nearly 3·1 million patients with colorectal cancer diagnosed from 2000 onwards (up to 2016 for most countries) were obtained from 21 European countries, and were used to analyse changes over time in age-standardised colorectal cancer incidence and stage distribution. The WHO mortality database was used to analyse changes over time in age-standardised colorectal cancer mortality over the same period for the 16 countries with nationwide data. Incidence rates were calculated for all sites of the colon and rectum combined, as well as the subsites proximal colon, distal colon, and rectum. Average annual percentage changes (AAPCs) in incidence and mortality were estimated and relevant patterns were descriptively analysed.
Findings |
In countries with long-standing programmes of screening colonoscopy and faecal tests (ie, Austria, the Czech Republic, and Germany), colorectal cancer incidence decreased substantially over time, with AAPCs ranging from −2·5% (95% CI −2·8 to −2·2) to −1·6% (−2·0 to −1·2) in men and from −2·4% (−2·7 to −2·1) to −1·3% (−1·7 to −0·9) in women. In countries where screening programmes were implemented during the study period, age-standardised colorectal cancer incidence either remained stable or increased up to the year screening was implemented. AAPCs for these countries ranged from −0·2% (95% CI −1·4 to 1·0) to 1·5% (1·1 to 1·8) in men and from −0·5% (−1·7 to 0·6) to 1·2% (0·8 to 1·5) in women. Where high screening coverage and uptake were rapidly achieved (ie, Denmark, the Netherlands, and Slovenia), age-standardised incidence rates initially increased but then subsequently decreased. Conversely, colorectal cancer incidence increased in most countries where no large-scale screening programmes were available (eg, Bulgaria, Estonia, Norway, and Ukraine), with AAPCs ranging from 0·3% (95% CI 0·1 to 0·5) to 1·9% (1·2 to 2·6) in men and from 0·6% (0·4 to 0·8) to 1·1% (0·8 to 1·4) in women. The largest decreases in colorectal cancer mortality were seen in countries with long-standing screening programmes.
Interpretation |
We observed divergent trends in colorectal cancer incidence, mortality, and stage distribution across European countries, which appear to be largely explained by different levels of colorectal cancer screening implementation.
Funding |
German Cancer Aid (Deutsche Krebshilfe) and the German Federal Ministry of Education and Research.
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Vol 22 - N° 7
P. 1002-1013 - juillet 2021 Retour au numéro
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