TY - JOUR
T1 - Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era
T2 - an international population-based study
AU - Cardoso, Rafael
AU - Guo, Feng
AU - Heisser, Thomas
AU - Hackl, Monika
AU - Ihle, Petra
AU - De Schutter, Harlinde
AU - Van Damme, Nancy
AU - Valerianova, Zdravka
AU - Atanasov, Trajan
AU - Májek, Ondřej
AU - Mužík, Jan
AU - Nilbert, Mef Christina
AU - Tybjerg, Anne Julie
AU - Innos, Kaire
AU - Mägi, Margit
AU - Malila, Nea
AU - Bouvier, Anne-Marie
AU - Bouvier, Véronique
AU - Launoy, Guy
AU - Woronoff, Anne-Sophie
AU - Cariou, Mélanie
AU - Robaszkiewicz, Michel
AU - Delafosse, Patricia
AU - Poncet, Florence
AU - Katalinic, Alexander
AU - Walsh, Paul M
AU - Senore, Carlo
AU - Rosso, Stefano
AU - Vincerževskienė, Ieva
AU - Lemmens, Valery E P P
AU - Elferink, Marloes A G
AU - Johannesen, Tom Børge
AU - Kørner, Hartwig
AU - Pfeffer, Frank
AU - Bento, Maria José
AU - Rodrigues, Jessica
AU - Alves da Costa, Filipa
AU - Miranda, Ana
AU - Zadnik, Vesna
AU - Žagar, Tina
AU - Lopez de Munain Marques, Arantza
AU - Marcos-Gragera, Rafael
AU - Puigdemont, Montse
AU - Galceran, Jaume
AU - Carulla, Marià
AU - Chirlaque, María-Dolores
AU - Ballesta, Monica
AU - Sundquist, Kristina
AU - Sundquist, Jan
AU - Weber, Marco
AU - Jordan, Andrea
AU - Herrmann, Christian
AU - Mousavi, Mohsen
AU - Ryzhov, Anton
AU - Hoffmeister, Michael
AU - Brenner, Hermann
N1 - Copyright © 2021 Elsevier Ltd. All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
KW - Adult
KW - Age Distribution
KW - Aged
KW - Colorectal Neoplasms/epidemiology
KW - Early Detection of Cancer
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Predictive Value of Tests
KW - Registries
KW - Sex Distribution
KW - Time Factors
UR - http://www.scopus.com/inward/record.url?scp=85108791289&partnerID=8YFLogxK
U2 - 10.1016/S1470-2045(21)00199-6
DO - 10.1016/S1470-2045(21)00199-6
M3 - Journal article
C2 - 34048685
SN - 1470-2045
VL - 22
SP - 1002
EP - 1013
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 7
ER -