Rafael Cardoso1, Feng Guo2, Thomas Heisser2, Monika Hackl3, Petra Ihle3, Harlinde De Schutter4, Nancy Van Damme4, Zdravka Valerianova5, Trajan Atanasov5, Ondřej Májek6, Jan Mužík6, Mef Christina Nilbert7, Anne Julie Tybjerg8, Kaire Innos9, Margit Mägi10, Nea Malila11, Anne-Marie Bouvier12, Véronique Bouvier13, Guy Launoy14, Anne-Sophie Woronoff15, Mélanie Cariou16, Michel Robaszkiewicz16, Patricia Delafosse17, Florence Poncet17, Alexander Katalinic18, Paul M Walsh19, Carlo Senore20, Stefano Rosso21, Ieva Vincerževskienė22, Valery E P P Lemmens23, Marloes A G Elferink24, Tom Børge Johannesen25, Hartwig Kørner26, Frank Pfeffer27, Maria José Bento28, Jessica Rodrigues29, Filipa Alves da Costa30, Ana Miranda30, Vesna Zadnik31, Tina Žagar31, Arantza Lopez de Munain Marques32, Rafael Marcos-Gragera33, Montse Puigdemont34, Jaume Galceran35, Marià Carulla35, María-Dolores Chirlaque36, Monica Ballesta37, Kristina Sundquist38, Jan Sundquist38, Marco Weber39, Andrea Jordan39, Christian Herrmann40, Mohsen Mousavi40, Anton Ryzhov41, Michael Hoffmeister42, Hermann Brenner43. 1. Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany. 2. Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. 3. Austrian National Cancer Registry, Statistics Austria, Vienna, Austria. 4. Belgian Cancer Registry, Brussels, Belgium. 5. Bulgarian National Cancer Registry, University Hospital of Oncology, Sofia, Bulgaria. 6. Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic. 7. Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark. 8. Danish Cancer Society Research Center, Copenhagen, Denmark. 9. Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia. 10. Estonian Cancer Registry, National Institute for Health Development, Tallinn, Estonia. 11. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland. 12. Digestive Cancer Registry of Burgundy, University Hospital of Dijon, INSERM U1231, French Network of Cancer Registries (FRANCIM), Dijon, France. 13. Digestive Tumors Registry of Calvados, University Hospital of Caen, U1086 INSERM UCN-ANTICIPE, French Network of Cancer Registries (FRANCIM), Caen, France. 14. Interdisciplinary Research Unit for the Prevention and Treatment of Cancer, Normandy University, University of Caen Normandy, INSERM-ANTICIPE, Caen, France; Department of Research, University Hospital of Caen, Caen, France. 15. Cancer Registry of Doubs, Centre Hospitalier Régional Universitaire Besançon, Besançon, France. 16. Digestive Tumors Registry of Finistère, Centre Hospitalier Régional Universitaire Morvan, French Network of Cancer Registries (FRANCIM), Brest, France. 17. Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France. 18. Cancer Registry of Schleswig-Holstein, Lübeck, Germany. 19. National Cancer Registry Ireland, Cork, Ireland. 20. University Hospital 'Città della Salute e della Scienza', SSD Epidemiologia Screening-CPO Piemonte, Turin, Italy. 21. Piedmont Cancer Registry, Turin, Italy. 22. Lithuanian Cancer Registry, National Cancer Institute, Vilnius, Lithuania. 23. Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands. 24. Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands. 25. Cancer Registry of Norway, Oslo, Norway. 26. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. 27. Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Surgery, Haukeland University Hospital, Bergen, Norway. 28. Department of Epidemiology, North Region Cancer Registry of Portugal, Portuguese Oncology Institute of Porto, Porto, Portugal; IPO Porto Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal; Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal. 29. Department of Epidemiology, North Region Cancer Registry of Portugal, Portuguese Oncology Institute of Porto, Porto, Portugal; IPO Porto Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal. 30. Portuguese National Cancer Registry, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal. 31. Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia. 32. Basque Country Cancer Registry, Vitoria-Gasteiz, Spain. 33. Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain. 34. Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain. 35. Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain. 36. Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain; Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute, Reus, Spain. 37. Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain. 38. Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden; 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; Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan. 39. Cancer Registry Bern-Solothurn, Bern, Switzerland. 40. Cancer Registry of Eastern Switzerland and Liechtenstein, St Gallen, Switzerland; Graubünden and Glarus Cancer Registry, Chur, Switzerland. 41. National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine; Taras Shevchenko National University of Kyiv, Kyiv, Ukraine. 42. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. 43. Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany. Electronic address: h.brenner@dkfz.de.
Abstract
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.
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.
Authors: Hermann Brenner; Michael Hoffmeister; Thomas Heisser; Anna Zhu; Rafael Cardoso Journal: Dtsch Arztebl Int Date: 2021-10-01 Impact factor: 5.594
Authors: Olusegun I Alatise; Anna J Dare; Patrick A Akinyemi; Fatimah B Abdulkareem; Samuel A Olatoke; Gregory C Knapp; T Peter Kingham Journal: Lancet Glob Health Date: 2022-07 Impact factor: 38.927
Authors: Rafael Cardoso; Feng Guo; Thomas Heisser; Harlinde De Schutter; Nancy Van Damme; Mef Christina Nilbert; Jane Christensen; Anne-Marie Bouvier; Véronique Bouvier; Guy Launoy; Anne-Sophie Woronoff; Mélanie Cariou; Michel Robaszkiewicz; Patricia Delafosse; Florence Poncet; Paul M Walsh; Carlo Senore; Stefano Rosso; Valery E P P Lemmens; Marloes A G Elferink; Sonja Tomšič; Tina Žagar; Arantza Lopez de Munain Marques; Rafael Marcos-Gragera; Montse Puigdemont; Jaume Galceran; Marià Carulla; Antonia Sánchez-Gil; María-Dolores Chirlaque; Michael Hoffmeister; Hermann Brenner Journal: Lancet Reg Health Eur Date: 2022-07-06
Authors: Johannes Van der Meer; Pavlos Mamouris; Vahid Nassiri; Bert Vaes; Marjan van den Akker Journal: BMJ Open Date: 2021-12-10 Impact factor: 2.692