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 - Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021

Y1 - 2021

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.

U2 - 10.1016/S1470-2045(21)00199-6

DO - 10.1016/S1470-2045(21)00199-6

M3 - Journal article

C2 - 34048685

AN - SCOPUS:85108791289

VL - 22

SP - 1002

EP - 1013

JO - The Lancet Oncology

JF - The Lancet Oncology

SN - 1470-2045

IS - 7

ER -