Editorial
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Dec 21, 2009; 15(47): 5907-5915
Published online Dec 21, 2009. doi: 10.3748/wjg.15.5907
Table 1 Colorectal cancer incidence in European countries in 2006
ParameterIncidence
Countries with the highest incidence> 70/100 000 men (ASR-E): Hungary (106), Czech Republic (94.4), Slovakia (87.1), Switzerland (79.1), Germany (70.2)
> 45/100 000 women (ASR-E): Switzerland (55.6), Norway (51.2), Hungary (50.6), Denmark (48), Czech Republic (46), Germany (45.1)
Countries with the lowest incidence< 40/100 000 men (ASR-E): Albania (13.6), Greece (31), Bosnia Herzegovina (34.6), Republic of Moldova (38.7), Finland (39.2)
< 26/100 000 women (ASR-E): Greece (21.3), Albania (21.4), Romania (25.1), Spain (25.4)
Adapted from: Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581-592. ASR-E: European age standard.
Table 2 Colorectal cancer mortality in European countries in 2006
ParameterMortality
Countries with the highest mortality> 40/100 000 men (ASR-E): Hungary (54.4), Czech Republic (51), Slovakia (43.3), Croatia (40.7)
> 20/100 000 women (ASR-E): Hungary (26.7), Slovakia (24.4), Czech Republic (24.1), Denmark (24.1), Norway (21.4)
Countries with the lowest mortality< 20/100 000 men (ASR-E): Albania (7.3), Greece (15.5), Finland (17.9), Switzerland (19.1), Cyprus (19.3), Bosnia Herzegovina (19.5)
< 12/100 000 women (ASR-E): Albania (9.9), Greece (10.8), Finland (11.3), Switzerland (11.6)
Adapted from: Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581-592.
Table 3 Epidemiology of colorectal cancer in the Europe (96 individual cancer registries, 1998-2002)
Parameter incidenceSexC18-C21Individual diagnoses
C18C19-C20C21
Crude incidence (cases/100.000 inhabitants)Men63.937.126.00.8
Women53.734.817.61.3
All58.635.921.71.1
ASR-EMen58.033.523.70.8
Women36.823.412.41.0
All45.827.617.30.9
ASR-WMen38.522.015.90.5
Women24.615.58.40.7
All30.618.311.70.6
Mean age (yr)Men69.169.768.265.4
Women71.371.970.467.7
All70.170.869.166.8
Ratio (males: females) (based on No. of cases)1.1:11.0:11.4:10.6:1
Adapted from: Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P, editors. Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon: IARC, 2007. Available from: URL: http://www-dep.iarc.fr/ section CI5 IX. Last accessed on August 8, 2009. ASR-W: World age standardization.
Table 4 Five-year relative survival rate (RSR) for colorectal cancer for selected European countries
CountryDiagnosesAssessment periodFive-year RSR (%)Change in time (%)Stage-specific estimates
EUROCARE pool[7]C18-C211995-199953.54.2NA
EUROCARE pool[8]C18-C212000-200256.2NANA
England & Wales[10,11]C181996-199947.6 M; 47.4 F5.6 M; 5.6 FNA
C19-C201996-199948.7 M; 51.3 F7.4 M; 8.1 FNA
Germany[12]C18-C212000-200260.8NA85.4 L; 58.1 R; 10.7 M
Finland[13]C18-C202000-200457.92.4NA
Norway[14]C18-C212000-200459.23.6NA
Slovenia[15]C18-C212000-200446.98.0NA
Sweden[16]C182000-200258.1 M; 59.7 F1.8 M; 2.6 FNA
C19-C212000-200257.5 M; 59.1 F2.5 M; -1.7 FNA
M: Estimate for males; F: Estimate for females; NA: Not available; L: Localized; R: Regional; M: Metastatic; NA: Not available. Numbers in brackets represents source of data available at references section.
Table 5 Screening methods
Type of methodMethod
Stool testsFor presence of occult blood (FOBT)
Guaiac-based (gFOBT)
Immunochemical (iFOBT)
For presence of abnormal DNA
Endoscopic examinationsFlexible sigmoidoscopy (FS) colonoscopy
Radiologic examinationsComputed tomographic colonography (CTC)
Double contrast barium enema (DCBE)
Table 6 Colorectal cancer screening programs in 2007
Program
Test typeScreening interval years or times in LTAge eligible national population
TypeStatusAge (yr)Persons (× 1000)
AustriaNonPBNatwFOBT1 or 2> 502210
NonPBNatwCS10> 502210
BelgiumNo Prog2880
BulgariaNonPBNatwFOBT1> 312340
CyprusPBNatw-planFOBT1 in LT5010
PBNatw-planCS1 in LT5510
Czech RepublicNonPBNatwFOBT2> 503010
DenmarkNo Prog1540
EstoniaNo Prog370
FinlandPBNatw-roll ongFOBT260-69570
FrancePBNatw-roll ongFOBT250-7416 600
GermanyNonPBNatwFOBT1 and 2> 5024 500
NonPBNatwCS10 (2 in LT)55-7418 800
GreeceNonPBNatwFOBT5> 503180
NonPBNatwCS5> 503180
HungaryPBNatw-pilotFOBT250-702630
IrelandNo Prog940
ItalyPBNatw-roll ongFOBT250-69 (70-75)13 800
PBReg-roll ongFS1 in LT58 or 6080
LatviaNonPBNatwFOBT1> 50630
LithuaniaNo Prog870
LuxembourgNo Prog120
MaltaNo Prog120
NetherlandsNo Prog4460
PolandPBNatw-roll ongCS1050-657500
PortugalPBNatw-planFOBT250-702520
RomaniaPBNatw-planFOBT250-745800
Slovak RepublicNonPBNatwFOBT> 501360
NonPBNatw-planCS10> 501360
SloveniaPBNatw-planFOBT250-69490
SpainPBReg-pilotFOBT250-69210
SwedenPBReg-planFOBT260-69220
UKPBNatw-roll ongFOBT2(50) 60-69 (74)7600
Dual prog/test-25 630
Subtotal106 490
Excluded pop.29 500
Total135 990
PB: Population based; Prog: Program; Natw: Nationwide; Reg: Regional; Plan: Planning; Roll ong: Rollout ongoing; Pilot: Piloting; CS: Colonoscopy; LT: Lifetime. dual prog/test: Individuals entered twice due to screening programs of different implementation or using different screening tests. excluded pop.: Individuals excluded from national target populations due to regional or national variations in the age group targeted for screening, or due to lack of screening programs in some regions of countries with regional implementation status. Adapted from: von Karsa L, Anttila A, Ronco G, Ponti A, Malila N, Arbyn M, Segnan N, Castillo-Beltran M, Boniol M, Ferlay J, Hery C, Sauvaget C, Voti L, Autier P. Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening - First Report. ISBN 978-92-79-08934-3. European Communities (publ.) Printed in Luxembourg by the services of the European Commission, 2008. Available from: URL: http://ec.europa.eu/health/ph_determinants/genetics/documents/cancer_screening.pdf. Last accessed on August 4, 2009.
Table 7 Cascade concept
LevelAverage riskHigh risk
1Colonoscopy in 10 years interval, from 50 years of ageSpecial procedure, for individual groups
2Colonoscopy once in a lifetime, at 50 years of ageSpecial procedure, for individual groups
3Flexible sigmoidoscopy in 5 years interval, from 50 years of age; colonoscopy to follow if positiveSpecial procedure, for individual groups
4Flexible sigmoidoscopy once in a lifetime, at 50 years of age; colonoscopy to follow if positiveSpecial procedure, for individual groups
5Flexible sigmoidoscopy once in a lifetime, at 50 years of age; colonoscopy to follow only if advanced adenoma is detectedSame as individuals with average risk, if resources are not available for colonoscopy
6FOBT in annual interval after 50 years of age; if positively tested, colonoscopy or double contrast barium enemaSame as individuals with average risk, if resources are not available for colonoscopy
Adapted from: World Gastroenterology Organization/International Digestive Cancer Alliance. Practice Guidelines: Colorectal cancer screening. Available from: URL: http://www.worldgastroenterology.org/colorectal-cancer-screening.html. Last accessed on August 4, 2009.