Report in English with a Dutch summary (KCE reports 45A)

22 Screening for Colorectal Cancer KCE reports vol.45
2 EPIDEMIOLOGY OF COLORECTAL CANCER
2.1 INTERNATIONAL CLASSIFICATION
Invasive colorectal cancer (CRC) is a malignant disease that starts in the colon
or in the rectum. This definition covers ICD-10 codes 32 C18 (Colon), C19
(RectoSigmoid) and C20 (Rectum) but not C21 (anus and anal canal). In Belgium
these ICD-10 codes are used for recording causes of death.
In clinical record registries such as the minimal data sets, however, the ICD-9-
CM 33 coding system is still being used. Here, colorectal cancers are covered by
codes 153.0 to 154.8 (with exclusion of codes 153.5 = malign neoplasm of
appendix and 154.3 = malign neoplasm of anus, unspecified).
Topographical (location) and morphological (histology) features of neoplastic
lesions are registered by means of the International Classification of Diseases
for Oncology (ICD-O) coding system, currently in its third revision 32. This is
widely used by cancer registries and in anatomopathological protocols of
resection specimens.
2.2 INCIDENCE
Colorectal cancer is the third most common malignant neoplasm in the world
and the second cause of cancer death, with lung cancer being the first cause of
death. Worldwide, colorectal cancer is diagnosed every year in around 1 Million
men and women, and about 500.000 die every year from the disease (Table 2).
If the westernised countries are combined (North America; those in northern,
southern, and western Europe; Australia and New Zealand), colorectal cancer
represents 12,6% of all incident cancer in men and 14,1% in women34, 35.
Table 2: Colorectal cancer worldwide, in Western Europe and in
Belgium (Globocan 2002)
MEN WOMEN
Cases Age-Standardized
Deaths Cases
Rate (/100.000)
Age-Standardized
Rate (/100.000) Deaths
World 550.465 20,1 278.446 472.687 14,6 250.532
Western Europe 64.886 42,9 29.968 60.122 29,8 30.823
Belgium 3.304 37,0 1.732 3.130 26,8 1.764
From Globocan 2002, International Agency for Research on Cancer
(http://www.dep.iarc.fr/ accessed May 16th, 2006)
In 2004 in Europe 36, there were an estimated 2.886.800 incident cases of cancer
diagnosed and 1.711.000 cancer deaths. The most common incident form of
cancer on the European Continent in 2004 was lung cancer (381.500 cases,
13,2% of all incident cases), followed by colorectal cancer (376.400, 13%) and
breast cancer (370.100, 12,8%). Lung cancer was also the largest cause of
cancer death (341.800 deaths, 20% of all deaths), followed by colorectal
(203.700, 11,9%), stomach (137.900, 8,1%) and breast (129.900, 7,6%)
The risk of colorectal cancer begins to increase after the age of 40 and starts to
rise more importantly after the ages of 50 to 55; thereafter the risk continues
to rise, approximately doubling with each succeeding decade 37, 38. Increase is
more slowly in women and, at every age, women have a lower incidence of
colorectal cancer than men 34.