Abstract
OBJECTIVES: The aims of this study were to determine whether pattern of patients presenting with colorectal cancer (CRC) in the last few years differs significantly from that previously reported in Australia, and to relate the trends, if present, to use of hormone replacement therapy (HRT). METHODS: We examined demographic and pathological characteristics of 145 consecutive CRC patients (65 females) treated in our institution in calendar years 2006-2007. Comparisons were made with data on 12536 CRC patients obtained from the Australian Association on Cancer Registries (AACR) for the year 2003, most recent available. Prescribing data for HRT were obtained from the Australian Commonwealth Department of Health and Ageing. RESULTS: The distribution of colon, sigmoid and rectal cancers in our series was 40%, 24.8% and 35.2%, respectively, which differs significantly from 65%, 8.1% and 26.9% in the AACR data (p < 0.01). Our cohort was significantly younger (65.4 ± 12.1 vs. 69.5 ± 12.3 years), especially females (63.0 ± 12.7 vs. 70.3 ± 13.0 years; p < 0.001). The proportion of female patients aged < 55 and < 60 years was significantly higher (30.8% vs. 13.8% and 41.5% vs. 21.4%, respectively). Younger patients have more aggressive and advanced cancers. In Australia HRT use declined since 2001 and fell by a half in 2006. CONCLUSIONS: In the changing CRC pattern of greatest concern is a significantly higher proportion of younger patients, especially females, with higher prevalence of more advanced and aggressive cancers, coincident with decreased prescribing of HRT. These findings may have important implications for refining screening and preventive strategies and on demand for radiotherapy services.
Highlights
Colorectal cancer (CRC) is the most prevalent non-skin malignancy and second highest cause of cancer-related death in Australia [1] as in other industrialized countries
Of 145 patients with CRC admitted to our hospital in the 2 year period there were 65 (44.8%) females with a mean age of 63.0 ± 12.7 years and 80 (55.2%) males with a mean age of 67.3 ± 11.4 years
In our series there was a more distal distribution of CRC comparing with that seen previously in the Australian population: the proportion of rectal (35.2% vs 26.9%, p = 0.032) and sigmoid cancers (24.8% vs 8.1%; p = 0.003) was significantly higher and the proportion of colon cancers (40% vs 65%, p = 0.001) was significantly lower
Summary
Colorectal cancer (CRC) is the most prevalent non-skin malignancy and second highest cause of cancer-related death in Australia [1] as in other industrialized countries. In the last two decades a decline in incidence and mortality rates for CRC has been observed in most developed countries including Australia [2,3,4,5,6,7,8,9]. The reasons for this trend may include risk factors modification, introduction of screening and improvements in medical intervention. No study to date has addressed possible effects of reduced HRT use on CRC trends
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