Decreased Colorectal Cancer Incidence and Incidence-Based Mortality in the Screening-Age Population of Ontario.

Lawrence F Paszat,Rinku Sutradhar,Elyse Corn,Jill Tinmouth,Linda Rabeneck,Nancy N Baxter

doi:10.1093/jcag/gwaa035

Lawrence F Paszat, Rinku Sutradhar + Show 4 more

Open Access

https://doi.org/10.1093/jcag/gwaa035

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Abstract

Background and AimsWe aimed to evaluate trends in Ontario, Canada, 2002 to 2016, in uptake of colorectal evaluative procedures, colorectal cancer (CRC) incidence and incidence-based mortality in the colorectal screening-age population.MethodsWe defined the screening age-eligible population as persons 51 to 74 years of age with ≥1 year eligibility for the Ontario Health Insurance Plan, excluding those with a diagnosis of CRC in the Ontario Cancer Registry (OCR) prior to age 50 or January 1, 2002. We computed annual up-to-date status with colorectal evaluative procedures from billing claims, and CRC incidence from the OCR. In order to compute incidence-based CRC mortality, we included persons with a first diagnosis of CRC between the ages of 51 and 74, diagnosed between January 1, 1992 and December 31, 2001, still alive and <75 years of age on January 1, 2002, based on cause of death from the OCR. Overall, age-stratified and sex-stratified trends were evaluated by Cochran–Armitage trend tests.ResultsPersons up to date with colorectal evaluative procedures increased from 628,214/2,782,061 (22.6%) in 2002 to 2,584,570/4,179,789 (62.2%) in 2016. CRC incidence fell from 129.3/100,000 in 2002 to 94.54/100,000 in 2016, and incidence-based CRC mortality fell from 40.8/100,000 to 24.1/100,000. Decreasing trends in overall and stratified incidence and mortality were all significant, except among persons 51 to 54 years old.ConclusionsThere was continued increase in persons up-to-date with colorectal evaluative procedures, and significant decrease in CRC incidence and incidence-based CRC mortality from 2002 through 2016.

Highlights

We aimed to evaluate trends in Ontario, Canada, 2002 to 2016, in uptake of colorectal evaluative procedures, colorectal cancer (CRC) incidence and incidence-based mortality in the colorectal screening-age population
Identification of the Cohort of Colorectal Screening-Eligible Persons We identified persons 51 to 74 years of age with ≥1 year eligibility for the Ontario Health Insurance Plan (OHIP) during 2002 to 2016 based on OHIP’s Registered Persons Database (RPDB), excluding those with a diagnosis of CRC in the Ontario Cancer Registry (OCR) age
Computation of Incidence-Based CRC Mortality To compute incidence-based CRC mortality [9,10] among persons aged 51 to 74 during 2002 to 2016, we identified the underlying population at risk for CRC death in the screening age-eligible age range by including persons diagnosed with CRC in the colorectal screening age range prior to January 1, 2002, still alive on that date, and still in the age range 51 to 74 years, followed until December 31, 2016, their 75th birthday, last date of OHIP eligibility or date of death, whichever came first

Summary

Introduction

We aimed to evaluate trends in Ontario, Canada, 2002 to 2016, in uptake of colorectal evaluative procedures, colorectal cancer (CRC) incidence and incidence-based mortality in the colorectal screening-age population. We computed annual up-to-date status with colorectal evaluative procedures from billing claims, and CRC incidence from the OCR. Conclusions: There was continued increase in persons up-to-date with colorectal evaluative procedures, and significant decrease in CRC incidence and incidence-based CRC mortality from 2002 through 2016. In 2008, Ontario established ColonCancerCheck (CCC, a population-based colorectal screening program for persons at average risk for CRC aged 50 to 74 years recommending biennial FOBT, and screening by colonoscopy for those with a first-degree relative affected by CRC) [8]

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