Epidemiology Of Colorectal Cancer Research Articles

Bevölkerungsbezogene Darmkrebsinzidenz im Zeitraum 2000 bis 2006 – Deuten sich erste Auswirkungen des Koloskopie-Screenings an? Eine gemeinsame Auswertung der Krebsregisterdaten aus Bremen, Hamburg, dem Saarland und Schleswig-Holstein

BACKGROUND: A quality assured colonoscopy screening was implemented in Germany in the year 2002. Persons aged 55 years or older with a health insurance are eligible. The primary aim of colonoscopy screening is the early detection of cancer. Furthermore, an incidence decrease is expected due to systematic adenomectomy. Up to date, neither a systematic monitoring of epidemiological data nor a mortality evaluation has been contracted by law. MATERIALS AND METHODS: Four population-based cancer registries of the federal states Bremen, Hamburg, Saarland, and Schleswig-Holstein in Germany provided incidence data on colorectal cancers during 2000 – 2006. Age-standardised and stage-specific incidence rates and time trends (Joinpoint analysis and APC method) are reported. RESULTS: Overall 34,100 colorectal cancers were registered, of which 91 % were within the screening-eligible age group. The incidence rise of in situ-cancers of the colon and rectum was significant. Changes in tumours of the T 3- and T 4-categories were not consistent. DISCUSSION: There seems to be a temporal linkage between the implementation of a quality assured colonoscopy screening and the epidemiology of colorectal cancers in Germany. The observed changes cannot be attributed definitively to the screening activities, because required data are not available on the population level. A linkage of screenees and cancer data from registered tumour patients, which allows an individual follow-up and a mortality evaluation, would be desirable.

Risk for colorectal cancer in elderly persons and possible methodologies for their screening

Most colorectal cancer (CRC) screening guidelines recommend average-risk screening up to the age of 75 years. However, increasing life span and incidence of proximal CRC could require changes to the age guidelines and adapting screening methodology for the elderly persons. Therefore, we reviewed our CRC epidemiology, international screening age-guidelines, and screening tests for the elderly persons and presented our long-term results of colonoscopy and semi-quantitated immunochemical fecal occult blood tests (I-FOBTs) in individuals that are 75 years or more. We examined the Israel National Cancer Registry (INCR) data to assess the risk of CRC in individuals aged 75 years or more. We re-examined files of patients aged 75 years or more, who underwent both colonoscopy and three I-FOBTs, and followed them through the INCR to identify new cases of CRC. Nationwide, during 2005 and 2007, 41.3% of all CRCs occurred in individuals aged 75 years or more. Both I-FOBT and colonoscopy were performed on 271 individuals (mean age: 78.5 years, standard deviation: 3.1). Both initial colonoscopy and I-FOBT of at least 50 ngHb/ml buffer in either of the first two tests identified six patients with CRC; INCR registered another stage 1 rectal CRC within 1 year. Therefore, the initial sensitivity to CRC of either test was 85.7% (95% confidence interval: 59.8 and 112), valid during a mean of 44.3 months and a standard deviation of 13.4 at INCR follow-up; 14 of 27 advanced adenomatous polyps were identified by I-FOBT, giving a sensitivity of 58.8% (95% confidence interval: 42.3 and 75.4) for CRC or advanced adenomatous polyps. Recently, 41.3% of our CRCs occurred in individuals aged 75 years or more, diagnosed clinically and not by screening. I-FOBT and initial colonoscopic CRC sensitivity were similar, both having false-negative results. Screening age guidelines need reconsideration; our initial results show that semi-quantitated I-FOBT screening is feasible but needs large-scale evaluation in 'healthy' elderly persons.

The Changing Epidemiology of Colorectal Cancer and Its Relevance to Adapting Age Screening Guidelines and Methods for the Elderly

The Changing Epidemiology of Colorectal Cancer and Its Relevance to Adapting Age Screening Guidelines and Methods for the Elderly

Abstract 1919: Baseline characteristics of colorectal cancer patients enrolled in the colorectal cancer outcomes, prognosis and epidemiology cohort (The COPE) study

Abstract Background: Obesity is a public health problem and an increasing number of colorectal cancer patients will be obese. The impact of obesity on the efficacy of colorectal cancer treatment and patient outcomes has only recently been elucidated. However, evidence is lacking on the mechanism linking obesity to poor outcomes among colorectal cancer patients. There are emerging data to suggest that the underlying mechanism for this association is mediated in part by hyperinsulinemia and insulin resistance, via the insulin-insulin-like growth factor (IGF) axis, and modulated in part by adiponectin. Using a multidisciplinary approach, the Colorectal Cancer Outcomes, Prognosis and Epidemiology Study will elucidate the biological effects of elevated insulin and IGF-factors on tumor gene expression and their impact on quality of life. Objective: The objectives of this presentation are to present the study design and baseline characterize of colorectal cancer participants enrolled to date in the COPE study. Methods: We are establishing a cohort of 350 colorectal cancer patients identified at the Moffitt Cancer Center. All patients will be followed at regular intervals to obtain data on health outcomes, health behaviors, symptoms, and quality of life, and blood draws will occur at (∼6 and 12 months post-enrollment). An electronic intake form collected use of dietary supplements and of medications (including multivitamins, folate, and NSAIDs, with type and frequency); smoking, and a brief assessment of physical activity at baseline. BMI, waist and hip measures are taken at each visit. The assessment of quality of life and symptoms will be based on validated standard instruments (European Organization for Research and Treatment of Cancer QLQ-C30) administered at baseline, 3, 6 and 12 month follow-up time points, with slight adaptations in timing for patients undergoing chemotherapy. Results: Overall, a total of seventy five colorectal cancer patients have been enrolled. Among these patients, 60% have colon cancer and 40% were diagnosed with rectal cancer. A majority of the patients were married with some higher education. Sixty percent of the participants were female. There was an equal distribution of cases enrolled across stages I – III, with very few stage IV patients. A full characterization of the cohort will be presented. Conclusion: Overall, the COPE study is designed to recruit a hospital based cohort of colorectal cancer cases to evaluate the association between body size, insulin/IGF and colorectal cancer outcomes. We have successfully recruited and followed patients over a twelve month period. We are now poised to evaluate our primary objectives among a cohort of colorectal cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1919. doi:10.1158/1538-7445.AM2011-1919

Abstract 3767: Familial colorectal cancer registry in Hispanics: A feasibility study

Abstract BACKGROUND: In Puerto Rico (PR), colorectal cancer (CRC) represents the second most common cause of cancer in men and women. Incidence and mortality of CRC are increasing in Puerto Rican Hispanics, especially among young individuals. Screening rates for CRC are lower in Hispanic-American individuals compared to non-Hispanic patients. However, there is limited data on genetic epidemiological CRC disparities in Hispanic patients. OBJECTIVES: (1) To prospectively identify and recruit 30 probands with a family history of CRC and 15 family-history negative (2) To prospectively identify and recruit selected relatives from the 45 probands. METHODS: Eligible cases are Hispanic patients with incident diagnosis of CRC, ≥ 21 years old. We identified the probands and their selected family members using the Puerto Rico Central Cancer Registry from July 1, 2007 to the present. PRELIMINARY DATA AND RECRUITMENT: Seven hundred and fifty-one communications were sent to the physicians, three hundred and seventy-four communications were responded (374/751=49.8%).Three hundred and forty-one communications were sent to the patients, one hundred and forty-seven letters were responded (147/341=43.1%) and 16 refused. One hundred and fifty-nine participants (probands and relatives) were enrolled. One hundred and two probands (mean age 56.9 ±13.3 yrs., 54.9% male); 30 with and 72 without family history of CRC. At present, we collected 153 (96.2%) risk factors questionnaires, 135 (84.9%) blood samples and 60 (52.6%) blocks of tissue. CONCLUSIONS: Successful implementation of logistics for identification of incident CRC through the PR Central Cancer Registry during a three-year period. We established the first Familial CRC island-wide registry in Puerto Rico through the implementation of a network of community physicians, laboratories and professional societies. We are developing a tissue and blood bank with epidemiological, nutritional, and demographic data that will assist us to understand the genetic epidemiology of CRC in Puerto Ricans. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3767. doi:10.1158/1538-7445.AM2011-3767

Association of use of bisphosphonates with risk of colorectal cancer.

371 Background: Bisphosphonates are commonly used for the treatment of osteoporosis and of bone metastases due to breast cancer and were recently reported to be associated with reduced risk of breast cancer, but their association with risk of other cancers is unknown. Methods: The Molecular Epidemiology of Colorectal Cancer (MECC) study is a population-based case-control study in northern Israel of colorectal cancer cases and age/sex/clinic/ethnic-group matched controls. Use of bisphosphonates prior to diagnosis was assessed in a subset of 933 pairs of post-menopausal female cases and controls, enrolled in Clalit Health Services (CHS), using computerized pharmacy records. Results: The use of bisphosphonates for more than one year prior to diagnosis, but not for less than a year, was associated with a significantly reduced relative risk of colorectal cancer (odds ratio=0.50, 95% CI: 0.35-0.71). This association remained statistically significant after adjustment for, vegetable consumption, sports activity, family history of colorectal cancer, , BMI, use of low-dose aspirin, statins, vitamin D and post-menopausal hormones (OR=0.40, 0.24-0.64). Concomitant use of bisphosphonates and statins did not further reduce the risk. Conclusions: The use of oral bisphosphonates for more than 1 year was associated with a 60% relative reduction in the risk of colorectal cancer similar to the recently reported association of this drug class with reduction in breast cancer risk. No significant financial relationships to disclose.

Colorectal Carcinoma: Why Is There a Lower Incidence in Nigerians When Compared to Caucasians?

Carcinoma of the colon and rectum is the 2nd commonest cancer in the United States; the leading cancer being lung cancer. It has been estimated that 130,200 new cases of colorectal cancer will be diagnosed annually while 56,300 sufferers will die from the disease (Murphy et al., 2000). In developing countries especially West Africa, the rate has not yet reached such magnitude. This suggests that there may be factors either anthropomorphic or environmental which may be responsible for this. The paper acknowledges the reduced incidence of colorectal cancer in native West Africans living in Africa and endeavours to highlight the various factors that produce this observation in medical literature. A diligent search through available literature on the aetiology, epidemiology and comparative anthropology of colorectal cancer was done. Internet search using Pubmed, British library online and Google scholar was also utilized. The rarity of adenomatous polyposis syndromes in the native West African contributes to the reduced incidence of colorectal cancer. Cancer prevention and cancer-protective factors are deemed to lie in the starchy, high-fiber, spicy, peppery foodstuff low in animal protein which many West African nations consume.

The changing epidemiology of colorectal cancer and its relevance for adapting screening guidelines and methods

In many countries at risk for colorectal cancer (CRC), screening guidelines provide average-risk screening for patients aged between the ages of 50 and 75 years. However, an earlier onset of CRC, an increasing life span and an incidence of right-sided CRC have been noted, which could require changes in age guidelines and screening methodology, especially for the elderly. We examined this in our Jewish populations using Israel Cancer Registry data, 1980-2008, computed by age groups, sex, ethnic groups, cancer site, and cancer stage. In patients who were below 50 years of age, there was no significant increase in incidence except for men born in Israel (P=0.05). In patients aged between 50 and 74 or more than 75 years there was an increased incidence (P<0.001 for both). However, the percentage for CRC patients aged between 50 and 74 years decreased but those who were aged more than 75 years increased (P<0.001 for both). Therefore, 45.3% of patients (39.1% aged ≥ 75 years) would not be electively screened. In addition, there was an increased trend (P<0.001) for right-sided (from cecum to and including the splenic flexure) CRC in patients both 50-74 and more than 75 years old. During 1999-2008, as compared with patients aged between 50 and 74 years, those below 50 years were less likely to be diagnosed with stage 1 or 2 CRC and more likely have stage 3 or 4 CRC (P<0.01 for all), whereas those aged more than 75 years were less likely to have stage 3 CRC (P<0.01). These results should influence CRC screening age guidelines, especially for 'healthy' individuals aged 75 years or more, and their need for noninvasive, but sensitive and specific pre-colonoscopy screening methodologies. In addition, the more advanced cancer stage in the patients aged below 50 years needs to make the treating physicians more aware of the fact that CRC can occur even at this age.

Bevölkerungsbezogene Darmkrebsinzidenz im Zeitraum 2000 bis 2006 – Deuten sich erste Auswirkungen des Koloskopie-Screenings an? Eine gemeinsame Auswertung der Krebsregisterdaten aus Bremen, Hamburg, dem Saarland und Schleswig-Holstein

A quality assured colonoscopy screening was implemented in Germany in the year 2002. Persons aged 55 years or older with a health insurance are eligible. The primary aim of colonoscopy screening is the early detection of cancer. Furthermore, an incidence decrease is expected due to systematic adenomectomy. Up to date, neither a systematic monitoring of epidemiological data nor a mortality evaluation has been contracted by law. Four population-based cancer registries of the federal states Bremen, Hamburg, Saarland, and Schleswig-Holstein in Germany provided incidence data on colorectal cancers during 2000 - 2006. Age-standardised and stage-specific incidence rates and time trends (Joinpoint analysis and APC method) are reported. Overall 34,100 colorectal cancers were registered, of which 91 % were within the screening-eligible age group. The incidence rise of in situ-cancers of the colon and rectum was significant. Changes in tumours of the T 3- and T 4-categories were not consistent. There seems to be a temporal linkage between the implementation of a quality assured colonoscopy screening and the epidemiology of colorectal cancers in Germany. The observed changes cannot be attributed definitively to the screening activities, because required data are not available on the population level. A linkage of screenees and cancer data from registered tumour patients, which allows an individual follow-up and a mortality evaluation, would be desirable.

Cost-Effectiveness of Colorectal Cancer Screening in High-Risk Spanish Patients: Use of a Validated Model to Inform Public Policy

The European Community has made a commitment to colorectal cancer (CRC) screening, but regional considerations may affect the design of national screening programs. We developed a decision analytic model tailored to a pilot screening program for high-risk persons in Spain with the aim of informing public policy decisions. We constructed a decision analytic Markov model based on our validated model of CRC screening that reflected CRC epidemiology and costs in persons with first-degree relatives with CRC in Aragón, Spain, and superimposed colonoscopy every 5 or 10 years from ages 40 to 80 years. The pilot program's preliminary clinical results and our modeling results were presented to regional health authorities. In the model, without screening, 88 CRC cases occurred per 1,000 persons from age 40 to 85 years. In the base case, screening reduced this by 72% to 77% and gained 0.12 discounted life years per person. Screening every 10 years was cost saving, and screening every 5 years versus every 10 years cost 7,250 euros per life year gained. Based on these savings, 36 to 39 euros per person per year could go toward operating costs while maintaining a neutral budget. If screening costs doubled, screening remained highly cost-effective but no longer cost saving. These results contributed to the health authorities' decision to expand the pilot program to the entire region in 2009. Colonoscopic screening of first-degree relatives of persons with CRC may be cost saving in public systems like that of Spain. Decision analytic modeling tailored to regional considerations can inform public policy decisions. Tailored decision analytic modeling can inform regional policy decisions on cancer screening.

Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study

ObjectiveEpidemiological data on synchronous and metachronous lung metastases from colorectal cancer are scarce. The aim of this study was to determine trends in the incidence, treatment and survival in colorectal...

Do nutraceutics play a role in the prevention and treatment of colorectal cancer?

Colorectal cancer is the third most common cancer worldwide with a 5-year survival of 50%. Current chemotherapeutic regimens used for advanced colorectal cancer provide an average survival of approximately 20 months. Non-toxic agents such as nutraceutics and supplements have been shown to aid in the prevention and adjuvant treatment of colorectal cancer. This article will discuss the epidemiology, progression, prevention, treatment, and recurrence of colorectal cancer and the role of nutraceutics and supplements in the treatment process.

Subsite-specific differences of estrogen receptor beta expression in the normal colonic epithelium: implications for carcinogenesis and colorectal cancer epidemiology

This study aimed at investigating whether a differential estrogen receptor beta (ER-beta) expression between the colonic subsites could correspond to a modification in proliferation, apoptosis, and adhesion of the normal colonocytes. ER-beta, Ki-67, Bcl-2, and E-cadherin expressions were investigated immunohistochemically, in normal epithelium biopsies from the ascending and the descending colon of 53 individuals, who underwent colonoscopy for the investigation of anemia and in whom no local pathology was identified. ER-beta immunoreactivity has been shown to be stronger at the superficial epithelium than the crypts' base, the difference being important only for the ascending colon. In addition, ER-beta expression was higher in the superficial epithelium of the ascending colon than that of the descending colon. The variations of ER-beta expression did not correspond to the alterations in Ki-67, Bcl-2, and E-cadherin expression. A subsite-specific variation of ER-beta expression has been shown in the normal colonic epithelium. This modulation of ER-beta might account for some well established specificities of colorectal cancer epidemiology like the right-sided predominance of the neoplasm in women and its gradual shift to more proximal sites over time.

Cost Effectiveness of CT Colonography for UK NHS Colorectal Cancer Screening of Asymptomatic Adults Aged 60–69 Years

Screening of populations at risk for colorectal cancer (CRC) allows the detection and successful treatment of tumours and their precursor polyps. The current UK CRC screening programme is faecal occult blood testing (FOBT), despite evidence from modelling studies to suggest that more cost-effective technologies exist. To assess the cost effectiveness of CT colonography (CTC) for colorectal cancer screening from the perspective of the UK NHS. A state-transition Markov model was constructed to estimate lifetime costs and health outcomes of a cohort of individuals screened at age 60-69 years using four different CRC screening technologies: FOBT, flexible sigmoidoscopy, optical colonoscopy and CTC. CTC screening offered every 10 years was cost saving compared with the current UK programme of biennial FOBT screening. This strategy also yielded greater health benefits (QALYs and life-years) than biennial FOBT screening. The model fit observed CRC epidemiology data well and was robust to changes in underlying parameter values. CTC remained cost effective under a range of assumptions in the univariate sensitivity analysis. However, in the probabilistic sensitivity analysis, CTC dominated FOBT in only 5.9% of simulations and was cost effective at a threshold of pound30,000 per QALY gained in 48% of simulations. CTC has the potential to provide a cost-effective option for CRC screening in the UK NHS and may be cost saving compared with the current programme of biennial FOBT. Further analysis is required to assess the impact of introducing CTC to the UK CRC screening programme on the NHS budget and capacity.

Abstract 2701: Clinical implications of UGT1A1*28 genotype testing in colorectal cancer patients

Abstract Purpose: Metastatic colorectal cancer is frequently treated with Irinotecan (CPT-11), a topoisomerase-I inhibitor. Irinotecan toxicity is relatively commonly observed. The gene UGT1A1 encodes an enzyme that catalyzes the glucuronidation of the active irinotecan metabolite SN-38 which is eliminated in the liver by metabolic alteration to an inactive form SN-38G. We retrospectively evaluated the association between UGT1A1 genetic variation, prevalence of severe toxicity and colorectal survival. Patients and Methods: In the Molecular Epidemiology of Colorectal Cancer (MECC) Study we identified 213 patients with metastatic colorectal cancer treated by irinotecan-based chemotherapy (FOLFIRI, IFL). DNA extracted from blood was used for genotyping either by simple determination of TATA box sequence in patient DNA or by implementation of fragment analysis that detects the difference in the number of nucleotides in the specific region analyzed. The polymorphism UGT1A1*28 is characterized by the presence of an additional TA repeat in the TATA sequence of the UGT1A1 promoter, ((TA)7TAA, instead of (TA)6TAA). Data on side effects and survival were extracted from full follow-up oncology records. Results: UGT1A1*28 genotypes 6/6, 6/7, 7/7 were detected in 41.8%, 46.5%, and 11.7% of the patients respectively. Observed grade 3-4 toxicity included: diarrhea 22.4%, leucopenia 9.3%, neutropenia 8.9%, neutropenic fever 3.7%, and mucositis 4%. No significant difference was observed in the rate of diarrhea in patients with UGT1A1*28 7/7 genotype (20%) as compared to these with the 6/6 genotype (27.5%). Hematological toxicity was significantly more common in patients with the 7/7 genotype. Neutropenic fever was observed in 24% of the 7/7 genotype but only in 2% of the 6/7 genotype and 0% of the 6/6 genotype. Oncological hospitalization rate was very high among the 7/7 group (45.8%) and significantly higher than among the 6/6 group (14.4%). The Median overall survival of patients with 7/7 was significantly lower (2.10 years) than that of patients with the 6/6 variant (4.13 years, p=0.002). Conclusion: UGT1A1*28 7/7 genotype is strongly associated with severe toxicity (mainly neutropenic fever) and oncological hospitalizations and with lower survival. These data support the FDA recommendation and product labeling to tailor treatment plans for colorectal cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2701.

Abstract 4740: Identification of new genes of clinical interest for colorectal cancer: Study design considerations for association studies

Abstract Introduction. About 70% of the familial aggregation of colorectal cancer (CRC) cannot be explained by known defects on the predisposing MisMatch Repair (MMR) genes. Recent Genome-Wide Association Studies (GWAS) have detected only a few variants which collectively account for a marginal proportion of this otherwise unexplained excess familial risk. The emerging paradigm is that genetic variants of clinical interest for familial CRC are rarer than those tested by GWAS, and therefore are not explored. Using data simulation and mathematical modelling, we tried to identify appropriate study designs in this setting. Methods. Using the mathematical properties of multilocus exchangeable models, we first selected combinations of allele frequencies, genotypic risks, number of loci, and degree of dominance of unknown biallelic susceptibility genes that were both compatible with the genetic epidemiology of CRC and of clinical interest. Then, using a simulation program for familial data, we assessed the sample sizes required to reach 90% power when comparing ascertainment strategies for association studies. Specifically, we investigated the effect of case selection according to familial criteria, and compared both population- and familial-based approaches. Our simulation program took into account real population data including demographics, CRC incidence by age and global mortality. Results. As expected, selecting cases on familial criteria considerably increased the power of association studies under the hypothesis of rare causal alleles of moderate to high effect. For example, for the case-control study design, if the mode of inheritance of causal variants was additive, with an allele frequency of 0.001 and a genotype relative risk of 10, the sample size required could be divided by 3 if all CRC cases had at least one affected first degree relative. When using the transmission disequilibrium test with the same genetic parameters in the familial-based approach, similar results were obtained in terms of numbers of parents-affected child triads. However, compared with the case-control design, the relative gains in power were lower for more frequent alleles. Finally, we found that unaffected relatives of familial CRC cases had a frequency of at-risk alleles similar to that of sporadic CRC cases, and therefore could be added to CRC cases in case-control studies. Conclusion. Although testing rare alleles is difficult because few individuals are exposed in a given population, ascertainment strategies based on cases selected from multiple CRC families, including both affected and unaffected individuals, could dramatically reduce the sample size for association studies. Our results could be useful to plan future studies, and highlight the potential of data collected in cancer genetics clinics. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4740.

Liver Resection of Colorectal Metastases in Elderly Patients

The ageing population, the specific epidemiology of colorectal cancer (CRC) and the high incidence of colorectal liver metastases (CRLM) have all led to a significant increase in elderly patients with CRLM seeking surgical management. Due to physiological and functional changes with advancing age (which may decrease the ability of the elderly to sustain aggressive treatment) and the lack of validated guidelines, surgeons still hesitate to plan surgical resection of CRLM in the elderly. Recently, a few studies have suggested that resection of CRLM in the elderly is feasible and yields good short- and long-term outcomes in the context of an intention-to-treat strategy. This article discusses the relevant literature and tries to put forth possible recommendations for the surgical management of elderly patients with CRLM. No chronological upper age limit should contraindicate curative treatment and well-selected elderly patients with advanced CRC can be offered a similar chance of long-term survival with the use of an optimal onco-surgical strategy.

Epidemiology of colorectal cancer in Asia

The prevalence of colorectal cancer is increasing in Asia. However, the age-standardized rate has reached a plateau in some countries. Some studies have shown a male predominance difference and increasing risk in the elderly, but not in the younger population. 'Right shifting' of colorectal cancer, not accountable by difference in age or the indications for endoscopic examination, has also been noted. Westernized diet is associated with colorectal cancer, but controversy remains on how it causes colorectal cancer. Alcohol consumption, obesity, diabetes mellitus, consumption of red and processed meat and cigarette smoking are linked to bowel cancer epidemiologically. Only high dietary calcium has a consistent negative (or 'protective') effect. The efficacy of fish oil, vitamin D, soy, phytoestrogens, folate, methionine, riboflavin and vitamin B6 has not been established. Aspirin and non-steroidal anti-inflammatory drugs use decrease risk of colorectal cancer after 5-10 years of use. There is no evidence for a detrimental effect of proton pump inhibitors or benefit of statins in colorectal cancer. In conclusion, there is a rising trend and prevalence of colorectal cancer in Asia. Dietary modification or supplementation may not be effective in preventing colorectal cancer. Surveillance of colorectal cancer in high-risk groups, according to current recommendation, is probably most effective.

Colorectal cancer mortality trends in Córdoba, Argentina

Background: Colorectal cancer is a leading cause of death worldwide for men and women, and one of the most commonly diagnosed in Córdoba, Argentina. The aim of this work was to provide an up-to-date approach to descriptive epidemiology of colorectal cancer in Córdoba throughout the estimation of mortality trends in the period 1986–2006, using Joinpoint and age-period-cohort (APC) models. Methods: Age-standardized (world population) mortality rates (ASMR), overall and truncated (35–64 years), were calculated and Joinpoint regression performed to compute the estimated annual percentage changes (EAPC). Poisson sequential models were fitted to estimate the effect of age (11 age groups), period (1986–1990, 1991–1995, 1996–2000 or 2001–2006) and cohort (13 ten-years cohorts overlapping each other by five-years) on colorectal cancer mortality rates. Results: ASMR showed an overall significant decrease (EAPC −0.9 95%CI: −1.7, −0.2) for women, being more noticeable from 1996 onwards (EAPC −2.1 95%CI: −4.0, −0.1). Age-effect showed an important rise in both sexes, but more evident in males. Birth cohort- and period effects reflected increasing and decreasing tendencies for men and women, respectively. Conclusions: Differences in mortality rates were found according to sex and could be related to age-period-cohort effects linked to the ageing process, health care and lifestyle. Further research is needed to elucidate the specific age-, period- and cohort-related factors.

Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors

In this article, the incidence, mortality, and survival rates for colorectal cancer are reviewed, with attention paid to regional variations and changes over time. A concise overview of known risk factors associated with colorectal cancer is provided, including familial and hereditary factors, as well as environmental lifestyle-related risk factors such as physical inactivity, obesity, smoking, and alcohol consumption.