Subsite- and stage-specific colorectal cancer trends in Estonia prior to implementation of screening. (February 2018)

• Record Type: Journal Article
• Authors: Innos, Kaire; Reima, Heigo; Baburin, Aleksei; Paapsi, Keiu; Aareleid, Tiiu; Soplepmann, Jaan
• Is Part Of: Cancer epidemiology. Volume 52(2018:Feb.)
• Page Start: 112
• Page End: 119
• Publication Date: 2018-02
• Subjects: Colorectal cancer -- Colon cancer -- Rectal cancer -- Anal cancer -- Incidence -- Survival -- TNM staging; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2017.12.016
• Languages: English
• ISSNs: 1877-7821

Abstract

Highlights: Colorectal cancer incidence and survival trends were studied by subsite and TNM stage. In the pre-screening era, colon cancer incidence rose only for right-sided tumours. The proportion of stage IV cancer did not change over time for any subsite. Significant survival increase was seen only for left-sided colon and rectal cancer. Both colon and rectal cancer showed significant survival gain for stage IV cancer. Abstract: Background: The occurrence of colorectal cancer (CRC) in Estonia has been characterised by increasing incidence, low survival and no screening. The study aimed to examine long-term incidence and survival trends of CRC in Estonia with specific focus on subsite and stage. Methods: We analysed CRC incidence and relative survival using Estonian Cancer Registry data on all cases of colorectal cancer (ICD-10 C18–21) diagnosed in 1995–2014. TNM classification was used to categorise stage. Results: Age-standardized incidence of colon cancer increased both in men and women at a rate of approximately 1% per year. Significant increase was seen for right-sided tumours, but not for left-sided tumours. Rectal cancer incidence increased significantly only in men and anal cancer incidence only in women. Age-standardized five-year relative survival for colon cancer increased from 50% in 1995–1999 to 59% in 2010–2014; for rectal cancer, from 38% to 56%. Colon cancer survival improved significantly for left-sided tumours (from 51% to 62%) and stage IV disease (from 6% to 15%). For rectal cancer, significant survival gain was seen for stage II (from 58% to 75%), stage III (from 34% to 70%) and stage IV (from 1% to 12%). Conclusion: In the pre-screening era in Estonia, increase in colon cancer incidence was limited to right-sided tumours. Large stage-specific survival gain, particularly for rectal cancer, was probably due to better staging and advances in multimodality treatment. Nonetheless, more than one quarter of new CRC cases are diagnosed at stage IV, emphasising the need for an efficient screening program.