Bowel (colorectal) cancer - UK incidence statistics

Bowel cancer is the third most common cancer among men in the UK, accounting for 14% of all new cases of cancer in males. In 2009, there were 41,142 new cases of bowel cancer in the UK (Table 1.1): 22,711 (55%) in men and 18,431 (45%) in women, giving a male:female ratio of 12:10.1-4

Almost two-thirds (64% in 2009) of all bowel cancers are cancers of the colon and over one-third (36%) are cancers of the rectum (including the anus). Most rectal cancer cases occur in men (60%), while colon cancer cases are approximately evenly divided between men and women (53% male). The crude incidence rate shows that there are around 75 new bowel cancer cases for every 100,000 males in the UK and around 59 for every 100,000 females (Table 1.1).1-4

The European age-standardised incidence rates (AS rates) are significantly lower in England compared with Wales, Scotland and Northern Ireland (males only).1-4 The rates do not differ significantly between Wales, Scotland and Northern Ireland for either sex (Table 1.1).1-4

Table 1.1: Bowel Cancer (C18-C21), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS rate

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A north-south divide in bowel cancer incidence has existed across the UK since at least the 1990s.5 The most recent data shows that the highest incidence rates are still in areas of Scotland, Northern Ireland and the north of England for males. However, a clear divide across the UK is much less evident for females, with many parts of England also experiencing high incidence rates, such as areas in the east and south-west.6

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Bowel cancer incidence is strongly related to age. In the UK between 2007 and 2009, an average 72% of bowel cancer cases were diagnosed in people aged 65 years and over (Figure 1.1). Age-specific incidence rates increase sharply from around age 50, peaking in the over-80s. Incidence rates are higher for males than females and this gap is widest between the ages of 65 and 74, when the male:female incidence ratio of age-specific rates (to account for the different proportions of males to females in each age group) is about 17:10. The male:female rate ratio decreases to 15:10 at age 85+ (Figure 1.1).1-4

Figure 1.1: Bowel Cancer (C18-C21), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK , 2007-2009

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Around a quarter (26% in 2007-2009) of bowel cancer cases occur in 60-69 year olds. People in England and Northern Ireland are currently offered bowel screening at two-year intervals between ages 60 and 69, though in England this is gradually being extended to include people aged 70-74. In Scotland people are currently offered screening from ages 50-74, and in Wales people are offered screening from ages 60-74.7-10

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Bowel cancer incidence trends for the UK are shown in Figure 1.2.1-4

Figure 1.2: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, UK, 1993-2009

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Bowel cancer incidence rates have overall increased in Britain since the mid-1970s (Figure 1.3). For men, European AS incidence rates have increased by 27% between 1975-1977 and 2007-2009, with most of this increase occurring between the mid-1970s and late 1990s. For women, the rise is much smaller, with rates increasing by 8% between 1975-1977 and 2007-2009.1-4

Figure 1.3: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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Bowel cancer incidence rates in Britain have overall increased for all age groups since the mid-1970s (Figure 1.4). The largest increases have been in people aged 60-69 and 70-79, with European AS incidence rates increasing by around 34% and 24%, respectively, between 1975-1977 and 2007-2009.1-3

Figure 1.4: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, By Age, Great Britain, 1975-2009

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Between 2006 and 2008, bowel cancer European AS incidence rates for people aged 60-69 increased by more than 12% in the UK (data not shown).1-4 This rise is almost certainly due to the roll out of bowel cancer screening, which started in England for 60-69 year olds in 2006, and has now been rolled-out across the whole of the UK.7-10 Between 2008 and 2009, there has been very little change in incidence rates for this age group in the UK.

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The  lifetime risk of developing bowel cancer in the UK is estimated to be 1 in 15 for men and 1 in 19 for women (calculated using 2008 data).11

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More tumours are diagnosed in the left hand side of the bowel than the right (Figure 1.5, note the right side of the picture). In Britain between 2007 and 2009, around 60% of tumours were diagnosed in the descending colon, sigmoid colon, rectosigmoid junction, rectum and anus.1-3

Figure 1.5: Bowel cancer (C18-21), Percentage Distribution of Cases within the Large Bowel, Great Britain, 2007-2009

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.12 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.13

Bowel cancer is the third most common cancer worldwide after lung and breast, with an estimated 1.24 million new cases diagnosed in 2008 (10% of the total). Bowel cancer incidence rates are lowest in Middle Africa and highest in Australia/New Zealand, with around a ten-fold variation in male and female World AS incidence rates between the regions of the world (Figure 1.6).13

Much of the geographical variation in incidence across the world can be attributed to differences in diet, particularly the consumption of red and processed meat, fibre and alcohol, as well as bodyweight and physical activity. Countries that have had a rapid ‘westernisation’ of diet, such as Japan,14 have seen a rapid increase in the incidence of colorectal cancer.15 Epidemiological studies report a rapid increase in risk for colorectal cancer in migrants moving from low to high risk countries.16

Figure 1.6: Bowel cancer (C18-C21), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Within the 27 countries of the European Union, the highest European AS incidence rates for 2008 are estimated to be in Slovakia for men (around 91 cases per 100,000) and Denmark for women (50 cases per 100,000), while the lowest rates are in Greece for both sexes (around 24 cases per 100,000 for men and 17 per 100,000 for females) (Figure 1.7).17

UK bowel cancer incidence rates are estimated to be the 14th (males) and 12th (females) highest in Europe (EU-27).17

Figure 1.7: Bowel cancer (C18-C21), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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There is evidence for a small association between bowel cancer incidence and deprivation in the UK for males (and possibly females). The most recent England-wide data for 2000-2004 shows European AS incidence rates are around 11% higher for men living in more deprived areas compared with the least deprived, though no significant differences are reported for women.18 A study in Scotland for 2005-2009 shows a similar deprivation gap for men and women combined.19 Comparable results have also been published in Northern Ireland (for men and women combined) and Wales (association seen in men only).20,21  

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK (Table 1.2) show that around 143,500 people were still alive at the end of 2006, up to ten years after being diagnosed with bowel cancer (excluding the anus, ICD-10 codes C18-C20).22 Worldwide, it is estimated that there were 3.26 million bowel cancer patients still alive in 2008, up to five years after their diagnosis.13

Table 1.2: Bowel Cancer (C18-C20), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

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