Bowel (colorectal) cancer - UK incidence statistics

Cancer of the large bowel (also known as colorectal cancer) is a common form of malignancy in developed countries but occurs much less frequently in the developing world. Around 110 new cases of colorectal cancer are diagnosed each day in the UK and it is the third most common cancer after breast and lung. In 2008 there were 39,991 new cases of large bowel cancer registered in the UK: around two-thirds (25,551) in the colon and one-third (14,440) in the rectum. 1-4

The distribution of cases throughout the large bowel is shown in Figure 1.1. 5 More tumours are diagnosed in the left hand side of the bowel (note the right side of the picture); with around 60% of tumours occurring in the sigmoid colon, rectosigmoid junction and rectum.

Figure 1.1: Bowel cancer (C18-21), Percentage Distribution of Cases within the Large Bowel, Great Britain, 2006-2008

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section updated 27/07/11

The number of cases of colorectal cancer and the incidence rates in each of the countries of the UK are shown in 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, 2008

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

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The occurrence of large bowel cancer is strongly related to age, with 86% of cases arising in people who are 60 years or older (Figure 1.2). 1-4 Until age 50, men and women have similar rates for bowel cancer, but in later life male rates predominate. In numerical terms, there are more male cases of bowel cancer in almost all age-groups up to the age of 84, after which female cases are in the majority, even though their rates are lower, as women make up a larger proportion of the elderly population. Overall the male:female ratio is 11:10.

Figure 1.2: Colorectal Cancer (C18-C21), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK , 2006-2008

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section updated 27/07/11

The lifetime risk for men of being diagnosed with colorectal cancer in the UK is estimated to be 1 in 15 and for women 1 in 19. These were calculated in July 2011 using the AMP method6 on 2008 data for the UK.1-4, 21-24 Colorectal cancer is now the third most common cancer in women after breast and lung cancer whereas in men it also ranks third after prostate and lung cancer.

Figure 1.3 shows the trends in the lifetime risk of developing bowel cancer in Great Britain since 1975 by sex. It shows that the lifetime risk has almost doubled between 1975 and 2008 from 3.5% (or 1 in 29 men) to 6.9% (or 1 in 15). In women the increase is more than a quarter, rising from 3.9% (or 1 in 26 women) to 5.4% (or 1 in 19 women). These estimates were derived using the AMP method on 2008 data for Great Britain.1-4, 21-24  These estimates assume no change in the current incidence rates and should be used as an approximate guide only.

Figure 1.3: Lifetime Risk of Developing Bowel Cancer, Great Britain, 1975-2008

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section updated 30/01/12

Data for bowel cancer patients diagnosed in England in 2000-2004 did show a deprivation gradient for male patients with incidence rates 11% higher in the most deprived groups than in the affluent groups. 19

section updated 31/12/09

Bowel cancer incidence rates vary across the country, particularly in men. Incidence rates are as low as 50 per 100,000 men in London, which along with the South East and the East of England, has rates below the England average. However, in the North East the incidence rate is more than 65 per 100,000 men and along with the North West and the West Midlands it has rates significantly higher than the England average. Female incidence rates across the country are much closer to the England average with London being the only region which is significantly lower at 35 per 100,000 women. (Figure 1.4). 7

Figure 1.4: Bowel cancer (C18-C21), European Age-Standardised Incidence Rates, By Government Office Region, 2006-2008

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In 2008 there were an estimated 334,000 new cases of colorectal cancer in the European Union (EU27). 18  The lowest rates for both men and women were in Greece. The highest rates for men were in Slovakia and for women in Denmark (Figure 1.5). 8 

Figure 1.5: Bowel cancer (C18-C21), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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In Europe, the incidence of colorectal cancer is increasing, particularly in southern and eastern Europe, where rates were originally lower than in western Europe. 11,12 In the USA, incidence rose until the mid-1980s but in the last two decades rates have fallen for both men and women.13

Worldwide an estimated 1.24 million new cases of colorectal cancer were diagnosed in 2008, Colorectal cancer is the third most common cancer in men (663,000 cases, 10.0% of the total) and the second in women (571,000 cases, 9.4% of the total) worldwide.9

Epidemiological studies report a rapid increase in risk for colorectal cancer in migrants moving from low to high risk countries14 and the rates for second generation migrants can be double that of first.15

Countries that have had a rapid ‘westernisation’ of diet , such as Japan, have seen a rapid increase in the incidence of colorectal cancer.16,17 Consumption of meat and dairy products in Japan increased ten-fold between the 1950s and 1990s.

Bowel cancer is the third most common cancer worldwide after lung and breast with almost 60% of all colorectal cancers occurring in the more developed regions. Figure 1.6 shows the large variation in rates, with the lowest rates in Africa and Asia and the highest in Australia/New Zealand and Western Europe.9

Differences of this magnitude, together with migration data (see Trends section below), suggest that many cases of colorectal cancer could be prevented. Japan is an exception to other countries in the Eastern Asia region with age-standardised rates similar to other highly developed countries.

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

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section updated 27/07/11

The bowel cancer incidence trend is shown in Figure 1.7 for the UK, and in Figure 1.8 for Great Britain. 2,3,10

Figure 1.7: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, UK, 1993-2008

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In Great Britain male bowel cancer incidence rates rose slowly by an average of 1% each year between 1979 and 1999, since when there has been a slight decrease. Over the same period the female rates have changed very little. 1-4

Figure 1.8: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, Great Britain, 1975-2008

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section updated 27/07/11

In Great Britain, all age groups have shown a slight increase in bowel cancer incidence rates since the mid 1970s. In the 60-69 age-group rates rose by around 20% - from around 120 cases per 100,000 in the mid 70s to around 146 cases per 100,000 in 2006. Similarly, incidence rates in 70-79 age-group have also risen by 20% since the mid 70s. However, since 2006 there has been an 11% increase in incidence rates for people aged 60-69 in Britain (12.5 per cent in England). This rise is almost certainly due to the roll out of bowel cancer screening which started in England in 2006, targeting this age group, and has now been rolled-out across the whole of the UK1-4

Figure 1.9: Bowel Cancer (C18-21), European Age-Standardised Incidence Rates, By Age, Great Britain, 1975-2008

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section updated 27/07/11

Prevalence data relate to those people in the UK population who were alive on a specific date having previously been diagnosed with cancer. The latest analysis shows that on 31st December 2006, around 143,500 people were alive up to ten years after being diagnosed with bowel cancer. 20 Table 1.3 shows the one, five and ten year prevalence by sex for bowel cancer (C18-20).

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section updated 27/07/11