Bowel (colorectal) cancer - UK mortality statistics

Bowel cancer is the third most common cause of cancer death among men in the UK, accounting for 11% of all male deaths from cancer. It is the third most common cause of death among women, responsible for 10% of all female cancer deaths.

In 2010, there were 16,013 deaths from bowel cancer in the UK (Table 2.1): 8,705 (54%) in men and 7,308 (46%) in women, giving a male:female ratio of 12:10.1-3 These comprised 9,806 (61%) deaths from colon cancer and 6,207 (39%) deaths from rectal cancer (including the anus). Most rectal cancer deaths are in men (3,739 or 60% male) but colon cancer deaths are approximately evenly divided between men and women (4,966 or 51% male). The crude mortality rate shows that there were around 28 bowel cancer deaths for every 100,000 males in the UK and 23 for every 100,000 females.

European age-standardised rates (ASRs) of bowel cancer deaths are significantly lower in England compared with Scotland.1-3 Rates do not differ significantly between England and Wales (when males and females are considered separately), between England and Northern Ireland, or between Wales, Scotland and Northern Ireland. 

A north-south divide in bowel cancer mortality rates has existed across the UK since at least the 1990s;12  the most recent data for England shows that rates are still higher in the north for males, but a clear divide is much less evident for females.4

Table 2.1: Bowel Cancer (C18-C21), Number of Deaths, Crude and European Age-Standardised (AS) Mortality Rates per 100,000 Population, UK, 2010

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

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section updated 01/03/12

Bowel cancer mortality is strongly related to age. In the UK between 2008 and 2010, an average 80% of bowel cancer deaths were in people aged 65 years and over (Figure 2.1).1-3  Mortality rates increase sharply from around age 50 in men and around age 65 in women, reaching a peak at age 85+ in both sexes. The male:female ratio increases with age, from 13:10 at age 50-54, to 14:10 at age 85+.

Figure 2.1: Bowel Cancer (C18-C21) Average Number of Deaths Per Year and Age-Specific Mortality Rates, UK, 2008-2010

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19% of bowel cancer deaths occur in people aged 60-69. People in England and Northern Ireland are currently offered bowel screening at two-year intervals between ages 60 and 69. In Scotland people are offered screening from ages 50 to 74. In Wales people are offered screening from ages 60 to 74. In England screening is gradually being extended to include people aged 70-74.

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Bowel cancer mortality rates have overall decreased in the UK since the early 1970s (Figure 2.2).1-3 For men, European age-standardised mortality rates were 39% lower in 2009-10 than in 1971-73. For women, rates were 52% lower in 2008-10 than in 1971-73.

For both sexes, UK bowel cancer mortality rates decreased steadily from the early 1970s to the early 1990s, and have decreased more rapidly since then. In the early 1970s around 35 males per 100,000 died from bowel cancer each year; by the early 1990s this had fallen to around 31 per 100,000; and by the late 2000s it had further fallen to around 22 per 100,000. For females, the bowel cancer mortality rate fell from around 28 per 100,000 in the early 1970s; to around 20 per 100,000 in the early 1990s; and to around 14 per 100,000 in the late 2000s. There are probably a combination of reasons for the decline in bowel cancer mortality rates, including earlier detection and better treatment. 

Bowel screening has been shown to reduce the risk of dying from bowel cancer by a quarter in people who are screened in England.13 A similar risk reduction has recently been observed in an, as yet, unpublished study in Scotland.14,15

Figure 2.2: Bowel Cancer (C18-C21), European Age-Standardised Mortality Rates, UK, 1971-2010

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UK bowel cancer mortality rates have decreased for all age groups in the last 40 years (Figure 2.3), with larger drops in younger age groups.1-3 Between 1971-73 and 2008-10, bowel cancer mortality rates fell by 52% in people aged 45-59, 46% in 60-69 year-olds, 44% in 70-79 year-olds, and 37% in people aged 80+. The lower mortality decreases in the older age groups may be explained in part by the under-staging and under-treatment of the elderly.5 The impact of screening on mortality rates in different age groups should be seen in the data in the coming years.

Figure 2.3: Bowel Cancer (C18-21), European Age-Standardised Mortality Rates, Persons, By Age, UK, 1971-2010

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section updated 01/03/12

Bowel cancer is the fourth most common cause of cancer death worldwide, estimated to be responsible for almost 610,000 deaths in 2008 (around 8% of the total). Bowel cancer mortality rates are lowest in Middle Africa and South-Central Asia and highest in Central and Eastern Europe, with a six-fold variation in male mortality rates between the regions of the world, and a five-fold variation in female rates (Figure 2.4).6

Figure 2.4: Bowel cancer (C18-C21), World Age-Standardised Mortality Rates, World Regions, 2008 Estimates

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Within the 27 countries of the European Union (EU-27), the highest bowel cancer mortality rates are in Hungary for both sexes (48.1 male deaths per 100,000, 25.0 deaths per 100,000); and the lowest rates are in Cyprus (11.4 male deaths per 100,000, 8.0 female deaths per 100,000) (Figure 2.5).7

Figure 2.5: Bowel cancer (C18-C21), European Age-Standardised Mortality Rates, EU-27 Countries, 2008 Estimates

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UK bowel cancer mortality rates are 23rd (males) and joint 20th (females) highest in Europe (EU-27).

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Male bowel cancer mortality rates are around 20% higher in the most deprived wards of England and Wales as compared with the least deprived wards,8 reflecting higher incidence in these groups.11 There is no obvious association with deprivation for females in England and Wales,8 or for either sex in Scotland and Northern Ireland.9,10

section updated 01/03/12