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Epidemiology of colorectal cancer in the Czech Republic

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svod.cz: epidemiology of malignant tumours in the Czech Republic

J. Gregor, D. Krejčí, J. Mužík, L. Šnajdrová

Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

CONTENTS

Introduction

The Czech National Cancer Registry (CNCR) is the main source of data on cancer epidemiology in the Czech Republic. CNCR has become an integral part of comprehensive cancer care, containing more than 2.6 million records from the period 1977–2018 and covering 100% of the Czech population. Registration of malignant tumours is stipulated by law and is obligatory [1]. CNCR data is publicly available on the website www.svod.cz [2].

Incidence and mortality rates

Colorectal cancer (CRC) is among the most commonly diagnosed cancers and its incidence rates in all developed countries are growing steadily. In international comparison, the burden of colorectal cancer in the Czech Republic is comparable to that in European countries on average. According to the latest data from GLOBOCAN 2018 [3], Czech male colorectal cancer incidence rates rank 14th in Europe, while female rates rank 19th in Europe (see more details in Epidemiology of colorectal cancer: international comparison). The population burden is very high indeed: each year around 7,700 patients are diagnosed with colorectal cancer in the Czech Republic, and there are approximately 3,400 deaths from colorectal cancer among the Czech population (Fig. 1a). Both incidence and mortality rates for colorectal cancer are higher in men than in women (Figs. 1b, 1c).

Apart from absolute numbers of newly diagnosed cases and deaths per year (Figs. 1a-c), CRC incidence and mortality rates can be recalculated per 100,000 persons (or men, women) in the population (Figs. 2a-c) or standardised on a certain age standard; the most common ones include the age-standardised world rate (ASR-W, Figs. 3a-c) and the new age-standardiseded European rate (ASR-E 2013, Figs. 4a-c). Such recalculations make it possible to compare CRC incidence and mortality rates with those of other countries (see more details in Epidemiology of colorectal cancer: international comparison).

Absolute numbers of new cases / deaths

Fig. 1a: C18–C20 incidence and mortality, both sexes. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 1b: C18–C20 incidence and mortality, men. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 1c: C18–C20 incidence and mortality, women. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994)

Rates per 100,000 persons

Fig. 2a: C18–C20 incidence and mortality, both sexes. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 2b: C18–C20 incidence and mortality, men. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 2c: C18–C20 incidence and mortality, women. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994)

Age-standardised world rates (ASR-W)

Fig. 3a: C18–C20 incidence and mortality (ASR-W), both sexes. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 3b: C18–C20 incidence and mortality (ASR-W), men. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 3c: C18–C20 incidence and mortality (ASR-W), women. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994)

Age-standardised European rates (ASR-E)

Fig. 4a: C18–C20 incidence and mortality (ASR-E), both sexes. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 4b: C18–C20 incidence and mortality (ASR-E), men. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994) Fig. 4c: C18–C20 incidence and mortality (ASR-E), women. Data source: CNCR (incidence in the entire period, mortality up to 1993), CZSO (mortality since 1994)

Prevalence rates

Some signs of improvement have been shown in recent years: in particular, mortality rates have stabilised and even begun to decrease (see above). This trend, however, when combined with the steadily growing incidence rates, inevitably leads to an increase in prevalence rates, i.e. a higher number of colorectal cancer survivors. In 2018, the prevalence of people with a history of colorectal cancer reached 59,166 in the Czech Republic, corresponding to an almost 35% increase in comparison with 2008 (43,860 colorectal cancer survivors (Fig. 5a); the increase was more than 36% in men (Fig. 5b) and 33% in women (Fig. 5c).

Absolute numbers of CRC survivors

Fig. 5a: C18–C20 prevalence, both sexes. Data source: CNCR Fig. 5b: C18–C20 prevalence, men. Data source: CNCR Fig. 5c: C18–C20 prevalence, women. Data source: CNCR

Rates per 100,000 persons

Fig. 6a: C18–C20 prevalence, both sexes. Data source: CNCR Fig. 6b: C18–C20 prevalence, men. Data source: CNCR Fig. 6c: C18–C20 prevalence, women. Data source: CNCR

Clinical stages

It is widely known that a cancer diagnosed at an early stage (or even at the stage of precancerous changes) is much more likely to be treated successfully and that the chance of survival in such cases is much higher. Available population-based data on colorectal cancer epidemiology in the Czech Republic, however, describes a rather gloomy situation: Figs. 7a-c show that a high proportion of new colorectal cancer patients in the Czech Republic are diagnosed with tumours in clinical stages III or IV, and that the numbers of these cases diagnosed in advanced stages are on the rise (Figs. 8a-c). This inevitably leads to markedly poorer treatment results, let alone related costs. Moreover, the situation has not much improved over time. Data also shows that the high proportion of advanced stages has been reported from all Czech regions (see more details in Epidemiology of colorectal cancer: comparison of Czech regions).

Proportion of clinical stages

Fig. 7a: C18–C20 – proportion of clinical stages, both sexes. Data source: CNCR Fig. 7b: C18–C20 – proportion of clinical stages, men. Data source: CNCR Fig. 7c: C18–C20 – proportion of clinical stages, women. Data source: CNCR

Incidence rates according to clinical stages

Fig. 8a: Incidence rates for C18–C20 according to clinical stages, both sexes. Data source: CNCR Fig. 8b: Incidence rates for C18–C20 according to clinical stages, men. Data source: CNCR Fig. 8c: Incidence rates for C18–C20 according to clinical stages, women. Data source: CNCR

Age structure of patients

Colorectal cancer markedly affects patients in working age. The typical age of Czech colorectal cancer patients is between 65 and 74 years, but almost 18% of all patients are under the age of 60 (Figs. 9a-c). The profiles of age-specific incidence rates for colorectal cancer (Figs. 10a-c) demonstrate the importance of the problem that colorectal cancer presents in oldest groups of the Czech population.

Number of cases in different age categories (analysed period: 2014–2018)

Fig. 9a: Age structure of patients with C18–C20, both sexes. Data source: CNCR Fig. 9b: Age structure of patients with C18–C20, men. Data source: CNCR Fig. 9c: Age structure of patients with C18–C20, women. Data source: CNCR

Age-specific incidence rates (analysed period: 2014–2018)

Fig. 10a: C18–C20 – age-specific incidence rate, both sexes. Data source: CNCR Fig. 10b: C18–C20 – age-specific incidence rate, men. Data source: CNCR Fig. 10c: C18–C20 – age-specific incidence rate, women. Data source: CNCR

References

  1. Institute of Health Information and Statistics of the Czech Republic: Czech National Cancer Registry (CNCR) [21 January 2021]. Available from WWW: http://www.uzis.cz/registry-nzis/nor
  2. Dušek, L., Mužík, J., Kubásek, M., Koptíková, J., Žaloudík, J., Vyzula, R.: Epidemiology of malignant tumours in the Czech Republic [online]. Masaryk University, Brno (Czech Republic) 2005. Available from WWW: http://www.svod.cz. ISSN 1802-8861.
  3. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer [cit. 2018-10-04]. Available from WWW: https://gco.iarc.fr/today.

Last updated on 21 January 2021