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Epidemiology of colorectal cancer: international comparison

Colorectal cancer (CRC) is among the most commonly diagnosed cancers worldwide. In 2020, according to the GLOBOCAN estimates [1], there were 1,931,590 new cases of CRC worldwide (3rd most common cancer worldwide, accounting for 10.7% of all cancers apart from non-melanoma skin cancer), and 519,820 new cases of CRC in Europe (2nd most common cancer in Europe, accounting for 12.9% of all cancers apart from non-melanoma skin cancer). In 2020, there were an estimated 935,173 deaths from CRC worldwide (9.5% of the total number of cancer deaths, 2nd most common cause of cancer related deaths), and 244,824 deaths from CRC in Europe (12.6% of the total number of cancer deaths, 2nd most common cause of cancer related deaths). The 5-year prevalence of CRC (i.e., the number of CRC patients who were alive five years after diagnosis) in 2020 was estimated at 5,253,335 worldwide (67.4 CRC survivors per 100,000 population) and 1,536,168 in Europe (205.1 CRC survivors per 100,000 population). In 2020, the cumulative risk of CRC in persons aged under 75 was 2.25% worldwide (2.71% in men, 1.83% in women) and 3.60% in Europe (4.50% in men, 2.85% in women) [1].

Basic overview of epidemiological characteristics

Tables 1 and 2 provide a basic overview of epidemiological characteristics of colorectal cancer worldwide and in Europe. This data demonstrates a significant colorectal cancer burden in European countries, which is still associated with very high mortality rates.

Table 1: Epidemiology of colorectal cancer worldwide. Source: GLOBOCAN 2020 [1].

Parameter

Men

Women

Both sexes

Incidence rates

number of new cases

1,065,960

865,630

1,931,590

number of new cases per 100,000 population

27.1

22.4

24.8

ASR(W)

23.4

16.2

19.5

proportion of all newly diagnosed cancers
(apart from non-melanoma skin cancer)

11.4%

9.9%

10.7%

rank among all newly diagnosed cancers
(apart from non-melanoma skin cancer)

3rd

2nd

3rd

Mortality rates

number of deaths

515,637

419,536

935,173

number of deaths per 100,000 population

13.1

10.9

12.0

ASR(W)

11.0

7.2

9.0

proportion of all cancer deaths
(apart from non-melanoma skin cancer)

9.4%

9.5%

9.5%

rank among all cancer deaths
(apart from non-melanoma skin cancer)

3rd

3rd

2nd

Prevalence rates (patients alive five years after diagnosis)

absolute number of survivors

2,850,679

2,402,656

5,253,335

rate per 100,000 population

72.5

62.2

67.4

Cumulative risk of developing colorectal cancer

from birth until the age of 75

2.71%

1.83%

2.25%

Table 2: Epidemiology of colorectal cancer in Europe. Source: GLOBOCAN 2020 [1].

Parameter

Men

Women

Both sexes

Incidence rate

number of new cases

281,714

238,106

519,820

number of new cases per 100,000 population

77.9

61.5

69.4

ASR(W)

37.9

24.6

30.4

proportion of all newly diagnosed cancers
(apart from non-melanoma skin cancer)

13.2%

12.5%

12.9%

rank among all newly diagnosed cancers
(apart from non-melanoma skin cancer)

3rd

2nd

2nd

Mortality rates

number of deaths

131,885

112,939

244,824

number of deaths per 100,000 population

36.5

29.2

32.7

ASR(W)

16.1

9.5

12.3

proportion of all cancer deaths
(apart from non-melanoma skin cancer)

12.3%

13.0%

12.6%

rank among all cancer deaths
(apart from non-melanoma skin cancer)

2nd

3rd

2nd

Prevalence rates (patients alive five years after diagnosis)

absolute number of survivors

822,371

713,797

1,536,168

rate per 100,000 population

227.4

184.4

205.1

Cumulative risk of developing colorectal cancer

from birth until the age of 75

4.50%

2.85%

3.60%

Incidence and mortality

High colorectal cancer incidence and mortality rates are also shown in Figures 1 and 2. Recent statistics have indicated that the burden of colorectal cancer in the Czech Republic is above the global average, and this applies particularly to Czech men. Czech colorectal cancer incidence rates in men rank 13th worldwide and 12th in Europe, while women’s rates rank 21st–23rd worldwide and 14th–16th in Europe. From the global perspective, colorectal cancer incidence and mortality rates have continuously been highest in Central and West European countries. Among European countries in 2020, Hungary, Slovakia and Norway had the highest incidence rates of colorectal cancer; the Czech Republic ranked 14th.

Figure 1: International comparison of colorectal cancer incidence rates. ASR(W) – age-standardized world incidence rate per 100,000 population. Left to right: both sexes, men, women. Source: GLOBOCAN 2020 [1].
Figure 2: International comparison of colorectal cancer mortality rates. ASR(W) – age-standardized world mortality rate per 100,000 population. Left to right: both sexes, men, women. Source: GLOBOCAN 2020 [1].

Prevalence and M/I ratio

International epidemiological statistics make it possible to estimate the ratio of mortality to incidence rates (M/I), which can be considered as an indirect indicator of survival of colorectal cancer patients in a given country (Figure 3). According to the most recent statistics, the Czech Republic with its M/I ratio at 0.37 slowly approaches the developed Western European countries, for which the M/I ratio ranges from 0.27 to 0.39. Recent data from the Czech National Cancer Registry [2] correspond to a M/I ratio close to 0.4: the incidence of 31.63 and the mortality of 13.13 (data from 2018 recalculated as ASR-W) give the ratio of 0.42. Internationally assessed prevalence rates (i.e., number of patients alive five years after diagnosis) are shown in Figure 4. As a logical consequence, the highest prevalence rates have been reported for countries with the lowest values of M/I ratio. As for colorectal cancer prevalence rates, the Czech Republic is slightly above-average among European countries.

 
Figure 3: International comparison of the ratio of mortality to incidence rates (M/I). Evaluation was done using the ASR(W) – age-standardized world incidence rate per 100,000 population. Source: GLOBOCAN 2020 [1].
Figure 4: International comparison of prevalence rates (patients alive five years after diagnosis). Source:GLOBOCAN 2020 [1].

International statistics have also confirmed that men have higher colorectal cancer incidence rates than women. The men:women ratio in the Czech population is 1.76, which ranks 13th in Europe (Figure 5). High values of this index are typical for Central European populations, while Nordic countries have reported lower ratios (typically less than 1.40).

Figure 5: International comparison of ratio of colorectal cancer incidence rates in men and women. Evaluation was done using the ASR(W) – age-standardized world incidence rate per 100,000 population. Source: GLOBOCAN 2020 [1].

Cumulative risk

Let us conclude this overview of international statistics with a summary of cumulative risk of colorectal cancer from birth until the age of 75 (Figure 6). High values of this risk reflect a high population burden with this disease, which is typical for European countries in particular. Cumulative risk for the Czech Republic is 4.04, so the Czech population ranks 15th globally and 14th in Europe.

Figure 6: International comparison of cumulative risk of colorectal cancer from birth to 75 years of age. Left to right: both sexes, men, women. Source: GLOBOCAN 2020 [1].

References

  1. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer [accessed on 1 March 2021]. Available from WWW: https://gco.iarc.fr/today.
  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], [accessed on 1 March 2021]. Available from WWW: http://www.svod.cz. Version 7.0 [2007], ISSN 1802 – 8861.

Last updated on 1 March 2021