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Cancer Causes & Control

, Volume 9, Issue 2, pp 145–152 | Cite as

Trends in colorectal cancer incidence in Sweden 1959-93 by gender, localization, time period, and birth cohort

  • Magnus Thörn
  • Reinhold Bergström
  • Ulf Kressner
  • Pär Sparén
  • Matthew Zack
  • Anders Ekbom
Article

Abstract

Objectives: This study examined invasive colorectal cancer incidence-rates in Sweden from 1959 through 1993 (n = 134,643 cases). Methods: Age-standardized rates were calculated using the Swedish population in 1970 as a reference. Results: In right-sided colon cancer (ascending and transverse colon including right and left flexures), male age-standardized rates rose from 8.0 to 15.0 (1.8 percent annually, 95 percent confidence interval [CI] = 1.3-2.4) and female rates increased from 9.1 to 14.4 (1.5 percent annually, CI = 1.0-2.0). For left-sided colon cancer (descending and sigmoid colon), the rates have been stable recently. For rectal cancer, the rates among men rose from 18.8 to 23.0 and among women from 10.7 to 14.7. For both men and women, the relative risk (RR) of right-sided colon cancer had been increasing in successive generations, until leveling-off in those born after 1930. The RR of left-sided colon cancer had been almost constant for cohorts born before 1930 but steadily decreasing in later-born cohorts. The RR of rectal cancer was slightly increasing in successive cohorts. Conclusions: Changes in lifestyle or carcinogenic exposures during early life probably explain Swedish colorectal cancer incidence-trends better than improved diagnostic activities.

Age factors cohort studies colonic neoplasms incidence rectal neoplasms Sweden 

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References

  1. 1.
    AmericanCancer Society. Cancer Facts and Figures – 1992. Atlanta, GA (USA): ACS, 1992.Google Scholar
  2. 2.
    TheCancer Registry. Cancer Incidence in Sweden 1959-1993. Stockholm, Sweden: National Board of Health and Welfare, 1961-96.Google Scholar
  3. 3.
    Muir C, Waterhouse J, Mack T, Powell J, Whelan S, eds. Cancer Incidence in Five Continents, Volume V. Lyon, France: International Agency for Research on Cancer, 1987.Google Scholar
  4. 4.
    Boyle P, Zaridze DG, Smans M. Descriptive epidemiology of colorectal cancer. Int J Cancer 1985; 36: 9–18.Google Scholar
  5. 5.
    Beart RW, Melton LJ 3rd, Maruta M, Dockerty MB, Frydenberg HB, O'Fallen WM. Trends in right and left-sided colon cancer. Dis Colon Rectum 1983; 26: 393–8.Google Scholar
  6. 6.
    Vobecky J, Leduc C, Devroede G. Sex differences in the changing anatomic distribution of colorectal carcinoma. Cancer 1984; 54: 3065–9.Google Scholar
  7. 7.
    Ghahremani GG, Dowlatshahi K. Colorectal carcinomas: diagnostic implications of their changing frequency and anatomic distribution. World J Surg 1989; 13: 321–4; Discussion 324-5.Google Scholar
  8. 8.
    DeJong UW, Day NE, Muir CS, et al. The distribution of cancer within the large bowel. Int J Cancer 1972; 10: 463–77.Google Scholar
  9. 9.
    Jensen OM. Different age and sex relationship for cancer of the subsites of the large bowel. Br J Cancer 1984; 50: 825–9.Google Scholar
  10. 10.
    Whittemore AS. Colorectal cancer incidence among Chinese in North America and the People's Republic of China: variation with sex, age and anatomical site. Int J Epidemiol 1989; 18: 563–8.Google Scholar
  11. 11.
    Dubrow R, Bernstein J, Holford TR. Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Connecticut. Int J Cancer 1993; 53: 907–13.Google Scholar
  12. 12.
    Johansen C, Mellemgaard A, Skov T, Kjaergaard J, Lynge E.Colorectal cancer in Denmark 1943-1988. Int J Colorect Dis 1993; 8: 42–7.Google Scholar
  13. 13.
    Dubrow R, Johansen C, Skov T, Holford TR. Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Denmark. Int J Cancer 1994; 58: 324–9.Google Scholar
  14. 14.
    WorldHealth Organization. International Classification of Diseases, Seventh Revision. Geneva, Switzerland: World Health Organization, 1957.Google Scholar
  15. 15.
    Fleiss JL. The standardization of rates. In: Fleiss JL.Statistical Methods for Rates and Proportions. New York, NY (USA): John Wiley and Sons, 1981; 237–55.Google Scholar
  16. 16.
    McCullagh P, Nelder JA. Generalized Linear Models (2nd Edition). London, England (UK): Chapman & Hill, 1989.Google Scholar
  17. 17.
    Clayton D, Schifflers E. Models for temporal variation in cancer rates. II. Age-period-cohort model. Stat Med 1987a; 6: 469–81.Google Scholar
  18. 18.
    Clayton D, Schifflers E. Models for temporal variation in cancer rates. I. Age-period and age-cohort models. Stat Med 1987b; 6: 449–67.Google Scholar
  19. 19.
    Jass JR, Path MRC. Do all colorectal carcinomas arise in preexisting adenomas? World J Surg 1989; 13: 45–51.Google Scholar
  20. 20.
    Eddy DM.Screening for colorectal cancer. Ann Intern Med 1990; 113: 373–84.Google Scholar
  21. 21.
    Desigan G, Wang M, Alberti-Flor J, Dunn GD, Halter S, Vaughan S. De novo carcinoma of the rectum: a case report. Am J Gastroenterol 1985; 80: 553–6.Google Scholar
  22. 22.
    Shamsuddin AM, Kato Y, Kunishima N, Sugano H, Trump BF.Carcinoma in situ in nonpolyploid mucosa of the large intestine. Report of a case with significance in strategies for early detection. Cancer 1985; 56: 2849–54.Google Scholar
  23. 23.
    Bedenne L, Faivre J, Boutron MC, Piard F, Cauvin JM, Hillon P. Adenocarcinoma sequence or 'de novo' carcino-genesis? A study of adenomatous remnants in a population-based series of large bowel cancers. Cancer 1992; 69: 883–8.Google Scholar
  24. 24.
    Sato M, Ahnen DJ. Regional variability of colonocyte growth and differentiation in the rat. Anat Rec 1992; 233: 409–14.Google Scholar
  25. 25.
    Sato M, Yamada K, Ahnan DJ. Proliferating cell nuclear antigen (PCNA) expression in human colonic mucosa [Abstract]. Gastroenterology 1990; 98: A 307.Google Scholar
  26. 26.
    McMichael AJ, Potter JD. Do intrinsic sex differences in lower alimentary tract physiology influence the sex-specific risks of bowel cancer and other biliary and intestinal diseases? Am J Epidemiol 1983; 118: 620–7.Google Scholar
  27. 27.
    Buffill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Int Med 1990; 113: 779–88.Google Scholar
  28. 28.
    Mellemgaard A, Engholm G, Lynge E. High and low risk groups for cancer of colon and rectum in Denmark: multiplicative Poisson models applied to register linkage data. J Epidemiol Community Health 1988; 42: 249–56.Google Scholar
  29. 29.
    Garabrant DH, Peters JM, Mack TM, Bernstein L. Job activity and colon cancer risk. Am J Epidemiol 1984; 119: 1005–14.Google Scholar
  30. 30.
    Vena J, Graham S, Zielezny M, Swanson MK, Barnes RE, Nolan J. Lifetime occupational exercise and colon cancer. Am J Epidemiol 1985; 122: 357–65.Google Scholar
  31. 31.
    Gerhardsson M, Norell SE, Kiviranta H, Petersen NL, Ahlbom A. Sedentary jobs and colon cancer. Am J Epidemiol 1986; 123: 775–80.Google Scholar
  32. 32.
    Cox B, Little J. Reduced risk of colorectal cancer among recent generations in New Zealand. Br J Cancer 1992; 66: 386–90.Google Scholar

Copyright information

© Chapman and Hall 1998

Authors and Affiliations

  • Magnus Thörn
    • 1
  • Reinhold Bergström
    • 2
  • Ulf Kressner
    • 1
  • Pär Sparén
    • 3
  • Matthew Zack
    • 4
  • Anders Ekbom
    • 5
  1. 1.Department of SurgeryUniversity HospitalUppsalaSweden
  2. 2.Department of Medical EpidemiologyKarolinska InstituteStockholmSweden
  3. 3.Department of StatisticsUppsala UniversityUppsalaSweden
  4. 4.Centers for Disease ControlAtlantaUSA
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA

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