Abstract
Between 1976–78 and 1985–87, the age-adjusted incidence rates of invasive colon cancer in the United States rose by 15 percent, 3 percent, 21 percent, and 16 percent among White males, White females, Black males, and Black females, respectively. The increases in incidence occurred in all age groups over age 54 and affected each of the major subsites of the colon nearly equally. The larger rates of increase have resulted in higher incidence among Blacks than Whites by the mid-1980s and an increasingly greater excess of this cancer in males. Trends toward earlier diagnosis of invasive colon cancer were found, with increasing rates for localized and regional diseases coupled with stable or decreasing distant-stage disease-rates. The incidence ofin situ colon cancer also rose substantially. The findings suggest that changes in diagnostic trends and risk-factor prevalence may be contributing to these patterns, and that the era when colon cancer predominated among White females is clearly over.
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References
Devesa SS, Silverman DT, Young JLJr. Cancer incidence and mortality trends among whites in the United States, 1947–84.JNCI 1987;79: 701–70.
Ries LAG, Hankey BF, Edwards BK, eds.Cancer Statistics Review 1973–87 Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1991; NIH Pub. No. 90–2789.
Ziegler RG, Devesa SS, Fraumeni JFJr. Epidemiologic patterns of colorectal cancer. In: Devita VTJr, Hellman S, Rosenberg SA, eds.Important Advances in Oncology 1986. Philadelphia, PA: J.B. Lippincott, 1986: 209–32.
Willett WC, Stampfer MJ, Colditz GA, et al. Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women.N Engl J Med 1990;323: 1664–72.
Lashner BA, Epstein SS. Industrial risk factors for colorectal cancer.Int J Health Services 1990;20: 459–83.
Hardcastle JD, Armitage NC, Chamberlain J, et al. Fecal occult blood screening for colorectal cancer in the general population: results of a controlled trial.Cancer 1986;58: 397–403.
Hardcastle JD, Chir M, Pye G. Screening for colorectal cancer: a critical review.World J Surg 1989;13: 38–44.
Young JLJr, Percy CL, Asire AJ, et al. Surveillance Epidemiology, End Results: incidence and mortality data, 1973–77.NCI Monogr 1981;57: 1–1082.
World Health Organization.International Classification of Diseases for Oncology. Geneva: WHO, 1976.
Snedecor GW, Cochran WG.Statistical Methods, 6th edn. Ames, IA: Iowa State University Press, 1972.
Weisman GA, Winawer SJ, Baldwin MP, et al. Multicenter evaluation of training of non-endoscopists in 30-cm flexible sigmoidoscopy.CA 1987;37: 26–30.
Winnan G, Berci G, Panish J, et al. Superiority of the flexible to the rigid sigmoidoscope in routine proctosigmoidoscopy.N Engl J Med 1980;302: 1011–2.
Longo WE, Ballantyne GH, Modlin IM. Colonoscopic detection of early colorectal cancers. Impact of a surgical endoscopy service.Ann Surg 1988;207: 174–8.
Knutson CO, Max MH. Value of colonoscopy in patients with rectal blood loss unexplained by rigid proctosigmoidoscopy and barium contrast enema examinations.Am J Surg 1980;139: 84–7.
Winchester DP, Fink DJ, Jolley PC. College and American society promote colorectal cancer awareness program.ACS Bull 1988;73: 31–7.
Lytle GH. Screening for colorectal carcinoma.Seminars Surg Oncol 1989;5: 194–200.
Allison JE, Feldman R. Cost benefits of hemoccult screening for colorectal carcinoma.Dig Dis Sci 1985;30: 860–5.
Selby JV, Friedman GD, Collen MF. Sigmoidoscopy and mortality from colorectal cancer: the Kaiser Permanente Multiphasic Evaluation Study.J Clin Epidemiol 1988;41: 427–34.
Winawer SJ, Schottenfeld D, Flehinger BJ. Colorectal Cancer Screening.JNCI 1991;83: 243–53.
American Cancer Society.The 1987 Survey of Public Awareness and Use of Cancer Tests Atlanta, GA: ACS, 1988; ACS Pub. No. 88–2M-No. 2520-LE.
Morson BC. Evaluation of cancer of the colon and rectum.Cancer 1974;34: 845–9.
Tierney RP, Ballantyne GH, Modlin IM. The adenoma to carcinoma sequence.Gynecol Obstet 1990;171: 81–94.
Muto T, Bussey JHR, Morson BC. The evolution of cancer of the colon and rectum.Cancer 1975;36: 2251–70.
Gilbertsen VA. Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer.Cancer 1974;34: 936–9.
Selby JV, Friedman GD, Quesenberry CP Jr,et al. Efficacy of sigmoidoscopy in asymptomatic persons [Abstract]. Presented at the 24th Annual Meeting of the Society for Epidemiologic Research, Buffalo, New York, 11–14 June 1991.
Leppert M, Burt R, Hughes JP, et al. Genetic analysis of an inherited predisposition to colon cancer in a family with a variable number of adenomatous polyps.N Engl J Med 1990;332: 904–8.
Ekbom A, Helmick C, Zack M, et al. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement.Lancet 1990;336: 357–9.
Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer: a population-based study.N Engl J Med 1990;323: 1228–33.
Willett W. The search for the causes of breast and colon cancer.Nature 1989;338: 389–94.
Kolonel LN. Fat and colon cancer: how firm is the epidemiologic evidence?Am J Clin Nutr 1987;45: 336–41.
Nomura A. An international search for causative factors of colorectal cancer [Editorial].JNCI 1990;82: 894–5.
Prentice RL, Sheppard L. Dietary fat and cancer: consistency of the epidemiologic data, and disease prevention that may follow from a practical reduction in fat consumption.Cancer Causes Control 1990;1: 81–97.
Schiffman MH, Felton JS. Fried foods and the risk of colon cancer [Letter].Am J Epidemiol 1990;131: 376–8.
Peters RK, Garabrant DH, Yu MC, et al. A case-control study of occupational and dietary factors in colorectal cancer in young men by subsite.Cancer Res 1989;49: 5459–68.
Gerhardsson De Verdier M, Hagman U, Norell S,et al. Diet, body mass, physical activity and colorectal cancer [Abstract]. Presented at the 24th Annual Meeting of the Society for Epidemiologic Research, Buffalo, NY, 11–14 June 1991.
Vanderlaan M, Watkins BE, Hwang M, et al. Monoclonal antibodies for the immunoassay of mutagenic compounds produced by cooking beef.Carcinogenesis 1988;9: 153–60.
Adamson RH, Thorgeirsson UP, Snyderwine EG, et al. Carcinogenicity of 2-amino-3-methylimidazo [4, 5-f] quinoline (IQ) in nonhuman primates: induction of tumors in three macaques.Jpn J Cancer Res 1990;81: 10–4.
International Agency for Research on Cancer.Certain Polycyclic Aromatic Hydrocarbons and Heterocyclic Compounds Lyon, France: IARC, 1973;IARC Monogr Eval Carcinog Risk Chem Humans, Vol 3: 91–136.
Rothman N, Poirier MC, Baser ME, et al. Formation of polycyclic aromatic hydrocarbon—DNA adducts in peripheral white blood cells during consumption of charcoal-broiled beef.Carcinogenesis 1990;11: 1241–3.
Newmark HL, Wargovich MJ, Bruce WR. Colon cancer and dietary fat, phosphate, and calcium: a hypothesis.JNCI 1984;72: 1323–5.
Garland C, Shekelle RB, Barrett-Connor E, et al. Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men.Lancet 1985;i(8424): 307–9.
Slattery ML, Sorenson AW, Ford MH. Dietary calcium intake as a mitigating factor in colon cancer.Am J Epidemiol 1988;128: 504–14.
Vogel VG, McPherson RS. Dietary epidemiology of colon cancer.Hematol Oncol Clin North Am 1989;3: 35–63.
Klatsky AL, Armstrong MA, Friedman GD, et al. The relations of alcohol beverage use to colon and rectal cancer.Am J Epidemiol 1988;128: 1007–15.
Longnecker MP. A case-control study of alcoholic beverage consumption in relation to risk of cancer of the right colon and rectum in men.Cancer Causes Control 1990;1: 5–14.
Longnecker MP, Orza MJ, Adams ME, et al. A metaanalysis of alcoholic beverage consumption in relation to risk of colorectal cancer.Cancer Causes Control 1990;1: 59–68.
Slattery ML, Schumacher MC, Smith KR, et al. Physical activity, diet, and risk of colon cancer in Utah.Am J Epidemiol 1988;128: 989–99.
Whittemore AS, Wu-Williams AH, Lee M, et al. Diet, physical activity, and colorectal cancer among Chinese in North America and China.JNCI 1990;82: 915–26.
Lee I-M, Paffenbarger RSJr, Hsieh C-c. Physical activity and risk of developing colorectal cancer among college alumni.JNCI 1991;83: 1324–9.
Nomura A, Heilbrun LK, Stemmermann GN. Body mass index as a predictor of cancer in men.JNCI 1985;74: 319–23.
Graham S, Marshall J, Haughey B, et al. Dietary epidemiology of cancer of the colon in Western New York.Am J Epidemiol 1988;128: 490–503.
Chute CG, Willett WC, Colditz GA. A prospective study of body mass, height, and smoking on the risk of colorectal cancer in women.Cancer Causes Control 1991;2: 117–24.
Weiss NS, Daling JR, Chow WH. Incidence of cancer of the large bowel in women in relation to reproductive and hormonal factors.JNCI 1981;67: 57–60.
Potter JD, McMichael AJ. Large bowel cancer in women in relation to reproductive and hormonal factors: a case-control study.JNCI 1983;71: 703–9.
Peters RK, Pike MC, Chang WWL, et al. Reproductive factors and colon cancers.Br J Cancer 1990;61: 741–8.
La Vecchia C, Franceschi S. Reproductive factors and colorectal cancer.Cancer Causes Control 1991;2: 193–200.
Welsh SO, Marston RM. Review of trends in food use in the United States, 1909–13 to 1980.J Am Diet Assoc 1982;81: 120–8.
Popkin BM, Haines PS, Reidy KC. Food consumption trends of US women: patterns and determinants between 1977 and 1985.Am J Clin Nutr 1989;49: 1307–19.
US Institute of Medicine.Improving America's Diet and Health: from Recommendations to Action, Washington D.C.: National Academy Press, 1991: 42–6.
Lanza E, Jones DY, Block G, et al. Dietary fiber intake in the US population.Am J Clin Nutr 1987;46: 790–7.
Block G, Rosenberger WF, Patterson BH. Calories, fat and cholesterol: intake patterns in the US population by race, sex and age.Am J Public Health 1988;78: 1150–5.
Patterson BH, Block G, Rosenberger WF, et al. Fruit and vegetables in the American diet: data from the NHANES II survey.Am J Public Health 1990;80: 1443–9.
Newell GR, Borrud LG, McPherson RS, et al. Nutrient intakes of whites, blacks and Mexican Americans in Southeast Texas.Prev Med 1988;17: 622–33.
Bartram HP, Wynder EL. Physical activity and colon cancer risk? Physiological considerations [Editorial].Am J Gastroenterol 1989;84: 109–12.
Powell KE, Paffenbarger RS. Workshop on epidemiologic and public health aspects of physical activity and exercise: a summary.Public Health Rep 1985;100: 118–26.
National Center for Health Statistics.Prevention Profile, Health, United States, 1989. Hyattsville, MD: Public Health Service, 1990; DHHS Pub. No. (PHS) 90–1232.
Additional information
Authors are with the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, National Institutes of Health. Address correspondence to Dr Chow, National Cancer Institute, 6130 Executive Blvd, EPN Room 407, Rockville, MD 20892, USA.
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Chow, WH., Devesa, S.S. & Blot, W.J. Colon cancer incidence: recent trends in the United States. Cancer Causes Control 2, 419–425 (1991). https://doi.org/10.1007/BF00054303
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DOI: https://doi.org/10.1007/BF00054303