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Bowel cancer incidence statistics

Incidence statistics for bowel cancer by country in the UK, age and trends over time are presented here. There are also data on lifetime risk, the distribution of cases, by geography, socio-economic variation, and prevalence. The ICD codes for bowel cancer (sometimes called colorectal cancer) are ICD-10 C18-C20 (which includes cancers of the colon, rectum and rectosigmoid junction).

The latest incidence statistics available for bowel cancer in the UK are 2010. Find out why these are the latest statistics available.

By country in the UK

Bowel cancer is the fourth most common cancer in the UK (2010), accounting for 13% of all new cases. It is the third most common cancer in both males (14% of the male total) and females (11%).1-4

In 2010, there were 40,695 new cases of bowel cancer in the UK (Table 1.1): 22,834 (56%) in men and 17,861 (44%) in women, giving a male:female ratio of 13:10.1-4  The crude incidence rate shows that there are around 75 new bowel cancer cases for every 100,000 males in the UK and around 56 for every 100,000 females (Table 1.1).1-4

Almost two-thirds (66%) of all bowel cancers are cancers of the colon and over one-third (34%) are cancers of the rectum (including the anus). More rectal cancer cases occur in men (8,753 or 63% male), while colon cancer cases are similar between men and women (14,081 or 53% male). The crude incidence rate shows that there are around 75 new bowel cancer cases for every 100,000 males in the UK and around 56 for every 100,000 females (Table 1.1).1-4

The European age-standardised incidence rates (AS rates) are significantly lower in England compared with Wales (males only), Scotland and Northern Ireland.1-4 The rates do not differ significantly between Wales, Scotland and Northern Ireland for males, but rates are significantly lower in Wales compared to Scotland and Northern Ireland for females (Table 1.1).1-4

Table 1.1: Bowel Cancer (C18-C20), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2010

Bowel (C18-C20) England Wales Scotland Northern Ireland UK
Male Cases 18,590 1,421 2,177 646 22,834
Crude Rate 72.2 96.6 86.0 73.0 74.5
AS Rate 56.5 67.6 66.6 66.1 58.2
AS Rate - 95% LCL* 55.7 64.1 63.8 61.0 57.5
AS Rate - 95% UCL* 57.3 71.1 69.4 71.2 59.0
Female Cases 14,628 933 1,790 510 17,861
Crude Rate 55.2 60.8 66.5 55.7 56.5
AS Rate 36.1 35.8 42.3 42.2 36.8
AS Rate - 95% LCL* 35.5 33.5 40.4 38.5 36.3
AS Rate - 95% UCL* 36.7 38.1 44.3 45.9 37.4
Persons Cases 33,218 2,354 3,967 1,156 40,695
Crude Rate 63.6 78.3 76.0 64.2 65.4
AS Rate 45.5 50.5 53.3 52.8 46.6
AS Rate - 95% LCL* 45.0 48.5 51.6 49.7 46.2
AS Rate - 95% UCL* 46.0 52.6 55.0 55.8 47.1
Colon (C18) England Wales Scotland Northern Ireland UK
Male Cases 11,388 874 1,403 416 14,081
Crude Rate 44.2 59.4 55.4 47.0 46.0
AS Rate 34.1 40.7 42.6 41.9 35.4
AS Rate - 95% LCL* 33.5 38.0 40.3 37.9 34.8
AS Rate - 95% UCL* 34.8 43.4 44.8 45.9 36.0
Female Cases 10,276 666 1,333 369 12,644
Crude Rate 38.8 43.4 49.5 40.3 40.0
AS Rate 24.8 25.2 31.1 30.0 25.5
AS Rate - 95% LCL* 24.3 23.3 29.4 27.0 25.1
AS Rate - 95% UCL* 25.3 27.2 32.8 33.1 26.0
Persons Cases 21,664 1,540 2,736 785 26,725
Crude Rate 41.5 51.2 52.4 43.6 42.9
AS Rate 29.0 32.3 36.2 35.1 30.0
AS Rate - 95% LCL* 28.7 30.7 34.9 32.6 29.6
AS Rate - 95% UCL* 29.4 33.9 37.6 37.5 30.4
Rectum (C19-C20) England Wales Scotland Northern Ireland UK
Male Cases 7,202 547 774 230 8,753
Crude Rate 28.0 37.2 30.6 26.0 28.6
AS Rate 22.4 26.9 24.1 24.2 22.8
AS Rate - 95% LCL* 21.8 24.7 22.4 21.1 22.3
AS Rate - 95% UCL* 22.9 29.2 25.8 27.4 23.3
Female Cases 4,352 267 457 141 5,217
Crude Rate 16.4 17.4 17.0 15.4 16.5
AS Rate 11.3 10.6 11.2 12.2 11.3
AS Rate - 95% LCL* 11.0 9.3 10.2 10.2 11.0
AS Rate - 95% UCL* 11.7 11.8 12.2 14.2 11.6
Persons Cases 11,554 814 1,231 371 13,970
Crude Rate 22.1 27.1 23.6 20.6 22.4
AS Rate 16.4 18.2 17.1 17.7 16.6
AS Rate - 95% LCL* 16.1 17.0 16.1 15.9 16.3
AS Rate - 95% UCL* 16.7 19.5 18.0 19.5 16.9

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

Download this table XLS (335KB)

A north-south divide in bowel cancer incidence has existed across the UK since at least the 1990s.5 The most recent data shows that the highest incidence rates are still in areas of Scotland, Northern Ireland and the north of England for males. However, a clear divide across the UK is much less evident for females, with many parts of England also experiencing high incidence rates, such as areas in the east and south-west.6

section reviewed 02/04/13
section updated 02/04/13

By age

Bowel cancer incidence is strongly related to age, with the highest incidence rates being in older men and women. In the UK between 2008 and 2010, an average 73% of bowel cancer cases were diagnosed in people aged 65 years and over (Figure 1.1). Age-specific incidence rates increase sharply from around age 50, with the highest rates in the 85+ age group. Incidence rates are significantly higher for males than females in adults aged 45 and over and this gap is widest between the ages of 65 and 74, when the male:female incidence ratio of age-specific rates (to account for the different proportions of males to females in each age group) is about 17:10. The male:female rate ratio decreases to around 15:10 at age 85+ (Figure 1.1).1-4

Figure 1.1: Bowel Cancer (C18-C20), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK, 2008-2010

cases_crude_bowel.swf

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Around a quarter (26%) of bowel cancer cases occur in 60-69 year olds. 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 50-74. In Wales people are offered screening from ages 60-74. In England screening is gradually being extended to include people aged 70-74.7-10

section reviewed 02/04/13
section updated 02/04/13

Trends over time

Bowel cancer incidence rates have overall increased in Great Britain since the mid-1970s (Figure 1.2). For males, European AS incidence rates have increased by 29% from 45 cases per 100,000 in 1975-1977 to 58 in 2008-2010, with most of this increase occurring in the 1980s and 1990s. For females, the rise is much smaller, with rates increasing by 6% from 35 to 37 per 100,000 females between 1975-1977 and 2008-2010.1-3

At the end of the 1990s bowel cancer rates fell by 5% (between 1998-2000 and 2001-2003) but they have since returned to the levels seen at the end of the millennium.

Figure 1.2: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, Great Britain, 1975-2010

inc_asr_gb_bowel.swf

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Bowel cancer incidence trends for the UK are shown in Figure 1.3.1-4 Over the last decade (between 1999-2001 and 2008-2010), the European AS incidence rates have overall increased by 3% for both males and females. Between 1998-2001 and 2001-2003 the European AS Incidence rates decreased by 4% and 6% in males and females, respectively. Since then (between 2001-2003 and 2008-2010), incidence rates have increased by 6% and 7% for males and females, respectively.

Figure 1.3: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, UK, 1993-2010

inc_asr_gb_bowel.swf

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Bowel cancer incidence rates increased for most of the specific broad age groups in Great Britain since the mid-1970s (Figure 1.4).1-3 The largest increases have been in people aged 60-69 and 70-79, with European AS incidence rates increasing by 37% and 25%, respectively, between 1975-1977 and 2008-2010.1-3 More than 23,000 people are now diagnosed in these age groups combined in the UK each year.

Figure 1.4: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, By Age, Great Britain, 1975-2010

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Between 2006 and 2008, bowel cancer European AS incidence rates for people aged 60-69 increased by more than 13% in the UK (data not shown).1-4 This rise is almost certainly due to the roll out of bowel cancer screening, which started in England for 60-69 year olds in 2006, and has now been rolled-out across the whole of the UK.7-10 Between 2008 and 2010, there has been very little change in incidence rates for this age group in the UK, but further increases are anticipated.1-4

section reviewed 02/04/13
section updated 02/04/13

Lifetime risk

Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life.  It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different. 

In 2010, lifetime risk of developing bowel cancer in the UK was 1 in 14 for men and 1 in 19 for women.11

The lifetime risk for bowel cancer has been calculated by the Statistical Information Team using the ‘Adjusted for Multiple Primaries’ (AMP) method; this accounts for the possibility that someone can have more than one diagnosis of bowel cancer over the course of their lifetime.28

section reviewed 02/04/13
section updated 02/04/13

 

Distribution of cases

More tumours are diagnosed in the left hand side of the bowel than the right (Figure 1.5, note the right side of the picture). In Britain between 2007 and 2009, around 60% of tumours were diagnosed in the descending colon, sigmoid colon, rectosigmoid junction, rectum and anus.1-3

Figure 1.5: Bowel Cancer (C18-21), Percentage Distribution of Cases within the Large Bowel, Great Britain, 2007-2009

inc_subsites_bowel

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section reviewed 26/03/12
section updated 26/03/12

By morphology

More than 90% of bowel cancer cases are adenocarcinomas and the majority of these arise from adenomatous polyps (adenomas). These common benign tumours develop from normal colonic mucosa and are present in about a third of the European and USA populations.23

The more difficult to detect flat adenomas account for about 10% of all lesions and may have a greater propensity to malignant change.24,25

Only a small proportion of polyps (1-10%) develop into invasive bowel cancer.26 Indicators for progression from adenomas to cancer include large size, villous histology and severe dysplasia.27

section reviewed 31/12/09
section updated 31/12/09

 

In Europe and worldwide

Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.12 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.13

Bowel cancer (including anal cancer; C18-C21) is the third most common cancer worldwide after lung and breast, with an estimated 1.24 million new cases diagnosed in 2008 (10% of the total). Bowel cancer incidence rates are lowest in Middle Africa and highest in Australia/New Zealand, with around a ten-fold variation in male and female World AS incidence rates between the regions of the world (Figure 1.6).13

Much of the geographical variation in incidence across the world can be attributed to differences in diet, particularly the consumption of red and processed meat, fibre and alcohol, as well as bodyweight and physical activity. Countries that have had a rapid ‘westernisation’ of diet, such as Japan,14 have seen a rapid increase in the incidence of colorectal cancer.15 Epidemiological studies report a rapid increase in risk for colorectal cancer in migrants moving from low to high risk countries.16

Figure 1.6: Bowel Cancer including Anal Cancer (C18-C21), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

world_inc_bowel.swf

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Within the 27 countries of the European Union, the highest European AS incidence rates for 2008 are estimated to be in Slovakia for men (around 91 cases per 100,000) and Denmark for women (50 cases per 100,000), while the lowest rates are in Greece for both sexes (around 24 cases per 100,000 for men and 17 per 100,000 for females) (Figure 1.7).17

UK bowel cancer (including anal cancer) incidence rates are estimated to be the 14th (males) and 12th (females) highest in Europe (EU-27).17

Figure 1.7: Bowel Cancer including Anal Cancer (C18-C21), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

EU27_inc_bowel.swf

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section reviewed 26/03/12
section updated 26/03/12

 

By socio-economic variation

There is evidence for a small association between bowel cancer incidence and deprivation in the UK for males (and possibly females). The most recent England-wide data for 2000-2004 shows European AS incidence rates are around 11% higher for men living in more deprived areas compared with the least deprived, though no significant differences are reported for women.18 A study in Scotland for 2005-2009 shows a similar deprivation gap for men and women combined.19 Comparable results have also been published in Northern Ireland (for men and women combined) and Wales (association seen in men only).20,21  

section reviewed 26/03/12
section updated 26/03/12

 

Prevalence

Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not.

In the UK more than 143,000 people were still alive at the end of 2006, up to ten years after being diagnosed with bowel cancer (Table 1.2).22

Table 1.2: Bowel Cancer (C18-C20), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

1 Year Prevalence 5 Year Prevalence 10 Year Prevalence
Male 14,635 51,183 78,483
Female 11,415 40,594 65,075
Persons 26,050 91,777 143,558

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Worldwide, it is estimated that there were around 3.26 million men and women still alive in 2008, up to five years after their diagnosis.13

section reviewed 17/05/13
section updated 17/05/13

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References for bowel cancer incidence

  1. Data were provided by the Office for National Statistics on request, June 2012. Similar data can be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations
  2. Data were provided by ISD Scotland on request, April 2012. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp
  3. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, April 2012. Similar data can be found here: http://www.wales.nhs.uk/sites3/page.cfm?orgid=242pid=59080
  4. Data were provided by the Northern Ireland Cancer Registry on request, October 2012. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/CancerData/OnlineStatistics/
  5. Quinn M WH, Cooper N, Rowan S. Cancer atlas of the United Kingdom and Ireland 1991-2000. London: Office for National Statistics; 2005.
  6. National Cancer Intelligence Network Cancer e-atlas. Accessed January 2012.
  7. NHS Screening Programme
  8. Scottish Bowel Screening Programme
  9. Bowel Screening Wales
  10. Northern Ireland Bowel Screening Programme
  11. Lifetime risk was calculated by the Statistical Information Team at Cancer Research UK, 2012.
  12. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12):2893-917.
  13. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr. Accessed May 2011.
  14. Matsumara Y. Nutrition trends in Japan. Asia Pac J Clin Nutr 2001;10 Suppl:S40-7.
  15. Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev 2009; 18(6):1688-94.
  16. Boyle P, Langman J. ABC of colorectal cancer: Epidemiology. BMJ 2000;321:805-808.
  17. European Age-Standardised rates calculated by the Cancer Research UK Statistical Information Team, 2011, using data from GLOBOCAN 2008 v1.2, IARC, version 1.2. http://globocan.iarc.fr
  18. National Cancer Intelligence Network (NCIN). Cancer incidence by deprivation England, 1995-2004. London: NCIN; 2008.
  19. ISD Scotland Cancer statistics. Colorectal cancer. Accessed March 2012.
  20. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994-2004: A comprehensive report. Belfast: Northern Ireland Cancer Registry/National Cancer Registry Ireland; 2009.
  21. Welsh Cancer Intelligence and Surveillance Unit. Cancer in Wales, 1995-2009: A Comprehensive Report. Cardiff: Welsh Cancer Intelligence and Surveillance Unit; 2011.
  22. National Cancer Intelligence Network (NCIN). One, five and ten-year cancer prevalence by cancer network, UK, 2006. London: NCIN; 2010.
  23. Midgley R, Kerr D. Colorectal cancer. Lancet 1999;353:391-399.
  24. Hardy R, Meltzer S, Jankowski J. ABC of colorectal cancer: Molecular basis for risk factors. BMJ 2000;321:886-889.
  25. O'Brien MJ, Winawer SJ, Zauber AJ, et al. Flat adenomas in the National Polyp Study: is there increased risk for high grade dysplasia initially or during surveillance. BMJ 2000;321:886-889.
  26. Scholefield J. ABC of colorectal cancer: Screening. BMJ 2000;321:1004-1006.
  27. Terry MB, Neugut AI, Bostick RM, et al. Risk factors for advanced colorectal adenomas: A pooled analysis. Cancer Epidemiol Biomarkers Prev 2002;11:622-629.
  28. Sasieni PD, Shelton J, Ormiston-Smith N, et al. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Br J Cancer 2011;105(3):460-5.
Updated: 2 April 2013