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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. 

Find out more about the coding and counting of this data.

By country in the UK

Bowel cancer is the fourth most common cancer in the UK (2011), 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%) separately.1-4

In 2011, there were 41,581 new cases of bowel cancer in the UK (Table 1.1): 23,171 (56%) in men and 18,410 (44%) in women, giving a male:female ratio of 13:10.1-4  The crude incidence rate shows that there are 75 new bowel cancer cases for every 100,000 males in the UK and 57 for every 100,000 females.1-4

The European age-standardised incidence rates (AS rates) are significantly lower in England compared with Wales (females only), Scotland and Northern Ireland.1-4 The rates do not differ significantly between Wales, Scotland and Northern Ireland for females, but rates are significantly lower in Wales compared to Scotland for males (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, 2011

England Wales Scotland Northern Ireland UK
Male Cases 18,971 1,297 2,239 664 23,171
Crude Rate 72.6 86.2 87.9 74.7 74.6
AS Rate 56.7 60.2 67.4 66.4 58.0
AS Rate - 95% LCL 55.9 57.0 64.6 61.3 57.3
AS Rate - 95% UCL 57.5 63.5 70.2 71.4 58.8
Female Cases 15,073 1,046 1,756 535 18,410
Crude Rate 55.9 67.1 64.9 57.8 57.2
AS Rate 36.8 40.6 41.9 42.9 37.6
AS Rate - 95% LCL 36.2 38.2 39.9 39.3 37.1
AS Rate - 95% UCL 37.4 43.1 43.9 46.5 38.2
Persons Cases 34,044 2,343 3,995 1,199 41,581
Crude Rate 64.1 76.5 76.0 66.1 65.8
AS Rate 46.0 49.6 53.3 53.5 47.0
AS Rate - 95% LCL 45.5 47.6 51.7 50.5 46.6
AS Rate - 95% UCL 46.5 51.6 55.0 56.5 47.5

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

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

Almost two-thirds (66%) of all bowel cancers are cancer of the colon and over one-third (34%) are cancers of the rectum, though this distribution varies by sex (Table 1.2). The crude incidence rate shows that there are 46 and 41 new colon cancer cases for every 100,000 males and females in the UK, respectively. The crude rates also show there are around 29 and 17 new rectal cancer cases for every 100,000 males and females in the UK, respectively (Table 1.2).1-4

Table 1.2: Colon (C18), Rectum and Rectosigmoid Junction (C19-C20) Cancers, Numbers of New Cases and European Age-Standardised (AS) Incidence Rates per Million Population, UK, 2011

Male Female Persons
Colon (C18) Cases 14,279 13,076 27,355
Crude Rate 45.9 40.7 43.3
AS Rate 35.2 26.2 30.3
AS Rate - 95% LCL 34.7 25.8 29.9
AS Rate - 95% UCL 35.8 26.7 30.7
Rectum and Rectosigmoid Junction (C19-C20) Cases 8,892 5,334 14,226
Crude Rate 28.6 16.6 22.5
AS Rate 22.8 11.4 16.7
AS Rate - 95% LCL 22.3 11.1 16.4
AS Rate - 95% UCL 23.2 11.7 17.0

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section reviewed 29/05/14
section updated 29/05/14

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 2009 and 2011, an average 43% of bowel cancer cases were diagnosed in people aged 75 years and over, and 95% were diagnosed in those aged 50 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 at ages 60-64, 65-69, and 70-74, when the male:female incidence ratio of age-specific rates (to account for the different proportions of males to females in each age group) are around 17:10.1-4

Figure 1.1: Bowel Cancer (C18-C20), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK, 2009-2011

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 are currently offered bowel screening at two-year intervals between ages 60 and 69 (though this age range is being extended upwards to 74), and in Northern Ireland between the ages of 60 and 71. In Scotland people are offered screening from ages 50-74. In Wales people are offered screening from ages 60-74.7-10

section reviewed 29/05/14
section updated 29/05/14

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% between 1975-1977 and 2009-2011, with most of this increase occurring in the 1980s and 1990s. For females, the rise is much smaller, with rates increasing by 7% between 1975-1977 and 2009-2011.1-3

At the end of the 1990s bowel cancer incidence rates had started to fall,28 but they have since risen following the introduction of the national bowel screening programmes. 

Figure 1.2: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, Great Britain, 1975-2011

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 2000-2002 and 2009-2011), the European AS incidence rates have overall increased by 5% and 6% for males and females, respectively. 

Figure 1.3: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, UK, 1993-2011

inc_asr_uk_bowel.swf

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Bowel cancer incidence rates increased for all 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 36% and 26%, respectively, between 1975-1977 and 2009-2011.1-3

Figure 1.4: Bowel Cancer (C18-20), European Age-Standardised Incidence Rates, By Age, Great Britain, 1975-2011

inc_asr_age_p_bowel.swf

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Between 2006 and 2008, bowel cancer European AS incidence rates for people aged 60-69 increased by 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, though this has now been followed by a small decrease in 2011.7-10 Between 2008 and 2010, there was very little change in incidence rates for this age group in the UK, but further increases are anticipated.1-4 This decrease may mean the prevalent pool of undiagnosed bowel cancers have now been detected in the population and incidence rates are starting to return to the pre-screening rates. Whether this is true or not will be seen in the coming years of data. 

section reviewed 29/05/14
section updated 29/05/14

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.27

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.22

The more difficult to detect flat adenomas account for about 10% of all lesions and may have a greater propensity to malignant change.23,24

Only a small proportion of polyps (1-10%) develop into invasive bowel cancer.25 Indicators for progression from adenomas to cancer include large size, villous histology and severe dysplasia.26

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

 

In Europe and worldwide

Bowel cancer (C18-C21) is the second most common cancer in Europe, with around 447,000 new cases diagnosed in 2012 (13% of the total). In Europe (2012), the highest World age-standardised incidence rates for bowel cancer are in Slovakia for men and Norway for women; the lowest rates are in Albania for both men and women. UK bowel cancer incidence rates are estimated to be the 20th highest in males in Europe, and 17th highest in females.14 These data are broadly in line with Europe-specific data available elsewhere.15

Bowel cancer (C18-C21) is the third most common cancer worldwide, with more than 1,360,000 new cases diagnosed in 2012 (10% of the total). Bowel cancer incidence rates are highest in Australia/New Zealand and lowest in Western Africa, but this partly reflects varying data quality worldwide.14

Use our interactive map to explore the data for bowel cancer.

Variation between countries may reflect different prevalence of risk factors, use of screening, and diagnostic methods.

section reviewed 11/06/14
section updated 11/06/14

 

By socio-economic variation

There is evidence for a small association between bowel cancer incidence and deprivation for males in England, while there is no evidence for an association for females.17 England-wide data for 2006-2010 show European age-standardised incidence rates are 13% higher for males living in the most deprived areas compared with the least deprived, while for females the rates are similar for those living in the least and most deprived areas (Figure 1.6).17 Male differences in deprivation are more marked than for females.

Figure 1.6: Bowel Cancer (C18-C20), European Age-Standardised Incidence Rates by Deprivation Quintile, England, 2006-2010

dep_inc_bar_bowel.swf

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The estimated gap in bowel cancer incidence between people living in the most and least deprived areas in England has not changed in the period 1996-2010. It has been estimated that there would have been around 770 fewer bowel cancer cases each year in England during 2006-2010 if all people experienced the same incidence rates as the least deprived.17

Associations with deprivation have also been investigated for mortality.

section reviewed 29/05/14
section updated 29/05/14

By ethnicity

Age-standardised rates for White males with bowel cancer range from 54.1 to 55.3 per 100,000. Rates for Asian males are significantly lower, ranging from 19.1 to 28.0 per 100,000 and the rates for Black males are also significantly lower, ranging from 29.7 to 43.8 per 100,000. For females there is a similar pattern - the age-standardised rates for White females range from 34.0 to 34.8 per 100,000, and rates for Asian and Black females are also significantly lower ranging from 11.3 to 17.5 per 100,000 and 20.4 to 31.6 per 100,000 respectively.28

Ranges are given because of the analysis methodology used to account for missing and unknown data. For bowel cancer, 146,495 cases were identified; 17% had no known ethnicity.

section reviewed 29/05/14
section updated 29/05/14

 

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 1.3).21

Table 1.3: 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, July 2013. 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, May 2013. 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, June 2013. 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, June 2013. 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. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed December 2013.
  15. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al.Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer (2013) 49, 1374-1403.
  16. 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
  17. Cancer Research UK and National Cancer Intelligence Network. Cancer by deprivation in England: Incidence, 1996-2010, Mortality, 1997-2011. London: NCIN; 2014.
  18. ISD Scotland Cancer statistics. Colorectal cancer. Accessed March 2012.
  19. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994-2004: A comprehensive report. Belfast: Northern Ireland Cancer Registry/National Cancer Registry Ireland; 2009.
  20. Welsh Cancer Intelligence and Surveillance Unit. Cancer in Wales, 1995-2009: A Comprehensive Report. Cardiff: Welsh Cancer Intelligence and Surveillance Unit; 2011.
  21. National Cancer Intelligence Network (NCIN). One, five and ten-year cancer prevalence by cancer network, UK, 2006. London: NCIN; 2010.
  22. Midgley R, Kerr D. Colorectal cancer. Lancet 1999;353:391-399.
  23. Hardy R, Meltzer S, Jankowski J. ABC of colorectal cancer: Molecular basis for risk factors. BMJ 2000;321:886-889.
  24. 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.
  25. Scholefield J. ABC of colorectal cancer: Screening. BMJ 2000;321:1004-1006.
  26. 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.
  27. 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.
  28. Jones AM, Morris E, Thomas J, et al. . Evaluation of bowel cancer registration data in England, 1996-2004. Br J Cancer 2009;101(8):1269-73.
Updated: 11 June 2014