Health  Vol.2 No.8 , August 2010
Changing trends in colorectal cancer: possible cause and clinical implications
ABSTRACT
OBJECTIVES: The aims of this study were to determine whether pattern of patients presenting with colorectal cancer (CRC) in the last few years differs significantly from that previously reported in Australia, and to relate the trends, if present, to use of hormone replacement therapy (HRT). METHODS: We examined demographic and pathological characteristics of 145 consecutive CRC patients (65 females) treated in our institution in calendar years 2006-2007. Comparisons were made with data on 12536 CRC patients obtained from the Australian Association on Cancer Registries (AACR) for the year 2003, most recent available. Prescribing data for HRT were obtained from the Australian Commonwealth Department of Health and Ageing. RESULTS: The distribution of colon, sigmoid and rectal cancers in our series was 40%, 24.8% and 35.2%, respectively, which differs significantly from 65%, 8.1% and 26.9% in the AACR data (p < 0.01). Our cohort was significantly younger (65.4 ± 12.1 vs. 69.5 ± 12.3 years), especially females (63.0 ± 12.7 vs. 70.3 ± 13.0 years; p < 0.001). The proportion of female patients aged < 55 and < 60 years was significantly higher (30.8% vs. 13.8% and 41.5% vs. 21.4%, respectively). Younger patients have more aggressive and advanced cancers. In Australia HRT use declined since 2001 and fell by a half in 2006. CONCLUSIONS: In the changing CRC pattern of greatest concern is a significantly higher proportion of younger patients, especially females, with higher prevalence of more advanced and aggressive cancers, coincident with decreased prescribing of HRT. These findings may have important implications for refining screening and preventive strategies and on demand for radiotherapy services.

Cite this paper
nullFisher, M. , Fisher, L. , Waxman, B. and Fisher, A. (2010) Changing trends in colorectal cancer: possible cause and clinical implications. Health, 2, 842-849. doi: 10.4236/health.2010.28127.
References
[1]   Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registries (AACR). (2007) Cancer in Australia: An overview 2006. Cancer Series, AIHW, Canberra, 2007, 37.

[2]   Chu, K.C., Tarone, R.E., Chow, W.H., Hankey, B.F. and Ries, L.A. (1994) Temporal patterns in colorectal cancer incidence, survival and mortality from 1950 through 1990. Journal of the National Cancer Institute, 86(13), 997-1006.

[3]   Nelson, R.L., Persky, V. and Turyk, M. (1999) Determination of factors responsible for the declining incidence of colorectal cancer. Diseases of the Colon & Rectum, 42(6), 741-752.

[4]   Boyle, P. and Leon, M.E. (2002) Epidemiology of colorectal cancer. British Medical Bulletin, 64, 1-25.

[5]   Rabeneck, L., El-Serag, H.B., Davila, J.A. and Sandler, R. S. (2003) Outcomes of colorectal cancer in the United States: no change in survival (1986-1997). American Journal of Gastroenterology, 98(2), 471-477.

[6]   Gupta, A. K., Melton, L.J., Petersen, G.M., Timmons, L. J., Vege, S.S., Harmsen, W.S., Diehl, N.N., Zinsmeister, A.R. and Ahlquist, D.A. (2005) Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: A population-based study. Clinical Gastroenterology and Hepatology, 3(2), 150-158.

[7]   Cress, R.D., Morris, C., Ellison, G.L. and Goodman, M. T. (2006) Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992- 2001. Cancer, 107(5), 1142-1152.

[8]   Koo, J. H., Jalaludin, B., Wong, S.K., Kneebone, A., Connor, S.J. and Leong, R.W. (2008) Improved survival in young women with colorectal cancer. American Journal of Gastroenterology, 103(6), 1488-1495.

[9]   Singh, H., Demers, A.A., Xue, L., Turner, D. and Bernstein, C.N. (2008) Time trends in colon cancer incidence and distribution and lower gastrointestinal endoscopy utilization in Manitoba. American Journal of Gastroenterology, 103(5), 1249-1256.

[10]   Wu, X., Cokkinides, V., Chen, V.W., Nadel, M., Ren, Y., Martin, J. and Ellison, G.L. (2006) Associations of subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis with county-level poverty, by race and sex. Cancer, 107(5), 1121-1127.

[11]   Liang, W. (2007) Age, sex and the risk of grade-specific second primary colorectal cancer: Evidence for the protective effect of female hormone. European Journal of Cancer, 43(12), 1856-1861.

[12]   Ferlay, J., Autier, P., Boniol, M., Heanue, M., Colombet, M. and Boyle, P. (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Annals of Oncology, 18(3), 581-592.

[13]   Crandall, C.J. (1999) Estrogen replacement therapy and colon cancer: A clinical review. Journal of Women's Health and Gender-Based Medicine, 8(9), 1155-1166.

[14]   Paganini-Hill, A. (1999) Estrogen replacement therapy and colorectal cancer risk in elderly women. Diseases of the Colon & Rectum, 42(10), 1300-1305.

[15]   Nanda, K., Bastian, L.A., Hasselblad, V. and Simel, D.L. (1999) Hormone replacement therapy and the risk of colorectal cancer: A meta-analysis. Obstetrics & Gynecology, 93(5), 880-888.

[16]   Di Leo, A., Messa, C., Cavallini, A. and Linsalata, M. (2001) Estrogens and colorectal cancer. Current Drug Targets-Immune, Endocrine & Metabolic Disorders, 1(1), 1-12.

[17]   Gambacciani, M., Monteleone, P., Sacco, A. and Genazzani, A.R. (2003) Hormone replacement therapy and endometrial, ovarian and colorectal cancer. Best Practice & Research Clinical Endocrinology & Metabolism, 17(1), 139-147.

[18]   Hoffmeister, M., Raum, E., Krtschil, A., Chang-Claude, J. and Brenner, H. (2009) No evidence for variation in colorectal cancer risk associated with different types of postmenopausal hormone therapy. Clinical Pharmacology & Therapeutics, 86(4), 416-424.

[19]   Grodstein, F., Newcomb, P.A. and Stampfer, M.J. (1999) Postmenopausal hormone therapy and the risk of colorectal cancer: A review and meta-analysis. American Journal of Medicine, 106(5), 574-582.

[20]   Chlebowski, R.T., Wactawski-Wende, J., Ritenbaugh, C., Hubbell, F.A., Ascensao, J., Rodabough, R.J., Rosenberg, C.A., Taylor, V.M., Harris, R., Chen, C., Adams-Campbell, L.L. and White, E. (2004) Estrogen plus progestin and colorectal cancer in postmenopausal women. The New England Journal of Medicine, 350(10), 991-1004.

[21]   Nelson, H.D., Humphrey, L.L., Nygren, P., Teutsch, S.M. and Allan, J.D. (2002) Postmenopausal hormone replacement therapy: Scientific review. JAMA, 288(7), 872-881.

[22]   Canfell, K., Banks, E., Moa, A.M. and Beral, V. (2008) Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia. Medical Journal of Australia, 188(11), 641-644.

[23]   Lindblom, A. (2001) Different mechanisms in the tumorigenesis of proximal and distal colon cancers. Current Opinion in Oncology, 13(1), 63-69.

[24]   Cheng, X., Chen, V.W., Steele, B., Ruiz, B., Fulton, J., Liu, L., Carozza, S.E. and Greenlee, R. (2001) Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997. Cancer, 92(10), 2547-2554.

[25]   Iacopetta, B. (2002) Are there two sides to colorectal cancer? International Journal of Cancer, 101(5), 403- 408.

[26]   Giovannucci, E., Pollak, M., Liu, Y., Platz, E.A., Majeed, N., Rimm, E.B. and Willett, W.C. (2003) Nutritional predictors of insulin-like growth factor I and their relationships to cancer in men. Cancer Epidemiology, Biomarkers & Prevention, 12(2), 84-89.

[27]   Matanoski, G., Tao, X.G., Almon, L., Adade, A.A. and Davies-Cole, J.O. (2006) Demographics and tumor characteristics of colorectal cancers in the United States, 1998-2001. Cancer, 107(5), 1112-1120.

[28]   Azzoni, C., Bottarelli, L., Campanini, N., Di Cola, G., Bader, G., Mazzeo, A., Salvemini, C., Morari, S., Di Mauro, D., Donadei, E., Roncoroni, L., Bordi, C., and Sarli, L. (2007) Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: Arguments for different mechanisms in the tumorigenesis. International Journal of Colorectal Disease, 22(2), 115-126.

[29]   Leopoldo, S., Lorena, B., Cinzia, A., Gabriella, D.C., Angela Luciana, B., Renato, C., Antonio, M., Carlo, S., Cristina, P., Stefano, C., Maurizio, T., Luigi, R., and Cesare, B. (2008) Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Annals Of Surgical Oncology, 15(5), 1429- 1439.

[30]   Cho, E., Smith-Warner, S.A., Ritz, J., van den Brandt, P.A., Colditz, G.A., Folsom, A.R., Freudenheim, J.L., Giovannucci, E., Goldbohm, R.A., Graham, S., Holmberg, L., Kim, D.H., Malila, N., Miller, A.B., Pietinen, P., Rohan, T.E., Sellers, T.A., Speizer, F.E., Willett, W.C., Wolk, A., and Hunter, D.J. (2004) Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Annals of Internal Medicine, 140(8), 603-613.

[31]   Moskal, A., Norat, T., Ferrari, P. and Riboli, E. (2007) Alcohol intake and colorectal cancer risk: A dose- response meta-analysis of published cohort studies. International Journal of Cancer, 120(3), 664-671.

[32]   Shrubsole, M.J., Wu, H., Ness, R.M., Shyr, Y., Smalley, W.E. and Zheng, W. (2008) Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. American Journal of Epidemiology, 167(9), 1050-1058.

[33]   Smalley, W., Ray, W.A., Daugherty, J. and Griffin, M.R. (1999) Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: A population-based study. Archives of Internal Medicine, 159(2), 161-166.

[34]   Rostom, A., Dube, C., Lewin, G., Tsertsvadze, A., Barrowman, N., Code, C., Sampson, M. and Moher, D. (2007) Nonsteroidal anti-inflammatory drugs and cyclo- oxygenase-2 inhibitors for primary prevention of colorectal cancer: A systematic review prepared for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 146(5), 376-389.

[35]   Dube, C., Rostom, A., Lewin, G., Tsertsvadze, A., Barrowman, N., Code, C., Sampson, M. and Moher, D. (2007) The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 146(5), 365-375.

[36]   Hebert-Croteau, N. (1998) A meta-analysis of hormone replacement therapy and colon cancer in women. Cancer Epidemiology, Biomarkers & Prevention, 7(8), 653-659.

[37]   Prihartono, N., Palmer, J.R., Louik, C., Shapiro, S. and Rosenberg, L. (2000) A case-control study of use of postmenopausal female hormone supplements in relation to the risk of large bowel cancer. Cancer Epidemiology, Biomarkers & Prevention, 9(4), 443-447.

[38]   Nichols, H.B., Trentham-Dietz, A., Hampton, J.M. and Newcomb, P.A. (2005) Oral contraceptive use, reproductive factors, and colorectal cancer risk: Findings from Wisconsin. Cancer Epidemiology, Biomarkers & Prevention, 14(5), 1212-1218.

[39]   Murff, H.J., Shrubsole, M.J., Smalley, W.E., Wu, H., Shyr, Y., Ness, R.M. and Zheng, W. (2007) The interaction of age and hormone replacement therapy on colon adenoma risk. Cancer Detection and Prevention, 31(2), 161-165.

[40]   Kennelly, R., Kavanagh, D.O., Hogan, A.M. and Winter, D.C. (2008) Oestrogen and the colon: Potential mechanisms for cancer prevention. Lancet Oncology, 9(4), 385- 391.

[41]   Rizk, D.E., Helal, T.E., Mason, N. and Berg, B. (1998) Non-evidence of estrogen receptors in the rectal mucosa. International Urogynecology Journal and Pelvic Floor Dysfunction, 9(3), 136-139.

[42]   Konstantinopoulos, P.A., Kominea, A., Vandoros, G., Sykiotis, G.P., Andricopoulos, P., Varakis, I., Sotiropoulou-Bonikou, G. and Papavassiliou, A.G. (2003) Oestrogen receptor beta (ERbeta) is abundantly expressed in normal colonic mucosa, but declines in colon adenocarcinoma paralleling the tumour's dedifferentiation. European Journal of Cancer, 39(9), 1251-1258.

[43]   Heiss, G., Wallace, R., Anderson, G.L., Aragaki, A., Bere- sford, S.A., Brzyski, R., Chlebowski, R.T., Gass, M., LaCroix, A., Manson, J.E., Prentice, R.L., Rossouw, J. and Stefanick, M.L. (2008) Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9), 1036-1045.

[44]   Chan, J.A., Meyerhardt, J.A., Chan, A.T., Giovannucci, E. L., Colditz, G.A. and Fuchs, C.S. (2006) Hormone replacement therapy and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 24(36), 5680- 5686.

[45]   Clarke, C.A. and Glaser, S.L. (2007) Declines in breast cancer after the WHI: Apparent impact of hormone therapy. Cancer Causes Control, 18(8), 847-852.

[46]   Ravdin, P.M., Cronin, K.A., Howlader, N., Berg, C.D., Chlebowski, R.T., Feuer, E.J., Edwards, B.K. and Berry, D.A. (2007) The decrease in breast-cancer incidence in 2003 in the United States. The New England Journal of Medicine, 356(16), 1670-1674.

[47]   Wada-Hiraike, O., Warner, M. and Gustafsson, J.A. (2006) New developments in oestrogen signalling in colonic epithelium. Biochemical Society Transactions, 34(6), 1114-1116.

[48]   Foley, E.F., Jazaeri, A.A., Shupnik, M.A., Jazaeri, O. and Rice, L.W. (2000) Selective loss of estrogen receptor beta in malignant human colon. Cancer Research, 60(2), 245- 248.

[49]   Jassam, N., Bell, S.M., Speirs, V. and Quirke, P. (2005) Loss of expression of oestrogen receptor beta in colon cancer and its association with Dukes' staging. Oncology Reports, 14(1), 17-21.

[50]   Di Leo, A., Barone, M., Maiorano, E., Tanzi, S., Piscitelli, D., Marangi, S., Lofano, K., Ierardi, E., Principi, M. and Francavilla, A. (2008) ER-beta expression in large bowel adenomas: implications in colon carcinogenesis. Digestive and Liver Disease, 40(4), 260-266.

[51]   Issa, J.P., Ottaviano, Y.L., Celano, P., Hamilton, S.R., Davidson, N.E. and Baylin, S.B. (1994) Methylation of the oestrogen receptor CpG island links ageing and neoplasia in human colon. Nature Genetics, 7(4), 536-540.

[52]   McMichael, A.J. and Potter, J.D. (1980) Reproduction, endogenous and exogenous sex hormones, and colon cancer: A review and hypothesis. Journal of the National Cancer Institute, 65(6), 1201-1207.

[53]   Alberts, D. S., Martinez, M.E., Hess, L.M., Einspahr, J.G., Green, S. B., Bhattacharyya, A. K., Guillen, J., Krutzsch, M., Batta, A. K., Salen, G., Fales, L., Koonce, K., Parish, D., Clouser, M., Roe, D., and Lance, P. (2005) Phase III trial of ursodeoxycholic acid to prevent colorectal adenoma recurrence. Journal of the National Cancer Institute, 97(11), 846-853.

[54]   Saydah, S.H., Platz, E.A., Rifai, N., Pollak, M.N., Brancati, F.L. and Helzlsouer, K.J. (2003) Association of markers of insulin and glucose control with subsequent colorectal cancer risk. Cancer Epidemiology, Biomarkers & Prevention, 12(5), 412-418.

[55]   Adlercreutz, H. (2002) Phyto-oestrogens and cancer. Lancet Oncology, 3(6), 364-373.

[56]   Hogan, A.M., Collins, D., Sheehan, K., Zierau, O., Baird, A.W. and Winter, D.C. (2010) Rapid effects of phytoestrogens on human colonic smooth muscle are mediated by oestrogen receptor beta. Molecular and Cellular Endocrinology, 320(1-2), 106-110.

[57]   Hedelin, M., Lof, M., Olsson, M., Adlercreutz, H., Sandin, S. and Weiderpass, E. (2008) Dietary phytoestrogens are not associated with risk of overall breast cancer but diets rich in coumestrol are inversely associated with risk of estrogen receptor and progesterone receptor negative breast tumors in Swedish women. Journal of Nutrition, 138(5), 938-945.

[58]   Rossouw, J.E., Prentice, R.L., Manson, J.E., Wu, L., Barad, D., Barnabei, V.M., Ko, M., LaCroix, A.Z., Margolis, K.L. and Stefanick, M.L. (2007) Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13), 1465- 1477.

[59]   Stefanick, M.L., Anderson, G.L., Margolis, K.L., Hendrix, S.L., Rodabough, R.J., Paskett, E.D., Lane, D.S., Hubbell, F.A., Assaf, A.R., Sarto, G.E., Schenken, R.S., Yasmeen, S., Lessin, L. and Chlebowski, R.T. (2006) Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. JAMA, 295(14), 1647-1657.

 
 
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