Variation in Occurrence, Management, and Outcome of Colorectal Cancer in the Netherlands, on the Eve of Mass Screening

The large bowel can be divided into the colon, the rectosigmoid, and the rectum. The colon starts where the small bowel ends and it is 1.5-1.8 metres long when stretched. The rectum forms the final 10-15 cm of the large bowel, opening to the outside at the anus. The rectosigmoid is the transitional zone between the colon and the rectum. Colorectal cancer (CRC) is the third most frequent cancer (14%) among males, after prostate (22%) and lung cancer (16%), and it is the second most common tumour (13%) among females, after breast cancer (31%) in the Netherlands. In 2007, 11,823 patients were diagnosed with CRC and 4,828 patients died of the disease. The incidence in the Netherlands is relatively high compared to other European countries, and ranks in the top 10.3 Worldwide, CRC accounted for about 1 million of new cancer diagnoses in 2002, representing nearly 10% of all new cancers. It occurs more frequently in the industrialized world. The disease rarely occurs before age 40, and the risk of CRC becomes highest around age 70.1 It is expected that the absolute number of patients with CRC increases with three percent per year in the Netherlands, mainly due to the aging population. Based on this estimation, the incidence of CRC in the Netherlands increases to 14,000 patients in 2015. As a percentage of total mortality, the risk of dying from CRC in the Netherlands is highest around age 60 (about 5%), which is important because it can be seen as an important cause of death. Later in life other causes of death proportionally start to occur more often.

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