Colorectal Cancer

Age-standardized Incidence Rates

Definition: The incidence rate that would have occurred if the age distribution in the population of interest was the same as that of the standard, where incidence rate is defined as the number of cases of cancer (malignant neoplasms) newly diagnosed during a year, per 100,000 people at risk

Numerator: Number of new cancer cases (all ages):

1. Breast (female)
2. Colorectal
3. Lung
4. Prostate (male)
5. Pancreas
6. Ovary (female)

Denominator: 1), 6): Annual female population estimate in hundreds of thousands; 2), 3), 5): Annual population estimates in hundreds of thousands 4: Annual male population estimate in hundreds of thousands

Age standardization: Direct method using the 2011 Canadian Census population

Data sources: Canadian Cancer Registry (CCR) Database – cancer incidence data; Demography Division of Statistics Canada – population estimates

Measurement timeframe: For overall trends, Canada – 1992 to 2012. By province – 2010 to 2012 combined

Stratification variables: Province, sex

Notes:

1. World Health Organization, International Classification of Diseases for Oncology, Third Edition (ICD- O-3) and the International Agency for Research on Cancer (IARC) rules for determining multiple primaries sites were used: colorectal (ICD-O-3: C18.0 to C18.9, C19.9, C20.9, C26.0), lung and bronchus (ICD-O-3: C34.0 to C34.9), female breast (ICD-O-3: C50.0 to C50.9), prostate (ICD-O-3: C61.9), pancreas (ICD-O-3: C25.0-C25.9), ovary (ICD-O-3: C56.9)
2. Joinpoint Regression Program 4.2.0.2 for Windows was used to analyze linear trends across years. The software takes trend data and fits the simplest joinpoint model that the data allow. The program starts with the minimum number of joinpoints (e.g. 0 joinpoints, which is a straight line) and tests whether more joinpoints are statistically significant and must be added to the model (up to that maximum number). This enables the user to test whether an apparent change in trend is statistically significant. The tests of significance use a Monte Carlo Permutation method. Annual Percent Change (APC) was reported to characterize trends in cancer rates over time. APC assumes that cancer rates are changing at a constant percentage of the rate of the previous year. The minimum and maximum number of joinpoints used in this analysis were 0 and 4 respectively. For further details, refer to the Joinpoint Regression Program documentation (http://surveillance.cancer.gov/joinpoint/).

Age-standardized Incidence Rates by Stage

Definition: The stage-specific incidence rate that would have occurred if the age distribution in the population of interest was the same as that of the standard, where incidence rate is defined as the number of cases of cancer (malignant neoplasms) newly diagnosed during a specific time period, per 100,000 people at risk. Incidence rates by stage are available for five cancers: breast, lung, colorectal, prostate, and ovarian cancer

Numerator: Number of new cancer cases for each stage during the given time period:

1. Breast (female)
2. Lung
3. Colorectal
4. Prostate (male)
5. Ovary (female)

Denominator: 1), 5): Population estimate per 100,000 women; 4): Population estimate per 100,000 men; 2), 3): Population estimate per 100,000 population

Measurement timeframe: 2011 to 2013 combined

Stratification variables: Province, stage at diagnosis (including stage I, II, III and IV)

Data sources: Provincial cancer agencies

Provinces submitting data: BC, AB, SK, MB, NB, NS, PE (breast, lung, colorectal, prostate); AB, SK, MB, NS, PE (ovarian)

Age standardization: Direct method using the 2011 Canadian census population

Province specific notes:

• AB: Hematology, sarcoma and melanoma morphologies were removed from the site-specific cancers. All 2011-2013 invasive primaries are collaborative staging and once coded there should be no cases with missing/not available stage values. AB used AB’s 2012 population provided by Alberta Health Services (DIMR/Analytics) and the standardized 2011 Canadian population weights indicated on CPAC’s data specification document. For this indicator, 8002, 8073 and 8803 are included as NSCLC.
• SK: SK-covered population estimates were used as the denominator in all standardized rates. NS: Lung (NSCLC + SCLC) also contains cases that could not be classified as either.

Notes:

1. World Health Organization, International Classification of Diseases for Oncology, Third Edition (ICD-O-3) and the International Agency for Research on Cancer (IARC) rules for determining multiple primaries sites were used: colorectal (ICD-O-3: C18.0, C18.2 to C18.9, C19.9, C20.9, C26.0), lung and bronchus (ICD-O-3: C34.0 to C34.9), breast (ICD-O-3: C50.0 to C50.9), prostate (ICD-O-3: C61.9).
2. Appendix C18.1 was excluded from colorectal cancer.
3. Sites with histology codes for lymphoma M-95 to M-98, sarcoma codes– 8800/3 were excluded.
4. Cases for patients with age under 18 at diagnosis were excluded.
5. American Joint Committee on Cancer 7 edition (AJCC 7) was used to classify cancer group stage.

Age-standardized Mortality Rates

Definition: The mortality rate that would have occurred if the age distribution in the population of interest was the same as that of the standard, where mortality rate is defined as the number of deaths due to cancer (malignant neoplasms) in a year per 100,000 people at risk

Numerator: Number of deaths from cancer (all ages):

1. Breast (female)
2. Colorectal
3. Lung
4. Prostate (male)
5. Pancreas
6. Ovary (female)

Denominator: 1), 6): Annual female population estimate in hundreds of thousands. 2), 3), 5): Annual population estimates in hundreds of thousands; 4): Annual male population estimate in hundreds of thousands

Age standardization: Direct method using the 2011 Canadian Census population

Data sources: Canadian Vital Statistics – Death Database – cancer mortality data; Demography Division of Statistics Canada – population estimates

Measurement timeframe: For overall trends, Canada – 1992 to 2011. By province – 2009 to 2011 combined

Stratification variables: Province

Notes:

1. Up to the year 1999, causes of death were coded according to World Health Organization (WHO), International Classification of Diseases, Ninth Revision (ICD-9): Colorectal (ICD-9 153-154), lung (ICD-9: 162), female breast (ICD-9: 174), prostate (ICD-9: 185), pancreas (ICD-9: 157), ovary (ICD-9: 183)
2. After the year 1999, causes of death were coded according to the World Health Organization (WHO), International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10): Colorectal (ICD-10:C18-C20, C26.0), lung (ICD-10 : C34), female breast (ICD-10: C50), prostate (ICD-10: C61), pancreas (ICD-10: C25), ovary (ICD-10: C56.9)
3. Joinpoint Regression Program 4.2.0.2 for Windows was used to analyze linear trends across years. The software takes trend data and fits the simplest joinpoint model that the data allow. The program starts with the minimum number of joinpoints (e.g. 0 joinpoints, which is a straight line) and tests whether more joinpoints are statistically significant and must be added to the model (up to that maximum number). This enables the user to test whether an apparent change in trend is statistically significant. The tests of significance use a Monte Carlo Permutation method. Annual Percent Change (APC) was reported to characterize trends in cancer rates over time. APC assumes that cancer rates are changing at a constant percentage of the rate of the previous year. The minimum and maximum number of joinpoints used in this analysis were 0 and 4 respectively. For further details, refer to the Joinpoint Regression Program documentation (http://surveillance.cancer.gov/joinpoint/).