Early stage diagnosis of the disease has nearly doubled in 2018 (39.1%) compared to the early stage diagnosis rate in 2000 (19.1%)
In 2018, 1,223 Israelis died of invasive colorectal cancer. A significant decrease in mortality was shown among the Jewish sector and stable trend in the Arab sector
Of special note: In October 2020, the Ministry of Health instructed that population under the age of 70, who have undergone surgery due to colon or uterine malignancies, take a Lynch Syndrome test – as an important means of protecting other family members
New study: Aspirin intake may reduce the risk of colorectal cancer in Lynch Syndrome patients
"Excuses" - a new campaign launched by the ICA, urging population over the age of 50 to undergo a fecal occult blood test once a year. Should a positive result be obtained, a colonoscopy must be performed that may detect polyps before they turn malignant
Ahead of Colorectal Cancer Awareness Month, marked in Israel and abroad in March, the Ministry of Health and the Israel Cancer Association publish the latest colorectal statistics in Israel.
Moshe Bar-Haim, CEO of the Israel Cancer Association: "The national screening test initiated by the ICA along with the Ministry of Health, and executed by the healthcare funds, succeeds in significantly increasing the early detection of the disease in the targeted age group, thus improving the chances of survivorship and recovery. For this reason, the public's compliance to early detection along with adopting a healthy lifestyle, has been proven to reduce the risk of morbidity and mortality, and is of utmost importance." Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control at the Ministry of Health: "Colorectal cancer is the second most prevalent malignant disease in Israel. The main risk factors are age, family history of the disease, previous benign tumor in the colon or an inflammatory bowel disease, genetic mutations as well as a lifestyle consisting of obesity, sedentarity, fatty and low-fiber diet, smoking and alcohol consumption. Colon cancer mortality in 2018 was mostly seen in older age, the highest of which in the 75+ age group.The Latest Statistics in Colorectal Cancer in Israel 2018:
(Due to the complexity of data collection, the latest information from the National Cancer Registry refers to 2018 collected data, and the most updated as if today).
In 2018, colorectal cancer was the second most prevalent malignant disease in the entire population, after prostate cancer in Jewish men, lung cancer in Arab men and breast cancer in Jewish, Arab and other (Christian women who are not Arab an those with no religious affiliation).
In that year, 3,095 new cases of invasive colorectal cancer were diagnosed;
1,606 (52%) men - of which 1,424 (89%) Jewish and other and 182 (11%) Arab;
1,489 (49%) women – of which 1,326 (89%) Jewish and other and 163 (11%) Arab.
2,314 (75%) of those new cases were diagnosed with invasive colon cancer, and the rest with rectal cancer.
Incidence rates (number of new cases):
Invasive colorectal cancer is typical in older age. The incidence rates increase with age and are the highest in the 75+ age group.
In 2018, the median age during diagnosis was 70 in men and women in the Jewish and other group; 65 in Arab men; and 60 in Arab women.
In analyzing the trends according to age groups, it was found that it amongst Jews and other ages 20-34, incidence was stable throughout the period of 2000-2018; a clear increase of about 7.0% per year was seen in women during that same period, which is an additional 16 Jewish women ages 20-34 – an increase of 2 new patients per 100,000.
Amongst Jews and other ages 35-49, incidence was stable in both sexes.
Amongst Jews and other ages 50-74, incidence in men was stable during 2000-2007 and a clear 4% decrease per year during 2007-2018. However, in women, a clear decrease of about 3% per year was seen throughout the period.
Amongst Jews and other ages 75+, incidence in men was stable during 2000-2003, followed by a clear decrease of about 4% per year (2003-2018). In women, an ongoing decrease was seen during the entire period.
In Israel, the early detection national screening program for colorectal cancer was initiated in 2005 by the ICA and the Ministry of Health. The program is based on a fecal occult blood test once a year, for ages 50 to 74 under normal risk. High risk patients are entitled to a colonoscopy examination covered by their healthcare fund. These examinations enable diagnosis and removal of benign colorectal tumors (which can potentially develop into cancer) as well as early detection of malignant tumors.
Early stage diagnosis of the disease has nearly doubled in 2018 (39.1% vs. 19.1%) compared to 2000, and the rate of those diagnosed with metastatic colorectal cancer dropped from 14.6% in 2000 to 9.0% in 2018 – these trends appear to reflect an increase in the compliance rate to undergo the national program early detection screening as well as an increase in awareness to the disease.
According to the National Program for Quality Indicators in Community Healthcare, the rate of population ages 50-74 in Israel who have taken the fecal occult blood test at least once in the previous year or a colonoscopy in the last ten years was 65% in 2018 (64% in men and 66% in women). This rate in higher than that reported in 2014 (58%) or 2016 (59%), representing an increase in compliance to undergo the screening.
When fecal occult blood is detected, the patient is referred to an urgent colonoscopy examination covered by the healthcare basket. The examination is also available for population age 40+ who have a first-degree relative that was diagnosed with colorectal cancer, and are recommended to take the test every 5 years or according to the physician's recommendation. If during the colonoscopy examination as benign tumor is found, it can be removed before it develops into cancer.
Temporal Trends in Incidence:
In Jews and other, colorectal cancer incidence has been stable from 1996 to 2005 in both sexes; followed by a distinct decrease of 4% in men and 3% in women per year. In Arab men from 1996 to 2008 in men and until 2006 in women (a 4% annual increase in men and 6% in women) in colorectal cancer incidence; followed by a stable trend in men and a distinct decrease in women (of about 2% per year) in women.
In analyzing the trends by age, a distinct decrease in screening tests was seen in the target group (ages 50-74) in both population groups. In Hewish women ages 20-34, and in Arab men and women ages 35-49, incidence rates have increased between 2000-2018.
In 2018, 1,223 Israelis died of invasive colorectal cancer: Mortality rates in Jews and other in 2018 was 9.7% in men and 7.0% in women. In Arabs, mortality rates were 8.3% in men and 6.2% in women.
Of the total cancer mortality, colorectal cancer is the second most prevalent cause in cancer mortality in Israel, and is responsible for the following:
11.2% of the total mortality after prostate cancer rate in Jewish and other men.
8.4% of the total mortality after prostate cancer rate in Arab men.
10.4% of the total mortality after breast cancer and lung cancer in Jewish and other women.
10.6% of the total mortality after breast cancer in Arab women.
The majority of colorectal cancer mortality in 2018 was seen in older age in all population groups, with mortality rates increasing significantly from the age of 55, the highest being in the 75+ age group.
In 2018, the average and medial age (the age before which and after which half of the patients died) at death time was 75.8 and 77.9 in Jewish and other men respectively, and 77.6 and 80.4 in Jewish and other women; 66.8 and 67.7 in Arab men and 65.0 and 66.4 in Arab women.Temporal Trends in Mortality:
In Jewish and other men and women, a distinct decrease in colorectal mortality was seen throughout the period of 1996-2018. In Arab men and women, the trend was kept stable throughout the period – 65.0 in Arab men and 66.4 in Arab women.
By international comparison, colorectal incidence rates in Israel are slightly higher than the international average, and Israel is ranked 56. The countries with the highest incidence rates are Hungary, Slovakia, Norway and Holland. However, by international comparison of colorectal cancer mortality rates, Israel was ranked 69, which is relatively low and equals the international average. The countries with the highest mortality rates are Slovakia, Hungary, Croatia and Moldova.
Guidelines for Early Detection of Colorectal Cancer:
The Ministry of Health accepted the position of the professional associations of Gastroenterology, Oncology, Genetics and the Israel Cancer Association and instructed hat population under the age of 70, who have undergone surgery due to colon or uterine malignancies, take a Lynch Syndrome test – as an important means of protecting other family members
The Ministry of Health accepted the position of the professional associations of Gastroenterology, Oncology, Genetics and the Israel Cancer Association and instructed that population under the age of 70, who have undergone surgery due to colon or uterine malignancies, take a Lynch Syndrome test – as an important means of protecting other family members. One of every 30 people with colon or uterine malignancies is found to be a carrier of Lunch syndrome. Most have a family background of multiple colon or uterine malignancies, with many family members of young age involved, but some cases do not involve such family history.
Testing for the presence of Lynch syndrome in a patient with malignancies is of paramount importance, since tumors in patients with Lynch syndrome are sensitive to immunological treatments, therefore detecting the syndromes may change the course of the disease and no less important – the detection enables to locate family members who are carriers and are at risk of developing cancer from a young age, and well as proper follow-up after the patients and his family members in order to prevent cancer morbidity and mortality.
According to the new instruction, from October 2020, population under the age of 70, who have undergone surgery due to colon or uterine malignancies, take a Lynch Syndrome test based on the surgical finding. Patients who are suspected to have Lynch syndrome in a pathological examination, will be asked to complete the genetic consulting for Lynch syndrome.
This decision places a number of challenges on the system:
Preparation by all healthcare funds, public and private hospitals for reliable testing for the presence of Lynch syndrome in any new diagnosed case.
To sum up, the ICA commends this important step for the patients and their families, a step that can prevent morbidity and mortality – and calls on the Ministry of Health and the healthcare funds to ensure it is properly implemented.
In marking Colorectal Cancer Awareness Month, the ICA produced a new radio infomercial and video to be aired on digital outlets titled "Excuses". The campaign encourages early detection screening tests for colorectal cancer, and was produced by BBDO Gitam. The infomercial features people making different excuses why not to undergo the screening. The campaign also urges population over the age of 50 to undergo a fecal occult blood test once a year in order to prevent the development of colorectal cancer or detect it at an early stage. If the result is positive, the infomercial reminds the public to continue with the checkup according to the physician's recommendation. A newspaper ad with the same messages with produced.
Aspirin may resuce the risk of colorectal cancer in patients with Lynch syndrome.
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Postponing Colonoscopy After Abnormal Stool-Based Screening increases the risk of colorectal cancer and morbidity.