Colorectal Cancer

National Program for Early Detection of Colorectal Cancer 

• In 2012, the Ministry of Health responded in the affirmative to ICA's initiative, and over the past eight years, has implemented the National Program for the Early Detection of Colorectal Cancer in conjunction with all local healthcare funds. 

• This program, monitored by Prof. Gad Rennert, ICA cancer control consultant, resembles the National Program for Early Detection of Breast Cancer in women, and its necessity is evidenced by the high colorectal cancer mortality rates.

• As part of this program conducted by the healthcare funds, every individual over the age of 50 is summoned to undergo a fecal occult blood test.  Patients at high risk are entitled to a colonoscopy examination, according to their primary physician's recommendation. 

• ICA's National Program initiative is accompanied by an extensive public information media campaign, mainly in March, marking Colorectal Cancer Awareness Month. 

• Colorectal is the second most common cancer (after breast cancer in women and prostate cancer in men).  Every year, about 3,200 new incidences of colorectal cancer are diagnosed in Israel.
  
  
• The risk of developing colorectal cancer among normal risk population is about 4.5%.
  
  
• Prof. Gad Rennert, Director of the National Colorectal Screening Program, reports an increase in compliance with fecal occult blood tests. In total, over 60% of the target population for early detection tests undergoes one of the 2 screening tests, either the fecal occult blood test or a colonoscopy exam. 

• According to the National Program estimate, about two thirds of the colonoscopy exams were performed as a test for high risk groups.  

• The national screening program has led to increased rates of detection and has also contributed to a decline in mortality rates.
  
  
• This is a preventable disease, and its early detection may significantly increase chances for a cure and recovery.   
  
  
  
  
  

  Disease stage during diagnosis
  
  

• Early stage diagnosis of the disease has nearly doubled (from 17% to 30%) over the past 27 years, as a result of the increase in compliance with the National Colorectal Cancer Screening Program, as well as increased awareness. This rate is 51% higher than the rate of patients diagnosed at an early stage in 2000 (19.9%).
  
  
• In March 2019, to mark Colorectal Cancer Awareness Month, the Israel Cancer Association together with the Ministry of Health presented the most updated data on colorectal cancer in Israel.
  
  
• Due to the complexity of data collection, the most updated information at the National Cancer Registry refers to 2016 collected data. According to this data, 2,998 Israelis were diagnosed with colorectal cancer in 2016; 1,534 men and 1,464 women.
  
  
• Each year, the screening program saves the lives of hundreds of Israelis thanks to the tireless activity of all healthcare funds and their vital contribution of the general physicians.
  
  
• Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control at the Ministry of Health and chairman of the Israel Cancer Association Committee on Prevention & Early Detection reported the new National Cancer registry findings and said: "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.
  
  In 2016, there was decrease in colorectal morbidity and a further decrease in incidence and mortality. That year, colorectal cancer was the third most prevalent form of cancer among Jewish men after prostate and lung cancer; the second most prevalent in Jewish women; the second most prevalent in Arab men after lung cancer and the second most prevalent in Arab women after breast cancer."
  
  
• ICA Vice Chair Miri Ziv notes that "the most effective, current ways to fight colorectal cancer are early detection and prevention. Simple tests may save your lives and the lives of hundreds of others each year. When a test comes out positive in for fecal occult blood test, it is essential and compulsory to undergo colonoscopy.  The healthcare funds reported that Israelis who were tested positive do not take the next step in examination. It is important to note that a benign result found in this test is removable even before it becomes cancerous, making this test an active prevention measure. Therefore, it is important to get tested. These tests can save lives."

The Latest Statistics in Colorectal Cancer in Israel 2019 

Incidence (number of new cases)

• In 2016, 2,998 Israeli residents were diagnosed with colorectal cancer; 1,534 (51%) men, 1,267 (83%) of them Jewish, 174 (11%) Arab and 93 (6%) "other" and 1,464 (50%) women, 1,243 (85%) of them Jewish, 174 (9%) Arab and 93 (6%) "other".  2,178 (73%) of these patients were diagnosed with colon cancer and the rest with rectal cancer.
  
  
• In 2016, colorectal cancer was the third most prevalent invasive cancer among Jewish men (12% of all new incidences that year) after prostate cancer and lung cancer; the second most prevalent among Jewish women (10.2%) after breast cancer; the second most prevalent among Arab men (13.1%) after lung cancer; and the second most common among Arab women (9.1%) after breast cancer.

• Age-adjusted incidence rates (per 100,000) for colorectal cancer in 2016 were 27.0% and 22.5% in Jewish men and women respectively.  Among Arabs, the rates were 28.4% in men and 18.5% in women, while among ‘other’ population groups, the rates were 44.4% in men and 27.3% in women.  The incidence rates increase with age and are the highest in the 75+ age group.
  
  
• Internationally compared to 36 of the OECD countries, Israel is almost at the lowest ranking (35, with Mexico being 36) in terms of incidence rate (Globocan 2018).
  
  

  Temporal Trends in Incidence
  
  

In Jewish men from 1990 to 2007, and in Jewish women in 2006, the incidence of colorectal cancer has been kept stable. Later on, a distinct decrease was seen in both sexes. In Arab men from 1990 to 2005 and in Arab women in 2007, an increase in colorectal cancer incidence occurred. Later on, the men kept stable, while the women distinctly decreased. In analyzing the trends according to age groups, it was found that it the last decade, the younger group (20-44) showed a rise in incidence mainly among women (Jewish and Arab) as well as in Arab men. However, it is important to note that the 20-44 age group represents an addition of less than five cases per year. The remaining age groups showed a decrease:

• The young group (20-44) in the last decade: in Jews, the incidence was stable in men, but in women there was a decrease since 2009. In Arabs, there was a rise both in men and in women. As said, it is important to note that the 20-44 age group represents an addition of less than five cases per year.
  
  

• The intermediate age group (45-64) in the last decade: this group includes some of the target population for the national colorectal screening program. In both Jewish men (since 2013) and women, a distinct decrease was shown in morbidity rates. In Arabs men and women, a distinct decrease was shown in morbidity since 2006.
  
  

• The older age group (65+) in the last decade: in Jewish men (since 2006) and women (since 2005), a distinct decrease in incidence was shown. In Arab men (since 2006) and women (since 2008), a distinct decrease in incidence was shown.
  
  

Mortality

• In 2016, 1,296 Israelis died of invasive colorectal cancer: 644 (50%) men, 559 (87%) of them Jewish, 63 (10%) of them Arab and 22 (3%) of them "other" populations; and 652 (49%) women, 572 of them Jewish, 52 (8%) Arab and 28 (4%) "other" population. 1,039 (80%) of the deceased were diagnosed with colon cancer and the rest with rectal cancer.
  
  
• Of the total cancer mortality. colorectal cancer is the second common cause in all population groups in 2016: 12.0% of the total mortality rate in Jewish men (second to lung cancer); 12.0% in Jewish women (second to breast cancer); 9.8% in Arab men (second to lung cancer); and 11.2% in Arab women (second to breast cancer).
  
  
• In Jewish men and women, as in Arab men, a distinct rise was seen in colorectal mortality trend from 1990 until 1994-1995. Later on, a distinct decrease was seen in all groups. The trend in Arab women was stable throughout that period.
  
  
• The colorectal mortality rates in 2015 were similar among the various population groups, and slightly higher among men in comparison to women.
  
  
• The majority of mortality was seen in older ages.

• According to OECD data, Israel ranks 8th worldwide in colon cancer incidence among women, and in 18th among men.  Although the rate of new incidences per year is higher than the OECD average, the mortality rate for colon cancer in Israel is lower than the OECD average.

Identifying High-Risk Populations

For over a decade, the ICA has adopted World Health Organization and the Union for International Cancer Control (UICC) guidelines regarding the importance of screening populations at high risk for colorectal cancer. This education program focuses on the general public within the community and in the workplace.

Aiming to promote early detection awareness and raise the test compliance rate, the ICA annually finances two years of targeted activity at centers that have demonstrated outstanding work in screening programs for high-risk populations, while conducting training activity for professional staff and educational programs for the general public. 

Guidelines for Early Detection 

• Normal risk population (symptom-free and no family background) – every individual over the age of 50 should undergo a fecal occult blood test once a year.  High risk patients are entitled to a colonoscopy examination covered by their healthcare fund.
  
  

• Population with colorectal cancer family history (first of second degree relative or two second-degree relatives) – should undergo colonoscopy from the age of 40, or 10 years prior to the diagnosis age of the relative. If the examination result is normal, 5-year follow-up examinations should be taken, or according to the primary physician’s recommendations.
  
  

• Population diagnosed with colorectal cancer – are advised to be checked for a possible detection of Lynch syndrome, which is vital information for their first-degree relatives.
  
  

• Population with increased family background – that is, multiple cases of colorectal or uterus malignancy in the family, at a young age, or when the existence of Lynch syndrome or familial adenomatous polyposis  (FAP) or suspected existence are known – to see any one of the early detection clinics for further inquiry.
  
  

• Population with other risk factors, such as an inflammatory bowel disease, past colon polyps or relatives with polyps – must consult a physician regarding the age and frequency in which colonoscopy should be performed.
  
  
  

  National Program for Early Detection of Colorectal Cancer

   

Israel Cancer Association experts recommend paying attention to symptoms and changes in the body which may indicate the existence of colorectal cancer. It is important to know that colorectal cancer may not cause al of the following symptoms, but even just one of them:

• Changes in fecal matter, such as diarrhea, soft, mucus-like stool, constipation, changes in the girth of the stool which lasts more than a few days.
  
  
• A feeling of fullness.
  
  
• Rectal bleeding or blood in feces, the blood can be red or even walnut color or almost black.
  
  
• Stomach pain.
  
  
• Weakness or anemia due to iron deficiency. 
  
  
• Weight loss.

The appearance of any one of these symptoms requires immediately attention by you a family physician. In such cases, the physician may consider referring to a colonoscopy examination. Fecal occult blood test are not meant for people who complain of such symptoms, but for people who are symptom-free, as part of the national screening program.