000169018 001__ 169018 000169018 005__ 20240229133635.0 000169018 0247_ $$2doi$$a10.1016/S1470-2045(21)00199-6 000169018 0247_ $$2pmid$$apmid:34048685 000169018 0247_ $$2ISSN$$a1470-2045 000169018 0247_ $$2ISSN$$a1474-5488 000169018 0247_ $$2altmetric$$aaltmetric:106426390 000169018 037__ $$aDKFZ-2021-01186 000169018 041__ $$aEnglish 000169018 082__ $$a610 000169018 1001_ $$0P:(DE-HGF)0$$aCardoso, Rafael$$b0$$eFirst author 000169018 245__ $$aColorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. 000169018 260__ $$aLondon$$bThe Lancet Publ. Group$$c2021 000169018 3367_ $$2DRIVER$$aarticle 000169018 3367_ $$2DataCite$$aOutput Types/Journal article 000169018 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1626333030_18178 000169018 3367_ $$2BibTeX$$aARTICLE 000169018 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000169018 3367_ $$00$$2EndNote$$aJournal Article 000169018 500__ $$a#EA:C120#LA:C070#/2021 Jul;22(7):1002-1013 000169018 520__ $$aColorectal cancer screening programmes and uptake vary substantially across Europe. We aimed to compare changes over time in colorectal cancer incidence, mortality, and stage distribution in relation to colorectal cancer screening implementation in European countries.Data from nearly 3·1 million patients with colorectal cancer diagnosed from 2000 onwards (up to 2016 for most countries) were obtained from 21 European countries, and were used to analyse changes over time in age-standardised colorectal cancer incidence and stage distribution. The WHO mortality database was used to analyse changes over time in age-standardised colorectal cancer mortality over the same period for the 16 countries with nationwide data. Incidence rates were calculated for all sites of the colon and rectum combined, as well as the subsites proximal colon, distal colon, and rectum. Average annual percentage changes (AAPCs) in incidence and mortality were estimated and relevant patterns were descriptively analysed.In countries with long-standing programmes of screening colonoscopy and faecal tests (ie, Austria, the Czech Republic, and Germany), colorectal cancer incidence decreased substantially over time, with AAPCs ranging from -2·5% (95% CI -2·8 to -2·2) to -1·6% (-2·0 to -1·2) in men and from -2·4% (-2·7 to -2·1) to -1·3% (-1·7 to -0·9) in women. In countries where screening programmes were implemented during the study period, age-standardised colorectal cancer incidence either remained stable or increased up to the year screening was implemented. AAPCs for these countries ranged from -0·2% (95% CI -1·4 to 1·0) to 1·5% (1·1 to 1·8) in men and from -0·5% (-1·7 to 0·6) to 1·2% (0·8 to 1·5) in women. Where high screening coverage and uptake were rapidly achieved (ie, Denmark, the Netherlands, and Slovenia), age-standardised incidence rates initially increased but then subsequently decreased. Conversely, colorectal cancer incidence increased in most countries where no large-scale screening programmes were available (eg, Bulgaria, Estonia, Norway, and Ukraine), with AAPCs ranging from 0·3% (95% CI 0·1 to 0·5) to 1·9% (1·2 to 2·6) in men and from 0·6% (0·4 to 0·8) to 1·1% (0·8 to 1·4) in women. The largest decreases in colorectal cancer mortality were seen in countries with long-standing screening programmes.We observed divergent trends in colorectal cancer incidence, mortality, and stage distribution across European countries, which appear to be largely explained by different levels of colorectal cancer screening implementation.German Cancer Aid (Deutsche Krebshilfe) and the German Federal Ministry of Education and Research. 000169018 536__ $$0G:(DE-HGF)POF4-313$$a313 - Krebsrisikofaktoren und Prävention (POF4-313)$$cPOF4-313$$fPOF IV$$x0 000169018 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo01.inet.dkfz-heidelberg.de 000169018 7001_ $$0P:(DE-He78)0311ebf3415e41860b4e2c56fbae6919$$aGuo, Feng$$b1$$udkfz 000169018 7001_ $$0P:(DE-He78)c465139c8b95a919efed7d35ca83ca80$$aHeisser, Thomas$$b2$$udkfz 000169018 7001_ $$aHackl, Monika$$b3 000169018 7001_ $$aIhle, Petra$$b4 000169018 7001_ $$aDe Schutter, Harlinde$$b5 000169018 7001_ $$aVan Damme, Nancy$$b6 000169018 7001_ $$aValerianova, Zdravka$$b7 000169018 7001_ $$aAtanasov, Trajan$$b8 000169018 7001_ $$aMájek, Ondřej$$b9 000169018 7001_ $$aMužík, Jan$$b10 000169018 7001_ $$aNilbert, Mef Christina$$b11 000169018 7001_ $$aTybjerg, Anne Julie$$b12 000169018 7001_ $$aInnos, Kaire$$b13 000169018 7001_ $$aMägi, Margit$$b14 000169018 7001_ $$aMalila, Nea$$b15 000169018 7001_ $$aBouvier, Anne-Marie$$b16 000169018 7001_ $$aBouvier, Véronique$$b17 000169018 7001_ $$aLaunoy, Guy$$b18 000169018 7001_ $$aWoronoff, Anne-Sophie$$b19 000169018 7001_ $$aCariou, Mélanie$$b20 000169018 7001_ $$aRobaszkiewicz, Michel$$b21 000169018 7001_ $$aDelafosse, Patricia$$b22 000169018 7001_ $$aPoncet, Florence$$b23 000169018 7001_ $$aKatalinic, Alexander$$b24 000169018 7001_ $$aWalsh, Paul M$$b25 000169018 7001_ $$aSenore, Carlo$$b26 000169018 7001_ $$aRosso, Stefano$$b27 000169018 7001_ $$aVincerževskienė, Ieva$$b28 000169018 7001_ $$aLemmens, Valery E P P$$b29 000169018 7001_ $$aElferink, Marloes A G$$b30 000169018 7001_ $$aJohannesen, Tom Børge$$b31 000169018 7001_ $$aKørner, Hartwig$$b32 000169018 7001_ $$aPfeffer, Frank$$b33 000169018 7001_ $$aBento, Maria José$$b34 000169018 7001_ $$aRodrigues, Jessica$$b35 000169018 7001_ $$aAlves da Costa, Filipa$$b36 000169018 7001_ $$aMiranda, Ana$$b37 000169018 7001_ $$aZadnik, Vesna$$b38 000169018 7001_ $$aŽagar, Tina$$b39 000169018 7001_ $$aLopez de Munain Marques, Arantza$$b40 000169018 7001_ $$aMarcos-Gragera, Rafael$$b41 000169018 7001_ $$aPuigdemont, Montse$$b42 000169018 7001_ $$aGalceran, Jaume$$b43 000169018 7001_ $$aCarulla, Marià$$b44 000169018 7001_ $$aChirlaque, María-Dolores$$b45 000169018 7001_ $$aBallesta, Monica$$b46 000169018 7001_ $$aSundquist, Kristina$$b47 000169018 7001_ $$aSundquist, Jan$$b48 000169018 7001_ $$aWeber, Marco$$b49 000169018 7001_ $$aJordan, Andrea$$b50 000169018 7001_ $$aHerrmann, Christian$$b51 000169018 7001_ $$aMousavi, Mohsen$$b52 000169018 7001_ $$aRyzhov, Anton$$b53 000169018 7001_ $$0P:(DE-He78)6c5d058b7552d071a7fa4c5e943fff0f$$aHoffmeister, Michael$$b54$$udkfz 000169018 7001_ $$0P:(DE-He78)90d5535ff896e70eed81f4a4f6f22ae2$$aBrenner, Hermann$$b55$$eLast author$$udkfz 000169018 773__ $$0PERI:(DE-600)2035574-9$$a10.1016/S1470-2045(21)00199-6$$gp. 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