Incidence and Mortality of Proximal and Distal Colorectal Cancer in Germany—Trends in the Era of Screening Colonoscopy.

Background The use of colonoscopy has increased since its introduction as a screening procedure in Germany, and the incidence of colorectal cancer (CRC) has decreased. It is unclear, however, to what extent this overall reduction applies to the prevention of cancer in the proximal colon, the distal colon, and the rectum. Methods We analyzed trends for CRC incidence (2000-2016) and mortality (2000-2018) in Germany by sex, age, and tumor site. Results The age-standardized incidence of CRC decreased by 22.4% (from 65.3 to 50.7 per 100 000) in men and by 25.5% (from 42.7 to 31.8 per 100 000) in women. Mortality decreased by 35.8% (from 29.6 to 19.0 per 100 000) in men and by 40.5% (from 19.0 to 11.3 per 100 000) in women. Despite population aging, the annual number of new cases went down from around 60 400 to 58 000 and the annual number of deaths from around 28 700 to 24 200. The decrease in incidence was highest in the age groups over 55 years. While the incidence of cancer in the distal colon and in the rectum went down by 34.5% and 26.2%, respectively, in men and by 41.0% and 27.9% in women, the incidence of cancer in the proximal colon remained stable in men and decreased by only 7.0% in women. Among the proximal cancers, however, a considerable shift in the direction of earlier stages was observed. Conclusion The findings support the assumption that increased use of colonoscopy has contributed to considerably reduced incidence of distal CRC and mortality from both proximal and distal CRC.