Changing sites of colorectal cancer in the Israeli Jewish ethnic populations and its clinical implications

Abstract

Countries at risk for colorectal cancer noted an increase in right-sided colorectal cancer. We examined this in the Israeli Jewish populations. Israel Cancer Registry data, 1982–2001, were computed by sex, age, ethnic group and colorectal cancer site: ‘rectal cancer’ included the recto-sigmoid junction, ‘right-sided’ colorectal cancer included proximal colon up to and including the splenic flexure. In both sexes, colorectal cancer trends increased significantly owing to colonic cancer (P<0.01) whereas rectal cancer decreased (P<0.01). Left and right colorectal cancer trends decreased in Israel born people (P<0.01), but in Asia-Africa born people increases were seen at both sites in the male (P=0.02 and 0.06, respectively) and female (P=0.03 and 0.01, respectively) population. In those ≥65 years old, right colorectal cancer trends increased in all men (P=0.05) and women (P=0.01). On comparing data from 1982–1986 with that from 1997–2001 right colorectal cancer showed an increase in both sexes (P<0.01): to 32.7% of male colorectal cancer and 57.6% of female colorectal cancer. In the period 1997–2001, the total male population ≥65 years had increased relatively by 7.5% (P<0.01), and women by 22.6% (P<0.01) and the proportion of right colorectal cancer in ≥65 years olds increased relatively by 10.9% in the male population, and 18.2% in the female population, with one-third of this increase occurring in Russian immigrants arriving after 1990. In conclusion, there is a trend for right colorectal cancer in Jews aged ≥65 years. The proportion and amount of colorectal cancer increased most significantly in older women, which was partially explained by their increasing numbers and by colorectal cancer occurring in recent immigrants from Russia, who were at high-risk for colorectal cancer. These results should influence colorectal cancer screening and diagnostic methodologies used.