Colorectal cancer (CRC) screening using biennial gFOBT was introduced in England in September 20061 and by 2010 was being offered >90% of 60–69 year olds, rising to >95% of 60–74 year olds by 2014. Uptake of screening has shown no substantial change since 2006 and in 2016 was 58% for the whole of England. This study seeks to examine the trends in CRC mortality and ascertain any impact of screening.Methods
Data for the period 2001–2016 was extracted from the ONS website (http://www.ons.gov.uk) and CRC mortality rates by 5 year age bands from age 45 calculated. CRC was defined according to the ICD 10th Revision codes C18 (colon) and C19/C20/C21 (rectum, recto-sigmoid and anus). To allow comparisons over time data on anal cancers and from Wales are included. Rates in age groups never offered screening were compared with those potentially screened (age group 65–74 years). Joinpoint analysis was undertaken to look for changes in trends.Results
Comparing 2005 and 2016 CRC mortality rates we found a decline of 28.8% in men and 27.4% in women in the 65–74 year olds, the age group where screening would be expected to have had greatest effect. In comparison in 50–59 year olds there was a 21.3% decline in CRC mortality in men and a 5.5% decline in women. Whilst joinpoint analysis identified no step change in mortality rate over time, closer examination of the data showed that the decline in CRC mortality has been predominantly in the C18 code (colon). For C18 there was a 37.8% decline in men and a 37.7% decline in women. In comparison there were 36.0% and 29.2% declines respectively in the 50–59 year olds. For the C19–21 code there was a mortality decline of 15.4% in men and 6.2% in women in the 65–74 year olds and in the 50–59 year olds a decline of 2.2% in men and an increase of 39.0% in women.Conclusion
Overall CRC mortality has shown a steady decline. Declines have been substantially greater in the screened age groups although no step change was identifiable with joinpoint analysis. At this time-point the mortality reductions are predominantly in colon cancer (C18). Despite concerns that gFOBT screening maybe less effective in women mortality reductions were similar to men.