title: Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997.
abstract: BACKGROUND
  Subsite specific incidence rates of colorectal cancer vary considerably by age, gender, and race. This variation may be related not only to distinctions in exposure to genetic and environment factors but also to current strategies of early detection screening. Patterns of stage of disease in anatomic subsite may reflect the effect of screening. This study used the largest aggregation of cancer incidence data in the U.S. to examine subsite specific incidence rates of colorectal cancer and the relation of stage of disease to anatomic subsites by race, gender, and age group.
  
  
  METHODS
  Data on the incidence of invasive colorectal cancer were obtained from 28 population-based central cancer registries. Age-specific and age-adjusted rates and stage distributions were analyzed by subsite, race, and gender.
  
  
  RESULTS
  The impact of screening can be observed in the percentage of localized disease, which increased from 31.9% among cancers in the proximal colon to 37.0% in the descending colon to 41.5% in the distal colorectum. Within the same subsite, blacks were less likely than whites to receive a diagnosis of localized disease and more likely to receive a diagnosis of distant disease whereas stage distributions were approximately the same for males and females. Blacks were more likely than whites to receive a diagnosis of proximal colon cancer than distal colorectal cancer. The male-to-female rate ratios progressively increased from the proximal colon to the distal colorectum. The ratios of proximal-to-distal colorectal cancer gradually increased with advancing age.
  
  
  CONCLUSIONS
  Differentials in stage of disease by subsites indicate a need for a targeted effort at early detection of cancer in the proximal colon. Risk factors and higher risk populations for colorectal cancers in each subsite need to be studied further to guide actions for improving the efficacy of screening.
authors.affiliation: Department of Public Health and Preventive Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. xwu@lsuhsc.edu
authors.forename: X
authors.initials: X
authors.lastname: Cheng
authors.forename: V W
authors.initials: VW
authors.lastname: Chen
authors.forename: B
authors.initials: B
authors.lastname: Steele
authors.forename: B
authors.initials: B
authors.lastname: Ruiz
authors.forename: J
authors.initials: J
authors.lastname: Fulton
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.forename: S E
authors.initials: SE
authors.lastname: Carozza
authors.forename: R
authors.initials: R
authors.lastname: Greenlee
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D018450:Disease Progression; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D011379:Prognosis; D044469:Racial Groups; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology