title: Unexplained inversion of the incidence ratio of colon and rectal cancer among men in East Germany. A time trend analysis including 147,790 cases.
abstract: BACKGROUND
  The incidence rate ratio of colon to rectal cancer is usually about 2:1. It has been observed for a while that the incidence of colon cancer among men (as opposed to women) in the Former German Democratic Republic (GDR) is lower than the rate of rectal cancer. Detailed analyses of this phenomenon have not been done so far. The aim was to give insights in this observation by detailed incidence and mortality analyses and to explore the worldwide ratio of colon and rectal cancers based on population-based cancer registry data.
  
  
  METHODS
  We analyzed age-standardized incidence and mortality data of colorectal cancers in East Germany (1961-1989 and 1996-2002; mortality 1980-2002), West Germany, Saarland (1970-2002) and all over the world (1978-82 up to 1993-97).
  
  
  RESULTS
  With the incidence increase of colorectal cancers in the GDR, the ratio of colon to rectal cancer incidence became larger and surpassed the reference value (ratio = 1) during the time of the reunification. Also the mortality data revealed a similar pattern. Estimated annual percentage increases of colon subsite incidences tended to be higher within the distal colon as compared to the proximal colon
  
  
  CONCLUSIONS
  Our analyses of international cancer registries over a period of 20 years show that the colon-rectum cancer ratio is positively associated with the overall incidence of colorectal cancer with a stronger association among women than men. Non-causal factors such as underdetection or registration artefacts are unlikely to explain the unusual colon/rectal rate ratio among men. A gradual decrease of the job-related physical activity among men may have contributed to the findings.
authors.affiliation: Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Magdeburger Str. 27, 06097, Halle, Germany. andreas.stang@medizin.uni-halle.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Stang
authors.forename: Roland
authors.initials: R
authors.lastname: Stabenow
authors.forename: Christa
authors.initials: C
authors.lastname: Stegmaier
authors.forename: Bettina
authors.initials: B
authors.lastname: Eisinger
authors.forename: Edeltraud
authors.initials: E
authors.lastname: Bischof-Hammes
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
mesh_terms: D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality / Q000639:trends; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D013997:Time Factors