title: Time trends in colon cancer incidence and distribution and lower gastrointestinal endoscopy utilization in Manitoba.
abstract: OBJECTIVE
  There are limited data on recent trends in subsite-specific colon cancer incidence and utilization of lower gastrointestinal endoscopy from Canada. The aim of our study was to determine the concomitant trends in right-sided colon cancer incidence and utilization of colonoscopy and flexible sigmoidoscopy (FS) in Manitoba.
  
  
  METHODS
  Cases of colon cancer diagnosed from 1964 to 2004 were identified from the Manitoba Cancer Registry. Lower gastrointestinal endoscopies performed between 1984 and 2003 were identified from Manitoba Health's Physician Claims database. Trends of age-standardized incidence rates were determined using Joinpoint analyses.
  
  
  RESULTS
  Rates of right-sided colon cancer showed a monotonic increase in both sexes (annual percent change [APC] in both sexes 1.04%, P < 0.001). The most rapid increase (200%) occurred in individuals of 70 yr of age and older. While rates of colonoscopies without polypectomies quadrupled between 1985 (257 per 100,000) and 2003 (1,083 per 100,000, APC 8.89%, P < 0.001), rates of colonoscopies with polypectomies quadrupled from 35 per 100,000 in 1985 to 140 per 100,000 in 2000, and then increased more rapidly in the subsequent 4 yr (233 per 100,000 in 2003, APC 20%, P < 0.001). Rates of FS declined between 1999 (342 per 100,000) and 2003 (257 per 100,000, APC -6.68%, P= 0.01).
  
  
  CONCLUSIONS
  The rates of right-sided colon cancer are continuing to increase in Manitoba, with the most rapid increase occurring in older individuals. Reasons for the increasing incidence of right-sided colon cancer despite increasing rates of colonoscopy need to be further explored, and may reflect increased detection of asymptomatic cancers or a real increase in right-sided colon cancer incidence.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Alain A
authors.initials: AA
authors.lastname: Demers
authors.forename: Lin
authors.initials: L
authors.lastname: Xue
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D003111:Colonic Polyps / Q000453:epidemiology / Q000601:surgery; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008350:Manitoba; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D015996:Survival Rate; D014600:Utilization Review