Trends in colorectal cancer incidence in Norway by gender and anatomic site: an age–period–cohort analysis

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Abstract
The purpose of this study was to examine the secular trend of colorectal cancer in Norway by gender and subsite. All new cases of cancer in proximal colon, distal colon and rectum diagnosed between 1958 and 1997 in Norway were included in the study, altogether 34 202 and 34 097 cases for men and women, respectively. The incidence data were fitted separately for each gender and subsite to an age–period–cohort model. An increase in incidence of colorectal cancer was seen from 1958 to 1997 for both men and women, although a moderate attenuation of the increase has taken place in the last 15–20 years. This observation is most pronounced for cancer of the distal colon, but is also evident for proximal colonic and rectal cancers. For the distal colon and rectum, the period effect is more important than the cohort effect for both genders, whilst opposite for the proximal colon. The main estimated trend for cohort effects is a steady increase for both men and women, apart from an unexpected drop in incidence among the cohorts born during or shortly after World War II. These findings indicate that different aetiological risk factors may act on cancers of the proximal and distal part of the large bowel and further suggest that exogenous risk factors acting very early in life may play a more important role for colorectal cancer than previously recognized.