CRT Cancer Research and Treatment : Official Journal of Korean Cancer AssociationCancer Res Treat 1598-2998 2005-9256 Korean Cancer Association 10.4143/crt.2015.484 crt-2015-484 Letter to the Editor Colorectal Cancer Incidence in Korea Is Not the Highest in the World ShinAesun MDPhD 1 2 JungKyu-Won MS 3 WooHyeongtaek MD 1 JeongSeung-Yong MDPhD 2 4 Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University, Seoul, Korea The Korea Central Cancer Registry, National Cancer Center, Goyang, Korea Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Correspondence: Aesun Shin, MD, PhD  Department of Preventive Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea  Tel: 82-2-740-8331, Fax: 82-2-747-4830, E-mail: shinaesun@snu.ac.kr 4 2016 28 1 2016 48 2 864 867 14 12 2015 10 1 2016 Copyright © 2016 by the Korean Cancer Association 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Recently, media as well as academic societies have referred to GLOBOCAN 2012 to support the high incidence rate of colorectal cancer in Korea. According to GLOBOCAN 2012, colorectal cancer incidence ranked third for men and fifth for women, and the highest when both sexes were combined among 184 countries (Table 1) [1]. Because GLOBOCAN intended to provide the most recent estimates of cancer incidence, mortality, and prevalence for 28 cancers worldwide, the quality of country estimates varied from high quality national or regional data to no data [1]. Therefore, the accuracy of estimates are dependent on the availability and the accuracy of the data from each country [1]. Korean data is high quality national data with rates projected to 2012. The most recent incidence data used for GLOBOCAN estimates was for the year 2009 [2]. Indeed, the age-standardized incidence of colorectal cancer increased by 5.3% annually between 1999 and 2012 [3]. However, according to the Korea Central Cancer Registry data, the colorectal cancer incidence decreased for men and stabilized for women in 2012 [3]. Since projection used for GLOBOCAN 2012 applied trends until 2009, which was an annual percent change of 6.2% for both sexes [4], the GLOBOCAN estimates overestimated the incidence for the Korean population.

We retrieved published incidence data of selected countries from 2008 to 2012 (or nearest year to 2012) (Table 2). In comparison of age-standardized incidence rates, Czech (2011), Slovakia (2008), and Slovenia (2011) showed higher incidence than Korea (2011 or 2012) in men. In women, most countries with recent data showed higher incidence compared to Korea. When both sexes were combined, incidence of Japan (2010), Netherlands (2012), Australia (2012), and New Zealand (2012) was higher than that of Korea.

In conclusion, the aim of GLOBOCAN 2012 is to provide worldwide estimates for cancer burden, and there are substantial differences between GLOBOCAN estimates and observed statistics due to methodology applied. Korea has experienced rapid transition in colorectal cancer epidemiology, therefore predicted estimates using past trends may not appropriately reflect the observed statistics. Although GLOBOCAN is useful for overviewing cancer burden, caution should be used in direct comparison or referring of the estimated incidence or mortality.

Conflict of interest relevant to this article was not reported.

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Estimated incidence of colorectal cancer, GLOBOCAN 2012 [1]

Rank Male
 Female
 Both sexes
Population Cases Crude rate (/100,000) ASR (/100,000) Population Cases Crude rate (/100,000) ASR (/100,000) Population Cases Crude rate (/100,000) ASR (/100,000)
1 Slovakia 2,347 88.1 61.6 Norway 1,947 78.7 35.8 Korea 33,773 69.5 45.0
2 Hungary 4,751 100.5 58.9 Denmark 2,297 81.5 35.7 Slovakia 3,963 72.3 42.7
3 Korea 20,036 82.7 58.7 Netherlands 6,321 75.1 33.9 Hungary 8,442 84.8 42.3
4 Czech 4,978 95.9 54.0 New Zealand 1,463 64.5 33.5 Denmark 4,832 86.4 40.5
5 Slovenia 932 93.3 49.7 Korea 13,737 56.4 33.3 Netherlands 13,918 83.3 40.2
6 Netherlands 7,597 91.5 47.5 Australia 7,079 61.6 32.0 Czech 8,336 78.9 38.9
7 Denmark 2,535 91.4 45.9 Hungary 3,691 70.7 30.5 Norway 3,913 78.9 38.9
8 Australia 8,790 76.9 45.5 Israel 1,881 48.3 30.3 Australia 15,869 69.2 38.4
9 Belgium 4,797 90.7 45.2 Belgium 3,886 70.7 29.5 New Zealand 3,018 67.6 37.3
10 Croatia 1,803 85.4 44.2 Slovakia 1,616 57.4 29.3 Slovenia 1,621 79.5 37.0

ASR, age-standardized incidence rate using the World Standard Population (Segi, 1960).

Observed age-standardized incidence ratesa) of colorectal cancer from selected cancer registries

Registry Coverage ICD-10 code Male
 Female
 Both sexes
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Asia
 Korea [5] National C18-20 45.9 49.0 48.6 51.4 50.0 24.7 25.9 25.3 26.4 26.8 34.1 36.2 35.9 37.8 37.3
 Japan [6] Regionalb) C18-20 43.8 48.3 50.1 - - 27.0 28.6 28.4 - - 34.7 37.6 38.4 - -
 Singapore [7] National 153-154c) 38.2 (2010-2014) 26.7 (2010-2014) -
America
 Canada [8] National C18-20 42.3 41.4 39.1 39.5 38.8 28.0 27.8 27.4 27.4 27.5 34.8 34.2 32.9 33.1 32.8
 USA [9] Regionald) 30.9 (2008-2012) 23.1 (2008-2012) 26.7 (2008-2012)
Europe
 Belgium [10] National C18-20 44.8 - - - - 28.8 - - - - - - - - -
 Croatia [11] National C18-20 - - - 41.2 42.4 - - - 21.0 23.0 - - - 29.6 31.2
 Czech [12] National C18-21 56.5 55.5 55.5 51.8 - 28.9 28.7 28.2 28.5 - - - - - -
 Denmark [13] National C18-21 43.3 44.4 43.2 41.9 42.0 33.7 32.9 32.8 34.6 33.9 - - - - -
 Israele) [14] National C18-20 44.1 38.8 36.2 35.1 33.6 32.9 28.5 29.2 27.2 25.1 - - - - -
 Ireland [15] National C18-20 43.1 45.2 42.7 41.3 44.1 26.3 26.7 27.1 26.3 26.7 34.1 35.5 34.4 33.5 34.7
 Italy [16] Regionalf) C18-21 42.8 40.7 - - - 27.5 25.5 - - - - - - - -
 Netherlands [17] National C18-20 45.1 44.9 45.9 46.1 45.4 31.6 31.9 31.4 32.9 32.4 38.3 38.4 38.6 39.5 38.9
 Norway [13] National C18-21 43.8 43.1 46.1 42.6 43.6 34.6 35.9 33.9 36.5 36.1 - - - - -
 Slovakia [18] National C18-20 61.3 - - - - 30.5 - - - - - - - - -
 Slovenia [7] National C18-20 47.9 53.1 57.2 54.6 - 27.0 26.8 30.0 28.2 - - - - - -
 Spain [19] Regionalg) C18-20 - - 40.2 - - - - 23.5 - - - - 31.2 - -
Oceania
 Australia [20] National C18-20 52.6 50.9 52.4 50.9 - 36.9 35.5 36.2 36.2 - 44.4 42.8 43.9 43.2 -
 New Zealand [21] National C18-21 50.0 49.9 49.8 52.4 49.1 39.8 39.6 41.3 37.5 38.6 44.5 44.5 45.3 44.6 43.5

ICD-10, International Classification of Diseases, 10th edition.

World Standard Population was used as a standard population,

Yamagata, Fukui, and Nagasaki,

ICD-9,

SEER 18 areas,

Jews,

AIRRUM (38 Registries pool),

Valencia.