Risk Factors

The relationship between diet and colorectal cancer has been studied a great deal. Generally, a direct association has been found between high fat intake, especially animal fat or red meat, and colorectal cancer. Similarly, a diet low in fiber, vegetables, and to some extent fruit has been found to increase the risk of colorectal cancer. Recent studies have found a possible protective effect of calcium and vitamin D in the diet. Up to half the cases of colorectal cancer may be due to dietary factors. Recently, studies have found that low physical activity is associated with colorectal cancer, and may account for over 30 percent of the cases of this cancer.

A family history of colorectal cancer, specifically in a first- degree relative, increases the risk of colorectal cancer, as does familial adenomatous polyposis (FAP), a rare inherited condition of many hundreds of large intestinal polyps. Other genetic defects are being studied. Inflammatory bowel disease such as ulcerative colitis or Crohn's disease has also been associated with an increased risk of colorectal cancer. Some studies have found that alcohol use increases the risk of colorectal cancer, but other studies did not find this. Some recent studies suggest that estrogen replacement therapy and non-steroidal anti- inflammatory drugs such as aspirin may reduce colorectal cancer risk.

Prevention and Control

The best means of prevention are a diet high in fiber from vegetables and fruits and low in fat and physical activity. Early detection of colorectal cancer can increase the chances of survival. The American Cancer Society has recommendations about the primary screening tests - digital rectal exams, fecal occult blood tests, and sigmoidoscopy (please see Appendix I). These tests lead to the diagnosis and removal of polyps, and thus, prevent colorectal cancer.

Incidence and Mortality in the U.S.

Colorectal cancer is the fourth most common cancer in the U.S. with 131,600 new cases estimated for 1998. The incidence rate of colorectal cancer is higher among men than women, but is similar for whites and blacks. The incidence increases greatly after age 50. Incidence rates have declined in recent years, primarily among whites. The decline may be due to increased screening and removal of polyps so that the polyps do not progress to invasive cancer.
Survival also has improved recently with 81 percent of patients living at least one year and 62 percent living at least five years after diagnosis. If detected in the localized stage, the five-year survival rate is 92 percent.

Approximately 56,500 people are expected to die from colorectal cancer in the U.S. in 1998. Colorectal mortality rates are slightly higher among blacks than whites. Mortality rates have fallen for men and women in the past twenty years, but the mortality rate for black men has been rising.

Incidence in New Jersey - 1986-1996

Tables 16 through 20 contain data on colorectal cancer incidence in New Jersey for the years 1986 through 1996. Figure 8 shows statewide trends for colorectal cancer. Statewide, white men had the highest rates and black men the second highest rates. Both white and black men had higher rates than white and black women, who had similar rates (see Figure 8). The counties followed the same pattern except black males had higher rates than white males in Burlington, Cumberland, Salem, and Somerset counties. White women had the second highest rates in Gloucester and Middlesex counties, and black women had the second highest rates in Cape May county (see Table 20). For the state as a whole, colorectal cancer rates generally declined in each race/gender group over the years, except during 1994-95 in black males and females (see Figure 8).

Conclusion

To continue the general decline in colorectal cancer rates, dietary changes such as less fat and more fiber, vegetables, and fruits and increased physical activity should continue. In addition, the screening recommendations for colorectal cancer, which result in early detection, should be followed.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	73	70.7	71	68.6	89	86.3	78	73.9	86	81.5	72	68.6	85	77.9	93	86.2	63	57.1	67	59.9	66	61.4
Bergen	341	74.6	374	81.3	324	71.1	329	71.3	316	68.1	328	68.9	352	74.6	312	64.7	278	58.0	301	62.7	259	53.5
Burlington	91	61.9	100	67.8	143	95.8	94	59.9	118	75.2	101	64.0	119	75.0	102	63.7	111	69.4	125	75.8	106	64.1
Camden	167	85.4	116	58.0	161	78.4	142	70.7	144	70.3	138	66.6	133	65.4	128	59.5	136	65.5	141	65.7	131	61.5
Cape May	44	71.3	58	92.4	71	107.1	57	83.6	62	88.3	59	86.3	58	80.7	56	72.8	47	66.6	52	74.5	43	62.5
Cumberland	37	61.0	53	85.6	45	74.4	42	65.5	43	67.7	48	76.4	52	78.7	41	62.2	48	74.3	32	52.2	48	79.0
Essex	204	72.2	220	78.7	193	71.7	190	70.5	183	70.5	183	69.8	186	71.5	141	54.8	146	56.3	147	57.0	148	58.6
Gloucester	54	67.5	63	80.0	54	62.1	53	60.2	67	77.3	66	69.0	70	72.9	63	65.5	64	66.7	55	57.3	53	53.0
Hudson	192	78.5	190	78.3	188	79.9	179	78.4	182	79.1	169	72.4	171	73.4	165	70.3	136	57.7	132	56.4	134	57.6
Hunterdon	28	64.2	21	48.4	37	83.8	30	69.9	45	99.9	27	58.1	31	68.7	40	81.3	24	47.4	24	48.9	31	57.8
Mercer	120	90.4	107	78.7	117	85.6	100	72.2	96	69.0	123	90.2	113	80.8	82	58.5	83	58.4	77	53.1	91	61.7
Middlesex	213	77.9	189	67.1	223	78.2	218	75.9	225	74.9	193	65.5	217	72.6	210	71.0	205	67.6	186	60.5	227	75.2
Monmouth	189	77.1	195	78.1	182	72.9	167	66.1	188	74.1	196	75.6	170	64.5	181	68.6	193	71.3	171	61.9	199	71.0
Morris	125	71.1	153	86.6	104	58.6	128	73.2	109	59.5	117	64.1	97	51.5	121	64.1	114	58.4	118	60.1	135	67.8
Ocean	244	78.3	275	89.1	236	74.6	269	78.6	274	78.5	252	70.0	248	67.1	235	63.5	231	63.1	241	60.8	228	56.4
Passaic	159	77.4	165	80.5	145	71.3	152	74.0	154	76.0	139	69.4	122	60.9	134	65.5	138	66.6	128	60.8	132	64.6
Salem	20	62.5	20	64.9	21	64.8	22	68.3	16	51.4	22	66.3	19	56.9	13	38.0	22	65.9	23	70.9	20	57.5
Somerset	71	77.6	65	67.4	68	68.5	53	52.8	72	69.1	62	58.0	62	58.6	60	52.9	65	55.5	68	57.9	60	49.7
Sussex	42	92.7	35	74.6	32	68.0	33	66.3	39	82.4	41	83.4	42	83.6	42	83.7	29	56.7	26	47.2	32	58.7
Union	193	77.9	200	80.6	213	85.4	179	73.1	180	72.5	203	82.4	164	66.1	166	66.4	148	59.6	141	56.8	129	51.3
Warren	40	95.1	28	65.5	34	74.4	49	108.7	32	71.1	39	84.5	39	81.9	49	100.7	38	75.3	27	54.0	36	68.9
STATE	2650	76.2	2700	76.9	2684	75.9	2566	71.9	2634	73.4	2582	71.1	2552	69.8	2434	65.7	2320	62.1	2283	60.4	2308	60.7

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	10	63.9	---	---	9	57.6	12	75.4	6	38.5	10	63.3	9	45.7	11	63.8	14	75.4	13	66.6	5	25.5
Bergen	11	86.7	8	53.4	11	81.3	6	34.8	7	49.2	7	44.4	8	44.0	13	82.3	10	60.0	10	55.5	8	37.9
Burlington	11	83.8	10	81.0	13	77.5	11	76.5	10	74.4	20	114.7	11	74.6	13	80.7	12	68.7	12	59.4	10	50.8
Camden	26	116.7	15	61.6	10	41.8	17	72.0	20	72.8	16	64.3	13	49.7	14	48.5	16	55.0	18	59.2	15	48.4
Cumberland	---	---	7	121.9	5	84.6	---	---	---	---	5	65.3	7	99.1	---	---	---	---	6	73.2	7	97.4
Essex	62	64.4	59	58.4	71	71.2	64	62.6	73	72.9	67	67.1	74	71.8	62	58.4	59	55.6	84	78.4	72	66.6
Gloucester	6	79.9	---	---	---	---	9	111.8	6	66.3	6	60.1	---	---	5	44.7	7	66.3	7	60.1	---	---
Hudson	13	66.7	17	77.6	8	40.4	13	67.0	14	54.1	12	46.1	15	66.6	13	63.1	14	58.8	14	54.7	15	52.8
Mercer	9	48.5	18	98.2	10	52.8	14	69.3	14	62.5	13	63.0	13	63.0	13	59.0	14	54.8	20	81.0	18	75.7
Middlesex	6	46.9	7	42.5	7	61.2	7	55.7	6	44.4	6	48.1	6	45.7	5	27.9	7	39.9	10	51.4	---	---
Monmouth	11	61.3	14	78.2	12	61.1	11	61.4	10	54.6	15	77.2	9	41.1	---	---	8	36.9	7	32.0	10	43.4
Passaic	8	55.6	6	31.7	15	90.2	7	34.5	7	41.7	6	28.3	8	41.3	12	66.0	11	54.5	19	86.7	10	47.6
Union	17	54.9	18	62.0	29	99.1	18	49.6	17	61.1	21	65.7	27	84.5	20	53.4	27	82.9	29	86.1	21	58.3
STATE	200	65.9	199	62.2	211	65.6	204	62.2	215	64.5	213	62.5	213	60.1	201	55.4	216	58.3	259	68.4	208	53.3

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cape May, Hunterdon, Morris, Ocean, Salem, Somerset, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	86	56.9	88	58.8	74	50.8	82	52.2	97	58.9	71	45.3	76	49.5	84	56.4	77	49.6	73	41.2	74	45.9
Bergen	354	52.8	295	43.7	342	51.2	339	49.6	307	45.5	331	48.0	323	46.2	288	41.0	281	38.6	301	44.3	296	42.7
Burlington	90	44.6	95	45.7	105	49.9	110	53.2	97	44.9	99	45.2	113	49.2	118	51.7	114	49.4	105	46.2	114	50.3
Camden	157	51.1	130	43.4	138	44.9	143	46.4	155	48.7	186	61.1	134	43.6	137	44.3	139	42.9	121	36.7	145	45.7
Cape May	46	52.9	55	56.4	60	65.9	58	63.8	54	63.2	55	57.5	60	59.9	61	49.8	45	40.6	62	57.8	41	40.4
Cumberland	41	45.0	38	45.1	41	48.6	45	49.3	41	44.2	40	44.0	37	40.3	39	41.6	42	45.9	28	32.3	34	41.3
Essex	224	50.1	225	51.5	206	46.0	222	52.5	202	48.0	189	46.3	162	38.7	161	43.6	166	43.2	147	37.7	168	42.5
Gloucester	52	45.9	78	68.0	56	46.0	66	53.5	61	49.5	68	51.9	74	57.9	61	44.6	74	54.4	69	53.0	65	47.9
Hudson	182	48.5	203	54.3	175	46.8	178	49.2	167	44.7	168	45.8	152	42.8	181	48.7	194	52.9	139	40.1	137	35.8
Hunterdon	30	55.8	22	38.9	28	49.3	25	38.1	20	31.9	32	50.1	29	48.3	37	66.7	32	52.3	31	47.6	25	35.8
Mercer	102	51.3	106	53.2	102	51.3	93	48.0	98	46.2	88	41.5	105	50.0	100	43.7	78	34.5	100	45.9	99	46.1
Middlesex	177	47.2	175	46.1	225	57.5	195	49.5	196	47.6	187	45.5	175	41.8	186	44.4	160	38.4	160	38.1	170	40.4
Monmouth	193	51.1	176	46.7	200	51.7	193	49.8	197	53.2	201	51.4	205	51.8	185	47.1	161	41.3	194	45.2	166	42.7
Morris	121	48.5	110	42.2	103	40.6	108	40.3	141	53.7	127	48.2	98	36.1	111	39.1	119	43.3	133	47.9	120	40.6
Ocean	217	49.4	245	55.2	231	48.0	258	50.6	219	41.6	219	41.5	231	44.5	219	41.0	231	43.5	222	38.6	220	36.3
Passaic	153	48.5	150	48.7	161	51.3	149	49.3	136	43.5	143	45.2	150	48.9	135	45.7	128	38.8	114	35.6	109	36.6
Salem	16	36.6	19	47.0	8	16.7	20	47.2	23	53.7	30	60.7	23	51.5	21	45.5	22	46.8	31	65.8	11	24.4
Somerset	66	48.8	56	42.5	55	39.2	50	37.1	80	52.2	46	30.2	69	43.8	59	39.4	54	34.4	63	39.9	40	23.2
Sussex	31	48.4	44	61.4	39	56.9	35	49.8	37	51.9	34	44.2	29	42.8	37	48.6	33	45.6	23	28.2	28	41.0
Union	165	45.5	215	58.4	190	51.6	188	50.3	175	46.8	182	49.8	156	41.1	146	37.9	145	37.8	151	39.6	147	40.7
Warren	31	48.3	38	58.3	40	57.5	26	38.3	52	72.7	41	60.2	36	52.2	40	56.5	30	42.3	36	52.6	38	51.3
STATE	2536	49.5	2566	49.8	2580	49.5	2586	49.2	2558	48.0	2544	47.4	2437	45.2	2406	44.4	2326	42.3	2304	41.8	2247	40.7

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	16	63.8	11	44.2	15	60.6	15	64.5	10	42.4	9	36.0	15	58.6	13	48.8	14	41.1	11	34.6	11	35.5
Bergen	19	89.7	16	75.6	---	---	14	58.7	14	57.0	10	40.9	14	58.9	---	---	16	57.7	12	46.9	9	29.9
Burlington	11	61.3	4	---	12	71.7	7	39.0	11	57.9	9	51.8	7	35.9	15	62.5	10	48.9	8	34.1	9	37.1
Camden	13	39.2	10	29.8	18	53.3	12	34.1	22	58.6	12	30.5	15	38.1	8	20.5	16	37.7	26	60.5	15	33.5
Essex	82	55.4	84	55.0	87	55.3	77	47.0	71	44.5	88	54.4	70	42.1	85	50.4	90	53.9	79	46.7	74	43.4
Hudson	16	55.5	13	41.7	17	52.4	19	54.9	23	68.7	20	59.9	20	58.4	13	39.4	20	56.8	23	65.2	14	37.8
Mercer	15	55.6	12	43.9	10	37.0	12	41.2	8	26.3	20	65.5	9	28.1	19	58.9	19	56.8	16	48.2	17	49.3
Middlesex	8	50.6	---	---	6	34.4	---	---	10	55.4	9	48.6	10	53.4	10	50.6	8	37.0	9	43.7	14	60.0
Monmouth	11	44.7	13	48.1	9	33.9	9	32.8	13	48.4	11	39.6	14	48.1	8	27.3	16	48.3	14	41.5	16	46.1
Passaic	14	54.6	9	38.5	11	43.5	8	31.4	8	30.6	15	51.1	11	35.7	13	44.5	13	34.2	9	27.4	14	41.3
Union	18	44.7	28	67.3	21	50.5	24	55.3	20	42.9	18	39.3	25	53.2	23	50.0	13	27.0	26	52.7	21	41.0
STATE	243	54.1	216	46.5	239	50.3	214	43.6	234	47.1	238	46.6	234	45.3	236	44.2	266	48.3	264	47.4	234	40.4

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cape May, Cumberland, Gloucester, Hunterdon, Morris, Ocean, Salem, Somerset, Sussex, and Warren counties. The dashes indicate fwer than five cases. Source: New Jersey State Cancer Registry.

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COUNTY	MALE				FEMALE
	WHITE		BLACK		WHITE		BLACK
	Number	Rate2	Number	Rate2	Number	Rate2	Number	Rate2
Atlantic	843	72.0	103	54.2	882	51.4	140	47.6
Bergen	3514	67.9	99	56.5	3457	45.8	132	48.9
Burlington	1210	70.4	133	75.7	1160	48.4	103	47.3
Camden	1537	68.0	180	61.6	1585	46.3	167	39.7
Cape May	607	79.8	15	56.8	597	54.9	29	64.6
Cumberland	489	70.5	54	70.7	426	43.2	47	40.5
Essex	1941	66.6	747	66.2	2072	45.5	887	49.7
Gloucester	662	66.3	54	51.8	724	52.0	50	35.7
Hudson	1838	71.1	148	58.6	1876	46.5	198	53.7
Hunterdon	338	65.8	---	---	311	46.8	5	84.1
Mercer	1109	72.6	156	66.4	1071	46.7	157	46.7
Middlesex	2306	71.5	71	42.8	2006	45.1	91	43.2
Monmouth	2031	70.7	109	49.4	2071	48.2	134	41.8
Morris	1321	64.7	20	52.7	1291	43.7	22	34.6
Ocean	2733	70.3	23	54.3	2512	44.5	27	46.9
Passaic	1568	69.6	109	52.7	1528	44.7	125	39.1
Salem	218	60.6	32	65.4	224	45.1	24	35.1
Somerset	706	60.0	32	70.7	638	38.9	33	51.2
Sussex	393	72.1	---	---	370	47.0	---	---
Union	1916	70.0	244	69.2	1860	45.6	237	47.4
Warren	411	79.8	---	---	408	53.4	---	---
STATE	27713	69.3	2339	61.5	27090	46.2	2618	46.6

¹Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
²Average annual rate.

*1996 data are preliminary. Source: New Jersey State Cancer Registry.