The rate of patients diagnosed at an early stage of colorectal cancer in 2018 was double that of 2000 (39.1% compared to 19.9%) and the rate of patients diagnosed with metastatic cancer dropped from 14.6% in 2000 to 9% in 2018, according to new annual data released by the Health Ministry to mark Colon Cancer Awareness Month.
In 2018, 65% of 50- to 74-year-old Israelis did either a fecal occult blood test in the last year or a colonoscopy within the last 10 years, marking a 6% increase compared to 2016 and a 7% increase compared to 2014, indicating an increase in testing.
In 2018, 3,095 Israelis were diagnosed with colorectal cancer, with 1,606 men and 1,489 women diagnosed. Some 75% of the cases were colon cancer while the rest were rectal cancer.
Colorectal cancer is more common among those who are older, with incidence rates rising sharply after age 50. The median age of diagnosis in 2018 was 70 for Jewish and other non-Arab men and women, 65 for Arab-Israeli men and 60 for Arab-Israeli women.
In 2018, 1,223 Israelis died due to colorectal cancer. This type of cancer is the second most common cause of cancer mortality in Israel. Most of the mortality caused by colorectal cancer in 2018 was among the elderly.
Among Jewish and non-Arab men and women, a significant decrease in mortality was recorded from 1996 to 2018. Among Arab men and women, the mortality rate has remained steady.
The incidence rate of colorectal cancer in Israel is slightly above the world average. The mortality rate in Israel, however, is relatively low and is the same as the global average.
Among Jewish and non-Arab men aged 20 to 34, the incidence rate was stable between 2000 and 2018, but among women a significant increase was recorded, with an about 7% increase every year, meaning about two new patients for every 100,000 people. Among Arab men and women of the same ages, incidence rates remained stable.
Among Jewish and non-Arab men and women aged 35 to 40, incidence rates remained stable. Among Arab men and women between the ages of 35 to 49, incidence rates noticeably increased with about a 5% increase each year on average from 2000 to 2018 for men and about a 3% increase each year for women.
Among Jewish and non-Arab men aged 50 to 74, a noticeable decrease in cases was reported from 2007 to 2018, with a 4% decrease each year. Among Jewish and non-Arab women, a decrease of about 3% each year was reported from 2000 to 2018. Among Arabs aged 50 to 74, decreases of 3% among men and 4% among women were recorded from 2008 to 2018.
Among Jewish and non-Arab men aged 75 and older, a noticeable decrease in cases was reported from 2003 to 2018, with a 4% decrease each year. Among women, a decrease in cases was reported from 2000 to 2018, with a 2% drop each year from 2000 to 2008 and about a 4% drop from 2008 to 2018. Among Arab men and women, incidence rates remained stable.
A national program for the early detection of colorectal cancer was launched in Israel in 2006 by the Health Ministry and the Israel Cancer Association. The program is based on fecal occult blood tests once a year for Israelis between the ages of 50 and 74 at average risk and colonoscopies for those at increased risk.
When occult blood is found in stool, patients are referred for a free colonoscopy covered by the health basket. The test is also for people over the age of 40 who have a first-degree relative who had colon cancer and they are advised to perform the test every five years or as recommended by their doctor.
The HMOs in Israel reported in 2018 that about 1/3 of patients who received a positive fecal occult blood test did not go on to perform a colonoscopy.
The Health Ministry and the Israel Cancer Association recommend that people at average risk with no complaints of symptoms or family history get a fecal occult blood test once a year starting at the age of 50.
People with a family history of colorectal cancer should perform a colonoscopy starting at the age of 40 or 10 years before the age of diagnosis of the affected relative. If the test returns normal, follow-up tests should be performed once every five years, or according to the doctor's recommendations.
People with a family history, including multiple cases, cases at a young age, when Lynch syndrome or familial polyposis is known or suspected should go for testing at the earliest age possible.
People with risk factors such as inflammatory bowel disease, previous intestinal polyps or polyps in relatives, should consult a physician about when to do a colonoscopy and the frequency of testing.
Since October 2020, the Health Ministry has ordered that anyone under the age of 70 who has undergone surgery for colon or uterine malignancy also undergo a Lynch syndrome test. One in 30 patients with bowel or uterine malignancy will also carry Lynch syndrome.
Testing for Lynch syndrome is important as tumors in patients with the syndrome are sensitive to immunological treatments, affecting treatment options and the diagnosis allows locating relatives with carriers who are at risk for cancer at a young age.
The Israel Cancer Association has produced a radio broadcast and a film for digital distribution called "Excuses," as part of a campaign to mark Colon Cancer Awareness Month.
The campaign, voluntarily produced by advertising company Gitam BBDO, encourages early screening and lists various excuses used by people who avoid getting tested.