Cancer By County
Colorectal Cancer
(Colon And Rectum)3-5

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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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Table 16.
Colorectal Cancer Incidence
By County, White Males, New Jersey - 1986-19961

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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Table 17.
Colorectal Cancer Incidence
By County1, Black Males, New Jersey - 1986-1996

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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Table 18.
Colorectal Cancer Incidence
By County, White Females, New Jersey - 1986-19961

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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Table 19.
Colorectal Cancer Incidence
By County1, Black Females, New Jersey - 1986-1996

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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Table 20.
Colorectal Cancer Incidence
By County, Race And Gender, New Jersey - 1986-1996 Combined1

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.

Figure 8.
Colorectal Cancer Incidence
by Gender and Race, New Jersey, 1986-1996

Firgure 8

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