An Estimate of the Potential for Cancer Prevention in Japan

Cancer prevention is an important strategy in cancer control and it consists of primary prevention and secondaryprevention. Major avoidable or manageable risk factors for cancer identified from previous studies are tobacco,diet and infection. Some cancer could be prevented by controlling those risk factors. In Japan screenings for gastriccancer, cervical cancer, lung cancer, breast cancer and colo-rectal cancer have been widely conducted under the Lawof Health Maintenance for the Aged. In planning and evaluating cancer control activities in Japan, it was considereduseful to estimate the potential of primary and secondary prevention of cancer. The author estimated the potentialof cancer prevention in Japan twice previously in 1990 and 1999. In this paper the potential of cancer prevention inJapan was re-estimated by using a different method and more recent data. From the present study it was estimatedthat about 25% of cancer occurrence could be prevented by control of smoking, diet and infection, about 9-15% ofcancer deaths could be prevented by cancer screening, and about 6- 10 % of cancer deaths could be prevented byapplication of the state-of-the art diagnosis and treatment of cancer, altogether about 40-50% of cancer occurrences/deaths could be prevented if all possible measures for cancer prevention are applied to the general public and cancerpatients in Japan.     

Gene-environment Interactions and Polymorphism Studies for Cancer Risk in Hospital-based Epidemiologic Research Program at Aichi Cancer Center II (HERPACC-II)

Genetic polymorphisms may modify the effects of environmental risk factors on cancer occurence. We have recentlylaunched a comprehensive epidemiologic project, HERPACC II (Hospital-based Epidemiologic Research Programat Aichi Cancer Center II), including both lifestyle and polymorphism data, following HERPACC-I which solelyconcentrated on lifestyle data. As of April 2001, about 3000 samples of DNA are being stored to conduct case-controlstudies. Genotyping of 46 polymorphisms has been conducted at the laboratory of the Division of Epidemiology andPrevention. Twelve case-control studies and two papers on a new PCR method, PCR-CTPP (polymerase chain reactionwith confronting two-pair primers), have been accepted for publication. Significant findings in Japanese were foundfor 1) gene-environment interaction for esophageal cancer between heavy drinking and aldehyde dehydrogenase 2(ALDH2), 2) malignant lymphoma risk with methylenetetrahydrofalate reductase (MTHFR) and methionine synthase(MS), 3) interactions between smoking and two polymorphisms, interleukin 1B (IL-1B) and myeloperoxidase (MPO)for Helicobacter pylori infection, and 4) smoking habits with dopamine receptor D2 (DRD2) and IL-1B. Furtherstudies on interactions with polymorphisms will continue to be conducted for Japanese, using larger sizes of samples.     

A Population-based Follow-up Study on Mortality from Cancer or Cardiovascular Disease and Serum Carotenoids,Retinol and Tocopherols in Japanese Inhabitants

Objective: Observational epidemiologic studies have shown that a high intake of dietary and high serum levels ofcarotenoids are associated with a reduced risk of mortality from cancer and cardiovascular disease. To investigatewhether high serum levels of carotenoids can reduce mortality rates, a population-based follow-up study was conductedamong Japanese inhabitants. Materials and Methods: Three thousand two hundred and fifty-four subjects (1,260males and 1,994 females) aged from 39 to 85 years who had attended health check-up programs from 1989 to 1995were recruited from the Japanese population. Serum levels of carotenoids, retinol and tocopherols were separatelydetermined by high-performance liquid chromatography. Hazard ratios for serum values of carotenoids, retinol andtocopherols were estimated by Cox’s proportional hazard model after adjusting for sex, age, and other confoundingfactors. Results: During the 11.7-year follow-up period, 140 deaths (86 males and 54 females) from cancer of all siteswere identified among the cohort subjects, including 41 from lung , 17 from stomach , 16 from colorectal and 12from liver cancer, as well as 89 deaths from cardiovascular disease, including 45 from heart disease and 37 fromstroke. High serum values of carotenoids including xanthophylls were apparently associated with low hazard ratiosfor mortality rates of cancer of all sites or of cardiovascular disease. High serum values of β-carotene, total carotene,provitamin A and total carotenoid for colorectal cancer or stroke also appeared to be related to low hazard ratios.Those of retinol and tocopherols were not associated with any reduction in risk of mortality from cancer orcardiovascular disease. Conclusions: Our follow-up study demonstrated that a typical Japanese diet related to elevatingserum levels of carotenoids with provitamin A activity may significantly reduce risk of mortality from cancer ofcertain sites or cardiovascular disease, especially colorectal cancer or stroke, while high serum levels of somexanthophylls, retinol and tocopherols do not.     

Colorectal Cancer in Central Tunisia: Increasing Incidence Trends over a 15-Year Period

Introduction: Significant variation in colorectal cancer incidence rates and trends has been observed acrosscountries. Data from Tunisia are sparse. In this paper, we analyzed trends in incidence rates of the colorectalcancer over a 15-year period, 1993-2007, in Central Tunisia. Design: Five-year age-specific rates, crude incidencerates, world age-standardized rates, and annual percent change were calculated using annual data on populationsize and its estimated age structure. Results: A total of 1,443 incident cases of colorectal cancer were registered,with a male to-female sex ratio of 1.1:1. The world age-standardized rate was 10.0 per 100,000 among femalesand 11.7 among males. Over time, there were significant increasing trends by +2.6% (95% CI: 0.1%, 5.1%)and +5.3% (95% CI: 2.7%, 7.9%) for females and males, respectively. Conclusion: The absence of a screeningprogram for colorectal cancer could explain the increasing trends observed among males and females in CentralTunisia. Our findings point the need to plan and develop effective programs aimed at the control and preventionof the spread of colorectal cancer in Tunisia.     

Breast Cancer in Young Women: Prognostic Factors and Clinicopathological Features

Objective:The aim of this study was to determine most significant prognostic factor for overall survival of invasiveduct operable breast cancer from clinical stage, pathological stage, epidemiological, anatomic and cellular andmolecular genetic factors. Materials and Methods: Research design was prospective cohort. Duct invasive operablebreast cancer patients who were diagnosed and treated with standard protocol since 1993, followed prospectivelyuntil November 2003 by clinical stage, pathological stage, age, tumor size, lymph node status, histological grade,mitotic index, ER,PR, c-erbB2, p53 and MIB-1, until revealed outcome (death). Prognostic factor was analyzedunivariately for overall survival with Kaplan Meier method. Difference between two survival group was analyzedwith log- rank test. Independent prognostic factor was analyzed multivariately using proportional hazard (Cox)regression. Results:With univariate analysis, significant prognostic factors for overall survival were clinical stage(p<0.001), pathological stage (p<0.001), tumor size (p<0.001), lymph node status (p<0.001) and adjuvant chemotherapy(p <0.005). Multivariately, most significant prognostic factors for survival were lymph node status (p = 0.001 ; Expβ = 7.775; 95% CI: 2.276 – 26.56) and clinical stage (p = 0.029; Exp β= 2.142; 95% CI: 1.081 – 4.244). Conclusion:Independent prognostic factors for survival are lymph node status and clinical stage.     

Magnitude of Arsenic Toxicity in Tube-well Drinking Water in Bangladesh and Its Adverse Effects on Human Health Including Cancer: Evidence from a Review of the Literature

Only after a decade from 1993, arsenic contamination of groundwater in Bangladesh has been reported as the ‍biggest arsenic catastrophe in the world. It is a burning public health issue in this country. More than 50 percent of ‍the total population is estimated at risk of contamination. Already thousands of people have been affected by the ‍disease arsenicosis. Many more may be on the way to manifest lesions in future. We conducted a review of previous ‍studies and published articles including MEDLINE database on this issue. We found that 59 districts out of 64 have ‍been already affected by arsenic in underground drinking water, where this particular source of drinking water is ‍the main source for 97 percent of the rural people. The water is unfortunately now a great threat for the human ‍being due to high level of arsenic. Continuous arsenic exposure can lead people to develop arsenicosis, which in turn ‍elevates the risk of cancer. Skin lesions are the most common manifestations in arsenicosis patients. Relatively poor ‍rural people and other socio-economically disadvantaged groups are more affected by this exposure. Until now ‍cancer patients have been relatively limited in Bangladesh. One of the reasons may be that several years are needed ‍to show cancer manifestations from the beginning of arsenic exposure. But it is suspected that after some years a ‍large number of patients will appear with cancer in different sites for arsenic exposure in drinking water. Various ‍studies have been conducted in arsenic affected countries - notably in Argentina, Chile, China, Japan, and Taiwan - ‍to find the potential of arsenic exposure to cause development of cancer. Among the arsenic related cancers, liver, ‍lung, skin, bladder and kidney cancers are reported to be prevalent in these countries. Unfortunately no scientific ‍study has been yet conducted in Bangladesh to find the relationship between arsenic exposure and cancers in different ‍sites of the body. So our aim is to conduct an ecological as well as a case-control study in the country in the future. ‍     

Adherence to Health-Related Lifestyle Behavior Recommendations and Association with Quality of Life among Cancer Survivors and Age-Matched Controls in Korea

Objectives: This study was conducted to determine the relationship between lifestyle behavior and qualityof life (QoL) among cancer survivors in Korea. Methods: Data for a total of 471 (173 men, 298 women)cancer survivors (CS) over 40 years old were obtained from the database of the 4th Korean National Healthand Nutrition Examination Survey (KNHANES IV). An identical number of subjects of the same age, sex,and education who had no restrictions in physical activity were randomly selected from the database andrepresented the control group (CG). Drinking, smoking, and exercise behavior were assessed. Results: Thenumber of heavy drinkers was lower in CS (9.4%) than in CG (15.8%) (p < .01); similarly, there were fewersmokers in CS (9.1%) than in CG (14.0%) (p < .05). The percentage of individuals engaging in vigorous,moderate, and low-intensity exercise did not differ between CS (13.6%, 14.7%, and 50.0%) and CG (14.3%,13.4%, and 49.7%, respectively). No differences in Euro QoL Questionnaire 5-Dimensional Classification(EQ-5D) scores on both drinking and smoking behaviors were noted. Compared to the non-exercisers, thelow-intensity exercisers in CG (0.91 ± 0.10 vs. 0.94 ± 0.09), vigorous-intensity exercisers in CS (0.84 ± 0.62vs. 0.91 ± 0.11), and low-intensity exercisers in CS (0.82 ± 0.22 vs. 0.88±0.13) scored higher on the EQ-5D.Conclusions: Although cancer survivors practiced more conscious health behavior in drinking and smoking,their engagement in exercise did not differ from that of non-cancer survivors. Since exercise engagementincreases QoL in general, implementation of an educational program that promotes exercise engagement incancer survivors may be required.     

Prevention and Health Education : How Recent Advances in the Science and Art of Health Education have been Applied in Practical Ways within Medical and other Settings for Prevention and Public Health

The terms health education, patient education, self-care education, school health education, and health promotion ‍are distinguished from each other as follows. Health education is a subset or strategy within each of these but is the ‍primary and dominant strategy in health promotion. Health education occurs through the health care providers in ‍various settings: worksites, medical, community agencies and schools. Nurses and midwives are the most important ‍health care providers to train people for health promotion and cancer prevention. We appreciate the importance of ‍the “Fight against Cancer” movement in the primary health care centre and its health care providers who inform ‍people about cancer and its symptoms, how to find lesions and early stages, and how to avoid hazardous factors. ‍This is as process of continuous information transfer by in-service education. Primary prevention should encompass ‍all actions aimed to reducing the occurrence of cancer. In reviewing recent advances in science and how the art of ‍health education has been applied in practical ways within medical and other settings for prevention and public ‍health, we can point ot the necessity for facilities like an APOCP Training Centre as a venue for scientific courses.     

World Cancer Research Fund/American Institute of Cancer Research 1997 Recommendations: applicability to digestive tract cancer in Japan

Objectives: This paper reviewed analytic epidemiological studies of the major Japanese digestive tract cancers, i.e. esophageal, stomach, colon and rectal. The applicability of the recommendations for prevention of these cancers by the World Cancer Research Fund/American Institute of Cancer Research (W&A) to Japan is considered.Methods: Papers were searched by the MEDLINE for the period 1966 through 1997. Among them, 43 relevant papers including data from Japan were reviewed.Results: Results for 11 lifestyle-related factors were considered. Cigarette smoking was a strong and consistent, thus, convincing, risk factor for esophageal cancer, and a possible risk factor for stomach and colorectal cancer. Excessive consumption of alcohol was a convincing risk factor for esophageal cancer, and a possible risk factor for stomach and colorectal cancer. Excessive salt intake was a risk factor supported by some strong evidence but inconsistent; therefore, it is a probable risk factor for stomach cancer and a possible risk factor for colorectal cancer. Low physical activity was a probable risk factor for colorectal cancer. On the other hand, sufficient intake of vegetables, including green–yellow vegetables, and fruits was regarded as a possible protective factor for these cancers.Conclusions: These observations were mostly consistent with those reported by W&A; therefore the recommendations by W&A for prevention of these cancers may be considered applicable to the current Japanese population.     

The Japan Multi-institutional Collaborative Cohort Study (J-MICC Study) to Detect Gene-environment Interactions for Cancer

The Japan Multi-institutional Collaborative Cohort Study (J-MICC Study) launched in 2005, supported bya research grant for Scientific Research on Special Priority Areas of Cancer from the Japanese Ministry ofEducation, Culture, Sports, Science and Technology. Although the main purpose is to confirm and detectgene-environment interactions of lifestyle-related diseases, mainly of cancer, through the cohort analyses, itincludes cross-sectional analyses on lifestyle factors, biomarkers, and genotypes, as well as confirmation/screening of new biomarkers usable for early diagnosis of cancer. The endpoints are cancer diagnosis and death.The participants diagnosed as cancer will be identified through population-based cancer registries, hospitalcancer registries, mail questionnaires, questionnaires at repeated visits, death certificates, health insurance data,and second survey questionnaires. Subjects are individuals aged 35 to 69 years enrolled from respondents tostudy announcements in specified areas, inhabitants attending health checkup examinations by localgovernments, visitors at health checkup centers, and patients at a cancer hospital. The number of subjects wasset to be 100,000 throughout Japan. The enrollment period is from April 2005 to March 2010. The second surveyis scheduled 5 years after their enrollment. The participants will be followed until 2025. The J-MICC CentralOffice is placed at Nagoya University Graduate School of Medicine. Ten participating research groups (CohortStudy Executing Groups) send baseline data and blood samples (buffy coat, serum, and plasma) anonymizedwith an identification number (J-MICC ID) to the Central Office. The data of second survey and follow-up willbe linked using J-MICC ID. This study is expected to produce many findings on lifestyle and genetic traitsassociated with lifestyle-related diseases including cancer among Japanese.     

TRAIL Mediated Signaling in Pancreatic Cancer

Research over the years has progressively shown substantial broadening of the tumor necrosis factor alpharelated apoptosis-inducing ligand (TRAIL)-mediated signaling landscape. Increasingly it is being realized that pancreatic cancer is a multifaceted and genomically complex disease. Suppression of tumor suppressors, overexpression of oncogenes, epigenetic silencing, and loss of apoptosis are some of the extensively studied underlying mechanisms. Rapidly accumulating in vitro and in vivo evidence has started to shed light on the resistance mechanisms in pancreatic cancer cells. More interestingly a recent research has opened new horizons of miRNA regulation by DR5 in pancreatic cancer cells. It has been shown that DR5 interacts with the core microprocessor components Drosha and DGCR8, thus impairing processing of primary let-7. Xenografting DR5 silenced pancreatic cancer cells in SCID-mice indicated that there was notable suppression of tumor growth. There is a paradigm shift in our current understanding of TRAIL mediated signaling in pancreatic cancer cellsthat is now adding new layers of concepts into the existing scientific evidence. In this review we have attempted to provide an overview of recent advances in TRAIL mediated signaling in pancreatic cancer as evidenced byfindings of in vitro and in vivo analyses. Furthermore, we discuss nanotechnological advances with emphasis on PEG-TRAIL and four-arm PEG cross-linked hyaluronic acid (HA) hydrogels to improve availability of TRAIL at target sites.     

A Case-Control Study of Colorectal Cancer in Relation to Lifestyle Factors and Genetic Polymorphisms: Design and Conduct of the Fukuoka Colorectal Cancer Study

A case-control study was designed to elucidate roles of dietary and other behavioral influences, in combination ‍with genetic susceptibility factors (genetic polymorphisms), in colorectal carcinogenesis. Both cases and controls ‍were residents in Fukuoka City and three adjacent areas. Cases were patients undergoing surgery for a first diagnosis ‍of colorectal cancer at 8 hospitals in the study area, and controls were randomly selected in the community by ‍frequency-matching with respect to the expected distribution by sex, age (10-year class), and residence . Dietary and ‍other lifestyle factors were ascertained by in-person interview, and venous blood was obtained for genotyping and ‍possible biochemical measurements. The cases were interviewed at each hospital during the period from 2000 to ‍2003, and controls were surveyed during the period from 2001 to 2002. A total of 840 cases of colorectal cancer and ‍833 controls were interviewed with participation rates of 80% for the cases and 60% for the controls. Informed ‍consent to genotyping was obtained from 685 cases and 778 controls. Further details of the design and conduct are ‍described with respect to methodological aspects.     

Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests

Background: Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation. Materials and Methods: People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups. Results: After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT nonparticipants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%). Conclusions: Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.     

Incidence and Current Trends of Colorectal Malignancies in an Unscreened,Low Risk Population

Introduction: Karachi falls into a low risk region for colorectal (CRC). The incidence rate is known butdetailed epidemiology and pathology data regarding the disease are not available. The aim of this study is todescribe CRC with reference to incidence, gender; topographic sub-site, tumor morphology, grade and stage atdiagnosis and to determine the trends of incidence. Materials and Methods: Four hundred and seventy threecases of colorectal cancer submitted to the Karachi Cancer Registry for Karachi South, years 1995-2002 werereviewed. Cases were analyzed in two time periods (1995-7 and 1998-2002) to facilitate the study of time trends.Results: A total of 151 CRC cases were registered during period one [86 (57%) males; 65 (43%) females] and322 cases [210 (65%) males; 112 (35%) females] in period two. Age standardized rate (ASR) world per 100,000,crude incidence rate (CIR) and relative frequency in period one were 5.3, 3.2 and 4.1% in males and 5.5, 3.2and 3.2% in females respectively. Corresponding figures for period two were 7.1, 4.5 and 4.7% for males and5.2, 2.8 and 2.7% in females. The male, female ratio was equal for colon (1:1). Men had more rectal cancers(2:1) and overall CRC (1.7:1). The mean age of the patients varied with sub-site and gender from 43.7 years to51.2 years. Cancers of the rectum presented at a relatively earlier age. Less then 5% of the cases were diagnosedin adolescents, 50% above 50 years of age and only 30% above 60 years. The ratio under-40 to above-40 forCRC patients was 0.3, which is much higher than the international average, indicating a younger age group atrisk. The first cases were observed in adolescents (15-19 years) and a peak was observed in the seventh decade.Colon to rectum ratio was 1:1 in males and 2:1 in females. Most cases presented with advanced disease, thoughsome down staging was observed in period 2 (1998-2002). Conclusion: The current low but increasing incidence(especially in men), the younger age and advanced stage of CRC at diagnosis reflects a low risk, unscreenedpopulation. With existing prevalence of high risk factors in Pakistan, the low CRC incidence may be an artifact.There are concerns that an aging population over the next decade and changing lifestyle patterns may translateinto a higher CRC incidence. Screening must be considered as part of the health sector planning for the futureand include the high risk younger age groups.     

Colorectal Cancer in Sweden a Descriptive Epidemiologic Study

In a register-based 19-year follow-up we studied the incidence rate of colorectal cancer in the Swedish 1960 census population. A total of 53 377 cases were identified: 28 003 men and 25 374 women. A U-shaped distribution of tumors in the large bowel was observed, with a minimum in the descending colon. Other findings were 1) An incidence gap between elderly men and women increasing with age and with distal direction in the large bowel; 2) An increase in the incidence of colorectal cancer with population density; 3) A higher incidence of colorectal cancer in the southwestern region than in the northern region and 4) A lower incidence of colon cancer among blue than among white collar workers and a lower incidence of colorectal cancer among never married men than among other men.     

Allele Frequencies of 25 Polymorphisms Pertaining to Cancer Risk for Japanese,Koreans, and Chinese

Allele frequencies are rather constant among different ethnic groups in many genetic polymorphisms, but some ‍polymorphisms vary in the allele frequency depending on the time when the germ-line base exchanges occurred in ‍the history of humans and on the adaptability of the phenotypes to given environment. This review documented the ‍allele frequencies of polymorphisms pertaining to cancer risk for Japanese, Koreans, and Chinese. Twenty-five ‍polymorphisms of 21 genes whose allele frequencies were available for at least two out of the three ethnic groups ‍were selected. They were ALDH2 Glu487Lys, COMT Val158Met, CYP1A1 MspI and Val/Ile, CYP1B1 Leu432Val, ‍CYP2E1 RsaI, CYP17 T-34C, ER C975G, GSTM1, GSTT1, GSTP1 Ile105Val, IL-1B C-511T, IL-1RN 86-bp VNTR ‍(variable number of tandem repeats), MTHFR C677T and A1298C, NAT1, NAT2, NQO1 Pro187Ser, OGG1 Ser326Cys, ‍p21 Ser31Arg, p53 Arg72Pro, TNF-A G-308A and G-238A, and XRCC1 Arg194Trp and Arg399Gln. The allele ‍frequencies were found for 24 in Japanese, 16 in Koreans, and 24 in Chinese. All of the polymorphisms had similar ‍allele frequencies for these ethnic groups, except the following polymorphisms; ALDH2 Glu487Lys whose Lys allele ‍was more common for Japanese and Taiwanese, COMT Val158Met whose Met allele was more common for Japanese, ‍and NAT2 rapid/slow whose slow alleles were more common for Chinese. When compared with the allele frequencies ‍among Caucasians, the following minor alleles were more frequent among Japanese/Koreans/Chinese; ALDH2 478Lys, ‍CYP1A1 m1 and m2, CYP2E1 c2, ER 975G, GSTT1 null, NAT1 *10, NQO1 187Ser, OGG1 326Cys, p21 31Arg, and ‍XRCC1 194Trp, and less frequent in COMT 158Met, GST-P1 105Val, IL-1RN non-4R, MTHFR 1298C, and TNF-A - ‍308A. The differences in genetic background may affect the impact on the lifestyle factors and/or genotypes examined ‍in epidemiological studies. However, the influences of the variations in the allele frequency seemed to be limited ‍among Japanese, Koreans, and Chinese. The substantial differences in the allele frequency from Caucasians could ‍modify the influences of lifestyle factors and polymorphism genotypes, resulting in the inconsistent results of ‍epidemiologic studies. ‍     

Increasing Incidence of Colorectal Cancer,Starting at a Younger Age for Rectal Compared to Colon Cancer in Brunei Darussalam

Background: Colorectal cancer (CRC) is the most common gastrointestinal malignancy and is a significantcause of mortality. Its incidence is generally increasing in Asia. Reports from the West have indicated that theincidence of rectal cancer is increasing in the younger population. This study assessed the time trend of CRCin Brunei Darussalam specifically assessing the different age groups at which the incidences start to increase.Materials and Methods: The National Cancer registry was reviewed (1991 to 2014). The age standardizedrate (ASR) and the age specific incidence rates (ASIRs) for three time periods (1991-1998), (1999-2006) and(2007-2014) were calculated. Results: The mean age of diagnosis was 59.3±14.6 years old, incidences beingslightly higher amongst men (57.6%) and Malays (67.1%). The most common tumor type was adenocarcinoma(96.4%). Rectal cancers accounted for 35.2% (n=372/1,056) of all cancers of the large bowel; more men wereaffected than women. The proportion of rectal cancer was also high among the indigenous group. In the threetime periods, the ASR for CRC increased from 16 per 100,000 (1991-1998) to 19.6 per 100,000 (1999-2006) and24.3 per 100,000 (2007-2014). The ASIRs for CRC increased markedly between the time periods 1998-2006 and2007-2014, beginning in the 40-44 years age group. For rectal cancers, the ASIRs started to increase in the 25-29age group onward whereas for colon cancers, the increase was observed at a later age, starting from the 45-49age group. Conclusions: Our study showed an increase in the incidence of CRC including in the younger agegroups. The increase was seen earlier in rectal cancer compared to colon cancer. These data mirror the trendsreported from the West.