**3.2 Incidence of colorectal cancer**

Two population-based cancer registrations have been running in the two prominent cities of Hanoi and Ho Chi Minh. The covered population was about 13 million (15% of the country population) in 2008 [6, 19, 21].

Age-standardized incidence rates per 100,000 (ASR) of colorectal cancer was 10.5 in men and 6.5 in women, during 1993–1997, in Hanoi and 12.4 in men and 9.0 in women, during 1995–1998, in Ho Chi Minh City [19, 21]. The incidence rate of colorectal cancer in Vietnam was one fifth of that in the United States (ASR 52.6 in men and 37.0 in women, respectively) [27].

Data on the cancer incidence rate in Vietnam might be deviated by 15–25% since the death certificate was not available at that time. During the 1990s, only 12% of Vietnamese had health insurance (HI). Thus, many cancer patients were not admitted to hospitals, which impacted directly on number of mortality in oncology patients [17]. According to GLOBOCAN 2018, 114,871 cancer patients in Vietnam are deceased in 2018, which takes up more than one third of the prevalent cases [4].

### **3.3 Mortality from colorectal cancer**

In eight regions, ASR colorectal cancer mortality rates were from 4.0 to 11.3 per 100,000 in men and from 3.0 to 7.8 per 100,000 in women (**Table 1**). The highest mortality rates were seen in both men (11.3 per 100,000) and women (7.8 per 100,000) in the region of the Mekong Delta River in the South of Vietnam.

In a specific province population, the colorectal cancer mortality rate per 100,000 person-years during 2005-2018 was 5.8, men 6.9, and women 5.0. Men to


**37**

*#*

*\$*

**Table 2.**

**Figure 1.**

*Age-specific mortality rate per 100,000 in men and women, 2005–2006.*

*Colorectal Cancer in Vietnam*

areas of the country (**Table 2**).

of 62 in men and 66 in women.

**3.4 Survival of colorectal cancer**

*&Crude rate per 100,000 person-years.*

*Proportion of death cases aged under 70 year-olds.*

*2000-2025. Men to women ratio (ASR-WHO) = 1.4 (6.9/5.0).*

*Mortality due to colorectal cancer by sex during 2005–2018 in Lang Son province.*

**Sex Year Total Crude** 

*DOI: http://dx.doi.org/10.5772/intechopen.93730*

women ratio was 1.4 in the Lang Son province located in North Vietnam, remote

The age-specific rate per 100,000 sharply increased in the age group of 50–59 with a peak of age group of 80+ at as high as 346.6 and 275.3 per 100,000 in men and women at the region of the Mekong Delta River in the South Vietnam, respectively (**Figure 1**). It supported the mentioned statement of the average age at death

ASR colorectal cancer mortality rates per 100,000 in men ranged from 4.0 to 11.3 and it was lower than the rate in the developed countries, which was as high as 17.7 (**Figure 2**). Nationwide, it was estimated to be 5.6 per 100,000 (ASR) or it was

ASR colorectal cancer mortality rates per 100,000 in women ranged from 3.0 to 7.8 and it was lower than the rate in the developed countries, which was as high as 12.3 (**Figure 3**). Nationwide, it was estimated to be 5.2 per 100,000 (ASR) or it was

Regarding colorectal cancer survival, there was a lack of surveillance data for cases incidence and mortality to estimate the relative survival in Vietnam. Two population-based cancer registries have been running in Vietnam, one in Hanoi

**rate&**

Men 2005–2018 201 4.4 6.2 66.7 6.9 Women 2005–2018 203 4.5 4.3 55.2 5.0 Both genders 2005–2018 404 4.5 5.1 60.9 5.8

*@Age-standardized rate per 100,000 person-years using the SEGI World standard population (in the 1960s).*

*Age-standardized rate per 100,000 person-years using the World Health Organization standard population for* 

**ASR-Segi@ % < 70# ASR-WHO\$**

one third when compared to that of the developed countries [25].

nearly half when compared to that of the developed countries [25].

### **Table 1.**

*Colorectal cancer mortality rate per 100,000 (ASR) by sex and regions, 2005–2006.*

### *Colorectal Cancer in Vietnam DOI: http://dx.doi.org/10.5772/intechopen.93730*

*Colorectal Cancer*

**3. Colorectal cancer incidence and mortality**

1990s in Vietnam among children and adolescents?

(15% of the country population) in 2008 [6, 19, 21].

men and 37.0 in women, respectively) [27].

**3.3 Mortality from colorectal cancer**

In terms of colorectal cancer in under-18 year-old people, 52 cases (1.13% of 4646 cases) were found [14]. Children and adolescents are not employed and therefore they are not exposed to occupational carcinogens. They are also rarely exposed to tobacco smoking and alcoholic beverages, according to a recent report on student health surveillance by WHO [26], as well as to dioxins in herbicides during the Vietnam War. What were the risk factors that induced colorectal cancer during the

Two population-based cancer registrations have been running in the two prominent cities of Hanoi and Ho Chi Minh. The covered population was about 13 million

Age-standardized incidence rates per 100,000 (ASR) of colorectal cancer was 10.5 in men and 6.5 in women, during 1993–1997, in Hanoi and 12.4 in men and 9.0 in women, during 1995–1998, in Ho Chi Minh City [19, 21]. The incidence rate of colorectal cancer in Vietnam was one fifth of that in the United States (ASR 52.6 in

Data on the cancer incidence rate in Vietnam might be deviated by 15–25% since

In eight regions, ASR colorectal cancer mortality rates were from 4.0 to 11.3 per 100,000 in men and from 3.0 to 7.8 per 100,000 in women (**Table 1**). The highest mortality rates were seen in both men (11.3 per 100,000) and women (7.8 per 100,000) in the region of the Mekong Delta River in the South of Vietnam. In a specific province population, the colorectal cancer mortality rate per 100,000 person-years during 2005-2018 was 5.8, men 6.9, and women 5.0. Men to

**Region Men Women**

*Colorectal cancer mortality rate per 100,000 (ASR) by sex and regions, 2005–2006.*

Red Delta River 68 5.5 6.9 75 5.8 5.2 Northeast 20 3.1 4.4 34 5.0 5.0 Northwest 7 2.8 4.7 9 3.4 5.0 North central coast 29 3.3 4.0 34 3.7 3.0 South central coast 18 5.4 7.7 13 3.7 4.1 Central highlands 9 3.1 6.0 7 2.3 3.7 Northeast South 34 4.0 6.3 24 2.7 3.4 Mekong Delta River 83 7.5 11.3 78 6.8 7.8

**Cases Crude ASR Cases Crude ASR**

the death certificate was not available at that time. During the 1990s, only 12% of Vietnamese had health insurance (HI). Thus, many cancer patients were not admitted to hospitals, which impacted directly on number of mortality in oncology patients [17]. According to GLOBOCAN 2018, 114,871 cancer patients in Vietnam are deceased in 2018, which takes up more than one third of the prevalent cases [4].

**3.1 Childhood colorectal cancer**

**3.2 Incidence of colorectal cancer**

**36**

**Table 1.**

women ratio was 1.4 in the Lang Son province located in North Vietnam, remote areas of the country (**Table 2**).

The age-specific rate per 100,000 sharply increased in the age group of 50–59 with a peak of age group of 80+ at as high as 346.6 and 275.3 per 100,000 in men and women at the region of the Mekong Delta River in the South Vietnam, respectively (**Figure 1**). It supported the mentioned statement of the average age at death of 62 in men and 66 in women.

ASR colorectal cancer mortality rates per 100,000 in men ranged from 4.0 to 11.3 and it was lower than the rate in the developed countries, which was as high as 17.7 (**Figure 2**). Nationwide, it was estimated to be 5.6 per 100,000 (ASR) or it was one third when compared to that of the developed countries [25].

ASR colorectal cancer mortality rates per 100,000 in women ranged from 3.0 to 7.8 and it was lower than the rate in the developed countries, which was as high as 12.3 (**Figure 3**). Nationwide, it was estimated to be 5.2 per 100,000 (ASR) or it was nearly half when compared to that of the developed countries [25].

## **3.4 Survival of colorectal cancer**

Regarding colorectal cancer survival, there was a lack of surveillance data for cases incidence and mortality to estimate the relative survival in Vietnam. Two population-based cancer registries have been running in Vietnam, one in Hanoi


*&Crude rate per 100,000 person-years.*

*@Age-standardized rate per 100,000 person-years using the SEGI World standard population (in the 1960s).*

*# Proportion of death cases aged under 70 year-olds.*

*\$ Age-standardized rate per 100,000 person-years using the World Health Organization standard population for 2000-2025. Men to women ratio (ASR-WHO) = 1.4 (6.9/5.0).*

### **Table 2.**

*Mortality due to colorectal cancer by sex during 2005–2018 in Lang Son province.*

**Figure 2.**

### **Figure 3.**

*ASR mortality rates per 100,000 by regions and in Vietnamese women, 2005–2006.*

established in 1988, and the other in Ho Chi Minh city established in 1990 [19, 21]. These institutions collected data from medical records only and there was a lack of follow-up data, so the data of incidence rates might be underestimated. We analyzed the survival rate for fatal colorectal cancer cases: 1-year survival was 33.5% and 5-year survival was 4.3%, men and women combined [13].

These data of incidence, mortality, and survival (among fatal cases only) of colorectal cancer cases in Vietnam have suggested that:

**39**

**Figure 4.**

*Colorectal Cancer in Vietnam*

*DOI: http://dx.doi.org/10.5772/intechopen.93730*

**3.5 Time trend of colorectal cancer mortality**

*World Health Organization standard population for 2000-2025.*

**rate&**

**Year Case Crude** 

• Risk factors-induced colorectal cancer might slightly be related to sex's lifestyles, we should examine the risk factors that affect both men and women.

estimated to be caused by 98% of environmental risk factors [3].

only (5.2% per year, **Table 4**) but not in women (1.8% per year, **Table 5**).

Between 2005 and 2018, the age-standardized mortality rate per 100,000 person-years (ASR-WHO) was increased from 3.4 to 9.8 in men and 2.2 to 3.9 in women (**Figure 4**). The significant increase trend was seen in both genders by 3.4% per year (**Table 3**). However, this significant increasing trend was observed in men

*The trend of colorectal cancer mortality from 2005 to 2018 by gender in the Lang Son province located in North Vietnam. Missing data in 2009-2010; ASR-WHO: Age-standardized rate per 100,000 person-years using the* 

 23 3.1 69.6 3.9 1.413 (0.747, 2.675) 0.288 26 3.5 73.1 4.6 1.590 (0.853, 2.964) 0.144 31 4.2 45.2 5.4 1.869 (1.023, 3.418) 0.042 35 4.8 60.0 6.3 2.147 (1.188, 3.879) 0.011 47 6.3 59.6 8.3 2.831 (1.605, 4.992) <0.001 34 4.6 61.8 5.9 2.073 (1.144, 3.775) 0.016 47 6.0 55.3 8.1 2.706 (1.534, 4.772) 0.001 41 5.2 61.0 6.9 2.343 (1.315, 4.174) 0.004 41 5.2 68.3 6.8 2.349 (1.318, 4.186) 0.004 27 3.4 44.4 4.5 1.527 (0.823, 2.834) 0.180

2005 16 2.2 75.0 2.8 1 (Reference)

**% < 70# ASR-WHO-\$ MRR (95% CI)\$\$ p**

• Prevention of colorectal cancer should be prioritized because the diseases were

## *Colorectal Cancer in Vietnam DOI: http://dx.doi.org/10.5772/intechopen.93730*

*Colorectal Cancer*

**38**

**Figure 3.**

**Figure 2.**

established in 1988, and the other in Ho Chi Minh city established in 1990 [19, 21]. These institutions collected data from medical records only and there was a lack of follow-up data, so the data of incidence rates might be underestimated. We analyzed the survival rate for fatal colorectal cancer cases: 1-year survival was 33.5%

These data of incidence, mortality, and survival (among fatal cases only) of

and 5-year survival was 4.3%, men and women combined [13].

*ASR mortality rates per 100,000 by regions and in Vietnamese women, 2005–2006.*

*ASR mortality rates per 100,000 by regions and in Vietnamese men, 2005–2006.*

colorectal cancer cases in Vietnam have suggested that:

