Colorectal Cancer Incidence Patterns in the United States, 1974-2013
Colorectal Cancer Incidence Patterns in the United States, 1974-2013
复制标题
DOI：
10.1093/jnci/djw322
复制
发表时间：
2017-08-01
影响因子：
10.3
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
--
作者：
Siegel, Rebecca L.;Fedewa, Stacey A.;Jemal, Ahmedin
背景：结直肠癌（CRC）在美国的发病率总体上迅速下降，但奇怪的是，在年轻人中却在增加。结直肠癌特异性和出生队列模式可以提供病因学线索，但最近尚未进行研究。方法：1974年至2013年监测、流行病学和最终结果领域的结直肠癌发病趋势（n = 490 305）采用发病率比（IRR）和年龄-时期-队列模型按5岁年龄组和出生队列进行分析。在前十年下降之后，自20世纪80年代中期以来，20至39岁成人的结肠癌发病率每年增加1.0%至2.4%，自20世纪90年代中期以来，40至54岁成人的结肠癌发病率每年增加0.5%至1.3%;直肠癌的发病率一直在以更长的时间和更快的速度增长（例如，从1974年到2013年，20-29岁的成年人每年增长3.2%）。在55岁及以上的成年人中，结肠癌和直肠癌的发病率自20世纪80年代中期和1974年以来普遍下降。从1989-1990年到2012-2013年，50 - 54岁成人的直肠癌发病率从55 - 59岁成人的一半上升到相当于55 - 59岁成人的一半。（每10万人24.7对24.5）IRR = 1.01，95%置信区间[CI] = 0.92 - 1.10），在55岁以下的成年人中诊断出直肠癌的比例从14.6%翻了一番，（95% CI = 14.0%至15.2%）至29.2%（95% CI = 28.5%至29.9%）。从1890年到1950年，出生队列的特定相对风险下降，但在1990年持续增加。因此，与1950年左右出生的成年人相比，1990年左右出生的人患结肠癌的风险增加了一倍（IRR = 2.40，95% CI = 1.11至5.19），直肠癌风险增加四倍（IRR = 4.32，95% CI = 2.19至8.51）。对于当代出生队列，特定于癌症的CRC风险已经上升到大约1890年出生的人的水平，强调需要提高临床医生和公众的认识，以及病原学研究，以阐明这一趋势的原因。此外，由于近三分之一的直肠癌患者年龄小于55岁，应考虑在50岁之前开始筛查。
Background: Colorectal cancer (CRC) incidence in the United States is declining rapidly overall but, curiously, is increasing among young adults. Age-specific and birth cohort patterns can provide etiologic clues, but have not been recently examined.Methods: CRC incidence trends in Surveillance, Epidemiology, and End Results areas from 1974 to 2013 (n = 490 305) were analyzed by five-year age group and birth cohort using incidence rate ratios (IRRs) and age-period-cohort modeling.Results: After decreasing in the previous decade, colon cancer incidence rates increased by 1.0% to 2.4% annually since the mid-1980s in adults age 20 to 39 years and by 0.5% to 1.3% since the mid-1990s in adults age 40 to 54 years; rectal cancer incidence rates have been increasing longer and faster (eg, 3.2% annually from 1974-2013 in adults age 20-29 years). In adults age 55 years and older, incidence rates generally declined since the mid-1980s for colon cancer and since 1974 for rectal cancer. From 1989-1990 to 2012-2013, rectal cancer incidence rates in adults age 50 to 54 years went from half those in adults age 55 to 59 to equivalent (24.7 vs 24.5 per 100 000 persons: IRR = 1.01, 95% confidence interval [CI] = 0.92 to 1.10), and the proportion of rectal cancer diagnosed in adults younger than age 55 years doubled from 14.6% (95% CI = 14.0% to 15.2%) to 29.2% (95% CI = 28.5% to 29.9%). Age-specific relative risk by birth cohort declined from circa 1890 until 1950, but continuously increased through 1990. Consequently, compared with adults born circa 1950, those born circa 1990 have double the risk of colon cancer (IRR = 2.40, 95% CI = 1.11 to 5.19) and quadruple the risk of rectal cancer (IRR = 4.32, 95% CI = 2.19 to 8.51).Conclusions: Age-specific CRC risk has escalated back to the level of those born circa 1890 for contemporary birth cohorts, underscoring the need for increased awareness among clinicians and the general public, as well as etiologic research to elucidate causes for the trend. Further, as nearly one-third of rectal cancer patients are younger than age 55 years, screening initiation before age 50 years should be considered.