Redefining Age-Based Screening and Diagnostic Guidelines: An Opportunity for Biological Aging Clocks in Clinical Medicine?
Redefining Age-Based Screening and Diagnostic Guidelines: An Opportunity for Biological Aging Clocks in Clinical Medicine?
复制标题
DOI：
10.1016/s2666-7568(22)00114-3
复制
发表时间：
2022-06
影响因子：
13.1
通讯作者：
Mair, William B.
中科院分区：
文献类型：
--
作者：
Nwanaji-Enwerem, Jamaji C.;Mair, William B.
临床医生经常注意到患者看起来比他们陈述的年龄更老或更年轻，以传达他们对患者的生物学或生理年龄以及随后的疾病风险的评估。衰老生物标志物的发展，如表观遗传时钟1，提供了一种更客观的方法来分子量化个体的衰老程度，而不仅仅是主体评估。然而，目前尚不清楚如何最好地将这些所谓的生物年龄指标纳入临床医学。将表观遗传衰老纳入临床医学的好处和困境是，它与大量疾病状态有关，同时与各种生理和心理风险因素有关。几项研究表明，表观遗传衰老在诊断癌症和监测癌症治疗反应方面发挥了作用。3-6考虑到癌症通常与衰老、其他疾病（如糖尿病或心血管疾病）以及更广泛的环境因素有关，在临床医学中引入生物年龄测量可能是一个合理的重点。然而，引入生物年龄的过程仍然难以捉摸。考虑到表观遗传年龄的广泛敏感性，我们建议它可用于改进基于年龄的癌症筛查指南。我们不建议以血液为基础的表观遗传年龄取代现有的筛查试验。我们建议纳入表观遗传生物学年龄，而不是实足年龄，将有助于重新定义指导方针，决定何时应该开始更多的组织特异性筛查。对于宫颈癌等癌症，建议在成年早期进行基于人乳头瘤病毒的宫颈筛查，生物学年龄辅助因素可能没有太大用处。然而，对于结直肠癌这样的癌症，建议从较年长的年龄开始进行结肠镜检查（例如，在美国为45岁），7个生物学年龄辅助指标可能更有用。有结直肠癌家族史的人被认为是高危人群，因此建议比一般人群更早开始筛查。同样，患有炎症性肠病（IBD）等已知会增加结直肠癌风险的疾病的人，建议开始进行筛查
Clinicians often note that patients seem older or younger than their stated age to convey their appraisal of a patient’s biological or physiological age and subsequent disease risks. Developments in ageing biomarkers, such as epigenetic clocks, 1 offer a more objective method of molecularly quantifying how well an individual is ageing beyond subject assessment. However, it remains unclear how best to incorporate these measures of so-called biological age into clinical medicine. Both a benefit and dilemma of incorporating epigenetic aging in clinical medicine is its association with a plethora of disease states while simultaneously being associated with various physical and psychosocial risk factors. 2 Several studies have suggested a role for epigenetic ageing in diagnosing cancer and monitoring response to cancer therapies. 3–6 Considering that cancer is often associated with ageing, other diseases (ie, diabetes or cardiovascular disease), and broader environmental factors, it could be a reasonable focus for introducing biological age measures in clinical medicine. 3 However, the process by which biological age could be introduced remains elusive. Considering the broad sensitivity of epigenetic age, we suggest that it could be used to improve chronological age-based cancer screening guidelines.We do not recommend that blood-based epigenetic age should replace existing screening tests. We propose that inclusion of epigenetic biological age, instead of chronological age, would help redefine guidelines that dictate when more tissue-specific screening should begin. For cancers such as cervical cancer, for which human papillomavirus-based cervical screening is recommended in early adulthood, biological age adjuncts might not be of much utility. However, for cancers such as colorectal cancer, for which screening colonoscopies are recommended from an older chronological age (eg, 45 years in the US), 7 biological age adjuncts could be more useful. Individuals with a family history of colorectal cancer are considered to be at higher risk population and therefore are recommended to begin screening earlier than the general population. Similarly, individuals with diseases known to increase the risk of colorectal cancer, such as inflammatory bowel disease (IBD), are advised to begin screening
登录
查看更多内容
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
DOI：
10.1093/jnci/djaa001
发表时间：
2020-10-01
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Heijnsdijk EAM;Gulati R;Tsodikov A;Lange JM;Mariotto AB;Vickers AJ;Carlsson SV;Etzioni R
通讯作者：
Etzioni R
影响因子：
4.4
作者：
Dugué PA;Bassett JK;Wong EM;Joo JE;Li S;Yu C;Schmidt DF;Makalic E;Doo NW;Buchanan DD;Hodge AM;English DR;Hopper JL;Giles GG;Southey MC;Milne RL
通讯作者：
Milne RL
影响因子：
10.3
作者：
Kresovich, Jacob K.;Xu, Zongli;Taylor, Jack A.
通讯作者：
Taylor, Jack A.
影响因子：
28.4
作者：
Mandelblatt JS;Ahles TA;Lippman ME;Isaacs C;Adams-Campbell L;Saykin AJ;Cohen HJ;Carroll J
通讯作者：
Carroll J