Screening for colorectal cancer in African Americans: determinants and rationale for an earlier age to commence screening.
Screening for colorectal cancer in African Americans: determinants and rationale for an earlier age to commence screening.
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DOI：
10.1007/s10620-014-3443-5
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发表时间：
2015-03
影响因子：
3.1
通讯作者：
Carethers, John M.
中科院分区：
文献类型：
--
作者：
Carethers, John M.
结直肠癌（CRC）筛查是一种具有高度成本效益的方法，可降低患者的发病率和死亡率，并降低人群中CRC的患病率。目前建议对无症状的一般人群进行CRC筛查开始于50岁，约95%的癌症发生在50岁之后。改变筛查时间和频率的决定因素包括腺瘤性息肉或CRC的个人或家族史，这些结肠病变的发病年龄，以及患者是否存在或可能存在较高风险的综合征，如炎症性肠病（IBD），家族性腺瘤性息肉病（FAP）或Lynch综合征。虽然种族，如家族史，是一个遗传因素，它并没有产生纳入相同的广泛的系统性筛查建议，尽管多项研究表明，从CRC的发病率和死亡率的差异，并有可能有针对性的筛选，以减少差异。特别是，与高加索人相比，非洲裔美国人（a）CRC筛查利用率较低，（B）CRC表现较早（比高加索人年轻0-8岁），并且通常具有更易于转移的侵袭性生物学特征，（c）在所有年龄段都具有较高的CRC患病率，并且在50岁之前具有较高的CRC比例（约11% vs高加索人5%），（d）不太可能知道或传播腺瘤或CRC的个人或家族史，这可能会改变他们的筛选到更早的年龄，（e）存在7-15%的额外右侧CRC，这些CRC不是微卫星不稳定的，（f）在每个十分位数的年龄中显示出更高的高风险腺瘤频率，和反映近端CRC过量的高风险近端腺瘤的过量，（g）具有表现出较低比例的良好预后生物标志物如MSI和较高比例的不良预后因子如EMAST的癌症，（h）可能具有更有利于引发和/或传播结肠瘤形成的肠道微生物群，和（i）可能证明CRC治疗的结果更差。这些流行病学、生物学和遗传学参数使非裔美国人患CRC的风险更高，与IBD、FAP和Lynch综合征患者非常相似，而与任何社会经济问题无关。在国家CRC筛查指南中将种族作为考虑因素，例如在50岁之前开始筛查，基于该人群的自然史和更具侵略性的行为，似乎是合理的。
Colorectal cancer (CRC) screening is a highly cost-effective approach to reduce morbidity and mortality of patients, as well as reduce the prevalence of CRC in populations. Current recommendations for CRC screening for the asymptomatic general population begin at age 50 years, an age after which ~95% of cancers occur. Determinants that modify the timing and frequency for screening include a personal or family history of adenomatous polyps or CRC, the age of onset of these colonic lesions, and the presence or potential for a patient to harbor a higher-risk syndrome such as inflammatory bowel disease (IBD), familial adenomatous polyposis (FAP), or Lynch syndrome.. Although race, like family history, is a heritable factor, it has not engendered inclusion in the same broad systematic screening recommendations despite multiple studies demonstrating a disparity in the incidence and mortality from CRC, and the potential for targeted screening to reduce the disparity. In particular, African Americans, when compared to Caucasians, (a) have lower CRC screening utilization rates, (b) have an earlier presentation of CRC (0-8 years younger than Caucasians) and, more often have aggressive biological features more prone to metastasis, (c) have a higher CRC prevalence at all ages and a higher proportion of CRCs before 50 years of age (~11% vs 5% in Caucasians), (d) are less likely to know or transmit personal or family history of adenomas or CRC that might change their screening to an earlier age, (e) present with 7-15% excess right-sided CRCs that are not microsatellite unstable, (f) show higher frequencies of high-risk adenomas at every decile of age, and an excess of high-risk proximal adenomas that mirror the excess of proximal CRCs, (g) have cancers that demonstrate lower proportions of good prognostic biomarkers such as MSI and higher proportions of bad prognosticators such as EMAST, (h) may possess gut microbiota more conducive to initiating and/or propagating colonic neoplasia, and (i) may demonstrate worse outcomes with treatment for CRC. These epidemiological, biological, and genetic parameters put African Americans at higher risk from CRC irrespective of any socioeconomic issues, much like IBD, FAP, and Lynch syndrome patients. Including race as a factor to consider in national CRC screening guidelines, such as commencing screening at an earlier age than 50 years, seems rational based on the natural history and more aggressive behavior in this population.
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影响因子：
29.4
作者：
Boland CR;Goel A
通讯作者：
Goel A
结肠癌的DNA测试和分子筛选。
影响因子：
12.6
作者：
Carethers, John M.
通讯作者：
Carethers, John M.
DOI：
10.1158/1055-9965.epi-13-0143
发表时间：
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期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
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作者：
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Zhu K
影响因子：
3.7
作者：
Carethers, John M.;Murali, Bhavya;McGuire, Kathleen L.
通讯作者：
McGuire, Kathleen L.
DOI：
10.1007/s11605-010-1340-6
发表时间：
2010-10
期刊：
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
影响因子：
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作者：
Devaraj B;Lee A;Cabrera BL;Miyai K;Luo L;Ramamoorthy S;Keku T;Sandler RS;McGuire KL;Carethers JM
通讯作者：
Carethers JM