Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain.
Eur J Cancer Prev. 2009 Nov;18(6):436-44. doi: 10.1097/CEJ.0b013e328330eb2f.
Incidence of colorectal cancer has steadily increased in both the sexes and across all age groups during the last decades in Spain, in contrast with other countries where incidence decreased during this period. This increase is more marked among men, probably due to a high exposure to risk factors such as smoking, heavy drinking, overweight and diabetes. Annual age-adjusted mortality rates have increased in Spain during the period 1951-2000, but from that time until 2006 these rates have kept steady in males and fallen in females. When analyzing the evolution of exposure to behavioural factors during this period, known as risk or protective factors for colorectal cancer in Spain, notorious increases in tobacco and alcohol consumption, red and processed meats intake and a decreased ingestion of vegetables, cereals and beans were observed. Cigarette smoking, alcohol consumption, red meats, poultry, fish, vegetables and fruit were highly, positively correlated with colorectal cancer incidence and mortality, and cereals and beans consumption showed strong, negative correlations. At the same time and during this period, physical exercise decreased and overweight, obesity and diabetes mellitus notably increased. Certain changes in diet and lifestyle can be attributed to the growth in income during the last decades, but the lack and delay in implementing legislative and educational measures by the State and Regional Governments during decades cannot be ignored. In colorectal cancer, a minimal time span of 10-15 years is necessary for changes in exposure to risk factors to be able to modify the incidence of the tumour. Therefore, the implementation of more vigorous legislative and educational measures in Spain against smoking, heavy drinking, red meat intake, sedentary lifestyle, overweight and others reviewed in this study, is urgent.
在过去几十年中，西班牙无论男女各年龄段的结直肠癌发病率都稳步上升，与其他国家在此期间发病率下降形成对比。这种增长在男性中更为明显，这可能是由于吸烟、大量饮酒、超重和糖尿病等高危因素的高暴露率所致。在 1951 年至 2000 年期间，西班牙的年年龄调整死亡率有所增加，但从那时起直到 2006 年，男性的死亡率保持稳定，而女性的死亡率则有所下降。在分析这一期间西班牙被称为结直肠癌风险或保护因素的行为因素暴露变化时，观察到烟草和酒精消费、红色和加工肉类摄入以及蔬菜、谷物和豆类摄入减少显著增加。吸烟、饮酒、红色肉类、家禽、鱼类、蔬菜和水果与结直肠癌的发病率和死亡率呈高度正相关，而谷物和豆类的摄入则呈强负相关。与此同时，在这一期间，体育锻炼减少，超重、肥胖和糖尿病显著增加。过去几十年收入增长可归因于饮食和生活方式的某些变化，但国家和地区政府数十年来缺乏和延迟实施立法和教育措施也不容忽视。在结直肠癌中，暴露于危险因素的变化需要 10-15 年的最小时间跨度才能改变肿瘤的发病率。因此，西班牙迫切需要实施更有力的立法和教育措施，以对抗吸烟、大量饮酒、红色肉类摄入、久坐不动的生活方式、超重和本研究中回顾的其他因素。
