Young Joanne P, Win Aung Ko, Rosty Christophe, Flight Ingrid, Roder David, Young Graeme P, Frank Oliver, Suthers Graeme K, Hewett Peter J, Ruszkiewicz Andrew, Hauben Ehud, Adelstein Barbara-Ann, Parry Susan, Townsend Amanda, Hardingham Jennifer E, Price Timothy J
Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; South Australian Health and Medical Research Institute (SAHMRI) Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
J Gastroenterol Hepatol. 2015 Jan;30(1):6-13. doi: 10.1111/jgh.12792.
The average age at diagnosis for colorectal cancer (CRC) in Australia is 69, and the age-specific incidence rises rapidly after age 50 years. The incidence has stabilized or is declining in older age groups in Australia during recent decades, possibly related to the increased uptake of screening and high-risk surveillance. In the same time frame, a rising incidence of CRC in younger adults has been well-documented in the United States. This rise in incidence in the young has not been reported from other countries that share long-term exposure to westernised urban lifestyles. Using data from the Australian Institute of Health and Welfare, we examined trends in national incidence rates for CRC under age 50 years and observed that rates in people under age 40 years have been rising for the last two decades. We further performed a review of the literature regarding CRC in young adults to outline the extent of current understanding, explore potential risk factors such as obesity, alcohol, and sedentary lifestyles, and to identify the questions remaining to be addressed. Although absolute numbers might not justify a population screening approach, the dispersal of young adults with CRC across the primary health-care system decreases probability of their recognition. Patient and physician awareness, aided by stool and emerging blood-screening tests and risk profiling tools, have the potential to aid in identification of those young adults who would most benefit from a colonoscopy through early detection of CRCs or by removal of advanced polyps.
澳大利亚结直肠癌（CRC）的平均诊断年龄为69岁，50岁以后年龄别发病率迅速上升。近几十年来，澳大利亚老年人群的发病率已趋于稳定或呈下降趋势，这可能与筛查和高危监测的普及增加有关。在同一时期，美国已充分证明年轻成年人中结直肠癌的发病率在上升。长期接受西方化城市生活方式影响的其他国家尚未报告年轻人发病率的这种上升情况。利用澳大利亚卫生与福利研究所的数据，我们研究了50岁以下人群结直肠癌的全国发病率趋势，观察到在过去二十年中，40岁以下人群的发病率一直在上升。我们进一步对有关年轻成年人结直肠癌的文献进行了综述，以概述当前的了解程度，探讨肥胖、饮酒和久坐不动的生活方式等潜在风险因素，并确定有待解决的问题。尽管绝对数字可能无法证明采用人群筛查方法的合理性，但患有结直肠癌的年轻成年人分散在初级卫生保健系统中，降低了他们被识别的可能性。借助粪便和新兴的血液筛查测试以及风险评估工具提高患者和医生的认识，有可能通过早期发现结直肠癌或切除晚期息肉来帮助识别那些最能从结肠镜检查中受益的年轻成年人。
