Sierra Monica S, Forman David
International Agency for Research on Cancer, Lyon, Rhone, France.
International Agency for Research on Cancer, Lyon, Rhone, France.
Cancer Epidemiol. 2016 Sep;44 Suppl 1:S74-S81. doi: 10.1016/j.canep.2016.03.010.
The colorectal cancer (CRC) burden is increasing in Central and South American due to an ongoing transition towards higher levels of human development. We describe the burden of CRC in the region and review the current status of disease control.
We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, as well as cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change for 1997-2008.
The CRC rate in males was 1-2 times higher than that in females. In 2003-2007, the highest ASRs were seen in Uruguayan, Brazilian and Argentinean males (25.2-34.2) and Uruguayan and Brazilian females (21.5-24.7), while El Salvador had the lowest ASR in both sexes (males: 1.5, females: 1.3). ASMRs were<10 for both sexes, except in Uruguay, Cuba and Argentina (10.0-17.7 and 11.3-12.0). CRC incidence is increasing in Chilean males. Most countries have national screening guidelines. Uruguay and Argentina have implemented national screening programs.
Geographic variation in CRC and sex gaps may be explained by differences in the prevalence of obesity, physical inactivity, diet, smoking and alcohol consumption, early detection, and cancer registration practices. Establishing optimal CRC screening programs is challenging due to lack of healthcare access and coverage, funding, regional differences and inadequate infrastructure, and may not be feasible. Given the current status of CRC in the region, data generated by population-based cancer registries is crucial for cancer control planning.
由于人类发展水平不断向更高层次转变，中美洲和南美洲的结直肠癌（CRC）负担正在增加。我们描述了该地区CRC的负担，并回顾了疾病控制的现状。
我们从13个国家的48个基于人群的癌症登记处获取了区域和国家层面的发病率数据，以及来自世界卫生组织死亡率数据库的18个国家的癌症死亡数据。我们估计了2003 - 2007年每10万人年的世界人口年龄标准化发病率（ASR）和死亡率（ASMR），以及1997 - 2008年的估计年度百分比变化。
男性的CRC发病率比女性高1 - 2倍。2003 - 2007年，乌拉圭、巴西和阿根廷男性的ASR最高（25.2 - 34.2），乌拉圭和巴西女性的ASR最高（21.5 - 24.7），而萨尔瓦多男女的ASR最低（男性：1.5，女性：1.3）。除乌拉圭、古巴和阿根廷（10.0 - 17.7和11.3 - 12.0）外，男女的ASMR均<10。智利男性的CRC发病率正在上升。大多数国家有国家筛查指南。乌拉圭和阿根廷已经实施了国家筛查计划。
CRC的地理差异和性别差距可能由肥胖、身体活动不足、饮食、吸烟和饮酒习惯、早期检测以及癌症登记做法的差异来解释。由于缺乏医疗保健可及性和覆盖范围、资金、区域差异以及基础设施不足，建立最佳的CRC筛查计划具有挑战性，并且可能不可行。鉴于该地区CRC的现状，基于人群的癌症登记处产生的数据对于癌症控制规划至关重要。
