Naing Cho, Lai Pei Kuan, Mak Joon Wah
School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, 4811, Queensland, Australia.
BMC Public Health. 2017 Aug 4;17(1):637. doi: 10.1186/s12889-017-4650-8.
This study aimed to estimate potential reductions in case incidence of colorectal cancer attributable to the modifiable risk factors such as alcohol consumption, overweight and physical inactivity amongst the Malaysian population.
Gender specific population-attributable fractions (PAFs) for colorectal cancer in Malaysia were estimated for the three selected risk factors (physical inactivity, overweight, and alcohol consumptions). Exposure prevalence were sourced from a large-scale national representative survey. Risk estimates of the relationship between the exposure of interest and colorectal cancer were obtained from published meta-analyses. The overall PAF was then estimated, using the 2013 national cancer incidence data from the Malaysian Cancer Registry.
Overall, the mean incidence rate for colorectal cancer in Malaysia from 2008 to 2013 was 21.3 per 100,000 population, with the mean age of 61.6 years (±12.7) and the majority were men (56.6%). Amongst 369 colorectal cancer cases in 2013, 40 cases (20 men, 20 women), 10 cases (9 men, 1 woman) or 20 cases (16 men,4 women) would be prevented, if they had done physical exercises, could reduce their body weight to normal level or avoided alcohol consumption, assuming that these factors are causally related to colorectal cancer. It was estimated that 66 (17.8%;66/369) colorectal cancer cases (42 men, 24 women) who had all these three risk factors for the last 10 years would have been prevented, if they could control these three risk factors through effective preventive measures.
Findings suggest that approximately 18% of colorectal cancer cases in Malaysia would be prevented through appropriate preventive measures such as doing regular physical exercises, reducing their body weight to normal level and avoiding alcohol consumption, if these factors are causally related to colorectal cancer. Scaling-up nationwide public health campaigns tailored to increase physical activity, controlling body weight within normal limits and avoid alcohol intake are recommended. Future studies with other site-specific cancers and additional risk factors are needed.
本研究旨在评估马来西亚人群中，因酒精摄入、超重和缺乏身体活动等可改变风险因素导致的结直肠癌发病率可能的降低情况。
针对三种选定的风险因素（缺乏身体活动、超重和酒精摄入），估算了马来西亚结直肠癌的性别特异性人群归因分数（PAF）。暴露患病率来自一项大规模的全国代表性调查。从已发表的荟萃分析中获取了感兴趣的暴露因素与结直肠癌之间关系的风险估计值。然后，使用马来西亚癌症登记处2013年的全国癌症发病率数据估算总体PAF。
总体而言，2008年至2013年马来西亚结直肠癌的平均发病率为每10万人21.3例，平均年龄为61.6岁（±12.7），大多数为男性（56.6%）。假设这些因素与结直肠癌存在因果关系，在2013年的369例结直肠癌病例中，如果进行体育锻炼、将体重降至正常水平或避免饮酒，分别有40例（20名男性，20名女性）、10例（9名男性，1名女性）或20例（16名男性，4名女性）病例可得到预防。据估计，如果过去10年中同时存在这三种风险因素的66例（17.8%；66/369）结直肠癌病例（42名男性，24名女性）能够通过有效的预防措施控制这三种风险因素，那么这些病例本可得到预防。
研究结果表明，如果这些因素与结直肠癌存在因果关系，那么通过适当的预防措施，如定期进行体育锻炼、将体重降至正常水平和避免饮酒，马来西亚约18%的结直肠癌病例可得到预防。建议在全国范围内扩大公共卫生运动，以增加身体活动、将体重控制在正常范围内并避免饮酒。未来需要针对其他特定部位癌症和更多风险因素开展研究。
