Troeung Lakkhina, Sodhi-Berry Nita, Martini Angelita, Malacova Eva, Ee Hooi, O'Leary Peter, Lansdorp-Vogelaar Iris, Preen David B
Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, WA, Australia.
Occupational Respiratory Epidemiology, School of Population Health, The University of Western Australia, Perth, WA, Australia.
Front Public Health. 2017 Jul 24;5:179. doi: 10.3389/fpubh.2017.00179. eCollection 2017.
To examine trends in colorectal cancer (CRC) incidence and colonoscopy history in adolescents and young adults (AYAs) aged 15-39 years in Western Australia (WA) from 1982 to 2007.
Descriptive cohort study using population-based linked hospital and cancer registry data.
Five-year age-standardized and age-specific incidence rates of CRC were calculated for all AYAs and by sex. Temporal trends in CRC incidence were investigated using Joinpoint regression analysis. The annual percentage change (APC) in CRC incidence was calculated to identify significant time trends. Colonoscopy history relative to incident CRC diagnosis was examined and age and tumor grade at diagnosis compared for AYAs with and without pre-diagnosis colonoscopy. CRC-related mortality within 5 and 10 years of incident diagnosis were compared for AYAs with and without pre-diagnosis colonoscopy using mortality rate ratios (MRRs) derived from negative binomial regression.
Age-standardized CRC incidence among AYAs significantly increased in WA between 1982 and 2007, APC = 3.0 (95% CI 0.7-5.5). Pre-diagnosis colonoscopy was uncommon among AYAs (6.0%, 33/483) and 71% of AYAs were diagnosed after index (first ever) colonoscopy. AYAs with pre-diagnosis colonoscopy were older at CRC diagnosis (mean 36.7 ± 0.7 years) compared to those with no prior colonoscopy (32.6 ± 0.2 years), < 0.001. At CRC diagnosis, a significantly greater proportion of AYAs with pre-diagnosis colonoscopy had well-differentiated tumors (21.2%) compared to those without (5.6%), = 0.001. CRC-related mortality was significantly lower for AYAs with pre-diagnosis colonoscopy compared to those without, for both 5-year [MRR = 0.44 (95% CI 0.27-0.75), = 0.045] and 10-year morality [MRR = 0.43 (95% CI 0.24-0.83), = 0.043].
CRC incidence among AYAs in WA has significantly increased over the 25-year study period. Pre-diagnosis colonoscopy is associated with lower tumor grade at CRC diagnosis as well as significant reduction in both 5- and 10-year CRC-related mortality rates. These findings warrant further research into the balance in benefits and harms of targeted screening for AYA at highest risk.
研究1982年至2007年西澳大利亚州（WA）15至39岁青少年及青年（AYA）人群中结直肠癌（CRC）发病率及结肠镜检查史的变化趋势。
基于人群的医院与癌症登记数据链接进行的描述性队列研究。
计算所有AYA人群及按性别划分的5年年龄标准化发病率和特定年龄发病率。采用Joinpoint回归分析研究CRC发病率的时间趋势。计算CRC发病率的年度百分比变化（APC）以确定显著的时间趋势。检查与CRC确诊相关的结肠镜检查史，并比较有和没有诊断前结肠镜检查的AYA在诊断时的年龄和肿瘤分级。使用负二项回归得出的死亡率比（MRR）比较有和没有诊断前结肠镜检查的AYA在确诊后5年和10年内的CRC相关死亡率。
1982年至2007年期间，WA州AYA人群中年龄标准化CRC发病率显著上升，APC = 3.0（95% CI 0.7 - 5.5）。诊断前结肠镜检查在AYA中并不常见（6.0%，33/483），71%的AYA在首次结肠镜检查后被诊断出患有CRC。与没有诊断前结肠镜检查的AYA相比，有诊断前结肠镜检查的AYA在CRC诊断时年龄更大（平均36.7 ± 0.7岁 vs 32.6 ± 0.2岁），P < 0.001。在CRC诊断时，有诊断前结肠镜检查的AYA中肿瘤分化良好的比例（21.2%）显著高于没有诊断前结肠镜检查的AYA（5.6%），P = 0.001。与没有诊断前结肠镜检查的AYA相比，有诊断前结肠镜检查的AYA在5年[MRR = 0.44（95% CI 0.27 - 0.75），P = 0.045]和10年死亡率方面，CRC相关死亡率显著更低[MRR = 0.43（95% CI 0.24 - 0.83），P = 0.043]。
在25年的研究期内，WA州AYA人群中CRC发病率显著上升。诊断前结肠镜检查与CRC诊断时较低的肿瘤分级相关，同时5年和10年CRC相关死亡率均显著降低。这些发现值得进一步研究针对高危AYA人群进行靶向筛查的利弊平衡。
