Department of Oncology, Cumming School of Medicine, University of Calgary, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Canada.
Prev Med. 2017 Dec;105:345-349. doi: 10.1016/j.ypmed.2017.10.007. Epub 2017 Oct 5.
Recent analyses in the United States have shown an overall decrease in the incidence of colorectal cancer despite contrasting increases in younger age groups. We examined whether these cohort trends are occurring in Canada. Age-specific trends in colon and rectal cancer incidence in Canada from the National Cancer Incidence Reporting System (1969-1992) and the Canadian Cancer Registry (1992-2012) were analyzed. We estimated annual percent changes (APC) with the Joinpoint Regression Program from the Surveillance Epidemiology, and End Results Program. Birth cohort effects were estimated using 5-year groups starting in 1888. Age-specific prevalence of class I, II and III obesity in Canada was examined from the National Population Health Survey (1994-2001) and the Canadian Community Health Survey (2001-2011). The reductions in CRC incidence among Canadians are limited to older populations. While reductions among younger age groups (20-29year olds (yo), 30-39yo and 40-50yo) were observed between 1969 and 1995, rates have returned to and surpassed historical levels (APCs 20-29yo colon cancer=6.24%, APCs 20-29yo rectal cancer=1.5%). Recent birth cohorts (1970-1990) have the highest incidence rate ratios ever recorded. Ecologic trends in obesity prevalence among these birth cohorts in Canada are suggestive of an impact on increasing incidence trends. Furthermore, obesity prevalence estimates suggest that these trends may continue to increase justifying further examination of the etiologic associations and biological impacts of excess adipose tissue among younger populations. While population-based screening of younger age groups deserves careful consideration, these concerning observed trends warrant public health action to address the growing obesity epidemic.
尽管美国年轻人群体的发病率呈上升趋势，但最近的分析显示，结直肠癌的总体发病率却有所下降。我们研究了这些队列趋势是否在加拿大出现。利用国家癌症发病率报告系统（1969-1992 年）和加拿大癌症登记处（1992-2012 年）的数据，分析了加拿大结肠癌和直肠癌发病率的年龄特定趋势。我们使用监测、流行病学和最终结果计划中的 Joinpoint 回归程序来估算年度百分比变化（APC）。使用从 1888 年开始的 5 年组估计出生队列效应。从国家人口健康调查（1994-2001 年）和加拿大社区健康调查（2001-2011 年）中检查了加拿大的 I 类、II 类和 III 类肥胖的流行率。加拿大 CRC 发病率的降低仅限于老年人群。虽然在 1969 年至 1995 年期间观察到年轻年龄组（20-29 岁、30-39 岁和 40-50 岁）的发病率降低，但这些年龄组的发病率已经恢复并超过了历史水平（APC 20-29 岁结肠癌=6.24%，APC 20-29 岁直肠癌=1.5%）。最近的出生队列（1970-1990 年）的发病率比率达到了历史最高水平。这些加拿大出生队列中肥胖流行的生态趋势表明，肥胖可能会对发病率上升趋势产生影响。此外，肥胖流行率的估计表明，这些趋势可能会继续增加，因此需要进一步研究年轻人中过多脂肪组织的病因关联和生物学影响。虽然对年轻人群进行基于人群的筛查值得认真考虑，但这些令人担忧的趋势需要采取公共卫生行动来应对日益严重的肥胖流行。
