Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Gastroenterology. 2019 Mar;156(4):958-965. doi: 10.1053/j.gastro.2018.11.060. Epub 2018 Dec 3.
BACKGROUND & AIMS: Increasing rates of young-onset colorectal cancer (CRC) have attracted substantial research and media attention, but we know little about racial disparities among younger adults with CRC. We examined racial disparities in young-onset CRC by comparing CRC incidence and relative survival among younger (<50-year-old) adults in 2 time periods.
Using data from the Surveillance, Epidemiology, and End Results program of cancer registries, we estimated CRC incidence rates (per 100,000 persons 20-49 years old) from 1992 through 2014 for different periods (1992-1996 vs 2010-2014) and races (white vs black). Relative survival was calculated as the ratio of observed survival to expected survival in a comparable cancer-free population.
From 1992-1996 to 2010-2014, CRC incidence increased from 7.5 to 11.0 per 100,000 in white individuals and from 11.7 to 12.7 per 100,000 in black individuals. The increase in rectal cancer was larger in whites (from 2.7 to 4.5 per 100,000) than in blacks (from 3.4 to 4.0 per 100,000); in the 2010-2014 period, blacks and whites had similar rates of rectal cancer. Compared with whites, blacks had smaller increases in relative survival with proximal colon cancer but larger increases in survival with rectal cancer (from 55.3% to 70.8%).
In an analysis of the Surveillance, Epidemiology, and End Results database, we found racial disparities in incidence of young-onset CRC and patient survival for cancer of the colon but minimal difference for rectal cancer. Well-documented and recent increases in young-onset CRC have largely been due to increases in rectal cancer, especially in whites.
越来越多的年轻人罹患结直肠癌（CRC）引起了大量研究和媒体的关注，但我们对年轻 CRC 患者的种族差异知之甚少。我们通过比较两个时期年轻（<50 岁）成年人的 CRC 发病率和相对生存率，研究了年轻 CRC 的种族差异。
我们利用癌症登记处监测、流行病学和最终结果计划的数据，估计了不同时期（1992-1996 年与 2010-2014 年）和不同种族（白种人与黑种人）之间的 CRC 发病率（每 10 万 20-49 岁人群中出现的病例数）。相对生存率是通过观察到的生存与可比无癌人群的预期生存之比计算得出的。
从 1992-1996 年到 2010-2014 年，白种人 CRC 发病率从每 10 万 7.5 例增加到 11.0 例，黑种人从每 10 万 11.7 例增加到 12.7 例。白人中直肠癌的增长幅度较大（从每 10 万 2.7 例增加到 4.5 例），而黑人中直肠癌的增长幅度较小（从每 10 万 3.4 例增加到 4.0 例）；在 2010-2014 年期间，黑人和白人直肠癌的发病率相似。与白人相比，黑人结肠癌的相对生存率增加幅度较小，但直肠癌的生存率增加幅度较大（从 55.3%增加到 70.8%）。
在对监测、流行病学和最终结果数据库的分析中，我们发现年轻 CRC 患者的发病和患者生存存在种族差异，结直肠癌患者如此，而直肠癌患者则不然。有记录可查且最近年轻人 CRC 的发病率增加主要归因于直肠癌的增加，尤其是白人。
