J Natl Cancer Inst. 2019 Oct 1;111(10):1104-1106. doi: 10.1093/jnci/djz098.
The extent to which the increase in early-onset colorectal cancer (CRC) in the United States varies geographically is unknown. We analyzed changes in CRC incidence and risk factors among people aged 20-49 years by state using high-quality population-based cancer registry data provided by the North American Association of Central Cancer Registries and national survey data, respectively. Early-onset CRC incidence was mostly stable among blacks and Hispanics but increased in 40 of 47 states among non-Hispanic whites, most prominently in western states. For example, rates increased in Washington from 6.7 (per 100 000) during 1995-1996 to 11.5 during 2014-2015 (rate ratio = 1.73, 95% confidence interval = 1.48 to 2.01) and in Colorado from 6.0 to 9.5 (rate ratio = 1.57, 95% confidence interval = 1.30 to 1.91). Nevertheless, current CRC incidence was highest in southern states. From 1995 to 2005, increases occurred in obesity prevalence in all states and heavy alcohol consumption in one-third of states, but neither were correlated with CRC incidence trends. Early-onset CRC is increasing most rapidly among whites in western states. Etiologic studies are needed to explore early life colorectal carcinogenesis.
美国早期结直肠癌（CRC）的地域分布程度尚不清楚。我们通过北美癌症登记中心协会提供的高质量人群癌症登记数据和全国调查数据，分别分析了 20-49 岁人群 CRC 发病率和危险因素的各州变化情况。黑人和西班牙裔人群的早期 CRC 发病率基本保持稳定，但在 47 个州中的 40 个州，非西班牙裔白人的发病率却有所上升，在西部各州尤为明显。例如，华盛顿州的发病率从 1995-1996 年的每 10 万人 6.7 例上升到 2014-2015 年的每 10 万人 11.5 例（发病率比=1.73，95%置信区间=1.48-2.01），科罗拉多州从 6.0 例上升到 9.5 例（发病率比=1.57，95%置信区间=1.30-1.91）。尽管如此，目前 CRC 的发病率在南部各州仍然最高。从 1995 年到 2005 年，所有州的肥胖流行率都有所增加，三分之一的州的重度饮酒量也有所增加，但两者都与 CRC 发病率趋势无关。在西部各州，白人的早期 CRC 发病率增长最快。需要进行病因学研究来探索早期结直肠致癌作用。
