Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA
Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA.
Gut. 2019 Dec;68(12):2179-2185. doi: 10.1136/gutjnl-2019-319511. Epub 2019 Sep 5.
Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking.
We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20-49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA).
During 2008-2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)).
CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.
尽管美国老年人群的结直肠癌（CRC）发病率迅速下降，但该疾病在该国的早发病例仍呈上升趋势。类似的模式也见于澳大利亚和加拿大，但缺乏对当代数据的全面全球分析。
我们从《五大洲癌症发病率》和补充来源中提取了长期数据，按年龄（20-49 岁和≥50 岁）报告了截至 2012 年或更晚诊断年份的全球 CRC 发病率和趋势（澳大利亚、芬兰、新西兰、挪威、瑞典、美国）。
2008-2012 年期间，年龄标准化的<50 岁成年人 CRC 发病率在印度（钦奈）为 3.5/100000（95%CI 3.2-3.9），在韩国为 12.9/100000（95%CI 12.6-13.3）。在最近可用数据的十年期间，36 个国家中有 14 个国家<50 岁成年人的发病率保持稳定；在奥地利、意大利和立陶宛，发病率下降；在 19 个国家，发病率上升，其中 9 个国家老年人群的发病率呈稳定或下降趋势（澳大利亚、加拿大、丹麦、德国、新西兰、斯洛文尼亚、瑞典、英国和美国）。在塞浦路斯、荷兰和挪威，年轻人的发病率上升速度是老年人的两倍（例如，挪威平均年百分比变化（AAPC）为 1.9（95%CI 1.4-2.5），而老年人为 0.5（95%CI 0.3-0.7））。在大多数有长期数据的高收入国家中，早发疾病的上升始于 20 世纪 90 年代中期。年轻人发病率上升最快的是韩国（AAPC 为 4.2（95%CI 3.4-5.0））和新西兰（AAPC 为 4.0（95%CI 2.1-6.0））。
CRC 发病率仅在横跨三大洲的九个高收入国家的年轻成年人中上升，这可能表明影响大肠致癌的生命早期暴露发生了变化。
