School of Population and Global Health, The University of Western, Australia.
Centre for Genetic Originals of Health and Disease, School of Biomedical Sciences, The University of Western, Australia; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Cancer Epidemiol. 2019 Oct;62:101591. doi: 10.1016/j.canep.2019.101591. Epub 2019 Sep 5.
The aim of this study was to examine factors including family history, medical history and comorbidities associated with the risk of colorectal cancer (CRC) in young (18-49 years) and middle-age (50-69 years) individuals.
State records were used to identify individuals born in Western Australia between 1945 and 1996, and their first-degree relatives. Individuals in the cohort and their relatives were linked to State cancer registry, hospital and mortality data to identify diagnoses of CRC and other risk factors. The associations between CRC and identified risk factors were examined using multivariable logistic regression.
For both young and middle-aged patients, family history of CRC, and a history of smoking, inflammatory bowel disease, liver disease and non-CRC cancer were associated with a significant increase in odds of CRC. In middle-aged patients, having a colonoscopy in the previous 10 years was associated with a reduced odds of CRC regardless of the detection of polyps. However, in young patients only the absence of polyps as confirmed by colonoscopy was associated with a decreased risk of CRC (OR: 0.38, 95%CI: 0.26 - 0.54, p < 0.001).
Many of the risk factors associated with CRC were similar in young and middle-aged persons, and should be used to identify high risk young patients for screening. The association between colonoscopy and polyps with CRC was modified by age, likely as the result of routine screening in middle-aged patients.
本研究旨在探讨家族史、既往病史和合并症等因素与青年（18-49 岁）和中年（50-69 岁）个体结直肠癌（CRC）风险的相关性。
利用州级记录，确定了出生于 1945 年至 1996 年间的澳大利亚西部个体及其一级亲属。队列中的个体及其亲属与州癌症登记处、医院和死亡率数据相联系，以确定 CRC 和其他危险因素的诊断。使用多变量逻辑回归来检查 CRC 与确定的危险因素之间的关联。
对于青年和中年患者，CRC 家族史以及吸烟、炎症性肠病、肝病和非 CRC 癌症的既往病史与 CRC 发生几率的显著增加相关。在中年患者中，在过去 10 年内进行结肠镜检查与 CRC 发生几率降低相关，无论息肉是否检出。然而，在青年患者中，仅结肠镜检查未发现息肉与 CRC 风险降低相关（OR：0.38，95%CI：0.26-0.54，p<0.001）。
许多与 CRC 相关的危险因素在青年和中年患者中相似，应用于识别高危青年患者进行筛查。结肠镜检查和息肉与 CRC 的关联受年龄影响，可能是由于中年患者常规筛查的结果。
