Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
CA Cancer J Clin. 2020 May;70(3):145-164. doi: 10.3322/caac.21601. Epub 2020 Mar 5.
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steepest among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.
结直肠癌（CRC）是美国第二大常见癌症死因。每 3 年，美国癌症协会都会根据基于人群的癌症登记处的发病率数据（截至 2016 年）和国家卫生统计中心的死亡率数据（截至 2017 年）更新 CRC 的发生情况。2020 年，约有 147950 人被诊断患有 CRC，53200 人将死于该疾病，其中包括 50 岁以下人群中的 17930 例和 3640 例死亡。2012 年至 2016 年期间，发病率范围从亚洲/太平洋岛民的 30（每 10 万人）到黑人的 45.7 和阿拉斯加原住民的 89。在 2000 年代，筛查年龄人群的发病率迅速下降，在 2011 年至 2016 年期间，65 岁及以上人群的发病率每年下降 3.3%，但在 50 至 64 岁人群中却出现逆转，该人群的发病率每年增加 1%。在 50 岁以下人群中，近端和远端结肠以及直肠肿瘤的发病率每年增加约 2%，这主要是由于非西班牙裔白人的趋势。2008 年至 2017 年期间，65 岁及以上人群的 CRC 死亡率每年下降 3%，50 至 64 岁人群每年下降 0.6%，而 50 岁以下人群每年上升 1.3%。50 岁及以上人群的死亡率下降幅度最大的是黑人，在 50 岁以下人群中也只有下降趋势，而不包括美洲印第安人/阿拉斯加原住民，其死亡率保持稳定。通过增加符合指南建议的筛查和高质量治疗的机会，特别是在阿拉斯加原住民中，以及阐明年轻人和中年人发病率上升的原因，可以加速结直肠癌的防治进展。
