Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Department of Oncology, University of Calgary, Calgary, AB, Canada.
Am J Gastroenterol. 2022 Sep 1;117(9):1502-1507. doi: 10.14309/ajg.0000000000001884. Epub 2022 Jun 10.
The incidence of early-onset colorectal cancer (eoCRC) has been increasing in North America. Debate remains as to whether the trends by topography, histology, stage, or mortality in this population are amenable to intervention from screening.
CRC incidence (2000-2017) and mortality (2000-2018) data were obtained from the Canadian Cancer Registry and Vital Statistics. Annual percentage changes (APC) in the incidence (topography and histology) and mortality of eoCRC were estimated using joinpoint regression. Incidence of late-stage CRC (III or IV) versus early-stage CRC (I or II) was compared between the eoCRC (age 20-49 years) and eligible screening (age 50-74 years) groups with Poisson regression.
Among women aged 20-49 years, the incidence of CRC significantly increased from 2000 to 2017 in both the distal colon (APC = 1.40) and rectum (APC = 3.00), whereas for men aged 20-49 years, the CRC incidence increased in the proximal colon (APC = 1.10), distal colon (APC = 3.00), and rectum (APC = 3.70). Among both men and women aged 20-49 years, the incidence of nonmucinous adenocarcinomas significantly increased (APC: 1.90 and 2.30, respectively), whereas mucinous adenocarcinomas decreased for women (APC = -1.60) and remained stable for men. Adults aged 30 to 49 years, when diagnosed with CRC, had a significantly higher risk of being diagnosed with a late-stage CRC compared with those in the age group of 50-74 years. Rectal cancer mortality increased from 2000 to 2018 in the eoCRC group (APC for women and men 3.80 and 3.40, respectively).
Emerging data support future modifications to guidelines on screening for eoCRC in Canada. Further research is required on the effect, cost-effectiveness, and risk prediction for targeted screening within this group.
北美地区的早发性结直肠癌（eoCRC）发病率一直在上升。对于这一人群的发病部位、组织学、分期或死亡率的趋势是否可以通过筛查进行干预，仍存在争议。
从加拿大癌症登记处和生命统计数据中获取 CRC 发病率（2000-2017 年）和死亡率（2000-2018 年）数据。使用 Joinpoint 回归估计 eoCRC 的发病率（发病部位和组织学）和死亡率的年百分比变化（APC）。用泊松回归比较 eoCRC（年龄 20-49 岁）和符合筛查条件（年龄 50-74 岁）组中晚期 CRC（III 期或 IV 期）与早期 CRC（I 期或 II 期）的发病率。
在 20-49 岁的女性中，2000 年至 2017 年，远端结肠（APC = 1.40）和直肠（APC = 3.00）的 CRC 发病率显著增加，而对于 20-49 岁的男性，近端结肠（APC = 1.10）、远端结肠（APC = 3.00）和直肠（APC = 3.70）的 CRC 发病率增加。在 20-49 岁的男性和女性中，非黏液性腺癌的发病率显著增加（APC：分别为 1.90 和 2.30），而女性的黏液性腺癌减少，男性保持稳定。30 至 49 岁的成年人诊断为 CRC 时，与 50-74 岁年龄组相比，他们被诊断为晚期 CRC 的风险显著更高。在 eoCRC 组中，直肠癌死亡率从 2000 年增加到 2018 年（女性和男性的 APC 分别为 3.80 和 3.40）。
新出现的数据支持加拿大对 eoCRC 筛查指南进行未来修改。需要进一步研究针对该人群的靶向筛查的效果、成本效益和风险预测。
