Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
Cancer Epidemiol Biomarkers Prev. 2023 Feb 6;32(2):164-166. doi: 10.1158/1055-9965.EPI-22-1126.
The incidence of colorectal cancer diagnosed before age 50, often referred to as early-onset colorectal cancer, has been increasing, whereas the overall colorectal cancer incidence has declined. Elucidating the drivers for the rising burden of early-onset colorectal cancer is a priority in cancer epidemiology and prevention. In this issue of Cancer Epidemiology, Biomarkers & Prevention, Chen and colleagues demonstrated that ecologic studies are a helpful method to reveal emerging risk factors at the population level and concluded that alcohol use might be a potential contributor to the rising incidence of early-onset colorectal cancer. Moving forward, because of the observed birth cohort effect in early-onset colorectal cancer, where younger generations have a steeper increase, hypothesis-driven investigations on emerging risk factors in recent generations, especially during early life, are warranted. Ultimately, the identified risk factors could be integrated with well-established microsimulation models of colorectal cancer, powerful tools that can simultaneously capture population-level secular changes in risk factors, relative risk estimates for each risk factor, and the natural history of colorectal cancer. This would allow us to quantitatively estimate the explained and unexplained portion of the rising incidence of early-onset colorectal cancer by calendar period and birth cohorts, and to help identify priorities in etiologic research, prevention, and early detection. See related article by Chen et al., p. 217.
50 岁前被诊断出的结直肠癌发病率，通常被称为早发性结直肠癌，一直在上升，而总体结直肠癌发病率却在下降。阐明早发性结直肠癌负担上升的驱动因素是癌症流行病学和预防的优先事项。在本期《癌症流行病学、生物标记物与预防》杂志中，Chen 及其同事证明，生态研究是一种在人群水平上揭示新出现的危险因素的有用方法，并得出结论，饮酒可能是早发性结直肠癌发病率上升的一个潜在因素。向前推进，由于早发性结直肠癌中观察到的出生队列效应，即年轻一代的发病率上升幅度更大，因此需要对新兴危险因素进行以假说为驱动的研究，尤其是在最近几代人，特别是在生命早期。最终，所确定的风险因素可以与结直肠癌的既定微模拟模型相结合，这些模型是强大的工具，可以同时捕捉到风险因素在人群层面上的随时间推移的变化、每个风险因素的相对风险估计值以及结直肠癌的自然史。这将使我们能够定量估计早发性结直肠癌发病率随时间和出生队列的上升部分的解释和未解释部分，并有助于确定病因研究、预防和早期检测的优先事项。请参阅 Chen 等人的相关文章，第 217 页。
