Triantafillidis John K, Georgiou Konstantinos, Konstadoulakis Manousos M, Papalois Apostolos E
Department of IBD and GI Endoscopy, Metropolitan General Hospital, Holargos 15562, Athens, Greece. Hellenic Society for Gastrointestinal Oncology, 354 Iera Odos, Chaidari 12461, Attica, Greece.
2 Department of Surgery, University of Athens School of Medicine, Aretaieion Hospital, Athens 11528, Greece.
World J Gastrointest Oncol. 2024 Mar 15;16(3):583-597. doi: 10.4251/wjgo.v16.i3.583.
During the last few years, epidemiological data from many countries suggest that the incidence and prevalence of many cancers of the digestive system are shifting from the older to the younger ages, the so-called "early-onset cancer". This is particularly evident in colorectal cancer and secondarily in other malignant digestive neoplasms, mainly stomach and in a lesser degree pancreas, and biliary tract. It should be emphasized that data concerning digestive neoplasms, except for those referring to the colon and stomach, could be characterized as rather insufficient. The exact magnitude of the shift in younger ages is expected to become clearer shortly, as long as relevant epidemiological data from many parts of the world would be available. The most important question concerns the etiology of this phenomenon, since its magnitude cannot be explained solely by the better diagnostic methodology and the preventive programs applied in many countries. The existing data support the assumption that a number of environmental factors may play a primary role in influencing carcinogenesis, sometimes from childhood. Changes that have appeared in the last decades related mainly to eating habits, consistency of gut microbiome and an increase of obese people interacting with genetic factors, ultimately favor the process of carcinogenesis. Even these factors however, are not entirely sufficient to explain the age-related changes in the frequency of digestive neoplasms. Studies of the individual effect of each of the already known factors or factors likely to be involved in the etiology of this phenomenon and studies using state-of-the-art technologies to accurately determine the degree of the population exposure to these factors are required. In this article, we attempt to describe the epidemiological data supporting the age-shifting of digestive malignancies and their possible pathogenesis. Finally, we propose some measures regarding the attitude of the scientific community to this alarming phenomenon.
在过去几年中，许多国家的流行病学数据表明，许多消化系统癌症的发病率和患病率正从老年人群转向年轻人群，即所谓的“早发性癌症”。这在结直肠癌中尤为明显，其次在其他恶性消化系统肿瘤中也有体现，主要是胃癌，胰腺癌和胆道癌的程度较轻。应该强调的是，除了关于结肠和胃的肿瘤数据外，有关其他消化系统肿瘤的数据相当不足。只要能获得世界许多地区的相关流行病学数据，年轻人群中发病率变化的确切幅度预计很快就会更加清晰。最重要的问题是这一现象的病因，因为其幅度不能仅用许多国家采用的更好的诊断方法和预防计划来解释。现有数据支持这样一种假设，即一些环境因素可能在影响致癌过程中起主要作用，有时从儿童时期就开始了。过去几十年出现的变化主要与饮食习惯、肠道微生物群的组成以及肥胖人群的增加与遗传因素相互作用有关，最终有利于致癌过程。然而，即使这些因素也不足以完全解释消化系统肿瘤发病率的年龄相关变化。需要对每个已知因素或可能参与这一现象病因的因素的个体效应进行研究，并使用最先进的技术准确确定人群接触这些因素的程度。在本文中，我们试图描述支持消化系统恶性肿瘤年龄转移的流行病学数据及其可能的发病机制。最后，我们针对科学界对这一惊人现象的态度提出了一些措施。
