Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
Int J Epidemiol. 2024 Aug 14;53(5). doi: 10.1093/ije/dyae123.
Colorectal cancer remains a major global public health challenge. Its incidence is shaped by a complex interplay of screening programmes and age, period and cohort factors.
We introduce a novel Age-Period-Cohort-Screening (APCS) model to analyse trends in colorectal cancer incidence in Taiwan from 2000 to 2019.
In 2010, the incidence of colorectal cancer in Taiwan increased by 19.2% (95% CI: 13.5%, 25.3%) for men and 15.6% (95% CI: 9.2%, 22.4%) for women. This was followed by annual declines of 3.4% (95% CI: 2.8%, 4.1%) and 3.1% (95% CI: 2.4%, 3.9%), respectively. By 2015 for men and 2014 for women, the age-standardized incidence had fallen below the levels projected in a no-screening scenario. By 2019, the incidence had further declined by 12.4% (95% CI: 11.8%, 13.1%) for men and 11.6% (95% CI: 10.7%, 12.6%) for women, compared with the no-screening scenario. Cohort effects have shown a persistent rise from 1920 to 1980: incidence increased 5.8-fold for men and 3.1-fold for women. The trend began to plateau after 1980, with a noticeable decline in women.
Through its screening programme, Taiwan has successfully reduced colorectal cancer incidence by 10% as of 2019. Furthermore, the incidence due to cohort effects has plateaued and even begun to decline. However, continued monitoring remains crucial. The advanced APCS model could serve as a robust analytical tool for other researchers and policy makers evaluating the impacts of cancer screening programmes on incidence trends.
结直肠癌仍然是一个重大的全球公共卫生挑战。其发病率是由筛查计划和年龄、时期和队列因素的复杂相互作用所决定的。
我们引入了一种新的年龄-时期-队列-筛查（APCS）模型，以分析 2000 年至 2019 年台湾结直肠癌发病率的趋势。
2010 年，台湾男性结直肠癌的发病率增加了 19.2%（95%可信区间：13.5%，25.3%），女性增加了 15.6%（95%可信区间：9.2%，22.4%）。此后，每年分别下降 3.4%（95%可信区间：2.8%，4.1%）和 3.1%（95%可信区间：2.4%，3.9%）。到 2015 年，男性的年龄标准化发病率已降至无筛查情景下的预测水平以下。到 2019 年，与无筛查情景相比，男性的发病率进一步下降了 12.4%（95%可信区间：11.8%，13.1%），女性下降了 11.6%（95%可信区间：10.7%，12.6%）。队列效应显示，1920 年至 1980 年期间持续上升：男性发病率增加了 5.8 倍，女性增加了 3.1 倍。1980 年后，这一趋势开始趋于平稳，女性发病率明显下降。
通过筛查计划，台湾成功地将结直肠癌发病率在 2019 年降低了 10%。此外，由于队列效应导致的发病率已经趋于平稳，甚至开始下降。然而，持续监测仍然至关重要。先进的 APCS 模型可以作为其他研究人员和决策者评估癌症筛查计划对发病率趋势影响的有力分析工具。
