Alarming colorectal cancer incidence trends: a case for early detection and prevention.

摘要

Despite being largely preventable, colorectal cancer (CRC) affects a large number of individuals across the globe. CRC incidence trends over a decade or more provide important information, both about the dynamics of demographic and lifestyle changes in many countries as well as about the success of early detection and prevention strategies. Recent CRC incidence trends in the United States have shown promising declines especially in distal CRC relative to proximal cancers. In contrast to U.S. trends, in this issue of CEBP, Center and colleagues [ref] show that CRC incidence rates have increased in most other major registries across the globe. This increase points toward a failed early detection and prevention strategy as well as failure to address lifestyle and dietary challenges of urbanization that affect most of the globe (Fig. 1). Significant declines in CRC incidence rates were seen in California, with twice the effect for distal cancers than for proximal cancer. This decline may indicate wider use of screening modalities such as flexible sigmoidoscopy, introduced in the 1980s. Flexible sig-moidoscopy reduced CRC incidence by detection and removal of premalignant polyps primarily in the distal colon and rectum. Aspirin and other nonsteroidal antiinflammatory drug use also may have contributed to this decline (1-3).