结直肠癌发病趋势的交互变化：筛查和出生队列的联合影响

Interacting trends of colorectal cancer incidence: the combined effects of screening and birth cohort

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

影响因子:5.9

分区:医学2区 Top / 公共卫生1区

发表日期:2024 Aug 14

作者: Chih-Lin Kuo, Jing-Rong Jhuang, Shih-Yung Su, Chun-Ju Chiang, Ya-Wen Yang, Li-Ju Lin, Pei-Chun Hsieh, Tsui-Hsia Hsu, Wen-Chung Lee

DOI: 10.1093/ije/dyae123

摘要

结直肠癌仍然是全球公共卫生的重大挑战，其发生率由筛查项目与年龄、时期及出生队列因素的复杂交互共同影响。我们提出一种新颖的年龄-时期-队列-筛查（APCS）模型，用于分析台湾2000年至2019年间结直肠癌发病趋势。2010年，台湾男性结直肠癌发病率较前一年增长19.2%（95% CI：13.5%—25.3%），女性增长15.6%（95% CI：9.2%—22.4%），随后每年分别下降3.4%（95% CI：2.8%—4.1%）和3.1%（95% CI：2.4%—3.9%）。到2015年（男性）和2014年（女性），年龄标准化的发病率已低于无筛查情景的预测水平。到2019年，男性和女性的发病率较无筛查情景分别下降12.4%（95% CI：11.8%—13.1%）和11.6%（95% CI：10.7%—12.6%）。队列效应显示，从1920年至1980年，发病率持续上升：男性增加了5.8倍，女性增加了3.1倍。1980年之后，趋势开始趋于平稳，女性出现明显下降。台湾通过筛查项目，已在2019年成功将结直肠癌发病率降低10%。此外，队列效应的影响趋于平稳，甚至开始下降，但持续监测仍非常重要。先进的APCS模型可为其他研究者和政策制定者评估癌症筛查对发病趋势影响提供有力的分析工具。

Abstract

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.