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▎ WuXi AppTec content team editors According to data from the World Health Organization (WHO) International Agency for Research on Cancer (IARC) in 2020, colorectal cancer is the third most common cancer in the world, and it is the second most common type of cancer in China.
However, a considerable part of colorectal cancer can be prevented.
A European multinational study showed that nearly 20% of colorectal cancer cases can be attributed to various unhealthy life>
There are a variety of screening tools that have the potential to improve the incidence and mortality of colorectal cancer.
Differences in screening strategies and implementation efforts will accumulate over time and will also be reflected in the different development trends of disease burden.
"The Lancet-Oncology" today published a large-scale transnational study led by scholars from the German Cancer Research Center.
It shows the profound effects of screening on the incidence and death of colorectal cancer through statistics of disease data in 21 European countries since 2000.
influences.
Screenshot source: The Lancet Oncology Currently, effective screening methods for colorectal cancer include fecal occult blood test (the most widely used is the fecal immunochemical test [FIT], which is better than the traditional guaiac stool occult blood test [gFOBT]) , Sigmoidoscopy and colonoscopy, etc.
Many European countries have colorectal cancer screening measures for people at general risk (mainly people aged 50-74), but the timing of the screening plan, the type of screening organization (opportunistic and group screening), and primary screening The screening methods and screening rates are very different.
The research team collected national cancer registration data from 16 countries and the corresponding WHO mortality data.
In addition, it also collected regional data from 5 countries, covering 21 countries since 2000 (most of the countries have data as of 2016).
Out of nearly 3.
1 million cases of colorectal cancer patients.1.
Changes in overall incidence rates In countries where colonoscopy and stool examinations have been commonly carried out for a long time, and more than half of the suitable populations are screened (such as Austria, the Czech Republic and Germany), the age-standardized incidence rate of colorectal cancer is obvious over time Decline, the average annual rate of decline ranges from -1.
6% to -2.
5% among men, and from -1.
3% to -2.
4% among women.
In contrast, the United Kingdom and Finland have also generally carried out screening for a long time, but using traditional gFOBT, the age-standardized incidence rate remained stable or increased during the study period (Figure 1A below).
In countries where screening programs have only been generally implemented in recent years, the age-standardized incidence of colorectal cancer has remained stable or on the rise before the launch of the screening program; however, after the launch of the screening program, the age-standardized incidence of colorectal cancer The upward trend of the rate has eased.
Among them, in several countries (Belgium, Denmark, the Netherlands, and Slovenia) that adopted FIT mass screening and quickly achieved high screening coverage (>50%), the age-standardized incidence rate initially increased, but then continued Descend (Figure 1B below).
▲In countries where screening programs (A) have been implemented early and screenings have become widespread in recent years (B), the age-standardized incidence rate (blue line-male, red line-female) and mortality rate (green line-) of colorectal cancer Male, purple line-female) change trend.
The vertical dotted line is the implementation time of different screening strategies.
(Image source: Reference [1]) In 5 countries with only partial regional data, the incidence rate also showed similar changes as the screening was carried out.
It is worth noting that in some countries that have carried out screening in recent years, the increase in the initial incidence seems to be largely due to the increase in the diagnosis of early colorectal cancer, rather than over-diagnosis.
This "early rise" trend is not observed in countries with long-term screening, which may be due to the early adoption of opportunistic screening (rather than centralized invitation).
On the contrary, in most countries without large-scale screening programs, the incidence of colorectal cancer is increasing steadily and continuously, with an average annual growth rate of 0.
3% to 1.
9% in men and 0.
6% to 1.
1% in women (see figure below) 2A). ▲The age-standardized incidence and mortality of colorectal cancer (A; green line-male, purple line-female) and disease stage (B) trends in countries without large-scale screening programs during the study period.
(Picture source: Reference [1]) 2.
Changes in the incidence of different parts of the colorectal In most countries that carry out large-scale screening programs, the changes promoted by screening are basically reflected in the lesions in the distal colon and rectum, as well as in suitable conditions.
Screen the age group.
For proximal colon cancer and non-screening age groups (especially those ≤49 years old) in most countries, the research team still observed an increase in the incidence, or even a smaller improvement even if there was a decrease.
This is consistent with previous evidence: colonoscopy is more effective for distal colorectal cancer.
This is mainly because the proximal colon is more likely to form serrated precancerous lesions, which are more difficult to detect during FIT and colonoscopy, and these lesions are more likely to evolve into cancer than conventional adenomas.
Although there are differences in the biology and carcinogenicity of proximal and distal colorectal cancer, emerging evidence also suggests that high-quality colonoscopy and some innovative technologies have the potential to reduce the incidence of proximal colorectal cancer.
On the other hand, this also supports the finding that the incidence of colorectal cancer among young people has increased in recent years.
In countries without large-scale screening programs, the incidence of colorectal cancer in almost all three sites and people of all ages has remained stable or rising.
Image source: 123RF3.
Mortality changes The age-standardized mortality rate of colorectal cancer in most countries has declined, but the decline is different.
Overall, among countries with long-term screening programs, colorectal cancer mortality rates have fallen the most.
The general decline in mortality also reflects the progress in the diagnosis and treatment of colorectal cancer, such as more effective treatments, improvements in surgical techniques, and perioperative diagnosis and treatment.
4.
Changes in the staging of colorectal cancer Among the countries that carried out screening earlier, the proportion of stage I colorectal cancer tumors in the Czech Republic (using FIT or colonoscopy) and Germany (using colonoscopy) increased slightly, and the proportion of stage IV tumors increased slightly.
Decrease, and this trend was observed in all 3 different sites (proximal colon, distal colon, and rectum). However, after screening with a sigmoidoscopy in England in 2013, no significant changes were observed.
Austria and Finland lack detailed staging data, and no substantial and continuous changes were observed in the aggregate analysis (Figure 3A below).
For countries that have only carried out screening in recent years, after FIT-based group screening has been carried out, it has been observed that the proportion of stage I colorectal cancer has increased.
Similarly, this trend is also reflected in the incidence patterns of three different parts.
on.
▲In the countries where screening has been widespread in recent years, the proportion of early colorectal cancer has increased (picture source: reference [1]) In countries without large-scale screening programs, the staging of colorectal cancer in most areas is not obvious Or continuous change.
The research team pointed out that in addition to screening and treatment, there are many other factors, especially life>
There is no evidence that the behavior of the population in these countries has undergone profound changes, and even if there is, it cannot explain the extent of the observed changes.
Therefore, based on these data, the research team believes that there are differences in the incidence, mortality, and staging trends of colorectal cancer in different countries, which may be largely due to the different levels of colorectal cancer screening.
Screening has made a significant contribution to reducing the burden of colorectal cancer, and the benefits of long-term screening and group screening (rather than opportunistic screening) are more obvious.
In addition, if the methods for detecting precancerous lesions of the proximal colon can be improved, screening is expected to promote a greater reduction in the incidence and mortality of colorectal cancer in the future.
At present, the number of weight-loss and metabolic surgeries in China has increased to more than 10,000 per year, and there is no significant difference in surgical procedures from international ones.
The Chinese guidelines recommend the following for people who consider weight loss metabolic surgery: Slide to read the current "China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines" related recommendations are as follows: General population screening start and end age recommendations recommend the general population to receive colorectal cancer from 40 years old For risk assessment, it is recommended that people who are assessed as low- and medium-risk receive colorectal cancer screening at the age of 50-75, and those with high-risk assessment results are recommended to receive colorectal cancer screening from the age of 40-75.
If one or more first-degree relatives suffer from colorectal cancer, the recommended starting age for colorectal cancer screening is 40 years old or 10 years earlier than the youngest patient among the first-degree relatives.
The starting and ending age of screening for high-risk populations of hereditary colorectal cancer is recommended for high-risk populations with Lynch syndrome caused by MLH1/MSH2 mutations.
The starting age for colonoscopy screening is 20-25 years old or earlier than the youngest patient in the family.
2~5 years.
The initial age of colonoscopy screening for high-risk populations with Lynch syndrome caused by MSH6/PMS2 mutations is 30 to 35 years or 2 to 5 years earlier than the age of onset of the youngest patient in the family.
The initial age of colonoscopy screening for high-risk groups of familial colorectal cancer type X Lynch-like syndrome is 5-10 years before the age of onset of the youngest patient in the family.
High-risk groups in a typical FAP family begin to undergo colonoscopy screening from 10 to 11 years old, and colonoscopy is performed every 1 to 2 years, and continues for life.
High-risk groups of mild FAP families should start colonoscopy every 2 years from the age of 18 to 20, and continue for life.
The initial age of colonoscopy screening for people at high risk of MUTYH gene-associated polyposis is 40 years or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives.
High-risk groups of hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome) begin colonoscopy screening at the age of 18-20.
High-risk groups of juvenile polyp syndrome begin to undergo colonoscopy screening at the age of 15.
The initial age of colonoscopy screening for high-risk groups of serrated polyposis syndrome is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives.
Colonoscopy is the gold standard for colorectal cancer screening.
Related reading "Blood Test" Early Screening for Colorectal Cancer! Benchmark Medical and the Zhongshan Sixth Hospital team published a non-invasive detection model study "The Lancet": Aspirin prevents colorectal cancer in high-risk populations with an effect of 10-20 years.
Reference materials: [1] Rafael Cardoso, et al.
, (2021).
Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study.
The Lancet Oncology, DOI: https://doi.
org/10.
1016/S1470-2045(21)00199- 6[2] Latest global cancer data: Cancer burden rises to 19.
3 million new cases and 10.
0 million cancer deaths in 2020.
Retrieved May 26, 2021, from global-cancer-data-cancer-burden-rises-to-19-3-million-new-cases-and-10-0-million-cancer-deaths-in-2020/[3] Chinese Medical Association Oncology Branch Early Diagnosis and Early Treatment Group.
Expert consensus on early diagnosis and treatment of colorectal cancer in China.
Chinese Medical Journal.
2020,100(22):1691-1698.
Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on the treatment plan, please go to a regular hospital for treatment.
However, a considerable part of colorectal cancer can be prevented.
A European multinational study showed that nearly 20% of colorectal cancer cases can be attributed to various unhealthy life>
There are a variety of screening tools that have the potential to improve the incidence and mortality of colorectal cancer.
Differences in screening strategies and implementation efforts will accumulate over time and will also be reflected in the different development trends of disease burden.
"The Lancet-Oncology" today published a large-scale transnational study led by scholars from the German Cancer Research Center.
It shows the profound effects of screening on the incidence and death of colorectal cancer through statistics of disease data in 21 European countries since 2000.
influences.
Screenshot source: The Lancet Oncology Currently, effective screening methods for colorectal cancer include fecal occult blood test (the most widely used is the fecal immunochemical test [FIT], which is better than the traditional guaiac stool occult blood test [gFOBT]) , Sigmoidoscopy and colonoscopy, etc.
Many European countries have colorectal cancer screening measures for people at general risk (mainly people aged 50-74), but the timing of the screening plan, the type of screening organization (opportunistic and group screening), and primary screening The screening methods and screening rates are very different.
The research team collected national cancer registration data from 16 countries and the corresponding WHO mortality data.
In addition, it also collected regional data from 5 countries, covering 21 countries since 2000 (most of the countries have data as of 2016).
Out of nearly 3.
1 million cases of colorectal cancer patients.1.
Changes in overall incidence rates In countries where colonoscopy and stool examinations have been commonly carried out for a long time, and more than half of the suitable populations are screened (such as Austria, the Czech Republic and Germany), the age-standardized incidence rate of colorectal cancer is obvious over time Decline, the average annual rate of decline ranges from -1.
6% to -2.
5% among men, and from -1.
3% to -2.
4% among women.
In contrast, the United Kingdom and Finland have also generally carried out screening for a long time, but using traditional gFOBT, the age-standardized incidence rate remained stable or increased during the study period (Figure 1A below).
In countries where screening programs have only been generally implemented in recent years, the age-standardized incidence of colorectal cancer has remained stable or on the rise before the launch of the screening program; however, after the launch of the screening program, the age-standardized incidence of colorectal cancer The upward trend of the rate has eased.
Among them, in several countries (Belgium, Denmark, the Netherlands, and Slovenia) that adopted FIT mass screening and quickly achieved high screening coverage (>50%), the age-standardized incidence rate initially increased, but then continued Descend (Figure 1B below).
▲In countries where screening programs (A) have been implemented early and screenings have become widespread in recent years (B), the age-standardized incidence rate (blue line-male, red line-female) and mortality rate (green line-) of colorectal cancer Male, purple line-female) change trend.
The vertical dotted line is the implementation time of different screening strategies.
(Image source: Reference [1]) In 5 countries with only partial regional data, the incidence rate also showed similar changes as the screening was carried out.
It is worth noting that in some countries that have carried out screening in recent years, the increase in the initial incidence seems to be largely due to the increase in the diagnosis of early colorectal cancer, rather than over-diagnosis.
This "early rise" trend is not observed in countries with long-term screening, which may be due to the early adoption of opportunistic screening (rather than centralized invitation).
On the contrary, in most countries without large-scale screening programs, the incidence of colorectal cancer is increasing steadily and continuously, with an average annual growth rate of 0.
3% to 1.
9% in men and 0.
6% to 1.
1% in women (see figure below) 2A). ▲The age-standardized incidence and mortality of colorectal cancer (A; green line-male, purple line-female) and disease stage (B) trends in countries without large-scale screening programs during the study period.
(Picture source: Reference [1]) 2.
Changes in the incidence of different parts of the colorectal In most countries that carry out large-scale screening programs, the changes promoted by screening are basically reflected in the lesions in the distal colon and rectum, as well as in suitable conditions.
Screen the age group.
For proximal colon cancer and non-screening age groups (especially those ≤49 years old) in most countries, the research team still observed an increase in the incidence, or even a smaller improvement even if there was a decrease.
This is consistent with previous evidence: colonoscopy is more effective for distal colorectal cancer.
This is mainly because the proximal colon is more likely to form serrated precancerous lesions, which are more difficult to detect during FIT and colonoscopy, and these lesions are more likely to evolve into cancer than conventional adenomas.
Although there are differences in the biology and carcinogenicity of proximal and distal colorectal cancer, emerging evidence also suggests that high-quality colonoscopy and some innovative technologies have the potential to reduce the incidence of proximal colorectal cancer.
On the other hand, this also supports the finding that the incidence of colorectal cancer among young people has increased in recent years.
In countries without large-scale screening programs, the incidence of colorectal cancer in almost all three sites and people of all ages has remained stable or rising.
Image source: 123RF3.
Mortality changes The age-standardized mortality rate of colorectal cancer in most countries has declined, but the decline is different.
Overall, among countries with long-term screening programs, colorectal cancer mortality rates have fallen the most.
The general decline in mortality also reflects the progress in the diagnosis and treatment of colorectal cancer, such as more effective treatments, improvements in surgical techniques, and perioperative diagnosis and treatment.
4.
Changes in the staging of colorectal cancer Among the countries that carried out screening earlier, the proportion of stage I colorectal cancer tumors in the Czech Republic (using FIT or colonoscopy) and Germany (using colonoscopy) increased slightly, and the proportion of stage IV tumors increased slightly.
Decrease, and this trend was observed in all 3 different sites (proximal colon, distal colon, and rectum). However, after screening with a sigmoidoscopy in England in 2013, no significant changes were observed.
Austria and Finland lack detailed staging data, and no substantial and continuous changes were observed in the aggregate analysis (Figure 3A below).
For countries that have only carried out screening in recent years, after FIT-based group screening has been carried out, it has been observed that the proportion of stage I colorectal cancer has increased.
Similarly, this trend is also reflected in the incidence patterns of three different parts.
on.
▲In the countries where screening has been widespread in recent years, the proportion of early colorectal cancer has increased (picture source: reference [1]) In countries without large-scale screening programs, the staging of colorectal cancer in most areas is not obvious Or continuous change.
The research team pointed out that in addition to screening and treatment, there are many other factors, especially life>
There is no evidence that the behavior of the population in these countries has undergone profound changes, and even if there is, it cannot explain the extent of the observed changes.
Therefore, based on these data, the research team believes that there are differences in the incidence, mortality, and staging trends of colorectal cancer in different countries, which may be largely due to the different levels of colorectal cancer screening.
Screening has made a significant contribution to reducing the burden of colorectal cancer, and the benefits of long-term screening and group screening (rather than opportunistic screening) are more obvious.
In addition, if the methods for detecting precancerous lesions of the proximal colon can be improved, screening is expected to promote a greater reduction in the incidence and mortality of colorectal cancer in the future.
At present, the number of weight-loss and metabolic surgeries in China has increased to more than 10,000 per year, and there is no significant difference in surgical procedures from international ones.
The Chinese guidelines recommend the following for people who consider weight loss metabolic surgery: Slide to read the current "China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines" related recommendations are as follows: General population screening start and end age recommendations recommend the general population to receive colorectal cancer from 40 years old For risk assessment, it is recommended that people who are assessed as low- and medium-risk receive colorectal cancer screening at the age of 50-75, and those with high-risk assessment results are recommended to receive colorectal cancer screening from the age of 40-75.
If one or more first-degree relatives suffer from colorectal cancer, the recommended starting age for colorectal cancer screening is 40 years old or 10 years earlier than the youngest patient among the first-degree relatives.
The starting and ending age of screening for high-risk populations of hereditary colorectal cancer is recommended for high-risk populations with Lynch syndrome caused by MLH1/MSH2 mutations.
The starting age for colonoscopy screening is 20-25 years old or earlier than the youngest patient in the family.
2~5 years.
The initial age of colonoscopy screening for high-risk populations with Lynch syndrome caused by MSH6/PMS2 mutations is 30 to 35 years or 2 to 5 years earlier than the age of onset of the youngest patient in the family.
The initial age of colonoscopy screening for high-risk groups of familial colorectal cancer type X Lynch-like syndrome is 5-10 years before the age of onset of the youngest patient in the family.
High-risk groups in a typical FAP family begin to undergo colonoscopy screening from 10 to 11 years old, and colonoscopy is performed every 1 to 2 years, and continues for life.
High-risk groups of mild FAP families should start colonoscopy every 2 years from the age of 18 to 20, and continue for life.
The initial age of colonoscopy screening for people at high risk of MUTYH gene-associated polyposis is 40 years or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives.
High-risk groups of hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers syndrome) begin colonoscopy screening at the age of 18-20.
High-risk groups of juvenile polyp syndrome begin to undergo colonoscopy screening at the age of 15.
The initial age of colonoscopy screening for high-risk groups of serrated polyposis syndrome is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives.
Colonoscopy is the gold standard for colorectal cancer screening.
Related reading "Blood Test" Early Screening for Colorectal Cancer! Benchmark Medical and the Zhongshan Sixth Hospital team published a non-invasive detection model study "The Lancet": Aspirin prevents colorectal cancer in high-risk populations with an effect of 10-20 years.
Reference materials: [1] Rafael Cardoso, et al.
, (2021).
Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study.
The Lancet Oncology, DOI: https://doi.
org/10.
1016/S1470-2045(21)00199- 6[2] Latest global cancer data: Cancer burden rises to 19.
3 million new cases and 10.
0 million cancer deaths in 2020.
Retrieved May 26, 2021, from global-cancer-data-cancer-burden-rises-to-19-3-million-new-cases-and-10-0-million-cancer-deaths-in-2020/[3] Chinese Medical Association Oncology Branch Early Diagnosis and Early Treatment Group.
Expert consensus on early diagnosis and treatment of colorectal cancer in China.
Chinese Medical Journal.
2020,100(22):1691-1698.
Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on the treatment plan, please go to a regular hospital for treatment.
