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首页> 外文期刊>Digestive Diseases and Sciences >Screening for Colorectal Cancer in African Americans: Determinants and Rationale for an Earlier Age to Commence Screening
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Screening for Colorectal Cancer in African Americans: Determinants and Rationale for an Earlier Age to Commence Screening

机译：非洲裔美国人结肠直肠癌的筛查：决定筛查年龄的因素和理由

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Colorectal cancer (CRC) screening is a cost-effective approach to reduce morbidity, mortality, and prevalence of CRC in populations. Current recommendations for asymptomatic populations begin screening at age 50 years, after which similar to 95 % of cancers occur. Determinants that modify timing and frequency for screening include: personal/family history of adenomas or CRC, age of onset of lesions, and presence or potential to harbor high-risk conditions like inflammatory bowel disease (IBD), familial adenomatous polyposis (FAP), or Lynch syndrome. Although race, like family history, is heritable, it has not engendered inclusion in systematic screening recommendations despite multiple studies demonstrating disparity in the incidence and mortality from CRC, and the potential for targeted screening to reduce disparity. African Americans, when compared to Caucasians, have lower CRC screening utilization, younger presentation for CRC, higher CRC prevalence at all ages, and higher proportion of CRCs before age 50 years (similar to 11 vs. 5 %); are less likely to transmit personal/family history of adenomas or CRC that may change screening age; show excess of high-risk proximal adenomas, matched with 7-15 % excess right-sided CRCs that lack microsatellite instability; show higher frequencies of high-risk adenomas for every age decile; and demonstrate genetic biomarkers associated with metastasis. These epidemiological and biological parameters put African Americans at higher risk from CRC irrespective of socioeconomic issues, like IBD, FAP, and Lynch patients. Including race as a factor in national CRC screening guidelines and commencing screening at an age earlier than 50 years seems rational based on the natural history and aggressive behavior in this population.
机译：大肠癌（CRC）筛查是一种降低人群中CRC的发病率，死亡率和患病率的经济有效的方法。当前对无症状人群的建议从50岁开始筛查，此后发生约95％的癌症。决定筛查时间和频率的决定因素包括：腺瘤或CRC的个人/家族史，病变的发病年龄，是否存在或可能具有高风险条件，例如炎症性肠病（IBD），家族性腺瘤性息肉病（FAP），或林奇综合症。尽管种族与家族史一样是可遗传的，但是尽管有多项研究表明CRC的发病率和死亡率存在差异，并且有针对性的筛查可以减少差异，但种族并未将其纳入系统的筛查建议中。与高加索人相比，非洲裔美国人的CRC筛查使用率较低，CRC的出现较年轻，各个年龄段的CRC患病率较高，且50岁之前的CRC比例较高（大约11％对5％）;不太可能传播可能改变筛查年龄的腺瘤或CRC的个人/家族史;表现出高风险的近端腺瘤过多，与缺少微卫星不稳定性的7-15％的右侧CRC匹配;在每个年龄十分位数中，高危腺瘤的发生频率更高;并证明与转移相关的遗传生物标记。这些流行病学和生物学参数使非裔美国人罹患CRC的风险更高，而与诸如IBD，FAP和Lynch患者等社会经济问题无关。根据自然史和该人群的攻击行为，将种族作为国家CRC筛查指南的一个因素并在50岁之前开始筛查似乎是合理的。

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