健康生活方式+内镜筛查,可大幅降低大肠癌发病率及死亡率
创作:szx 审核:szx 02月22日
  • 纳入75,873名女性及42,875名男性,中位随访26年期间,共有2836例结直肠癌发生,并有1013例结直肠癌死亡;
  • 基于BMI、吸烟状态、体育锻炼、酒精摄入及饮食情况计算健康生活方式评分;
  • 无论是否进行内镜筛查,更高的健康生活方式评分与较低的结直肠癌发病率显著相关;
  • 对于结直肠癌发病率,内镜筛查的人群归因危险度为32%,健康生活方式结合内镜筛查的人群归因危险度为61%;
  • 生活方式及内镜筛查与结直肠癌死亡率也有相似的关联。
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szx
PLoS Medicine上发表的一项前瞻性队列研究结果,对近12万名美国人进行近30年的随访后发现,接受内镜筛查可分别降低32%的结直肠癌发病率及34%的结直肠癌死亡率,而内镜筛查+健康生活方式可分别降低61%的结直肠癌发病率及55%的结直肠癌死亡率。
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PLoS Medicine [IF:10.5]

Healthy lifestyle, endoscopic screening, and colorectal cancer incidence and mortality in the United States: A nationwide cohort study

健康生活方式、内镜筛查与美国人的结直肠癌发病率及死亡率:一项全国范围内的队列研究

10.1371/journal.pmed.1003522

02-01, Article

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Background: Healthy lifestyle and screening represent 2 major approaches to colorectal cancer (CRC) prevention. It remains unknown whether the CRC-preventive benefit of healthy lifestyle differs by endoscopic screening status, and how the combination of healthy lifestyle with endoscopic screening can improve CRC prevention.
Methods and findings: We assessed lifestyle and endoscopic screening biennially among 75,873 women (Nurses’ Health Study, 1988 to 2014) and 42,875 men (Health Professionals Follow-up Study, 1988 to 2014). We defined a healthy lifestyle score based on body mass index, smoking, physical activity, alcohol consumption, and diet. We calculated hazard ratios (HRs) and population-attributable risks (PARs) for CRC incidence and mortality in relation to healthy lifestyle score according to endoscopic screening. Participants’ mean age (standard deviation) at baseline was 54 (8) years. During a median of 26 years (2,827,088 person-years) follow-up, we documented 2,836 incident CRC cases and 1,013 CRC deaths. We found a similar association between healthy lifestyle score and lower CRC incidence among individuals with and without endoscopic screening, with the multivariable HR per one-unit increment of 0.85 (95% CI, 0.80 to 0.90) and 0.85 (95% CI, 0.81 to 0.88), respectively (P-interaction = 0.99). The fraction of CRC cases that might be prevented (PAR) by endoscopic screening alone was 32% (95% CI, 31% to 33%) and increased to 61% (95% CI, 42% to 75%) when combined with healthy lifestyle (score = 5). The corresponding PAR (95% CI) increased from 15% (13% to 16%) to 51% (17% to 74%) for proximal colon cancer and from 47% (45% to 50%) to 75% (61% to 84%) for distal CRC. Results were similar for CRC mortality. A limitation of our study is that our study participants are all health professionals and predominantly whites, which may not be representative of the general population.
Conclusions: Our study suggests that healthy lifestyle is associated with lower CRC incidence and mortality independent of endoscopic screening. An integration of healthy lifestyle with endoscopic screening may substantially enhance prevention for CRC, particularly for proximal colon cancer, compared to endoscopic screening alone.

First Authors:
Kai Wang

Correspondence Authors:
Mingyang Song

All Authors:
Kai Wang,Wenjie Ma,Kana Wu,Shuji Ogino,Andrew T Chan,Edward L Giovannucci,Mingyang Song

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