（来源：Siegel RL, et al. Gut，2019; 68: 2179–2185.）

目的：在美国，尽管中老年人的结直肠癌（CRC）发病率显著下降，但年轻人的发病率却在增加，类似情况在澳大利亚及加拿大亦有报道，但目前尚缺乏全球范围内的资料分析。

Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking.

设计：我们获取了五大洲的肿瘤发病长期资料及其他补充资料，分析了2012年及之前的全球范围内诊断为CRC的发病率及趋势。按年龄分为20～49岁组（年轻组）及50岁及以上组（中老年组）。

Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand,Norway, Sweden, USA).

结果：2008-2012年期间，50岁以下组的年龄标准化CRC发病率为3.5/10万（印度）至12.9/10万（韩国）。在最近十年间，该组的发病率在36个国家内稳定在14/10万，在奥地利、意大利及立陶宛下降，在19个国家上升（其中9个国家的老年组发病率稳定或上升）。在塞浦露斯、荷兰及挪威年轻组的发病率倾向比中老年组高两倍。在大多数高收入国家，年轻人CRC发病率的上升开始于1990年代中期，上升最快的是韩国及新西兰。

Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)).

结论：在三大洲的9个高收入国家中，CRC的年轻发病率无例外地升高。这提示早年生活中某些信号因素的暴露可能会影响大肠肿瘤的发生。

Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.

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结肠癌如何早发现才是最关键的，一般职工体检，谁没事就去检查结肠