Determining Risk of Colorectal Cancer and Starting Age of Screening Based on Lifestyle, Environmental, and Genetic Factors

被引：287

作者：

Jeon, Jihyoun ^{[1
]}

Du, Mengmeng ^{[2
]}

Schoen, Robert E. ^{[3
]}

Hoffmeister, Michael ^{[4
,5
,6
,7
]}

Newcomb, Polly A. ^{[8
]}

Berndt, Sonja I. ^{[9
]}

Caan, Bette ^{[10
]}

Campbell, Peter T. ^{[11
]}

Chan, Andrew T. ^{[12
,13
,14
,15
]}

Chang-Claude, Jenny ^{[4
,5
,6
,7
]}

Giles, Graham G. ^{[16
,17
]}

Gong, Jian ^{[8
]}

Harrison, Tabitha A. ^{[8
]}

Huyghe, Jeroen R. ^{[8
]}

Jacobs, Eric J. ^{[11
]}

Li, Li ^{[18
]}

Lin, Yi ^{[8
]}

Le Marchand, Loic ^{[19
]}

Potter, John D. ^{[8
]}

Qu, Conghui ^{[8
]}

Bien, Stephanie A. ^{[8
]}

Zubair, Niha ^{[8
]}

Macinnis, Robert J. ^{[16
,17
]}

Buchanan, Daniel D. ^{[20
,21
,22
]}

Hopper, John L. ^{[21
,23
,24
]}

Cao, Yin ^{[12
,13
,14
]}

Nishihara, Reiko ^{[12
,13
]}

Rennert, Gad ^{[25
]}

Slattery, Martha L. ^{[26
]}

Thomas, Duncan C. ^{[27
]}

Woods, Michael O. ^{[28
]}

Prentice, Ross L. ^{[8
]}

Gruber, Stephen B. ^{[29
]}

Zheng, Yingye ^{[8
]}

Brenner, Hermann ^{[4
,5
,6
,7
]}

Hayes, Richard B. ^{[30
]}

White, Emily ^{[8
]}

Peters, Ulrike ^{[8
]}

Hsu, Li ^{[8
]}

机构：

[1] Univ Michigan, Dept Epidemiol, 1415 Washington Hts, Ann Arbor, MI 48109 USA

[2] Mem Sloan Kettering, New York, NY USA

[3] Univ Pittsburgh, Med Ctr, Dept Med & Epidemiol, Pittsburgh, PA USA

[4] German Canc Res Ctr, Div Clin Epidemiol & Aging Res, Heidelberg, Germany

[5] German Canc Res Ctr, Div Prevent Oncol, Heidelberg, Germany

[6] Natl Ctr Tumor Dis, Heidelberg, Germany

[7] German Canc Res Ctr, German Canc Consortium, Heidelberg, Germany

[8] Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, 1124 Columbia St, Seattle, WA 98104 USA

[9] NCI, Div Canc Epidemiol & Genet, NIH, Dept Hlth & Human Serv, Bethesda, MD 20892 USA

[10] Kaiser Permanente Med Care Program, Div Res, Oakland, CA 94611 USA

[11] Amer Canc Soc, Epidemiol Res Program, Atlanta, GA 30329 USA

[12] Massachusetts Gen Hosp, Clin & Translat Epidemiol Unit, Boston, MA 02114 USA

[13] Harvard Med Sch, Boston, MA USA

[14] Massachusetts Gen Hosp, Div Gastroenterol, Boston, MA 02114 USA

[15] Brigham & Womens Hosp, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA

[16] Canc Council Victoria, Canc Epidemiol & Intelligence Div, Melbourne, Vic, Australia

[17] Univ Melbourne, Sch Global & Populat Hlth, Ctr Epidemiol & Biostat, Melbourne, Vic, Australia

[18] Case Western Reserve Univ, Cleveland, OH 44106 USA

[19] Univ Hawaii, Ctr Canc, Program Epidemiol, Honolulu, HI 96822 USA

[20] Univ Melbourne, Dept Pathol, Colorectal Oncogen Grp, Genet Epidemiol Lab, Parkville, Vic, Australia

[21] Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Parkville, Vic, Australia

[22] Royal Melbourne Hosp, Genet Med & Family Canc Clin, Parkville, Vic, Australia

[23] Seoul Natl Univ, Sch Publ Hlth, Dept Epidemiol, Seoul, South Korea

[24] Seoul Natl Univ, Inst Hlth & Environm, Seoul, South Korea

[25] Carmel Hosp, Haifa, Israel

[26] Univ Utah, Dept Internal Med, Hlth Sci Ctr, Salt Lake City, UT 84112 USA

[27] Univ Southern Calif, Keck Sch Med, Dept Prevent Med, Los Angeles, CA USA

[28] Mem Univ Newfoundland, St John, NF, Canada

[29] Univ Southern Calif, USC Norris Comprehens Canc Ctr, Los Angeles, CA USA

[30] NYU, Sch Med, Dept Populat Hlth, Div Epidemiol, New York, NY USA

来源：

GASTROENTEROLOGY | 2018年 / 154卷 / 08期

基金：

美国国家卫生研究院; 英国医学研究理事会; 加拿大健康研究院;

关键词：

Colon Cancer; GECCO; CORECT; Colonoscopy; GENOME-WIDE ASSOCIATION; SUSCEPTIBILITY LOCI; POOLED ANALYSIS; COLON-CANCER; MENDELIAN RANDOMIZATION; PREDICTION MODELS; FAMILY-HISTORY; BREAST-CANCER; IDENTIFIES; RED MEAT;

D O I：

10.1053/j.gastro.2018.02.021

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND & AIMS: Guidelines for initiating colorectal cancer (CRC) screening are based on family history but do not consider lifestyle, environmental, or genetic risk factors. We developed models to determine risk of CRC, based on lifestyle and environmental factors and genetic variants, and to identify an optimal age to begin screening. METHODS: We collected data from 9748 CRC cases and 10,590 controls in the Genetics and Epidemiology of Colorectal Cancer Consortium and the Colorectal Transdisciplinary study, from 1992 through 2005. Half of the participants were used to develop the risk determination model and the other half were used to evaluate the discriminatory accuracy (validation set). Models of CRC risk were created based on family history, 19 lifestyle and environmental factors (E-score), and 63 CRC-associated single-nucleotide polymorphisms identified in genome-wide association studies (G-score). We evaluated the discriminatory accuracy of the models by calculating area under the receiver operating characteristic curve values, adjusting for study, age, and endoscopy history for the validation set. We used the models to project the 10-year absolute risk of CRC for a given risk profile and recommend ages to begin screening in comparison to CRC risk for an average individual at 50 years of age, using external population incidence rates for non-Hispanic whites from the Surveillance, Epidemiology, and End Results program registry. RESULTS: In our models, E-score and G-score each determined risk of CRC with greater accuracy than family history. A model that combined both scores and family history estimated CRC risk with an area under the [GRAPHICS] receiver operating characteristic curve value of 0.63 (95% confidence interval, 0.62-0.64) for men and 0.62 (95% confidence interval, 0.61-0.63) for women; area under the receiver operating characteristic curve values based on only family history ranged from 0.53 to 0.54 and those based only E-score or G-score ranged from 0.59 to 0.60. Although screening is recommended to begin at age 50 years for individuals with no family history of CRC, starting ages calculated based on combined E-score and G-score differed by 12 years for men and 14 for women, for individuals with the highest vs the lowest 10% of risk. CONCLUSIONS: We used data from 2 large international consortia to develop CRC risk calculation models that included genetic and environmental factors along with family history. These determine risk of CRC and starting ages for screening with greater accuracy than the family history only model, which is based on the current screening guideline. These scoring systems might serve as a first step toward developing individualized CRC prevention strategies.

引用

页码：2152 / +

页数：32

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