Journal of the American Medical Association最新文献_第2页

Early-Onset Gastrointestinal Cancers: A Review. 早发性胃肠道癌症：综述。

Journal of the American Medical Association Pub Date : 2025-07-17 DOI: 10.1001/jama.2025.10218

Thejus Jayakrishnan, Kimmie Ng

{"title":"Early-Onset Gastrointestinal Cancers: A Review.","authors":"Thejus Jayakrishnan, Kimmie Ng","doi":"10.1001/jama.2025.10218","DOIUrl":"https://doi.org/10.1001/jama.2025.10218","url":null,"abstract":"Importance: Early-onset gastrointestinal (GI) cancer is typically defined as GI cancer diagnosed in individuals younger than 50 years. The incidence of early-onset GI cancer is rising globally, and early-onset GI cancers represent the most rapidly increasing early-onset cancer in the US.Observations: Worldwide, among early-onset GI cancers reported in 2022, colorectal cancer (CRC) was the most common (54.3%; 184 709 cases), followed by gastric cancer (23.8%; 80 885 cases), esophageal cancer (13.2%; 45 056 cases), and pancreatic cancer (8.6%; 29 402 cases). In the US, among early-onset GI cancers reported in 2022, 20 805 individuals were diagnosed with early-onset CRC, 2689 with early-onset gastric, 2657 with early-onset pancreatic, and 875 with early-onset esophageal cancer. Most early-onset GI cancers are associated with modifiable risk factors including obesity, poor-quality diet (eg, sugar-sweetened beverages, ultraprocessed foods), sedentary lifestyle, cigarette smoking, and alcohol consumption. Nonmodifiable risk factors include family history, hereditary syndromes (eg, Lynch syndrome), and inflammatory bowel disease for patients with early-onset CRC. Approximately 15% to 30% of early-onset GI cancers have pathogenic germline variants in genes such as DNA mismatch repair genes and BRCA1/2. All patients with early-onset GI cancers should undergo germline and somatic genetic testing to guide treatment, screen for other cancers (eg, endometrial cancer in Lynch syndrome), and assess familial risk. Treatment for early-onset GI cancers are similar to later-onset GI cancers and may include chemotherapy, surgery, radiation, and therapies such as poly-adenosine diphosphate ribose polymerase inhibitors for BRCA-associated pancreatic cancer. Compared with GI cancers diagnosed after age 50 years, patients with early-onset GI cancers typically receive more treatments but often have similar or shorter survival. Specialized centers and multidisciplinary teams can support patients with challenges around fertility preservation, parenting with cancer, financial difficulty, and psychosocial distress. Currently, screening is not recommended for most early-onset GI cancers, although in the US, screening for CRC is recommended for average-risk individuals starting at age 45 years. High-risk individuals (eg, those with Lynch syndrome, a first-degree relative with CRC, or advanced colorectal adenoma) should begin CRC screening earlier, at an age determined by the specific risk factor.Conclusions and relevance: Early-onset GI cancers, typically defined as cancer diagnosed in individuals younger than 50 years, are among the largest subset of early-onset cancers globally. Treatment is similar to later-onset GI cancers and typically involves a combination of chemotherapy, surgery, and radiation, depending on the cancer type and stage. The prognosis for patients with early-onset GI cancers is similar to","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal Vasopressin Initiation in Septic Shock. 感染性休克的最佳抗利尿激素起始。

Journal of the American Medical Association Pub Date : 2025-07-17 DOI: 10.1001/jama.2025.8093

Catherine A Gao, William F Parker

引用次数: 0

What Is Antimicrobial Resistance? 什么是抗菌素耐药性？

Journal of the American Medical Association Pub Date : 2025-07-17 DOI: 10.1001/jama.2025.10052

Cesar A Arias, David van Duin

引用次数: 0

Drug Versioning and Legal Accountability. 药品版本控制和法律责任。

Journal of the American Medical Association Pub Date : 2025-07-16 DOI: 10.1001/jama.2025.8087

Eva Parente, Robert A Bohrer

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Drug Versioning and Legal Accountability-Reply. 药品版本控制和法律责任-答复。

Journal of the American Medical Association Pub Date : 2025-07-16 DOI: 10.1001/jama.2025.8090

S Sean Tu, Timothy Bonis

引用次数: 0

Gerontology. 老年病学。

Journal of the American Medical Association Pub Date : 2025-07-16 DOI: 10.1001/jama.2025.4679

Francis A Neelon

引用次数: 0

WHO Assembly Adopts First Pandemic Agreement. 世卫组织大会通过第一份大流行协定。

Journal of the American Medical Association Pub Date : 2025-07-15 DOI: 10.1001/jama.2025.7804

Samantha Anderer

引用次数: 0

Evidence Supports Removing Restrictions on Mifepristone. 证据支持取消米非司酮的限制。

Journal of the American Medical Association Pub Date : 2025-07-15 DOI: 10.1001/jama.2025.8138

Daniel Grossman, Erica Chung

引用次数: 0

Skin Cancer Burden Rising in Older Adults, Study Finds. 研究发现，老年人皮肤癌负担增加。

Journal of the American Medical Association Pub Date : 2025-07-15 DOI: 10.1001/jama.2025.7806

Samantha Anderer

引用次数: 0

What to Know About the First FDA-Cleared Blood Test for Alzheimer Biomarkers. 关于首个fda批准的阿尔茨海默病生物标志物血液检测，你应该知道些什么？

Journal of the American Medical Association Pub Date : 2025-07-15 DOI: 10.1001/jama.2025.9013

Rita Rubin

引用次数: 0