{"title":"USPSTF 2008 年更新筛查建议后的老年人结直肠癌情况","authors":"Jason Semprini","doi":"10.1016/j.canep.2024.102677","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.</p></div><div><h3>Methods</h3><p>We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74).</p></div><div><h3>Results</h3><p>There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.</p></div><div><h3>Discussion</h3><p>The USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.</p></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"93 ","pages":"Article 102677"},"PeriodicalIF":2.4000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation\",\"authors\":\"Jason Semprini\",\"doi\":\"10.1016/j.canep.2024.102677\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.</p></div><div><h3>Methods</h3><p>We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74).</p></div><div><h3>Results</h3><p>There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.</p></div><div><h3>Discussion</h3><p>The USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.</p></div>\",\"PeriodicalId\":56322,\"journal\":{\"name\":\"Cancer Epidemiology\",\"volume\":\"93 \",\"pages\":\"Article 102677\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancer Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1877782124001565\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1877782124001565","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景直肠癌（CRC）筛查可以提高发现率，防止癌前息肉变成恶性肿瘤。2008 年，美国预防服务工作组（USPSTF）更新了他们的政策，不再建议 75 岁以上的成年人进行 CRC 筛查。我们从行为风险因素监测系统（Behavioral Risk Factor Surveillance System）获取数据，分析血便和结肠镜筛查情况；从监测、流行病学和最终结果项目（Surveillance, Epidemiological, End Results program）获取数据，分析 CRC 分期和存活情况；从全国癌症集中登记协会（National Association of Centralized Cancer Registries）获取数据，分析 CRC 发病率；从全国卫生统计中心（National Center for Health Statistics）获取数据，分析死亡率。通过差分设计，我们比较了 2008 年前后暴露组（75 岁以上）与类似的未暴露组（65-74 岁）的结果趋势变化。但我们发现，2008 年的更新与老年人在过去两年内完成结肠镜检查的概率下降 3.0% 个百分点有关（C.I. = -4.0, -2.0）。在确诊为 CRC 的老年人中，更新后出现晚期的概率增加了 1.5 个百分点（C.I. = 1.1, 1.9）。最后，政策更新还与较低的 CRC 发病率（估计值 = -13.9 例/100,000 人口；C.I. = -22.6, -5.1）和死亡率（估计值 = -5.6 例死亡/100,000 人口；C.I. = -10.1, -1.1）相关。讨论USPSTF 2008 年的建议与结肠镜检查次数减少有关，尤其是在 85 岁以上的成年人中。该建议或 2021 年更新的指南是否能通过减轻老年人的 CRC 筛查负担来优化人口健康仍是未知数。
Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation
Background
Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.
Methods
We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74).
Results
There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.
Discussion
The USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.
期刊介绍：
Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including:
• Descriptive epidemiology
• Studies of risk factors for disease initiation, development and prognosis
• Screening and early detection
• Prevention and control
• Methodological issues
The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.
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