臺灣結直腸癌發生率篩檢政策的影響及世代效應：年齡-年代-世代-篩檢模型的分析

Abstract

背景：結直腸癌是全球重要的公共衛生問題。為了降低結直腸癌發生率及死亡率，許多國家(包含臺灣)已實行多年的結直腸癌篩檢計畫。除了篩檢政策外，結直腸癌發生率還會受到年齡、年代及世代三種因素的影響。 方法：本研究提出年齡-年代-世代-篩檢模型，除了年齡、年代、世代效應外，新增篩檢效應。我們使用此模型評估結直腸癌篩檢政策對結直腸癌發生率的影響，以及釐清結直腸癌發生率的世代效應。本研究使用臺灣癌症登記資料庫，包含2000年至2019年的結直腸癌發生個案。 結果：臺灣男性結直腸癌發生率在2000年至2010年間上升後趨於穩定，女性則在2000年至2012年間上升後呈現下降。篩檢於2010年後影響50至79歲年齡層。男女性發生率分別在2010年先上升19.2%及15.6%，隨後每年分別下降3.4%及3.1%。男女性年齡標準化發生率分別於2015年及2014年低於假設無篩檢情境下的發生率。至2019年，男女性年齡標準化發生率與假設無篩檢情境下的發生率相比已下降12.4%及11.6%。結直腸癌發生率的世代效應於1920年後不斷上升，至1980年後開始趨緩，女性甚至下降。 結論：臺灣推動篩檢政策至2019年已有效降低結直腸癌發生率的十分之一。結直腸癌發生率的世代效應增加已趨緩並下降。然而，本研究僅觀察至1990年出生世代，往後是否會反轉上升，仍值得關注。

Background: Colorectal cancer is a significant global public health issue. To reduce the incidence and mortality rates of colorectal cancer, many countries, including Taiwan, have implemented colorectal cancer screening programs for several years. The incidence rate of colorectal cancer is influenced not only by screening program but also by age, period, and cohort factors. Methods: In this study, we propose an age-period-cohort-screening model that incorporates age, period, cohort effects, and the additional impact of screening. We apply this model to assess the impact of colorectal cancer screening program on the incidence rate of colorectal cancer and to clarify the cohort effects on colorectal cancer incidence. We utilize data from the Taiwan Cancer Registry Database, encompassing colorectal cancer cases from 2000 to 2019. Results: The incidence rate of colorectal cancer in Taiwanese males showed an upward trend from 2000 to 2010, followed by stabilization, while females exhibited an increase until 2012, followed by a subsequent decline. In 2010, the incidence rates for males and females increased by 19.2% and 15.6%, respectively, but then experienced annual declines of 3.4% and 3.1%. The age-standardized incidence rates for both males and females dropped below the rates hypothesized under a scenario without screening in 2015 and 2014, respectively. By 2019, the age-standardized incidence rates for males and females had decreased by 12.4% and 11.6%, respectively, compared to the rates hypothesized in a scenario without screening. The cohort effects on colorectal cancer incidence for both males and females continued to rise after 1920 and began to plateau after 1980, with a decline observed in females. Conclusion: Taiwan has successfully reduced the incidence rate of colorectal cancer by ten percent through the implementation of the screening program until 2019. The cohort effect on colorectal cancer incidence has shown a slowing and declining trend. However, this study only observed up to the birth cohort of 1990, it remains important to monitor whether the incidence rates will reverse and start rising again.