前言：結直腸癌為世界排名第四的常見癌症，且高發生率的國家大都是分布在澳洲、歐洲和北美洲，低發生率的國家則多分布於非洲、中南亞洲的某些國家。然而結直腸癌發生率除了在世界各國有高低區分，趨勢也有巨大的變化。特別是年齡別發生率的變化趨勢在各國有差異，其中發現在澳洲與美國的早發族群發生率正不斷增加，年長族群則是趨於平穩與下降的情形，這樣的現象可能反映出國家的篩檢率以及移除癌前病變的增加，而早發族群發生率的上升趨勢，則可能是這些族群並不屬於建議接受篩檢範圍內的族群。而各國經濟發展程度的差異，也可發現發生率趨勢的變化有所不同。發生率的上升趨勢大都呈現在經濟上正在轉換的國家，由於經濟快速發展加上生活、飲食西化的關係，導致發生率趨勢也隨之上升。相較之下，高收入國家結直腸癌的高發生率則是已經漸趨穩定。因此得知飲食在結直腸癌的預防和因果關係扮演很重要的角色，目前已經有許多研究證實各種食物對於結直腸癌的影響，然而仍然有許多食物對於結直腸作用的危險或保護作用在文獻上的解釋仍然有限。目的：以全人口為單位從性別、年齡與居住地區等不同面向來探討其結直腸癌發生率趨勢之間的差異，並且進一步利用累積發生率觀察不同世代間的差異，接著觀察國人食物攝取量隨著時間的變化趨勢對於結直腸癌發生率的變化趨勢的生態相關性。方法：本研究利用國民健康署癌症登記線上互動查詢系統，計算1979年至2013年20歲以上世界人口年齡標準化發生率，再利用美國國家癌症中心的Surveillance, Epidemiology and End Results Program(SEER)的連接點迴歸模型(joinpoint regression)分別分析台灣結直腸癌發生率依年齡、性別及都市化程度分層之趨勢變化。並計算不同出生世代的累計發生率以觀察各世代發生結直腸癌的風險是否有差異。再利用行政院農業委員會糧食平衡表，以斯皮爾曼等級相關係數分析國人每年飲食和營養素攝取量與結直腸癌發生率變化趨勢之間的生態相關性，並且考慮飲食影響結直腸癌發生的延遲效應，延遲時間分別為0、5、10、15年。結果與討論：台灣整體結直腸癌發生率在本研究的分析結果，是呈持續上升的趨勢，且男性發生率高於女性。早發族群的發生率趨勢正顯著上升，非早發族群從早期較大的上升趨勢轉為較趨緩的趨勢。相關研究指出，大腸癌篩檢因為找出了先前未確診的病患，可能在早期會使大腸癌發生率增加。也可能因為台灣自1995年開始實施全民健康保險，使得民眾就醫便利性提升，大腸癌發現的機率也跟著提升。另外在早發族群的發生率趨勢分布並沒有隨都市化程度有太大的改變，表示都市化程度不是影響結直腸癌發生率上升的主要因素，這也許反映出由於台灣經濟不斷在發展與進步，生活方式受到西方國家的影響，因此在飲食方面也會跟著改變。在不同出生世代的族群之累積發生率，看到越年輕的世代累積發生率越高，也因此顯示年輕世代(1975-1979)得到結直腸癌的風險較先前的世代都來的高，因此近期的出生世代族群在結直腸癌的預防政策需要更多的注意。在飲食與發生率的生態相關性，危險因子中，僅牛肉和羊肉與預期結果相符為正相關；而保護因子除了牛奶以外，其餘皆與預期結果相符為負相關，其中穀類和魚類更呈現顯著的高度負相關。因此，對於國人飲食的變化量，仍需要持續關注，且除了上述幾項較強實證結果的食物，其餘各種食物對於結直腸癌是否為保護或危險因子仍有很大的研究空間。結論：早發族群的結直腸癌發生率趨勢，持續以一定的每年變化百分比(APC）在上升，加上近期的出生世代得結直腸癌的風險較高於先前的出生世代，因此應進一步評估是否該將篩檢年齡向較年輕人口轉移。加上早發族群並沒有受都市化程度的影響，因此應針對其他可能導致結直腸癌的環境因素像是生活、飲食型態深入研究，並加以控制。

SUMMARY: We examined the annual percent change (APC) in age-standardized CRC incidence rates between 1979 and 2013 with Joinpoint Regression Program and tested for pairwise differences between subgroups. We also calculated the cumulative incidence rates of birth cohorts to investigate the difference of CRC risks in every birth cohort. Then we analyzed the ecological correlation between food consumption and CRC incidence rate with Spearman’ s rank test in consideration of the effect of lag time. CRC incidence rates in the young-onset group increased significantly since 1984 to 2013. In the non-young onset group, there was significant increase in the early times (1979-1999), but the increase begins to level off in the recent decade. In the ecological correlation between food and CRC incidence rate, we found that only beef and lamb were positivity correlated with incidence rate, and that most of protective factors were negativity correlated with incidence rate. A shift of the recommended age of CRC screening to the younger population in Taiwan should be considered and evaluated. Also, there should be more concerned on the environmental factors like life and diet style, which may lead to CRC.

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