Epidemiological characteristics and prevention of colorectal cancer globally and in China: an interpretation of the Global Cancer Statistics Report 2022_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Libin ¹ , HUANG Qiushi ^1,2 ,  YANG Lie ¹

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Gastrointestinal Surgery, Chengdu Second People’s Hospital, Chengdu 610017, P. R. China;

Corresponding author：

YANG Lie, Email: lie_222@163.com

Keywords：

colorectal cancer; incidence; mortality; screening policy; geographical characteristic

DOI：

10.7507/1007-9424.202404014

Video：

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Abstract Full text Figures/Tables Video References Cited by

Colorectal cancer is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide. In recent years, with the development and change of society and economy, the epidemiological characteristics of colorectal cancer related to geographic economy and health resources have caused its incidence to show a trend of regional differentiation. At present, the diagnosis, treatment, prevention and control of colorectal cancer in China are still facing great challenges, therefore, summarizing the risk factors related to the incidence of colorectal cancer in China from the global epidemiological characteristics of colorectal cancer can further guide the prevention, control and clinical diagnosis and treatment of colorectal cancer in China, and is of great significance to improve the heavy burden of colorectal cancer. Therefore, this paper discusses the epidemiological characteristics of colorectal cancer in recent years and the screening policies in different regions based on the report of the International Agency for Research on Cancer and related studies, so as to provide the relevant basis for the prevention and control of colorectal cancer in the new situation in the future.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024 Apr 4.
2.	郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.
3.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
4.	Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut, 2023, 72(2): 338-344.
5.	Liu Y, Rao K, Wu J, et al. China’s health system performance. Lancet, 2008, 372(9653): 1914-1923.
6.	Doubeni CA, Major JM, Laiyemo AO, et al. Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence. J Natl Cancer Inst, 2012, 104(18): 1353-1362.
7.	Aarts MJ, Lemmens VE, Louwman MW, et al. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer, 2010, 46(15): 2681-2695.
8.	Carethers JM, Doubeni CA. Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies. Gastroenterology, 2020, 158(2): 354-367.
9.	Fang JY, Zheng S, Jiang B, et al. Consensus on the prevention, screening, early diagnosis and treatment of colorectal tumors in China: chinese society of gastroenterology, October 14-15, 2011, Shanghai, China. Gastrointest Tumors, 2014, 1(2): 53-75.
10.	Li S. Understanding the ‘Chinese consensus on screening, early diagnosis, early therapy, and prevention for colorectal cancer and adenoma'. Chinese Journal of Gastroenterology, 2012, 17(5): 257-259.
11.	陈万青, 曹毛毛. 加强癌症早诊早治, 实施健康中国战略. 中国肿瘤, 2019, 28(9): 643-645.
12.	陈万青, 李霓, 石菊芳, 等. 中国城市癌症早诊早治项目进展. 中国肿瘤, 2019, 28(1): 23-25.
13.	Sandouk F, Al Jerf F, Al-Halabi MH. Precancerous lesions in colorectal cancer. Gastroenterol Res Pract, 2013, 2013: 457901.
14.	Dove-Edwin I, Thomas HJ. Review article: the prevention of colorectal cancer. Aliment Pharmacol Ther, 2001, 15(3): 323-336.
15.	Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer, 2018, 119(7): 785-792.
16.	Programme UND. The rise of the South : human progress in a diverse world. The rise of the South : human progress in a diverse world; 2013.
17.	Rabeneck L, Chiu HM, Senore C. International perspective on the burden of colorectal cancer and public health effects. Gastroenterology, 2020, 158(2): 447-452.
18.	Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut, 2017, 66(4): 683-691.
19.	Harris R, Sawaya GF, Moyer VA, et al. Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U. S. preventive services task force. Epidemiol Rev, 2011, 33: 20-35.
20.	Dobrow MJ, Hagens V, Chafe R, et al. Consolidated principles for screening based on a systematic review and consensus process. CMAJ, 2018, 190(14): E422-E429.
21.	Goede SL, Rabeneck L, van Ballegooijen M, et al. Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. PLoS One, 2017, 12(3): e0172864.
22.	Levin TR, Corley DA, Jensen CD, et al. Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population. Gastroenterology, 2018, 155(5): 1383-1391. e1385.
23.	Rabeneck L, Tinmouth JM, Paszat LF, et al. Ontario’s ColonCancerCheck: results from Canada’s first province-wide colorectal cancer screening program. Cancer Epidemiol Biomarkers Prev, 2014, 23(3): 508-515.
24.	Ponti A, Basu P, Ritchie D, et al. Key issues that need to be considered while revising the current annex of the European Council Recommendation (2003) on cancer screening. Int J Cancer, 2020, 147(1): 9-13.
25.	Armaroli P, Villain P, Suonio E, et al. European code against cancer, 4th edition: cancer screening. Cancer Epidemiol, 2015, 39 Suppl 1: S139-S152.
26.	Anttila A, Lönnberg S, Ponti A, et al. Towards better implementation of cancer screening in Europe through improved monitoring and evaluation and greater engagement of cancer registries. Eur J Cancer, 2015, 51(2): 241-251.
27.	Basu P, Ponti A, Anttila A, et al. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer, 2018, 142(1): 44-56.
28.	Senore C, Basu P, Anttila A, et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut, 2019, 68(7): 1232-1244.
29.	Sung JJ, Ng SC, Chan FK, et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut, 2015, 64(1): 121-132.
30.	Sarakarn P, Promthet S, Vatanasapt P, et al. Preliminary results: colorectal cancer screening using fecal immunochemical test (FIT) in a Thai population aged 45-74 years: a population-based randomized controlled trial. Asian Pac J Cancer Prev, 2017, 18(10): 2883-2889.
31.	Chiu HM, Ching JY, Wu KC, et al. A risk-scoring system combined with a fecal immunochemical test is effective in screening high-risk subjects for early colonoscopy to detect advanced colorectal neoplasms. Gastroenterology, 2016, 150(3): 617-625. e613.
32.	Zhang T, Xu Y, Ren J, et al. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health, 2017, 16(1): 42.
33.	Qu R, Ma Y, Zhang Z, et al. Increasing burden of colorectal cancer in China. Lancet Gastroenterol Hepatol, 2022, 7(8): 700.
34.	Xu L, Zhao J, Li Z, et al. National and subnational incidence, mortality and associated factors of colorectal cancer in China: a systematic analysis and modelling study. J Glob Health, 2023, 13: 04096.
35.	Cai SR, Huang YQ, Zhang SZ, et al. Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results. BMC Cancer, 2019, 19(1): 47.
36.	Papadakos JK, Hasan SM, Barnsley J, et al. Health literacy and cancer self-management behaviors: a scoping review. Cancer, 2018, 124(21): 4202-4210.
37.	方巧林, 张海波. 中国居民健康素养研究进展. 健康教育与健康促进, 2022, 17(6): 602-606.
38.	Takahashi K, Nakamura S, Watanabe K, et al. Availability of financial and medical resources for screening providers and its impact on cancer screening uptake and intervention programs. Int J Environ Res Public Health, 2022, 19(18): 11477.
39.	《健康中国行动: 癌症防治实施方案(2019-2022)》. 2023.https://www.gov.cn/gongbao/content/2020/content_5483906.htm.
40.	《“健康中国2030”规划纲要》. 2016.https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm?eqid=8f41987b002a7e4a000000026471aa44.
41.	Cao M, Li H, Sun D, et al. Cancer screening in China: the current status, challenges, and suggestions. Cancer Lett, 2021, 506: 120-127.
42.	Li Y, Lv X, Liang J, et al. The development and progress of health literacy in China. Front Public Health, 2022, 10: 1034907.
43.	Chen ZH, Lin L, Wu CF, et al. Artificial intelligence for assisting cancer diagnosis and treatment in the era of precision medicine. Cancer Commun (Lond), 2021, 41(11): 1100-1115.
44.	Huang RL, Liu Q, Wang YX, et al. Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study. BMJ Open, 2021, 11(7): e045168.
45.	Wang W, Yin P, Liu YN, et al. Mortality and years of life lost of colorectal cancer in China, 2005-2020: findings from the national mortality surveillance system. Chin Med J (Engl), 2021, 134(16): 1933-1940.
46.	Moutel G, Duchange N, Lièvre A, et al. Low participation in organized colorectal cancer screening in France: underlying ethical issues. Eur J Cancer Prev, 2019, 28(1): 27-32.
47.	The Lancet Gastroenterology Hepatology None. USPSTF recommends expansion of colorectal cancer screening. Lancet Gastroenterol Hepatol, 2021, 6(1): 1.
48.	Wan S, Chen Y, Xiao Y, et al. Spatial analysis and evaluation of medical resource allocation in China based on geographic big data. BMC Health Serv Res, 2021, 21(1): 1084.
49.	He S, Li H, Cao M, et al. Geographic, demographic, and socioeconomic disparities and factors associated with cancer literacy in China: national cross-sectional study. JMIR Public Health Surveill, 2023, 9: e43541.
50.	Sonnenberg A. Iconography : Cost-effectiveness in the prevention of colorectal cancer. Arquivos Brasileiros De Cardiologia, 2001, 77(5): 439-452.
51.	Ryan-Harshman M, Aldoori W. Diet and colorectal cancer: review of the evidence. Can Fam Physician, 2007, 53(11): 1913-1920.
52.	Jensen BW, Gamborg M, Gögenur I, et al. Childhood body mass index and height in relation to site-specific risks of colorectal cancers in adult life. Eur J Epidemiol, 2017, 32(12): 1097-1106.
53.	Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol, 2015, 16(1): 36-46.
54.	Chan DS, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One, 2011, 6(6): e20456.
55.	Pham NM, Mizoue T, Tanaka K, et al. Meat consumption and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol, 2014, 44(7): 641-650.
56.	Vieira AR, Abar L, Chan DSM, et al. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol, 2017, 28(8): 1788-1802.
57.	Aune D, Lau R, Chan DS, et al. Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology, 2011, 141(1): 106-118.
58.	Ubago-Guisado E, Rodríguez-Barranco M, Ching-López A, et al. Evidence update on the relationship between diet and the most common cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: a systematic review. Nutrients, 2021, 13(10): 3582.
59.	Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ, 2011, 343: d6617.
60.	Arayici ME, Mert-Ozupek N, Yalcin F, et al. Soluble and insoluble dietary fiber consumption and colorectal cancer risk: a systematic review and meta-analysis. Nutr Cancer, 2022, 74(7): 2412-2425.
61.	Yu Y, Jing X, Li H, et al. Soy isoflavone consumption and colorectal cancer risk: a systematic review and meta-analysis. Sci Rep, 2016, 6: 25939.
62.	Zhu B, Sun Y, Qi L, et al. Dietary legume consumption reduces risk of colorectal cancer: evidence from a meta-analysis of cohort studies. Sci Rep, 2015, 5: 8797.
63.	Kikuchi N, Nishiyama T, Sawada T, et al. Perceived stress and colorectal cancer incidence: the Japan Collaborative Cohort Study. Sci Rep, 2017, 7: 40363.
64.	Kroenke CH, Bennett GG, Fuchs C, et al. Depressive symptoms and prospective incidence of colorectal cancer in women. Am J Epidemiol, 2005, 162(9): 839-848.
65.	Galli F, Scotto L, Ravenda S, et al. Personality factors in colorectal cancer: a systematic review. Front Psychol, 2021, 12: 590320.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024 Apr 4.
2. 郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.
3. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
4. Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut, 2023, 72(2): 338-344.
5. Liu Y, Rao K, Wu J, et al. China’s health system performance. Lancet, 2008, 372(9653): 1914-1923.
6. Doubeni CA, Major JM, Laiyemo AO, et al. Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence. J Natl Cancer Inst, 2012, 104(18): 1353-1362.
7. Aarts MJ, Lemmens VE, Louwman MW, et al. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer, 2010, 46(15): 2681-2695.
8. Carethers JM, Doubeni CA. Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies. Gastroenterology, 2020, 158(2): 354-367.
9. Fang JY, Zheng S, Jiang B, et al. Consensus on the prevention, screening, early diagnosis and treatment of colorectal tumors in China: chinese society of gastroenterology, October 14-15, 2011, Shanghai, China. Gastrointest Tumors, 2014, 1(2): 53-75.
10. Li S. Understanding the ‘Chinese consensus on screening, early diagnosis, early therapy, and prevention for colorectal cancer and adenoma'. Chinese Journal of Gastroenterology, 2012, 17(5): 257-259.
11. 陈万青, 曹毛毛. 加强癌症早诊早治, 实施健康中国战略. 中国肿瘤, 2019, 28(9): 643-645.
12. 陈万青, 李霓, 石菊芳, 等. 中国城市癌症早诊早治项目进展. 中国肿瘤, 2019, 28(1): 23-25.
13. Sandouk F, Al Jerf F, Al-Halabi MH. Precancerous lesions in colorectal cancer. Gastroenterol Res Pract, 2013, 2013: 457901.
14. Dove-Edwin I, Thomas HJ. Review article: the prevention of colorectal cancer. Aliment Pharmacol Ther, 2001, 15(3): 323-336.
15. Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer, 2018, 119(7): 785-792.
16. Programme UND. The rise of the South : human progress in a diverse world. The rise of the South : human progress in a diverse world; 2013.
17. Rabeneck L, Chiu HM, Senore C. International perspective on the burden of colorectal cancer and public health effects. Gastroenterology, 2020, 158(2): 447-452.
18. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut, 2017, 66(4): 683-691.
19. Harris R, Sawaya GF, Moyer VA, et al. Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U. S. preventive services task force. Epidemiol Rev, 2011, 33: 20-35.
20. Dobrow MJ, Hagens V, Chafe R, et al. Consolidated principles for screening based on a systematic review and consensus process. CMAJ, 2018, 190(14): E422-E429.
21. Goede SL, Rabeneck L, van Ballegooijen M, et al. Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. PLoS One, 2017, 12(3): e0172864.
22. Levin TR, Corley DA, Jensen CD, et al. Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population. Gastroenterology, 2018, 155(5): 1383-1391. e1385.
23. Rabeneck L, Tinmouth JM, Paszat LF, et al. Ontario’s ColonCancerCheck: results from Canada’s first province-wide colorectal cancer screening program. Cancer Epidemiol Biomarkers Prev, 2014, 23(3): 508-515.
24. Ponti A, Basu P, Ritchie D, et al. Key issues that need to be considered while revising the current annex of the European Council Recommendation (2003) on cancer screening. Int J Cancer, 2020, 147(1): 9-13.
25. Armaroli P, Villain P, Suonio E, et al. European code against cancer, 4th edition: cancer screening. Cancer Epidemiol, 2015, 39 Suppl 1: S139-S152.
26. Anttila A, Lönnberg S, Ponti A, et al. Towards better implementation of cancer screening in Europe through improved monitoring and evaluation and greater engagement of cancer registries. Eur J Cancer, 2015, 51(2): 241-251.
27. Basu P, Ponti A, Anttila A, et al. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer, 2018, 142(1): 44-56.
28. Senore C, Basu P, Anttila A, et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut, 2019, 68(7): 1232-1244.
29. Sung JJ, Ng SC, Chan FK, et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut, 2015, 64(1): 121-132.
30. Sarakarn P, Promthet S, Vatanasapt P, et al. Preliminary results: colorectal cancer screening using fecal immunochemical test (FIT) in a Thai population aged 45-74 years: a population-based randomized controlled trial. Asian Pac J Cancer Prev, 2017, 18(10): 2883-2889.
31. Chiu HM, Ching JY, Wu KC, et al. A risk-scoring system combined with a fecal immunochemical test is effective in screening high-risk subjects for early colonoscopy to detect advanced colorectal neoplasms. Gastroenterology, 2016, 150(3): 617-625. e613.
32. Zhang T, Xu Y, Ren J, et al. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health, 2017, 16(1): 42.
33. Qu R, Ma Y, Zhang Z, et al. Increasing burden of colorectal cancer in China. Lancet Gastroenterol Hepatol, 2022, 7(8): 700.
34. Xu L, Zhao J, Li Z, et al. National and subnational incidence, mortality and associated factors of colorectal cancer in China: a systematic analysis and modelling study. J Glob Health, 2023, 13: 04096.
35. Cai SR, Huang YQ, Zhang SZ, et al. Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results. BMC Cancer, 2019, 19(1): 47.
36. Papadakos JK, Hasan SM, Barnsley J, et al. Health literacy and cancer self-management behaviors: a scoping review. Cancer, 2018, 124(21): 4202-4210.
37. 方巧林, 张海波. 中国居民健康素养研究进展. 健康教育与健康促进, 2022, 17(6): 602-606.
38. Takahashi K, Nakamura S, Watanabe K, et al. Availability of financial and medical resources for screening providers and its impact on cancer screening uptake and intervention programs. Int J Environ Res Public Health, 2022, 19(18): 11477.
39. 《健康中国行动: 癌症防治实施方案(2019-2022)》. 2023.https://www.gov.cn/gongbao/content/2020/content_5483906.htm.
40. 《“健康中国2030”规划纲要》. 2016.https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm?eqid=8f41987b002a7e4a000000026471aa44.
41. Cao M, Li H, Sun D, et al. Cancer screening in China: the current status, challenges, and suggestions. Cancer Lett, 2021, 506: 120-127.
42. Li Y, Lv X, Liang J, et al. The development and progress of health literacy in China. Front Public Health, 2022, 10: 1034907.
43. Chen ZH, Lin L, Wu CF, et al. Artificial intelligence for assisting cancer diagnosis and treatment in the era of precision medicine. Cancer Commun (Lond), 2021, 41(11): 1100-1115.
44. Huang RL, Liu Q, Wang YX, et al. Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study. BMJ Open, 2021, 11(7): e045168.
45. Wang W, Yin P, Liu YN, et al. Mortality and years of life lost of colorectal cancer in China, 2005-2020: findings from the national mortality surveillance system. Chin Med J (Engl), 2021, 134(16): 1933-1940.
46. Moutel G, Duchange N, Lièvre A, et al. Low participation in organized colorectal cancer screening in France: underlying ethical issues. Eur J Cancer Prev, 2019, 28(1): 27-32.
47. The Lancet Gastroenterology Hepatology None. USPSTF recommends expansion of colorectal cancer screening. Lancet Gastroenterol Hepatol, 2021, 6(1): 1.
48. Wan S, Chen Y, Xiao Y, et al. Spatial analysis and evaluation of medical resource allocation in China based on geographic big data. BMC Health Serv Res, 2021, 21(1): 1084.
49. He S, Li H, Cao M, et al. Geographic, demographic, and socioeconomic disparities and factors associated with cancer literacy in China: national cross-sectional study. JMIR Public Health Surveill, 2023, 9: e43541.
50. Sonnenberg A. Iconography : Cost-effectiveness in the prevention of colorectal cancer. Arquivos Brasileiros De Cardiologia, 2001, 77(5): 439-452.
51. Ryan-Harshman M, Aldoori W. Diet and colorectal cancer: review of the evidence. Can Fam Physician, 2007, 53(11): 1913-1920.
52. Jensen BW, Gamborg M, Gögenur I, et al. Childhood body mass index and height in relation to site-specific risks of colorectal cancers in adult life. Eur J Epidemiol, 2017, 32(12): 1097-1106.
53. Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol, 2015, 16(1): 36-46.
54. Chan DS, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One, 2011, 6(6): e20456.
55. Pham NM, Mizoue T, Tanaka K, et al. Meat consumption and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol, 2014, 44(7): 641-650.
56. Vieira AR, Abar L, Chan DSM, et al. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol, 2017, 28(8): 1788-1802.
57. Aune D, Lau R, Chan DS, et al. Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology, 2011, 141(1): 106-118.
58. Ubago-Guisado E, Rodríguez-Barranco M, Ching-López A, et al. Evidence update on the relationship between diet and the most common cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: a systematic review. Nutrients, 2021, 13(10): 3582.
59. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ, 2011, 343: d6617.
60. Arayici ME, Mert-Ozupek N, Yalcin F, et al. Soluble and insoluble dietary fiber consumption and colorectal cancer risk: a systematic review and meta-analysis. Nutr Cancer, 2022, 74(7): 2412-2425.
61. Yu Y, Jing X, Li H, et al. Soy isoflavone consumption and colorectal cancer risk: a systematic review and meta-analysis. Sci Rep, 2016, 6: 25939.
62. Zhu B, Sun Y, Qi L, et al. Dietary legume consumption reduces risk of colorectal cancer: evidence from a meta-analysis of cohort studies. Sci Rep, 2015, 5: 8797.
63. Kikuchi N, Nishiyama T, Sawada T, et al. Perceived stress and colorectal cancer incidence: the Japan Collaborative Cohort Study. Sci Rep, 2017, 7: 40363.
64. Kroenke CH, Bennett GG, Fuchs C, et al. Depressive symptoms and prospective incidence of colorectal cancer in women. Am J Epidemiol, 2005, 162(9): 839-848.
65. Galli F, Scotto L, Ravenda S, et al. Personality factors in colorectal cancer: a systematic review. Front Psychol, 2021, 12: 590320.

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