北京城区女性乳腺癌发病死亡和生存情况20年监测分析

目的 探讨北京城区乳腺癌发病率、死亡率及生存率的变化特点,为乳腺癌的预防与控制提供依据。方法 利用1982-2001年北京城区肿瘤登记报告资料,并结合1982年1月1日至1983年12月30日和1987年1月1日至1988年12月30日两个时期新发病例的随访资料,对北京城区女性乳腺癌的发病率、死亡率、生存率进行比较分析。结果 1982-2001年北京城区女性乳腺癌发病率及世界标准人口标化率呈逐年上升趋势,平均每年递增4．6％和4．9％。其流行特征：（1）年龄别发病率呈现一条由低到高的双峰曲线;（2）20年间各年龄组发病率均呈增高趋势;（3）35～64岁截缩发病率高达95．3／10万;（4）1982-1983年和1987-1988年两个时期相比,5年观察生存率（OSR）从62．0％上升到68．7％,相对生存率（RSR）由66．3％增长到74．2％;（5）20年间,死亡率一直在8／10万～10／10万的水平上波动。结论 北京城区女性乳腺癌发病率呈逐年上升的流行趋势,死亡率呈平稳状态,5年生存率在不断提高。北京市乳腺癌的二级预防是有效果的。     

国外肿瘤防治的现状和主要经验

（续１）１．２抓住关键环节,重点突破 癌症控制的总体目标是降低癌症发病率和死亡率,提高癌症的５年生存率,改善癌症患者的生存质量。美国癌症控制策略从预防和治疗两个方面着手,抓住一级预防（控烟、合理膳食）、普查（乳腺癌和宫颈癌）和治疗（及时推广研究成果）三个关键环节,重点突出控烟,在短期内成功地遏制了癌症发病率和死亡率上升的趋势。深入持久的控烟工作取得了显著效果：美国成人吸烟率由１９７１年的３７％下降到１９９４年的２５％,相应地,美国男性肺癌发病率自１９８４年起稳步下降,１９８３年至１９９５年间共下…     

2006－2013年江苏省昆山市居民结直肠癌发病与死亡趋势分析

目的：结直肠癌是影响居民健康的主要癌症之一,且发病率呈现明显上升趋势。本研究探讨江苏省昆山市2006－2013年结直肠癌发病与死亡趋势。方法江苏省昆山市2006－2013年结直肠癌发病和死亡病例来源于昆山市肿瘤登记报告;计算结直肠癌粗发病（死亡）率与发病（死亡）的年龄标化率（age standardized rate,ASR）;使用平均年度变化百分比（annual percent change,APC）及其95％CI,评价结直肠癌发病率和死亡率在年份之间变化趋势。结果江苏省昆山市2006－2013年结直肠癌发病 ASR 在女性人群中呈明显上升趋势,APC＝2．3％,95％CI 为0．5％～4．2％;结直肠癌发病率总体变化趋势（APC＝0．6％,95％ CI 为－0．8％～1．9％）与男性人群（APC＝－0．8％,95％ CI 为－3.5％～1．5％）差异无统计学意义。昆山市2006－2013年结直肠癌死亡 ASR 在总体（APC ＝－5．3％,95％CI 为－9．0％～－1．6％）和女性（APC ＝－9．1％,95％CI 为－16．2％～－2．0％）人群中呈下降趋势,差异有统计学意义;而男性人群中结直肠癌死亡 ASR 的变化差异无统计学意义,APC＝－2．1％,95％CI 为－6．2％～2．0％。结论虽然结直肠癌死亡率呈现下降趋势,但是结直肠癌发病数逐年增加。因结直肠癌造成的疾病负担逐年增加,在全人群中开展结直肠癌预防控制十分必要。     

北京市城区居民癌症患者生存率分析

目的：了解北京市地区癌症患者生存情况,为评价肿瘤诊治效果提供数据。方法：利用北京肿瘤登记处20世纪80年代所积累的肿瘤登记报告病例和随访资料,采用经曲寿命表法进行肿瘤生存率分析。结果：北京城区居民主要恶性肿瘤中,5年相对生存率最高的为女性乳腺癌（74．2％）,其次为结直肠癌（39．8－44．1％）,生存率较低的肿瘤是肺癌,食管癌（11．8－13．9％）,预后最差的是肝癌（3．4％－5．3％）,1982年－1983年与1987年－1988年两个时期的比较,各种主要肿瘤的生存率均有不同程度的提高。结论：北京市各种不同部位肿瘤患者中,除女性乳腺癌外,主要恶性肿瘤生存率普遍降低,但随着医疗诊治技术的改进,癌症患者的生成期不断在改善。     

天津市2008—2016年女性乳腺癌发病及死亡趋势分析

摘 要：［目的］ 分析天津市2008—2016年女性乳腺癌发病、死亡水平和变化趋势，为开展相关预防和研究工作提供参考。［方法］ 基于2008—2016年天津户籍居民肿瘤随访登记数据，计算女性乳腺癌发病率、死亡率、标化率和过早死亡损失寿命年（YLL）等指标，采用Joinpoint回归分析变化趋势。［结果］ 2008—2016年天津市共报告女性乳腺癌新发病例24 180例，占肿瘤新发病例的18.64%（居第2位），报告死亡病例4465例，占肿瘤死亡病例的7.30%（居第4位）；城乡标化发病率比为1.59∶1，标化死亡率比为1.56∶1。2008—2016年天津女性乳腺癌粗发病率（AAPC=5.50%）、标化发病率（AAPC=4.60%）均呈上升趋势（P<0.01）；粗死亡率（AAPC=3.50%）呈上升趋势，标化死亡率未有明显上升趋势（AAPC=1.60%，P>0.05）。2008—2016年天津城区乳腺癌发病率低年龄组增长较快，而死亡率高年龄组增长较快；农村地区乳腺癌发病率各年龄组增长均较快，死亡率以高年龄组增长为主。城区乳腺癌发病高峰在65~69岁年龄组，农村发病高峰在55~59岁年龄组。［结论］ 天津女性乳腺癌发病率仍处于快速上升期，但59岁以下死亡率未见明显上升趋势，乳腺癌防控和治疗取得了一定成效。应进一步开展健康干预和重点人群筛查等预防措施。     

江苏省海安县2004-2011年女性乳腺癌流行趋势分析

目的：研究海安县2004-2011年女性乳腺癌的发病率、死亡率及流行趋势。方法：根据海安县2004-2011年肿瘤登记报告数据库及人口资料,进行女性乳腺癌发病率、死亡率、累积率和截缩率分析,采用年变化率（annualpercentchange,APC）模型分析各种率的时间变化趋势。结果：海安县2004-2011年女性乳腺癌粗发病率、中国标化率、世界标化率分别为17．54／10万女性人口（以下发病或死亡率单位如此同,将其省略）、11．06／10^5和10．06／10^5;35～64岁截缩世标发病率和0h70岁累积发病率分别为31．61／10^5和1．06％,居女性恶性肿瘤全部发病病例的第5位。女性乳腺癌粗发病率、中国标化率和世界标化率APC分别为10．53％、7．40％和7．68％,其中粗发病率和世界标化率呈显著上升趋势,P值均do．01;中国标化率呈上升趋势,P〈0．05。女性乳腺癌粗死亡率、中国标化率和世界标化率分别为7,02／10^5、4．43／10^5和4．09／10^5;35～64岁截缩世标死亡率和0～70岁累积死亡率分别为9．59／10^5和0．45％。居女性恶性肿瘤全部死亡病例的第6位。女性乳腺癌粗死亡率、中国标化率和世界标化率APC分别为2．62％、1．83％和1．50％,死亡趋势相对稳定,P值均〉0．05。结论：海安县2004-2011年女性乳腺癌发病率增长趋势明显,死亡率变化趋势相对稳定。     

我国恶性肿瘤发病趋势

近几年心脑血管病和恶性肿瘤已占我同死因的前三位，约占死亡总数的60％。对比美国1985年和中国1986年调整死亡率的分布非常接近。恶性肿瘤发病率是根据上海、天津、启东等地材料，加上死亡率等估计出来的。以1985年与1980年对比，男性肺癌上升最快，增加了148．2％，总的发病率由6.4/10万上升到9.5/10万（上升104．7％），食管癌男性下降21．9％，女性下降17．1％宫颈癌下降44．59％。上海市从1980年起有较完整肿瘤登记资料。男性标化发病率稳中有降（从233．08／10万下降到209．60／10万），女性由于乳腺癌增加而变动不大（从145.23／10万…     

乳腺癌手术的乳房修复与重建

正自20世纪70年代末至今全球乳腺癌发病率一直呈上升趋势,位居女性恶性肿瘤首位。随着乳腺癌筛查项目和乳腺癌综合治疗的开展,20世纪90年代以来乳腺癌死亡率已出现下降趋势。乳腺癌的无病生存率和总生存率显著提高。面临乳腺癌患者生存期的延长,其身心健康日益受到人们的关注。传统的乳腺癌手术在治疗肿瘤的同时也破坏了     

局部晚期乳腺癌改良根治术后两种辅助放化疗模式的疗效与成本效果分析

目的：结合疗效从经济学角度对局部晚期乳腺癌改良根治术后 FEC －T 后程同步放疗和序贯放疗模式进行分析,为术后辅助治疗模式选择提供参考。方法：采用成本－效果分析对155例改良根治术后接受FEC －T 后程同步放疗或序贯放疗的局部晚期乳腺癌病例进行疗效评价及成本效果分析。结果：中位随访39个月。与序贯模式比较,后程同步放疗模式未增加不良反应;缩短平均治疗时间6．2周,改善3年无复发生存率（92．3％ vs 81．8％,P ＝0．046）,有改善3年的无疾病进展生存率和总生存率趋势;3年无疾病进展生存率的成本－效果比,后程同步模式为999．96元／％,序贯模式为1349．31元／％,增量成本－效果比为－889．38元／％。结论：改良根治术后 FEC －T 后程同步放疗模式及序贯放疗模式都具有良好耐受性及疗效。后程同步放疗模式有更好的疾病控制及成本－效果比,可作为局部晚期乳腺癌的改良根治后辅助治疗模式的良好选择。     

70例卵巢癌的诊治分析

卵巢癌的发病率一向认为仅次于宫颈癌与子宫体癌[1]，占妇科恶性肿瘤的第三位，近30年来发病率增加了2－3倍[2]，且有继续增长的趋势。死亡率已超过宫颈癌与宫体癌死亡率之和，占妇科肿瘤的首位。70％以上的病人就诊已属晚期（Ⅲ、Ⅳ期），5年生存率仍在30％－40％之间徘徊。回顾我们已治疗过的70例卵巢癌，旨在探索卵巢癌有效的治疗方法，以提高生存率。临床资料一、年龄与生育：本组70例，最小年龄8岁，最大年龄70岁，平均年龄49岁。未婚未育8例、已婚未育1例。二、症状与体征：主要症状为腹腔胀满、疼痛，发现腹部肿块，少数为排尿排便困…     

乳腺癌改良根治术后复发高危患者的放疗结果和预后因素分析

目的 总结本院高危乳腺癌患者改良根治术后的治疗结果,探讨放疗的作用和照射野的选择,并对生存预后因素进行分析.方法 回顾性分析381例T_3～T_4期和(或)腋窝淋巴结转移数≥4个的改良根治术后乳腺癌患者临床资料.用Kaplan-Meier法计算生存率,并Logrank法检验.单因素分析临床病理和治疗因素对生存率的影响,多因素分析用Cox回归模型.结果 中位随访时间为48个月.总5年无局部区域复发率为89.7%、总生存率为76.8%.放疗显著提高5年无局部区域复发生存率(93.4%:77.1%,χ~2=19.95,P=0.000)和总生存率(80.9%:62.3%,χ~2=15.47,P=0.001).胸壁和锁骨上区域照射能提高患者的5年无胸壁复发生存率(96.8%:86.2%;χ~2=12.66,P=0.001)和无锁骨上淋巴结复发生存率(97.7%:90.7%,χ~2=9.98,P=0.002),腋窝照射对5年无腋窝复发生存率无影响(98.4%:96.1%,χ~2=0.74,P=0.389).多因素分析显示未放疗(χ~2=14.42,P=0.000)、腋窝淋巴结阳性数≥10个(χ~2=21.60,P=0.000)和T_4期(χ~2=10.79,P=0.001)是总生存率的独立不良预后因素.结论 T_3～T_4期和(或)腋窝淋巴结转移数≥4个乳腺癌患者改良根治术后放疗显著降低局部复发率和提高总生存率,照射部位可选择同侧胸壁和锁骨上淋巴结引流区.     

局部晚期乳腺癌新辅助化疗和改良根治术后放疗价值分析

目的 分析局部晚期乳腺癌患者neoCT和改良根治术后放疗的价值,以及探讨能否根据化疗疗效进行个体化放疗。 方法 选取本院1999—2013年收治的临床Ⅲ_A、Ⅲ_B期乳腺癌病例,完成neoCT和改良根治术的 523例纳入分析,其中 404例术后行放疗,119例未行放疗。用Kaplan-Meier法计算复发率和生存率,Logrank法单因素预后分析,Cox模型多因素预后分析。 结果 放疗组患者 5年LRR显著低于未放疗组(13.9%∶24.8%,P=0.013),DFS显著高于未放疗组(64.1%∶53.9%,P=0.048),OS相近(83.2%∶78.2%,P=0.389)。ypT₃—T₄、ypN₂—N₃以及病理Ⅲ期亚组中放疗患者 5年LRR显著低于未放疗患者(P<0.05),放疗患者 5年OS显著高于未放疗患者(P<0.05)。158例ypN₀期放疗患者 5年LRR显著低于未放疗患者(P=0.004)。41例ypCR患者仅 2例LRR,均未放疗。多因素分析显示放疗是影响全组及ypN₀期患者LRR的因素。 结论 放疗显著降低临Ⅲ_A、Ⅲ_B期乳腺癌neoCT和改良根治术后患者LRR,同时降低ypT₃—T₄、ypN₂—N₃和病理Ⅲ期亚组患者复发率、死亡率。目前尚无充足证据可以根据化疗反应免除ypN₀期和pCR患者术后放疗。     

Risk Factors and Control Strategies for the Rapidly Rising Rate of Breast Cancer in Korea

Due to the aging population and tremendous changes in life style over the past decades, cancer has been the leading cause of death in Korea. The incidence rate of breast cancer is the second highest in Korea, and it has shown an annual increase of 6.8% for the past 6 years. The major risk factors of breast cancer in Korean women are as follows: Early menarche, late menopause, late full-term pregnancy (FTP), and low numbers of FTP. Height and body mass index increased the risk of breast cancer in postmenopausal women only. There are ethnic variations in breast cancer due to the differences in genetic susceptibility or exposure to etiologic agent. With the epidemiological evidences on the possibility of further increase of breast cancer in Korea, the Korean Government began implementing the National Cancer Screening Program against breast cancer in 2002. Five-year survival rates for female breast cancer have improved significantly from 78.0% in early 1993-1995 to 90.0% in 2004-2008. This data indicate that improvement of the survival rate may be partially due to the early diagnosis of breast cancer as well as the increased public awareness about the significance of early detection and organized cancer screening program. The current primary prevention programs are geared towards strengthening national prevention campaigns. In accordance with the improvement in 5-year survival rate, the overall cancer mortality has started to decrease. However, breast cancer death rate and incidence rates are still increasing, which need further organized effort by the Korean Government.     

Evaluation of recent trends in cancer mortality and incidence among blacks

Recent trends in the cancer incidence, mortality, and 5-year survival rate for the black population were evaluated using the available national data up to 1981. Blacks have the highest overall age-adjusted cancer rates in both incidence and mortality of any US population group. The overall cancer incidence rates for blacks rose 17%, while for whites it increased 13% from 1969 to 1981. The rate in black men has increased 22.9%, while the rate in black women has increased 13.1%. The overall increase is the result of increases in cancers of the lung, prostate, colon-rectum, and esophagus. The age-specific incidence of lung cancer reflects the decrease of its incidence in those between 20 and 40 years of age because of the change in smoking habits after the Surgeon General's report on smoking. The overall cancer mortality rates for blacks increased 39% during the period. Lung cancer had the highest mortality rate, having increased more than 77.8% since 1969. This trend greatly reflects the recent increase in lung cancer incidence among black women. The overall 5-year cancer survival pattern for blacks was almost unchanged from 1973 to 1981, while whites had slightly higher survival rates during this period. However, blacks had substantial increases in survival rates for cancers of the esophagus and bladder during the period.     

Analysis of the indicence and Survival of Female Breast Cancer Patients in Beijing Over a 20-Year Period

A bout 30-years of information concerning cancer morbidity and mortality has been collected by the Cancer Registration Office of Beijing since its establishment in 1976. The information suggested that lung cancer and female breast cancer (FBC) are relativ…     

双侧原发性乳腺癌临床与预后分析

目的探讨双侧原发性乳腺癌(BPBC)的临床病理特点及预后。方法收集217例BPBC患者的临床病理与随访资料,着重分析BPBC的发生率、发病年龄、间隔时间和生存率。结果BPBC的发生率为2．1％,同时性双侧原发性乳腺癌(sBPBC)和异时性双侧原发性乳腺癌(mBPBC)的发病高峰年龄均为48岁左右,大多在绝经前发病。mBPBC中位间隔时间为57．6个月。sBPBC与mBPBC患者的中位生存时间分别为29．6个月和27．8个月,生存率差异无显著性。绝经状态与BPBC患者的生存率无关。结论sBPBC与mBPBC发病高峰年龄相同。BPBC患者的预后分析应以第2癌为起点计算。BPBC比单侧原发性乳腺癌患者的预后差,sBPBC与mBPBC患者预后相同,且不受绝经状态影响。一侧乳腺癌术后应密切随诊,尤其是在第1癌发生后的5年内,以早期发现第2侧乳腺癌。     

A comparison of trends in incidence and mortality rates of breast cancer, incidence to mortality ratio and stage at diagnosis between Arab and Jewish women in Israel, 1979-2002.

In Israel, breast cancer is the most common malignancy in women, but there are large intra-population differences. The aim of this study was to compare the incidence and mortality, incidence to mortality rate ratio and stage at diagnosis of breast cancer between Arab and Jewish women in Israel. Data on all cases of breast cancer, stage at diagnosis and mortality were obtained from the National Cancer Registry and the Central Bureau of Statistics. Trends in age-specific and age-adjusted incidence and mortality rates, rate ratios and stage at diagnosis were examined for Arab and Jewish women during 1979-2002. Five-year survival rates for 1995-1999 were compared by stage. Among Arab women, age-adjusted incidence rates increased by 202.1%, from 14.1 per 100,000 in 1979-1981 to 42.6 in 2000-2002. Among Jewish women, the rates increased by 45.7%, from 71.1 per 100,000 women in 1979-1981 to 103.6 in 2000-2002. Incidence to mortality rate ratio increased for both population groups, but it is still lower among Arab women. In every age group, Arab women were more likely to be diagnosed at a more advanced stage of the disease. The rise in breast cancer incidence and mortality rates and the later stage of diagnosis among Arab women emphasize the urgent need for increasing early detection of breast cancer in the Arab population by improving rates of compliance with screening mammography.     

Patterns of Disparity: Ethnic and Socio-economic Trends in Breast Cancer Mortality in New Zealand

Objective To test whether trends in breast cancer mortality varied by ethnicity and socio-economic position during the 1980s and ‘90s in New Zealand. Methods Four cohorts of the entire New Zealand population for 1981–84; 86–89; 91–94 and 96–99 allowed direct determination of socio-economic trends in breast cancer mortality. For ethnicity, unlinked routine census and mortality data were used with adjustment factors for undercounting of Māori and Pacific deaths. Results Māori and non-Māori non-Pacific mortality rates changed little until mid-1990s with Māori experiencing 25% higher mortality. In 1996–99, Māori rates increased notably to become 68% higher than non-Māori non-Pacific (SRR 1.68; 95% CI: 1.49–1.90). Pacific women experienced an approximate three-fold increase in breast cancer mortality over time. There appeared to be reducing mortality among higher income and education groups but trends within socio-economic groups were not statistically significant. Nevertheless, by 1996–99, there was a significant 22% excess mortality (SRR 1.22; 95% CI: 1.01–1.49) for low compared with high-income groups. Conclusions Widening ethnic, and probably, socio-economic disparities in breast cancer mortality are likely due to both underlying incidence and differential survival trends. Disparities are likely to increase once the full differential mortality benefits of screening impact on the population.