2009年中国肿瘤疾病负担和城乡差异分析

目的 肿瘤目前已成为世界性重大公共卫生问题,其造成的疾病负担已明显高于其他疾病.本研究通过计算肿瘤早死所致生命损失年(years of life lost,YLL)反映其造成的疾病负担,分析中国肿瘤疾病负担及城乡差异,为中国肿瘤防治工作提供一定依据.方法 采用2012年《中国肿瘤登记年报》中的数据,包括性别、年龄、城乡间肿瘤发病死亡率以及相应人口数,计算YLL、YLL率及平均减寿年数(average years of life lost,AYLL).采用ICD-10将各肿瘤分类.结果 2009年中国肿瘤造成的AYLL为9.42年/人,城市为8.84年/人,农村为10.33年/人.YLL男性高于女性,随年龄增长先增后减,城市与农村男女各自出现交叉后城市YLL反高于农村.2009年中国城市肺癌造成的YLL所占比例最高,为24.2％.农村肿瘤YLL中肝癌占比例最高,为21.7％.2009年中国城市和农村肿瘤死因顺位不同,除农村男性外(肝癌最高为10.50‰),其余居首位的均是肺癌(城市,男为5.29‰,女为2.40‰;农村,女为2.23‰).肺癌、肝癌和胃癌YLL有城乡差异,肺癌影响年龄范围较大(35～80岁);肝癌是较年轻化的肿瘤(YLL 25岁时便有增长趋势),其造成的AYLL农村和城市均为最高(城市12.13年/人,农村12.87年/人);农村男性胃癌造成的YLL在所有人群中最高.结论 肿瘤所造成的YLL与年龄、性别均有相关,且有城乡差异.肺癌影响人群范围最广,肝癌造成的AYLL最高.肿瘤疾病负担呈现农村高于城市,男性高于女性,政府应制定有针对性的措施,合理利用卫生资源,减少早死对人类和社会造成的负担.     

Socio-economic class differences in cancer incidence in cali,Colombia

Based on census tract information, cancer incidence rates for three socio-economic strata of the city of Cali, Colombia, were calculated. Strong negative associations with socio-economic status were found for cancers of the cervix and stomach. Colon cancer and endocrine-related cancers were positively associated with socio-economic status, while no such association was found for rectal cancer. Contrary to data from developed countries, all smoking-related cancers were positively associated with socio-economic class. The role of socio-economic gradients in developing countries is stressed as a basis for etiological research.     

Gender differences in pain, fatigue, and depression in patients with cancer

A quick review of virtually any research topic documents the pervasiveness of sex and gender bias throughout all of science. A large portion of both animal and human research has been, and continues to be, done primarily with male subjects. This gender bias influences research results and often leads to inappropriate and questionable generalizations of research findings, usually from studies done with male participants to females. Needless to say, this bias exists in symptom management research on pain, fatigue, and depression in patients with cancer. This article reviews the evidence from the studies on gender differences in pain, fatigue, and depression in patients with cancer. It should be noted that research studies on gender differences in cancer-related pain, fatigue, and depression are minimal in number, are restricted to studies of the differences in prevalence rates and severity scores, and for the most part have yielded inconsistent results. Additional investigations are warranted to determine whether the gender differences in prevalence rates and severity of these symptoms represent clinically meaningful differences. If these gender differences are substantiated, these findings will guide the design of studies to elucidate the underlying mechanisms for these differences, as well as the development and testing of gender specific interventions to treat cancer-related pain, fatigue, and depression.     

Gender differences in UVB-induced skin carcinogenesis, inflammation, and DNA damage

The American Cancer Society reports the incidence of squamous cell carcinoma in males to be thrice the incidence in females. This increased squamous cell carcinoma incidence has been attributed to men accumulating more sun exposure and using less sun protection than women. To date, there have been no controlled studies examining the effect of gender on skin tumor development following equal doses of UVB. Gender differences in UVB-induced skin carcinogenesis were examined using the Skh-1 mouse model. After chronic exposure to equal doses of UVB, male mice developed tumors earlier and had more tumors than female mice; tumors in male mice tended to be larger, and the total tumor burden was greater than in females. In addition, tumors in males were of more advanced histologic grade compared with those of female mice. To evaluate the contribution of differences in inflammation and DNA damage to differences in skin carcinogenesis, male and female Skh-1 mice were exposed once to 2,240 J/m(2) UVB and examined 48 h after exposure. Surprisingly, male mice developed less of an inflammatory response, as determined by skin fold thickness and myeloperoxidase activity, compared with females. Interestingly, male mice showed more cutaneous oxidative DNA damage than the females and lower antioxidant levels. These results show a gender bias in skin carcinogenesis and suggest that the gender difference in tumor development is more influenced by the extent of oxidative DNA damage and antioxidant capacities than by inflammatory response.     

Strain and sex differences in N-nitrosohexamethyleneimine carcinogenesis in NZB, NZC, NZO, and NZY mice

The carcinogenic activity of N-nitrosohexamethyleneimine [(NHEX) CAS: 932-83-2; hexahydro-1-nitroso-1H-azepine] was studied in male and female mice of the four inbred strains NZB/BlGd, NZC/BlGd, NZO/BlGd, and NZY/BlGd. A total of 158 mice received NHEX treatment; 1,338 untreated controls were used, all kept under identical laboratory conditions for their natural life-spans. Beginning at age 50 days a 1.56-mM NHEX solution (200 mg/liter) was given instead of drinking water for 8 weeks, which resulted in nearly the same total dosage of 0.7 +/- 0.04 g or 5.7 +/- 0.2 mmol NHEX/kg body weight in both sexes of all four strains. In both sexes of all four strains the main types of tumors after NHEX treatment were squamous papillomas and carcinomas of the esophagus, squamous stomach, and oropharynx and hepatocellular carcinomas. Tumors of the hepatic bile ducts, glandular stomach, and lung and malignant lymphomas were also induced by NHEX, but these tumors had a predilection for certain strains only. The incidences of other tumors characteristic of the untreated mice in each particular strain, such as tumors of the ovary in NZC, tumors of the breast in NZY, and tumors of the duodenum in NZO, were not increased significantly by NHEX treatment. The incidence of main tumor types in NHEX-treated mice varied greatly between strains, e.g., esophageal papillomas and carcinomas in 81% of male NZC versus 32% in male NZB mice. Some marked sex differences also emerged in NHEX-treated animals, e.g., the occurrence of liver angiosarcomas only in males of three strains and the 53% incidence of hepatocellular tumors in male NZY mice compared to the absence of liver tumors in female NZY mice.     

Age, gender, and racial differences in incidence and survival in primary CNS lymphoma

Background:

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that accounts for ∼4% of newly diagnosed central nervous system (CNS) tumours. The objective of this study was to analyse the epidemiology, incidence, and outcome of these rare tumours.

Methods:

Primary brain and CNS lymphoma cases were identified from the Surveillance, Epidemiology, and End Results (SEER) research data sets for the years 1980–2008 for analysis of trends in incidence and survival. SEER^*Stat v. 7.0.4 software was used to analyse the data.

Results:

The overall incidence rate of PCNSL was 0.47 per 100 000 person-years. The incidence was significantly higher in males compared with females, blacks aged 0–49 years at diagnosis compared with whites, and whites aged 50 years and older at diagnosis compared with blacks. After a significant decline in incidence between 1995 and 1999, incidence rates rose slightly; those aged 75+ years at diagnosis had the most dramatic increase in incidence rates over time. Five-year survival rates were significantly higher in whites compared with blacks aged 0–49 years at diagnosis, but was primarily driven by white women aged 0–49 years.

Conclusion:

There is an increase in incidence of PCNSL in the elderly, and elderly blacks have lower incidence compared with white population. Survival remains poor and is negatively dominated by factors associated with HIV infection and advanced age.     

Cancer survival increases in Europe, but international differences remain wide

The EUROCARE project analysed cancer survival data from 45 population-based cancer registries in 17 European countries, revealing wide international differences in cancer survival. We calculated 5-year relative survival for 1836287 patients diagnosed with one of 13 cancers during the period 1978-1989. The data, from 20 cancer registries in 13 countries, were grouped into four regions: Finland, Sweden, Iceland (Northern Europe); Denmark, England and Scotland (UK and Denmark); France, The Netherlands, Germany, Italy and Switzerland (Western Europe); Estonia and Poland (Eastern Europe), and broken down into four periods (1978-1980, 1981-1983, 1984-1986, 1987-1989). For each cancer, mean European and regional survival was estimated as the weighted mean of 5-year relative survival in each country. Survival increased with time for all tumours, particularly for cancers of testis (12% increase, i.e. from 79.9 to 91.9%), breast, large bowel, skin melanoma (approximately 9-10%), and lymphomas (approximately 7%). For most solid tumours, survival was highest in Northern Europe and lowest in Eastern Europe, and also low in the UK and Denmark. Regional variation was less marked for the lymphomas. Survival improved more in Western than Northern Europe, and the differences between these regions fell for bowel cancer (from 8.0% for those diagnosed in 1978-1980 to 2% for those diagnosed in 1987-1989), breast cancer (from 7.4% to 3.9%), skin melanoma (from 13.4% to 11.0%) and Hodgkin's disease (from 7.2 to 0.6%). For potentially curable malignancies such as Hodgkin's disease, large bowel, breast and testicular cancers, there were substantial increases in survival, suggesting an earlier diagnosis and more effective treatment. The persisting regional differences suggest there are corresponding differences in the availability of diagnostic and therapeutic facilities, and in the effectiveness of healthcare systems.     

21-Gene recurrence scores: racial differences in testing, scores, treatment, and outcome

BACKGROUND:

African American (AA) women experience higher breast cancer mortality than white (W) women. These differences persist even among estrogen receptor (ER)‐positive breast cancers. The 21‐gene recurrence score (RS) predicts recurrence in patients with ER‐positive/lymph node‐negative breast cancer according to RS score—low risk (RS, 0‐18), intermediate risk (RS, 19‐31), and high risk (RS, >31). The high‐risk group is most likely to benefit from chemotherapy, to achieve minimal benefit from hormonal therapy, and to exhibit lower ER levels (intrinsically luminal B cancers). In the current study, the authors investigated racial differences in RS testing, scores, treatment, and outcome.

METHODS:

Tumor registry data from 3 Atlanta hospitals identified women who were diagnosed with breast cancers during 2005 through 2009. Medical record abstraction provided information on RS and other tumor/treatment factors. Statistical analyses used chi‐square/exact tests and logistic regression.

RESULTS:

Of 2186 patients, including 1192 AA women and 992 W women, 853 women had stage I or II, ER‐positive/lymph node‐negative disease and, thus, were eligible for RS testing (AA = 372 [31.2%]; W = 481 [48.5%]; P < .0001); and 272 women (31.8%) received testing (AA = 76 [20.4%]; W = 196 [40.7%]; P < .0001). Tumors were distributed into the following groups according to risk: low risk (n = 133), medium risk (n = 113), and high risk (n = 26). The mean RS did not differ by race, but risk groups did (low‐risk group: 46.1% vs 50% for AA women and W women, respectively; high‐risk group: 15.8% vs 7.1%, respectively; P = .043). In multivariate analyses, AA race (odds ratio, 3.6) was associated independently with high risk scores.

CONCLUSIONS:

AA women were half as likely as W women to receive 21‐gene RS testing but were 2‐fold more likely to be categorized as high risk. The current data suggested that testing guidelines are not applied equivalently, testing bias may attenuate racial differences in RS, and disparate outcomes may be explained in part by differences in RS, although compliance and pharmacogenomics also may play a role. Cancer 2012;. © 2011 American Cancer Society.     

Lung cancer in women: exploring sex differences in susceptibility, biology, and therapeutic response

Src tyrosine kinases regulate a large number of important mechanisms in normal and cancerous cells, are overexpressed in a broad range of tumors including lung cancer, and thus represent a potential target for cancer therapy. Preclinical experiments indicate that small-molecule inhibitors of Src block tumor growth, metastasis, and angiogenesis. Phase I data from healthy volunteers also suggest that inhibitors of Src prevent bone resorption. Several phase II trials with small-molecule inhibitors of Src are under way or have been initiated in lung cancer and in other malignancies, as discussed herein.     

Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population

BACKGROUND: Low-income, minority, and rural women face a greater burden with regard to cancer-related morbidity and mortality and are usually underrepresented in cancer control research. The Robeson County Outreach, Screening and Education Project sought to increase mammography use among low-income, minority, and rural women age > 40 years. The current article reports on racial disparities and barriers to screening, especially those related to knowledge, attitudes, and behaviors. METHODS: A baseline survey was administered to 897 women age > 40 years who lived in rural Robeson County in North Carolina. The sample consisted of three principal racial groups: whites, African Americans, and Native Americans. Survey comparisons were made among racial groups with respect to knowledge, attitudes, and behaviors regarding breast and cervical carcinoma screening. RESULTS: Overall, Native American and African-American women had lower levels of knowledge, more inaccurate beliefs, and more barriers to screening compared with white women. Among the notable findings were that 43% of the patient population did not mention mammograms and 53% did not mention Pap smears as breast and cervical carcinoma screening tests, respectively; furthermore, compared with white women, significantly fewer African-American and Native American women mentioned these tests (P < 0.001). Sixty-seven percent of all women reported that a physician had never encouraged them to receive a mammogram, although 75% reported having received a regular checkup in the preceding year. CONCLUSIONS: Although all low-income rural women experienced significant barriers to receiving cancer screening tests, these barriers were more common for minority women compared with white women. More research is needed to identify ways to overcome such barriers, especially among Native American women. The results of the current study have important implications with respect to the designing of interventions aimed at improving cancer screening for all women.     

Hospital differences in patient satisfaction with care for breast, colorectal, lung and prostate cancers

BackgroundWe have investigated cancer patient satisfaction with care and the extent to which it varies between and within hospitals.Design and methodsA national survey of cancer patients in England with questions in 10 different dimensions for four common cancers: breast, colorectal, lung and prostate (55,674 patients). We compared hospitals across tumour types, and against the national average.ResultsDissatisfaction was greater (p < 0.001) in younger, female patients. Breast cancer patients expressed least, and prostate cancer patients expressed greatest dissatisfaction. Breast, colorectal and prostate cancers showed significant (p < 0.001) pair-wise correlations for standardised satisfaction scores, particularly for in-hospital care. Summed hospital satisfaction scores showed significant associations across different dimensions of care.ConclusionsCancer patient satisfaction is measurably different between hospitals, as well as by tumour type. For many aspects of care there is evidence of systemic hospital-level factors that influence satisfaction as well as factors common to the care pathways experienced by individual patients. Factors amenable to clinical or managerial intervention deserve further investigation.     

Ethnic differences in prostate cancer

Background:

It is recognised that the risk of prostate cancer is higher in black men than in white men worldwide. Recent studies suggest that a number of genetic mutations in black men predispose them to this disease; hence, race as well as environmental factors such as diet and migration are thought to be the determining factors.

Methods:

This review compares data from the United States (US), which suggest that African-American men have a 60% higher risk for developing prostate cancer with poorer prognosis in comparison with their white counterparts, with similar studies carried out in the United Kingdom (UK) and also in African and Caribbean countries.

Conclusions:

Studies from the United States and the United Kingdom came to significantly different conclusions, and this has implications for policy development, awareness raising among black men in each country and clinical practice.     

Racial differences in lung cancer

Although race, in and of itself, is not a relevant biologic variable, racial differences in disease characteristics and outcomes have been reported in many malignancies, including lung cancer. The lung cancer incidence rate in blacks has been consistently higher than that in whites for many years. This racial disparity is seen primarily in men and is significantly greater in younger age groups. The reason for higher lung cancer incidence rates in blacks remains unclear, but racial differences in smoking habits, socioeconomic variables, and the metabolism of tobacco carcinogens may all play an important role. Blacks are also more likely than whites to present with squamous cell carcinoma and with advanced-stage disease. A significant racial difference in survival rates has developed over the past 30 years, with a poorer prognosis noted in black patients, particularly those with local- and regional-stage disease. This disparity appears to be due to a lack of improvement in the survival of black patients with lung cancer, but the biological and/or societal basis for racial variations in survival have not been determined. In summary, significant racial differences exist in lung cancer incidence and survival rates. Further research is required to determine the factors responsible for these differences and to develop effective preventative and therapeutic interventions that will impact favorably on the incidence and prognosis of this disease.     

Pediatric brain tumors in Non-Hispanics,Hispanics, African Americans and Asians: differences in survival after diagnosis

Background Racial differences in survival for children with brain tumors have not been well studied, particularly in Hispanics and Asians. The objective of this study was to assess racial differences in survival of children with brain tumors, focusing on Hispanics, African Americans and Asians compared to Non-Hispanics.Methods Subjects identified through the SEER Program were 2799 children, ≤19 years old at diagnosis, newly diagnosed between 1973 and 1996 with primary, malignant brain tumors. Chi-square tests were used to evaluate prognostic variables by race. Kaplan–Meier models and Cox proportional hazards models were used to assess racial differences in overall survival and in survival by histological type of tumor.Results The distribution histological type of tumor varied significantly by race. Overall survival was similar for Hispanics, African Americans, Asians compared to Non-Hispanics, although trends of increased risk of death for the minority groups were noted when stratifying by histological type of tumor.Conclusions Racial differences in survival could exist by histological type of tumor, but further work is necessary for a more complete understanding of these differences.