乳腺癌在中国的流行状况和疾病特征

中国女性乳腺癌发病率和死亡率在全球处于比较低的水平,但呈迅速增长的趋势,尤其是农村地区近10年来上升趋势明显。我国女性乳腺癌的发病率和死亡率的年龄和地区分布具有明显特征,总体生存率估计与发展中国家持平,地区和城乡差异明显。目前,尚缺乏以人群为基础的系统资料以描述女性乳腺癌组织病理学、诊断时期别和分子分型等疾病特征的分布。我国乳腺癌的防控策略应更多地侧重于疾病监测、病因学和生存研究,并采取措施提高农村地区乳腺癌预防、筛查和临床诊治服务能力,缩小城乡之间乳腺癌的生存率差距,遏制农村死亡率上升势头。现就中国女性乳腺癌的发病、死亡和生存概况,以及乳腺癌疾病特征的分布状况作一综述。     

2015年上海市恶性肿瘤流行特征分析

背景与目的：恶性肿瘤严重威胁着居民健康,已成为重大的公共卫生问题。本研究旨在描述和分析2015年上海市恶性肿瘤流行特征。方法：根据上海市恶性肿瘤病例报告登记系统收集的恶性肿瘤发病和死亡资料,按地区、性别分层,分别计算恶性肿瘤发病与死亡粗率、标化率、前10位恶性肿瘤发病与死亡顺位和构成等,并应用Joinpoint统计软件分析2002—2015年上海市肺癌发病和死亡趋势,估算总体和分阶段的年度变化百分比（annual percent change,APC）。采用Segi’s世界标准人口年龄构成计算标化率。结果：2015年上海市共报告恶性肿瘤新发病例71 610例,死亡病例38 445例。病理学诊断比例（percentage of morphologically verified cases,MV%）为78.42%,只有死亡医学证明书比例（percentage of death certifications only,DCO%）为0.21%,死亡发病比（mortality to incidence ratio,M/I）为0.55。上海市恶性肿瘤粗发病率为497.33/10万,标化发病率为228.82/10万,男性标化发病率低于女性,市区低于郊区。恶性肿瘤发病在40岁以后快速上升,在80~84岁年龄组达到高峰。全市发病前10位恶性肿瘤依次为肺癌、结直肠癌、甲状腺癌、胃癌、乳腺癌、肝癌、前列腺癌、胰腺癌、脑和中枢神经系统肿瘤以及膀胱癌,前10位恶性肿瘤占全部恶性肿瘤发病的76.59%。全市恶性肿瘤粗死亡率为267.00/10万,标化死亡率为95.99/10万,男性标化死亡率高于女性,市区和郊区基本持平。死亡率在45岁以后快速上升,在≥85岁年龄组达到高峰。死亡前10位恶性肿瘤依次为肺癌、结直肠癌、胃癌、肝癌、胰腺癌、乳腺癌、食管癌、胆囊癌、前列腺癌以及脑和中枢神经系统肿瘤,前10位恶性肿瘤占全部恶性肿瘤死亡的78.07%。截至2016年12月31日,上海市共有399 027例现患肿瘤病例,现患率为2.77%。市区现患率为3.07%,郊区为2.55%。乳腺癌是现患病例中最常见的恶性肿瘤,占15.33%。现患病例生存达5年的占50.90%。肺癌是上海市发病和死亡均位居第1位的恶性肿瘤。Joinpoint趋势分析显示,2011年男性和女性肺癌发病率均出现拐点。男性肺癌发病率在2002—2011年期间显著下降,APC为-1.34%（P<0.001）,自2011年起显著上升,APC为3.30%（P<0.001）;女性肺癌发病率在2002—2011年期间无明显变化趋势,较为平稳,2011—2015年期间呈快速上升趋势,APC达15.25%（P<0.001）。与发病率变化不同,2002—2015年间上海市男性肺癌死亡率呈缓慢持续下降趋势,APC为-0.72%（P=0.03）,女性无明显变化趋势。与2002年相比,2015年男性和女性肺癌诊断时期别为Ⅰ期的病例比例和腺癌比例均明显上升。男性肺癌诊断时期别Ⅰ期比例由2002年的3.96%上升到2015年的11.08%,女性由3.72%上升至23.57%。男性腺癌比例由2002年的15.81%上升到2015年的34.46%,女性由28.76%上升至66.08%。结论：肺癌、消化系统恶性肿瘤、甲状腺癌和女性乳腺癌仍是威胁上海市居民健康的主要癌种。乳腺癌是现患病例中最常见的恶性肿瘤。自2011年开始,男性和女性肺癌发病率显著上升,提示与低剂量螺旋CT广泛应用有一定关系,但需更多数据和研究支持。     

Current trends in colorectal cancer: site, incidence, mortality and survival in England and Wales

The objective was to examine trends in colorectal cancer (CRC) incidence and mortality in England and Wales over the last 30 years. Age-standardized incidence, mortality and survival rates for CRC, based on data from the National Cancer Intelligence Centre at the Office for National Statistics, were calculated and trends assessed.Between 1971 and 1997 the total number of cases of CRC increased by 42%, from 20 400 to 28 900. The site distribution of CRC between 1971 and 1994 was: rectum 38%, sigmoid 29%, caecum 15%, transverse colon and flexures 10%, ascending colon 5%, and descending colon 3%. Between 1971 and 1997 the direct age- standardized incidence increased by 20% in males and by 5% in females. The direct age-standardized mortality fell by 24% in males and by 37% in females. Age-standardized relative 5–year survival in adults improved from 22%–27% for patients diagnosed during 1971–1975 to over 40% for those diagnosed during the period 1991–1993.In conclusion, the incidence of CRC in England and Wales has been steadily rising. It is more common in males and has increased more rapidly in males than in females. The reasons for these trends remain unclear. Five-year survival has improved substantially, but rates are still below those in comparable countries elsewhere in Europe and in the USA.     

安徽省肿瘤登记地区2015年胃癌发病与死亡

目的 分析安徽省肿瘤登记地区2015年胃癌的发病和死亡情况,为制定胃癌防治措施提供基础数据。方法 经过质量审核后,22个肿瘤登记处数据被纳入分析,按照地区(城乡)、性别分层计算胃癌发病率、死亡率,采用2000年中国标准人口和Segi′s世界人口构成分别计算中国人口和世界人口年龄标化发病/死亡率。结果 安徽省肿瘤登记地区报告胃癌新发病例9 383例,死亡病例6 681例。全省胃癌死亡发病比(M/I)为0.71,病理诊断率(MV%)为64.19%,只有死亡让明书比例(DCO%)为2.59%。安徽省肿瘤登记地区2015年胃癌发病粗率为43.85/10万(男性60.94/10万,女性25.78/10万),中国人口标化率为30.99/10万,世界人口标化率为30.86/10万;城市地区发病粗率为35.82/10万,中国人口标化率为25.00/10万;农村地区发病粗率为49.79/10万,中国人口标化率为35.52/10万。安徽省肿瘤登记地区2015年胃癌死亡粗率为31.22/10万(男性43.74/10万,女性17.99/10万),中国人口标化率为21.33/10万,世界人口标化率为21.04/10万;城市地区死亡粗率为25.55/10万,中国人口标化率为17.25/10万;农村地区死亡粗率为20.51/10万,中国人口标化率为24.44/10万。结论 必须将农村人口以及男性人口作为胃癌防治的重点对象,推进上消化道癌的早诊早治,提高早期胃癌的检出率,减少胃癌发病与死亡造成的疾病负担。     

Larynx cancer in Slovakia and the role of anatomical subsites

During the time period 1968–92, 6958 laryngeal cancers (6602 in men and 356 in women) were diagnosed in Slovakia and notified to the National Cancer Registry. We analysed long-term trends in incidence, mortality and survival. Mortality and incidence rates in Slovakian men rose rapidly until 1980 and more slowly subsequently. The mortality-to-incidence ratio initially was 40% and increased to 70% in the period 1985–88. A log-linear model showed that the more recent generations experienced the slowest increase in incidence. Incidence and mortality rates in women remained stable and did not exceed 1 per 100 000. The 5-year survival probability from invasive larynx cancer was 47%. Survival rates had shown no particular trend by year and age at diagnosis. The main finding was that 5-year survival from supraglottis cancer is 20% poorer than survival from glottis cancer. Supraglottis is the prevalent larynx subsite in countries with high larynx, oropharynx and oesophagus incidence rates. This supports the hypothesis that supraglottis cancer is more strongly linked to a synergistic effect of smoking and alcohol than glottis cancer.     

The role of radium implants in cancer of the oral cavity and oral pharynx

Eighty-five patients with squamous cell carcinoma of the oral cavity tonsillar region or base of the tongue received a radium implant. Implants were done as a supplement to external irradiation except in three patients in whom it was the sole form of treatment. The median dose was 8500 rad given in about 8 weeks, 6000–6500 rad given by opposing lateral fields using ⁶⁰Co radiation; 25% of the patients received doses higher than 8600 rad. The implant boosted the dose to the primary.Most of the patients who had radium implants had advanced disease. The overall control rate of the primary was 45.9%, the highest control achieved with smaller lesions. Surgery was performed in 26 patients for recurrence at the primary; five developed osteonecrosis of the jaw bone. The survival at 4 and 5 years was approximately equal for Stages I and II (80%); it was 40% for Stages III and IV.     

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。     

ANALYSIS OF LUNG CANCER INCIDENCE AND MORTALITY IN TIANJIN

Verification of the cases of lung cancef, from Tianjin Cancer Registration System In 1981 - 1987, was conducted. It was suggested that lung cancer incidence and mortality had Increased and ranked first among various malignant tumors in that period. In urban area, the standardized incidence of male lung cancer was 44. 27/100,000, and was 24. 19% in malignant events; in female it was 32. 00/100, 000, and 26. 33% respectively. The ratio of male to female was 1.38. In comparing with the standardised Incidence of lung cancer in some other countries and regions, the epidemiology features of the disease in Tianjin were lower In sex ratio and higher in female Incidence, approximately similar to the levels in Shanghai and Beijing.     

Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as <45 years old) have been reported in recent years.To assess geographical variations and trends worldwide in incidence of oral and oropharyngeal cancer in young patients, a systematic review was conducted in PubMed and Google scholar databases from 1975 to June 2016. Seventy-eight studies were selected for further study.Nineteen population-based studies on incidence rate were available from 13 countries, showing a prominent increase over time except for the Netherlands. A notable rise of oral (mobile) tongue cancer among white women and oropharyngeal cancer in white men was observed. Data suggest that cancer in young patients may be a distinct clinical entity and characterised by different aetiology and pathogenesis. Additionally, the relative proportion of oral and oropharyngeal cancer in young patients to total incidence revealed a significant difference between estimates from North America (5.5%) and both Africa (17.2%) and Middle East (14.5%).It is concluded that (i) a rising trend in oral and oropharynx cancers is observed in young patients worldwide; (ii) incidence studies should properly define outcomes in age cohorts and use a consensus cut-off for young patients; (iii) more population-based studies should be performed in non-Western regions to get accurate global measures of incidence for these cancers in young subpopulations and (iv) there is an urge to identify new aetiological factors in these young patients.     

Dietary patterns and oral and pharyngeal cancer using latent class analysis

The methods traditionally used to identify a posteriori dietary patterns are principal components, factor and cluster analysis. The aim of our study is to assess the relationship between dietary patterns derived with latent class analysis (LCA) and oral/pharyngeal cancer risk (OPC), highlighting the strengths of this method compared to traditional ones. We analyzed data from an Italian multicentric case–control study on OPC including 946 cases and 2,492 hospital controls. Dietary patterns were derived using LCA on 25 food groups. A multiple logistic regression model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for OPC according to the dietary patterns identified. We identified four dietary patterns. The first one was characterized by a high intake of leafy and fruiting vegetable and fruits (Prudent pattern), the second one showed a high intake of red meat and low intake of selected fruits and vegetables (Western pattern). The last two patterns showed a combination-type of diet. We labeled “Lower consumers-combination pattern” the cluster that showed a low intake of the majority of foods, and “Higher consumers-combination pattern” the one characterized by a high intake of various foods. Compared to the “Prudent pattern”, the “Western” and the “Lower consumers-combination” ones were positively related to the risk of OPC (OR = 2.56, 95% CI: 1.90–3.45 and OR = 2.23, 95% CI: 1.64–3.02). No difference in risk emerged for the “Higher consumers-combination pattern” (OR = 1.28, 95% CI: 0.92–1.77).     

Co-morbidity and treatment outcomes of elderly pharyngeal cancer patients: a matched control study

Treatment choice in elderly pharyngeal cancer patient is disputed. This study was aimed to asses association of co-morbidity, complications and survival in different treatment modalities of pharyngeal cancer patients.Retrospective analysis of pharyngeal cancer patients, diagnosed between 1997 and 2007 in a tertiary referral hospital was performed. Patients 75 years and older (n = 42), were matched with two control patients 64 years and younger (n = 84). Co-morbidity (ACE-27), treatment related complications and survival data were assessed and analyzed.Frequency of co-morbidity was similar in both age groups, although discarding alcohol abuse resulted in higher incidence of co-morbidity in the elderly group. Complication rate was not significantly different. In a multivariate analysis only stage found to be a significant predictor of complications. Survival estimates adjusted to sex, age and birth cohort revealed co-morbidity to be a significant predictor for survival in elderly and young patients.No evidence has been found to treat elderly pharyngeal cancer patients differently than younger ones. Treatment related complications are not predicted by co-morbidities in young and elderly patients; however survival is predicted by comorbidity. Therefore thorough pre-treatment evaluation and care necessary in the elderly population.     

Incidence and mortality trend of cervical cancer in 11 cancer registries of China

Objective:In many countries,the cervical cancer prevalence has declined but less information about the changes is available in China.This study aims to understand the epidemiological characteristics and trend of cervical cancer in China.Methods:Cervical cancer data of 11 cancer registries during 1988-2002 in China were analyzed.The age and urban/rural differences and trend of cervical cancer incidence and mortality were described and discussed.Results:During 1988-2002,a total of 6007 incidence cases and 3749 mortality cases of cervical cancer were reported in the 11 cancer registries.The incidence crude rate of cervical cancer was 3.80/100,000 and the world age adjusted rate was 2.78/100,000.In the same period,the mortality crude rate was 2.37/100,000 and the world age adjusted rate was 1.66/100,000.Declined incidence and mortality trends were observed during this period in urban as well as in rural areas.When calculating the rates by age group,we found that the declining trends were only for older women and increasing trends for younger women,especially for women in the rural areas.Conclusion:The incidence and mortality rates declined during the period of 1988-2002 in China for older women.The younger women showed an increasing trend during the same period,especially for women in rural area.     

2016年山西省肿瘤登记地区肝癌发病与死亡分析

目的 分析2016年山西省肿瘤登记地区居民肝癌发病、死亡情况,为制订肝癌防治策略提供依据。方法 收集山西省12个肿瘤登记地区居民肝癌发病和死亡资料,统计肝癌发病率、死亡率等指标,分别采用2000年中国标准人口年龄构成和Segi's世界标准人口年龄构成计算中标率和世标率,分析不同性别、年龄、以及城乡居民肝癌发病率和死亡率。结果 2016年山西省肿瘤登记地区肝癌新发病例754例,发病率为15.42/10万（男性19.40/10万,女性11.29/10万）,中标率和世标率分别为10.72/10万、10.75/10万;城市地区发病率为10.14/10万,中标率为6.73/10万;农村地区发病率为19.00/10万,中标率为13.48/10万。山西省肿瘤登记地区肝癌死亡病例761例,死亡率为15.56/10万（男性19.80/10万,女性11.17/10万）,中标率和世标率分别为10.71/10万、10.86/10万。城市地区死亡率14.90/10万,中标率为9.86/10万,农村地区死亡率为16.01/10万,中标率为11.37/10万。肝癌发病率和死亡率均随年龄增加呈上升趋势,35岁以后发病率上升较为明显,全省发病率和死亡率分别在80岁和85岁年龄组达到高峰,男性高于女性。结论 山西省肿瘤登记地区肝癌发病率和死亡率均低于全国平均水平,男性发病率高于女性,农村地区发病率高于城市地区,应将男性及农村地区人群作为肝癌防治的重点对象。     

2010—2016年广西肿瘤登记地区肝癌发病和死亡分析及变化趋势

目的 分析2010—2016年广西肿瘤登记地区肝癌发病和死亡特征及其变化趋势,为广西制定肝癌防控措施提供依据.方法 收集2010—2016年广西肿瘤登记地区上报的恶性肿瘤发病与死亡资料,计算肝癌发病率、死亡率、构成比、0～74岁累积率、35～64岁截缩率,按地区(城市/农村)、性别和年龄分层.采用2000年中国人口普查...     

2017年福建省肿瘤登记地区肝癌发病和死亡分析

目的 分析2017年福建省肿瘤登记地区肝癌发病和死亡数据,为肝癌防治策略制定和评估提供科学依据.方法 根据全国肿瘤登记中心制定的数据审核和评价方法,对福建省12个肿瘤登记处上报的2017年数据进行评价,将符合要求的10个登记处数据合并分析.按城乡、性别和年龄组分别计算肝癌发病和死亡粗率、标化率、累积率(0～74岁).中...     

Family history of breast cancer and all-cause mortality after breast cancer diagnosis in the Breast Cancer Family Registry

Although having a family history of breast cancer is a well established breast cancer risk factor, it is not known whether it influences mortality after breast cancer diagnosis. We studied 4,153 women with first primary incident invasive breast cancer diagnosed between 1991 and 2000, and enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. Cases were oversampled for younger age at diagnosis and/or family history of breast cancer. Carriers of germline mutations in BRCA1 or BRCA2 were excluded. Cases and their relatives completed structured questionnaires assessing breast cancer risk factors and family history of cancer. Cases were followed for a median of 6.5 years, during which 725 deaths occurred. Cox proportional hazards regression was used to evaluate associations between family history of breast cancer at the time of diagnosis and risk of all-cause mortality after breast cancer diagnosis, adjusting for established prognostic factors. The hazard ratios for all-cause mortality were 0.98 (95% confidence interval [CI] = 0.84–1.15) for having at least one first- or second-degree relative with breast cancer, and 0.85 (95% CI = 0.70–1.02) for having at least one first-degree relative with breast cancer, compared with having no such family history. Estimates did not vary appreciably when stratified by case or tumor characteristics. In conclusion, family history of breast cancer is not associated with all-cause mortality after breast cancer diagnosis for women without a known germline mutation in BRCA1 or BRCA2. Therefore, clinical management should not depend on family history of breast cancer.     

2016年云南省肿瘤登记地区肝癌发病和死亡情况及2011—2016年变化趋势

目的 掌握云南省2016年肝癌发病和死亡情况及2011—2016年变化趋势,为肝癌防控提供参考依据.方法 利用云南省2011—2016年的肿瘤登记数据和相关人口数,采用Excel 2007和IARC发布的IARCcrgTools 2.05软件审核、评估数据,利用SAS 9.4和Excel 2007计算肝癌发病率、死亡率...     

Oral cancer survival in young people in South East England

The incidence rate of oral cancer among young people in the UK has been increasing since 1970s. The objective of this study was to compare relative survival of young people (under 45 years of age) diagnosed with oral cancer with that of older people (45 years and older) resident in South East England. Between 1986 and 2002, 5 year relative survival was higher among young people compared with the older group, suggesting age was a strong independent predictor of survival. Apart from age other independent predictors of survival included stage, treatment and affluence but residence was not a significant predictor of survival in either age group. For the young age group (0–44 years) mean relative survival for the period under study was relatively constant but consistently higher in younger women than in younger men.     

Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s

IntroductionWe present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s.MethodsData on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin’s disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990–1994 and 2000–2002 using data from EUROCARE-3 and -4.ResultsTrends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers.ConclusionCancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.     

2014年广西肿瘤登记地区结直肠肛门癌发病和死亡分析

目的  分析2014年广西结直肠肛门癌发病和死亡情况。方法  按照全国肿瘤登记中心制定的审核方法和评价标准评估广西肿瘤登记地区上报的2014年肿瘤登记数据,将9个入选的肿瘤登记地区的肿瘤发病、死亡和人口数据进行汇总,按地区（城乡）、性别、年龄别分层,计算结直肠肛门癌的发病率、死亡率、构成比和截缩率等。人口标准化率根据2000年全国人口普查结构和Segis′s世界人口结构。结果  2014年广西纳入分析的9个肿瘤登记地区结直肠肛门癌新发病例为1 716例（其中男性1 039例,女性677例）,发病率为24.74/10万,中标率为19.68 /10万,世标率为19.37/10万,男性发病率高于女性（28.73% vs 20.40%,χ²=48.433,P<0.001）;城市地区发病率为36.19/10万,中标率为27.45/10万;农村地区发病率为19.24/10万,中标率为16.07/10万。结直肠肛门癌死亡病例827例（其中男性518例,女性309例）,死亡率为11.93/10万,中标率为9.06/10万,世标率为9.00 /10万,男性死亡率高于女性（14.32% vs 9.31%,χ²=36.400,P<0.001）;城市地区死亡率为17.63/10万,中标率为13.21/10万;农村地区死亡率为9.18/10万,中标率为7.13/10万。结论  广西肿瘤登记地区结直肠肛门癌发病和死亡例数男性均高于女性,城市地区高于农村地区,45岁以上的中老年人群尤其是城市地区男性人群是重点开展肿瘤防治工作的对象。