2004—2016年广州市食管癌发病趋势分析

摘 要：［目的］ 分析2004—20016年广州市居民食管癌发病趋势。［方法］ 根据广州市肿瘤登记处收集的2004—20016年广州市食管癌的病例资料,计算、分析分年和分地区粗发病率、2000年中国人口标化发病率（中标率）、Segi’s世界人口标化发病率（世标率）和发病年度变化率百分比（APC）,利用Jointpoint回归分析各性别和地区变化趋势。［结果］ 2016年广州市户籍居民新发病例498例,男、女性世标率之比为7.31∶1（男性6.43/10万,女性0.88/10万）。男、女性食管癌发病粗率、世标率均呈下降趋势,世标率女性（APC=-8.85%,95%CI：-10.40%~-7.30%）较男性（APC=-4.46%,95%CI：-5.40%~-3.50%）下降速度更快（P=0.04）。城区、郊区、郊县发病变化差异较大,城区世标率（APC=-7.68%,95%CI：-9.80%～-5.50%）下降最多,郊区粗率未有变化（APC=0.14%,95%CI：-1.00%～1.30%）,郊县粗率（APC=4.30%,95%CI：1.20%～7.00%）呈上升趋势。 ［结论］ 广州市食管癌低于全国平均水平,但郊县食管癌发病率呈上升趋势,应加强对郊县食管癌的防治。     

2008~2013年河南省林州市食管癌发病趋势分析

目的：探讨2008-2013年河南省林州市食管癌发病的变化规律,为制定防治策略提供数据支持。方法 ：提取2008-2013年河南省林州市肿瘤登记处的食管癌发病数据,分性别、年龄别计算发病率和标准化人口年龄结构调整的发病率。采用Joinpoint软件分析近几年食管癌发病率的变化趋势,采用对数线性回归计算年平均变化百分比。结果：2008-2013年河南省林州市食管癌共新发病例5460例,粗发病率为85.98/10万;中国人口标准化发病率（中标率）为71.60/10万,世界人口标准化发病率（世标率）为72.46/10万。2008-2013年,该地区食管癌发病率平均每年降低1.98%[年平均变化率（AAPC）为-1.98%,95%CI为-3.43%~ -0.51%] ,其中女性较男性下降明显。调整人口结构后,食管癌中标率平均每年以5.21%的幅度下降（AAPC为-5.21%,95%CI为-7.76%~ -2.60%）,世标率平均每年以5.23%的幅度下降（AAPC为-5.23%,95%CI为-8.12%~ -2.25%）。结论 ：食管癌是河南省林州市最常见的恶性肿瘤,是肿瘤防治工作的重点,通过长期危险因素的预防控制及筛查技术的普遍开展,该地区食管癌的发病率呈现逐年下降趋势。     

1972—2021年江苏省启东市食管癌发病流行趋势分析

摘 要：［目的］ 分析江苏省启东市1972—2021年全人群食管癌发病特征及趋势。［方法］ 基于启东市癌症登记病例数据库,收集整理1972—2021年食管癌发病登记资料及历年人口资料,分析计算食管癌粗发病率、中国人口标化发病率（中标率）、世界人口标化发病率（世标率）、35~64岁截缩率、0~74 岁累积发病率、累积发病风险等。应用Joinpoint 4.9.1.0软件进行回归分析,计算食管癌发病率平均年度变化百分比（AAPC）及其95%置信区间。［结果］ 1972—2021年启东市共报告食管癌发病5 762例,占同期全部恶性肿瘤发病总数的3.91%;粗发病率、中标率和世标率分别为10.27/10万、3.60/10万和6.11/10万,35~64岁截缩率与0~74岁累积发病率分别为7.79/10万和0.74%,食管癌累积发病风险为0.74%。男女性粗发病率、中标率及世标率的性别比分别为2.37∶1、3.08∶1及2.97∶1。食管癌的发病平均年龄由1972—1976年的66.18岁上升至2017—2021年的72.28岁,50年间平均发病年龄为69.24岁。1972—2021年0~44岁、45~54岁、55~64岁、65~74岁和75岁及以上年龄组食管癌发病率AAPC分别为-2.03%、-3.11%、-2.29%、-2.08%和-0.70%,除0~44岁外其余年龄组发病率下降趋势均有统计学意义（P均<0.05）。1972—2021年男性、女性及男女合计粗发病率的AAPC分别为1.12%、0.84%及1.02%,上升趋势有统计学意义（P均<0.001）;中标率的AAPC分别为-2.03%、-3.00%及-2.15%;世标率的AAPC分别为-1.95%、-2.56%及-2.00%,下降趋势均有统计学意义（P均<0.001）。［结论］ 1972—2021年启东市全人群食管癌中标率和世标率呈下降趋势,但粗发病率呈上升趋势。随着人口老龄化的加剧及危险因素暴露的累积,食管癌防治工作仍需得到全社会关注。     

应用内镜普查研究食管癌高发区贲门癌的发病情况

目的：了解食管癌高发区贲门癌的发病情况。制定更为有效的预防策略。方法：在食管癌高发区应用电子内镜直接碘染色检查法对高危人群共行3次内镜普查。结果：1）贲门癌的癌前病变即贲门腺上皮重度不典型增生的检出率为0.62%-1.50%。2）早期贲门癌的检出率分别为0.44%,0.68%及0.64%。中晚期贲门癌检出率分别为0.22%,0.17%及0.21%。3）91.30%-95.00%贲门重度不典型增生及早期贲门癌病变位于贲门时钟位（顺时针）10点位-2点位，大多数贲门癌前病变及早期贲门癌内镜下主要表现为贲门粘膜糜烂或浅溃疡。4）食管癌与贲门癌检出率之比为2.4-4.1:1。结论：在食管癌高发区直接应用内镜进行普查。除对食管癌及其癌前病变有较高的检出率外。对贲门癌及其癌前病变也有较高的检出率。因此在食管癌高发区也应重视贲门癌的防治及研究工作。     

食管癌发病水平及变化趋势

食管癌在世界癌症发病中占第8 位,位居全球癌症死因的第6 位。食管癌预后较差,对人类健康的危害严重。我国是食管癌高发国家,也是世界上食管癌新发病例最多的国家。食管癌的组织学类型主要分为食管鳞癌和食管腺癌,从上世纪70代开始许多西方国家的食管鳞癌发病率呈下降趋势,与此相反食管腺癌的发病率迅速增加,成为增长速度最快的恶性肿瘤之一。中国人群食管癌的病理类型以鳞状上皮细胞癌为主,该组织学类型占我国食管癌发病的90% 以上。我国食管癌发病率呈明显的地区差异,食管鳞癌和食管腺癌的发病水平、地理分布、时间变化趋势及发病危险因素存在较大差别。本文阐述食管癌发病水平及变化趋势,以期为我国食道癌预防和控制策略制定、实施与效果评估提供基础信息。      

1999～2002年全球癌症发病与死亡趋势分析

文章就1999～2002年全球与我国癌症发病与死亡的变化趋势进行了分析。2002年全球癌症发病数与死亡数比1999年年均增长分别达11．6％和9．9％．预示21世纪初叶将有可能出现一个癌症发展的高峰期。     

磁县食管癌普查研究

 1991年磁县承担了国家"八五"攻关课题--食管癌高发现场综合防治研究。 因此, 1992年进行了9个乡、镇126187人群的食管细胞学普查。 检出食管癌179例(发病率140/10万, 患病率1068/10万), 近癌为172例(发病率136/10万, 患病率1026/10万), 重11患者866例(发病率686/10万, 患病率170/10万), 重Ⅰ患者3179例(发病率2519/10万, 患病率1898/10万), 轻增5346例(发病率4237/10万, 患病率31920/10万)。 普查率达71.4％, 为食管癌的综合防治研究创造了先决条件。     

重庆市食管癌发病趋势及影响因素定量分析

摘 要：［目的］ 了解重庆市食管癌发病趋势及影响因素,为开展食管癌防治工作提供建议。［方法］ 收集整理2006~2014年重庆市肿瘤登记点报告食管癌新发病例,统计分析粗发病率、中标率、年度变化百分比（APC）,趋势变化采用曲线估计指数分布回归模型进行判别。利用恶性肿瘤发病率差别分解法计算出人口因素和非人口因素对恶性肿瘤发病的贡献率。［结果］ 2006~2014年重庆市食管癌发病率呈上升的趋势,发病率由2006年的10.51/10万上升至2014年的17.79/10万,APC为7.68%（F=7.42,P<0.05）。中标率由2006年的9.16/10万上升至2014年的10.48/10万,APC为2.74%（P>0.05）。重庆市食管癌发病率上升受人口因素与非人口因素的协同作用,人口因素与非人口因素的贡献率分别为79.12%和20.88%。农村地区人口因素与非人口因素的贡献率分别为129.01%和-29.01%。［结论］ 重庆市食管癌发病率呈上升的趋势,受人口因素与非人口因素的协同作用,应加强非人口因素的干预工作,做好三级预防。     

以隐血检测法初筛普查上消化道肿瘤七年总结

我院采用隐血珠作为普查上消化道肿瘤的初步筛选方法，从1986年至1993年，在全国各地20余个地区，作隐血检测242296人，其中17915人接受了胃镜检查，病理证实为肿瘤的共638人，平均癌检出率为3．56％。得出的结论是采用隐血检测法普查上消化道肿瘤，特异性虽不是很高，但可以发现大显的早期癌，同时提供上消化道粘膜潜在的疾病信息。     

Cervical cancer prevented by screening: Long‐term incidence trends by morphology in Norway

Both major morphologic types of cervical cancer, squamous cell carcinoma (SCC) and adenocarcinoma (AC), are causally related to persistent infection with high‐risk human papillomavirus (hrHPV), but screening has primarily been effective at preventing SCC. We analysed incidence trends of cervical cancer in Norway stratified by morphologies over 55 years, and projected SCC incidence in the absence of screening by assessing the changes in the incidence rate of AC. The Cancer Registry of Norway was used to identify all 19,530 malignancies in the cervix diagnosed in the period 1956–2010. The majority of these (82.9%) were classified as SCCs, 10.5% as ACs and the remaining 6.6% were of other or undefined morphology. By joint‐point analyses of a period of more than five decades, the average annual percentage change in the age‐standardised incidence was ?1.0 (95%CI: ?2.1–0.1) for cervical SCC, 1.5 (95%CI:1.1–1.9) for cervical AC and ?0.9 (95%CI: ?1.4 to ?0.3) for cervical cancers of other or undefined morphology. The projected age‐standardised incidence rate of cervical SCC in Norway, assuming no screening, was 28.6 per 100,000 woman‐years in 2010, which compared with the observed SCC rate of 7.3 corresponds to an estimated 74% reduction in SCC or a 68% reduction due to screening in the total cervical cancer burden. Cytology screening has impacted cervical cancer burden more than suggested by the overall observed cervical cancer incidence reduction since its peak in the mid‐1970s. The simultaneous substantial increase in cervical adenocarcinoma in Norway is presumably indicative of an increase in exposure to HPV over time.     

Impressive time-related influence of the Dutch screening programme on breast cancer incidence and mortality, 1975-2006

The aim of this study was to assess changes in the trends in breast cancer mortality and incidence from 1975 to 2006 among Dutch women, in relation to the implementation of the national breast cancer screening programme. Screening started in 1989 for women aged 50-69 and was extended to women aged 70-75 years in 1998 (attendance rate approximately >80%). A joinpoint Poisson regression analysis was used to identify significant changes in rates over time. Breast cancer mortality rates increased until 1994 (age group 35-84), but thereafter showed a marked decline of 2.3-2.8% per annum for the age groups 55-64 and 65-74 years, respectively. For the age group of 75-84 years, a decrease started in the year 2001. In women aged 45-54, an early decline in breast cancer mortality rates was noted (1971-1980), which is ongoing from 1992. For all ages, breast cancer incidence rates showed an increase between 1989 and 1993, mainly caused by the age group 50-69, and thereafter, a moderate increase caused by age group 70-74 years. This increase can partly be explained by the introduction of screening. The results indicate an impressive decrease in breast cancer mortality in the age group invited for breast cancer screening, starting to show quite soon after implementation.     

Esophageal and gastric cancer incidence trends in Golestan,Iran: An age-period-cohort analysis 2004 to 2018

Golestan province in the northeast of Iran is part of the Asian esophageal cancer belt and is known as a high-risk area for esophageal (EC) and gastric cancers (GC). Data on incident cases of EC and GC during 2004 to 2018 were obtained from the Golestan Population-based Cancer Registry (GPCR). The age-standardized incidence rates (ASRs) were calculated and presented per 100 000 person-years. The estimated annual percentage change (EAPC) with 95% confidence interval (95% CI) were calculated. We also fitted age-period-cohort (APC) models to assess nonlinear period and cohort effects as incidence rate ratios (IRRs). Overall, 3004 new cases of EC (ASR = 15.7) and 3553 cases of GC (ASR = 18.3) were registered in the GPCR. We found significant decreasing trends in incidence rates of EC (EAPC = −5.0; 95% CI: −7.8 to −2.2) and less marked nonsignificant trends for GC (EAPC = −1.4; 95% CI: −4.0 to 1.4) during 2004 to 2018. There was a strong cohort effect for EC with a consistent decrease in the IRR across successive birth cohorts, starting with the oldest birth cohort (1924; IRR = 1.9 vs the reference birth cohort of 1947) through to the most recent cohort born in 1988 (IRR = 0.1). The marked declines in EC incidence rates in Golestan relate to generational changes in its underlying risk factors. Despite favorable trends, this population remains at high risk of both EC and GC. Further studies are warranted to measure the impact of the major risk factors on incidence with a view to designing effective preventative programs.     

Exploring time trends in cancer incidence

We examined incidence time-trends for lung, stomach, intestinal, prostate, and breast cancer among Whites diagnosed in the United States between 1973 and 1987. For each sex and five-year age group, we modeled cancer incidence as a log-linear function of diagnosis-year to permit extrapolation over time and simple summarization of trends. Comparisons with nonparametric estimates show that, except for breast cancer, the model performs well. Plots of the annual percent change in incidence cf age illustrate the way in which time trends depend on age. Between 1973 and 1987, stomach cancer incidence decreased by about two percent per year. The annual change in lung cancer incidence progressed from a two to three percent decrease in persons under age 40 to an increase of two percent in men and eight percent in women by age 80. Intestinal cancer incidence decreased annually by as much as three percent in persons under age 50, remained constant in women aged 50 to 74, and otherwise increased about one percent per year. The annual increase in prostate cancer incidence declined from about six percent in men under age 40 to about two percent in men over age 80. After a surge in female breast-cancer diagnoses in 1974, the annual increase in incidence between 1980 and 1987 stabilized at four to six percent.Authors are with the Statistics and Biomathematics Branch, National Institute of Environmental Health Sciences. Address correspondence to Dr Dinse, Statistics and Biomathematics Branch, B3-02, National Institute of Environmental Health Sciences, P.O. Box 12233, Research Triangle Park, NC 27709, USA.     

The influence of birth cohort and calendar period on global trends in ovarian cancer incidence

Ovarian cancer is the eighth most common cancer in women worldwide and incidence rates vary markedly by world region. Our study provides a comprehensive overview of ovarian cancer incidence trends globally, examining the influence of birth cohort and period of diagnosis on changing risk. We presented current patterns and trends of ovarian cancer incidence until 2012 using data from successive volumes of Cancer Incidence in Five Contents. The incidence of ovarian cancer is highest in northern and eastern European countries and in northern America. Declining trends were observed in most countries with the exception of a few central and eastern Asian countries. Marked declines were seen in Europe and North America for women aged 50–74 where rates have declined up to 2.4% (95% CI: −3.9, −0.9) annually in Denmark (DNK) over the last decade. Additionally, declines in the incidence rate ratio (IRR) were observed for generations born after the 1930s, with an additional strong period effect seen around 2000 in United States and DNK. In contrast, IRRs increased among younger generations born after the 1950s in Japan and Belarus. Overall, the favorable trends in ovarian cancer incidence is likely due to the increase use of oral contraceptive pills, and changes in the prevalence of other reproductive risk and protective factors for ovarian cancer over the years studied. Changes in disease classifications and cancer registry practices may also partially contribute to the variation in ovarian cancer incidence rates. Thus, continuous cancer surveillance is essential to detect the shifting patterns of ovarian cancer.     

Changing trends in incidence of lung cancer by histologic type in Scotland

Lung cancer is a major public health concern worldwide. Our study aims to examine trends in incidence of lung cancer in Scotland during 1959-97 and by histologic type for 1975-97. In Scotland, lung cancer is the most commonly diagnosed cancer in men and is the second most commonly diagnosed cancer in women. Due to poor survival rates, trends in incidence and mortality display similar patterns. Within the United States and many parts of Europe, falls in the incidence of squamous cell carcinoma have occurred whilst the incidence of adenocarcinoma has increased. Data were extracted from the Scottish Cancer Registry. Trends in incidence were examined by standardising rates to the World Standard Population. Age-specific rates were examined by year of diagnosis and mid year of birth. In Scotland the incidence of lung cancer in men has fallen since the late 1970s, whereas incidence in women has continued to increase. Incidence rates of adenocarcinoma have increased over time but squamous cell carcinoma remains the predominant type of lung cancer in Scotland. The quality of lung cancer registration data has improved over time, although a large proportion of lung cancers (>20%) are not microscopically verified. Changes in histologic types are unlikely to be solely due to diagnostic advances. Rates of adenocarcinoma have increased steadily over time, and this may be due to changes in cigarette design during the 1950s.     

Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors

BackgroundCervical cancer trends in a given country mainly depend on the existence of effective screening programmes and time changes in disease risk factors, notably exposure to human papillomavirus (HPV). Screening primarily influences variations by period of diagnosis, whereas changes in risk factors chiefly manifest themselves as variations in risk across successive birth cohorts of women.MethodsWe assessed trends in cervical cancer across 38 countries in five continents, age group 30–74 years, using age-standardised incidence rates (ASRs) and age-period-cohort (APC) models. Non-identifiability in APC models was circumvented by making assumptions based on a consistent relationship between age and cervical cancer incidence (i.e. approximately constant rates after age 45 years).FindingsASRs decreased in several countries, except in most of Eastern European populations, Thailand as well as Uganda, although the direction and magnitude of period and birth cohort effects varied substantially. Strong downward trends in cervical cancer risk by period were found in the highest-income countries, whereas no clear changes by period were found in lower-resourced settings. Successive generations of women born after 1940 or 1950 exhibited either an increase in risk of cervical cancer (in most European countries, Japan, China), no substantial changes (North America and Australia) or a decrease (Ecuador and India).InterpretationIn countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging.FundingBill and Melinda Gates Foundation (BMGF).     

50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence

Background:

Nordic countries'' data offer a unique possibility to evaluate the long-term benefit of cervical cancer screening in a context of increasing risk of human papillomavirus infection.

Methods:

Ad hoc-refined age-period-cohort models were applied to the last 50-year incidence data from Denmark, Finland, Norway and Sweden to project expected cervical cancer cases in a no-screening scenario.

Results:

In the absence of screening, projected incidence rates for 2006–2010 in Nordic countries would have been between 3 and 5 times higher than observed rates. Over 60 000 cases or between 41 and 49% of the expected cases of cervical cancer may have been prevented by the introduction of screening in the late 1960 s and early 1970 s.

Conclusions:

Our study suggests that screening programmes might have prevented a HPV-driven epidemic of cervical cancer in Nordic countries. According to extrapolations from cohort effects, cervical cancer incidence rates in the Nordic countries would have been otherwise comparable to the highest incidence rates currently detected in low-income countries.     

Mass screening programmes and trends in cervical cancer in Finland and the Netherlands

With respect to cervical cancer management, Finland and the Netherlands are comparable in relevant characteristics, e.g., fertility rate, age-of-mother at first birth and a national screening programme for several years. The aim of this study is to compare trends in incidence of and mortality from cervical cancer in Finland and the Netherlands in relation to the introduction and intensity of the screening programmes. Therefore, incidence and mortality rates were calculated using the Cancer Registries of Finland and the Netherlands. Data on screening intensity were obtained from the Finnish Cancer Registry and the Dutch evaluation centre at ErasmusMC-Rotterdam. Women aged 30-60 have been screened every 5 years, in Finland since 1992 and in the Netherlands since 1996. Screening protocols for smear taking and referral to the gynaecologist are comparable. Incidence and mortality rates have declined more in Finland. In 2003, age-adjusted incidence and mortality in Finland were 4.0 and 0.9 and in the Netherlands 4.9 and 1.4 per 100,000 woman-years, respectively. Excess smear use in the Netherlands was estimated to be 24 per 1,000 women during a 5-year interval compared to 121 in Finland. The decline in mortality in Finland seems to be almost completely related to the screening programme whereas in the Netherlands it was initially considered to be a natural decline. Differences in risk factors might also play a role: the Netherlands has higher population density and higher percentages of immigrants and (female) smokers. The greater excess smear use in Finland might also have affected incidence.     

Global trends in oral and pharyngeal cancer incidence and mortality

To provide an up-to-date overview of recent trends in mortality from oral and pharyngeal cancer, we analyzed death certification data for 61 countries worldwide provided by the World Health Organization in 2010–2015, and, for selected most populous countries, over the period 1970–2016. For 12 largest countries, we analyzed incidence derived from Cancer Incidence in Five Continents in 1960–2012 for all oral and pharyngeal cancers and by subsites. In 2015, male age-standardized (world population) death rates per 100,000 were 5.03 in the European Union (EU), 8.33 in the Russian Federation, 2.53 in the United States (USA), and 3.04 in Japan; corresponding rates in women were 1.23, 1.23, 0.82, and 0.76. Male mortality decreased over the last decades in several European countries, with earlier and sharper declines in southern Europe; conversely, mortality was still increasing in a few eastern European countries and the United Kingdom. Mortality in men also decreased in Argentina, Australia, and Hong Kong, while it leveled off over more recent calendar years in Brazil, Japan, Mexico, the Republic of Korea, as well as in Australia and the USA. Female mortality slightly rose in various European countries. Overall incidence trends in the largest countries were broadly consistent with mortality ones, but oropharyngeal cancer incidence rose in many countries. Changes in tobacco and alcohol exposure in men over the last decades likely explain the favorable trends in oral and pharyngeal cancer mortality and incidence observed in selected countries worldwide, while increased human papillomavirus infection is likely responsible for the rise in oropharyngeal cancer incidence.