Risk–benefit analysis of micronutrients

Traditionally, different approaches have been used to determine the recommended dietary allowances for micronutrients, above which there is a low risk of deficiency, and safe upper levels, below which there is a negligible risk of toxicity. The advice given to risk managers has been in the form of point estimates, such as the recommended dietary allowance (RDA) and the tolerable upper level (UL). In future, the gap between the two intake–response curves may become narrower, as more sensitive indicators of deficiency and toxicity are used, and as health benefits above the recommended daily allowance are taken into account. This paper reviews the traditional approaches and proposes a novel approach to compare beneficial and adverse effects across intake levels. This model can provide advice for risk managers in a form that will allow the risk of deficiency or the risk of not experiencing the benefit to be weighed against the risk of toxicity. The model extends the approach used to estimate recommended dietary allowances to make it applicable to both beneficial and adverse effects and to extend the intake–incidence data to provide a range of estimates that can be considered by the risk manager. The data-requirements of the model are the incidence of a response at one or more levels of intake, and a suitable coefficient of variation to represent the person-to-person variations within the human population. A coefficient of variation of 10% or 15% has been used for established recommended dietary allowances and a value of 15% is proposed as default for considerations of benefit. A coefficient of variation of 45% is proposed as default for considerations of toxicity, based on analyses of human variability in the fate and effects of therapeutic drugs. Using this approach risk managers, working closely with risk assessors, will be able to define ranges of intake based on a balance between the risks of deficiency (or lack of benefit) and toxicity.     

中国2009年白血病发病和死亡资料分析

[目的]评估中国肿瘤登记地区2009年白血病发病与死亡情况.[方法]按照全国肿瘤登记中心制定的审核方法和评价标准,对全国104个肿瘤登记处上报的2009年肿瘤登记数据进行评估,共72个登记处的数据入选,计算白血病发病率、死亡率、构成、累积率;人口标准化率根据全国1982年人口普查的人口结构和Segi’s世界人口结构为标准.[结果]2009年72个登记地区共覆盖人口85 470 522人(其中城市57 489 009人,农村27 981 513人),白血病新发病例4 853例,死亡病例3 661例.白血病总体MV％为93.72％、DCO％为1.50％、M/I比例为0.75,其中城市地区分别为94.38％、1.45％和0.71,农村地区分别为91.68％、1.68％和0.88.全国肿瘤登记地区白血病发病率为5.68/10万(男性6.35/10万,女性4.99/10万),中标率为4.34/10万,世标率为4.92/10万,累积率(0～74岁)为0.44％,占全部恶性肿瘤发病的1.99％;城市地区发病率为6.37/10万,中标率4.85/10万,世标率5.53/10万;农村地区发病率为4.25/10万,中标率为3.41/10万,世标率为3.76/10万.全国肿瘤登记地区白血病死亡率为4.28/10万(男性5.00/10万,女性3.55/10万),中标率为2.88/10万,世标率为3.35/10万,累积率(0～74岁)为0.31％,占全部恶性肿瘤死亡的2.37％;城市地区死亡率为4.56/10万,中标率2.91/10万,世标率3.43/10万;农村地区死亡率为3.72/10万,中标率2.82/10万,世标率3.14/10万.白血病发病率、死亡率均为城市高于农村,男性高于女性.髓样白血病发病率、死亡率远高于淋巴样白血病.[结论]积极开展白血病病因学研究,制定有效的干预措施,以期降低白血病发病率和死亡率.     

Incidence and mortality of female breast cancer in the AsiaPacific region

Objective： To provide an overview of the incidence and mortality of female breast cancer for countries in the Asia-Pacific region.Methods： Statistical information about breast cancer was obtained from publicly available cancer registry and mortality databases（such as GLOBOCAN）, and supplemented with data requested from individual cancer registries. Rates were directly age-standardised to the Segi World Standard population and trends were analysed using joinpoint models.Results： Breast cancer was the most common type of cancer among females in the region, accounting for 18% of all cases in 2012, and was the fourth most common cause of cancer-related deaths（9%）. Although incidence rates remain much higher in New Zealand and Australia, rapid rises in recent years were observed in several Asian countries. Large increases in breast cancer mortality rates also occurred in many areas, particularly Malaysia and Thailand, in contrast to stabilising trends in Hong Kong and Singapore, while decreases have been recorded in Australia and New Zealand. Mortality trends tended to be more favourable for women aged under 50 compared to those who were 50 years or older. Conclusion： It is anticipated that incidence rates of breast cancer in developing countries throughout the Asia-Pacific region will continue to increase. Early detection and access to optimal treatment are the keys to reducing breast cancerrelated mortality, but cultural and economic obstacles persist. Consequently, the challenge is to customise breast cancer control initiatives to the particular needs of each country to ensure the best possible outcomes.     

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.     

哈尔滨市南岗区2006—2015年乳腺癌发病、死亡趋势分析及预测

目的 分析乳腺癌发病率和病死率的趋势,预测未来5年乳腺癌发病率和病死率水平.方法 搜集2006—2015年哈尔滨市南岗区乳腺癌发病死亡登记数据,计算发病率、病死率、调整发病率、调整病死率,利用Join Point分析10年间恶性肿瘤发病、死亡趋势,并采用Age-Period-Cohort Bayesian模型预测2016—2020年乳腺癌的发病率、病死率.结果 南岗区女性乳腺癌的平均诊断年龄为(53.93±11.75)岁,各年度平均诊断年龄比较,差异无统计学意义(P﹥0.05),但呈逐年增加趋势(P﹤0.01).2006—2015年,女性乳腺癌的发病率、中标发病率、世标发病率分别为59.14/10万、41.67/10万、39.18/10万;女性乳腺癌的病死率、中标病死率和世标病死率分别为12.66/10万、8.38/10万、8.30/10万.乳腺癌世标发病率呈显著上升趋势(APC=5.3％,95％CI:3.3％～7.3％),世标病死率无明显变化(APC=-0.8％,95％CI:-3.6％～2.1％).预测2020年乳腺癌的发病率和病死率将分别达到91.20/10万和15.24/10万.结论 南岗区女性乳腺癌发病率和病死率呈逐年增长趋势,预测未来5年发病率和病死率仍呈增加趋势.     

Increasing thyroid cancer incidence in Canada, 1970-1996: time trends and age-period-cohort effects.

We examined time trends in thyroid cancer incidence in Canada by age, time period and birth cohort between 1970 and 1996. Age-specific incidence rates by time period and birth cohort were calculated and age-period-cohort modelling used to estimate effects underlying the observed trends. Overall age-adjusted incidence rates of thyroid cancer doubled, from 3.3 and 1.1 per 100 000 in 1970-72 to 6.8 and 2.2 per 100 000 in 1994-96, among females and males respectively. Almost all the increase between 1970-72 and 1994-96 was due to papillary carcinoma of the thyroid. Age, birth cohort and period effects significantly improved the fit of the model for females, while age and birth cohort effects were significant determinants of the incidence among males. There were significant differences in the patterns/curvature for age, period and birth cohort effects between women and men. Our results suggest that the increases in thyroid cancer incidence in Canada may be associated with more intensive diagnostic activities and change in radiation exposure in childhood and adolescence. Temporal changes in reproductive factors among young women may explain some of the gender differences observed.     

五种补益方对环磷酰胺造模小鼠骨髓、胸腺细胞周期的影响

目的：研究六味地黄汤等五种补益方对环磷酰胺造模小鼠骨髓、胸腺细胞周期的影响。方法：采用流式细胞术检测细胞周期，结果：五种补益方向能拮抗环磷酰胺引起的骨髓，胸腺细胞增殖抑制，结论：六味地黄汤等五种补益方能拮抗环磷酰胺引起的免疫抑制，有望用于临床辅助化疗。