上海市区恶性肿瘤发病趋势分析(1972～1999年)

目的对上海市区1972～1999年肿瘤发病资料进行统计、分析,了解肿瘤发病率的变化趋势.方法病例统一按照国际疾病分类(ICD-9)进行编码.根据人口普查资料中的性别、年龄构成用内插法和外推法估算各年的年龄组平均人口数.用世界标准人口计算标化率.发病率每年变化百分比,用对数直线回归法估计,并用病例数加权.结果 1972～1999年间,男性所有部位肿瘤标化率从250.0/10万降至214.8/10万,女性从175.3/10万降至163.4/10万.男女性结肠癌、胆道癌、肾癌,男性前列腺癌、多发性骨髓瘤以及女性脑和神经系统肿瘤的发病率上升幅度均达到100%及以上.男女性胰腺癌、直肠癌、非何杰金淋巴瘤、男性脑和神经系统肿瘤、女性乳腺癌、宫体癌、卵巢癌的发病率呈明显上升趋势.男女性食管癌和女性宫颈癌的发病率下降幅度达到一半以上,胃癌和肝癌的发病率也呈明显下降趋势,肺癌发病率在男、女性别中均变化不大.结论上述发病率变化趋势提示除了肿瘤诊断和报告情况的改善外,包括居民生活方式在内的环境因素的变化起着重要作用,需要深入开展流行病学研究,明确危险因素,提出有效的预防方法.

Cancer incidence trends in urban Shanghai,1972-1999

Objective Incidence rates for a number of cancers during 1972-1999 among residents in urban Shanghai were analyzed to determine the relative importance and time-trend of various malignancies. Methods The registered cases were coded according to the ninth revision of the ICD. Population estimates were based on periodic censuses, with age- and sex-specific annual estimates derived by linear inter- and extrapolation for the remaining years. The incidence rates were adjusted to the World standard population using the direct method. Annual percent changes in incidence were estimated by means of a linear regression of the logarithm of the respective rates on calendar year, weighted by the number of cases. Results Over the 28-year period, the age-adjusted rates for all cancers combined, decreased from 250.0 to 214.8 per 100,000 among men and from 175.3 to 163.4 among women. Rates doubled for cancers of the colon, biliary tract, and kidney in both sexes, for cancer of prostate, multiple myeloma in males and for that of brain/nervous system in females. Substantial increases were also seen for cancers of the pancreas, rectum, non-Hodgkin's lymphoma in both sexes, for cancers of the breast, corpus uteri, ovary in females and for cancers of brain/nervous system in males. Rates declined by at least one-half for cancers of the esophagus and cervix, with notable decreases also for cancers of the stomach and liver. Rates for lung cancer in both sexes changed little.Conclusion Some of these trends might reflect variations in improvement of diagnosis and case reporting, but changes in lifestyle and other environmental exposures played most important roles. Further epidemiological research in Shanghai is needed to identify risk factors influencing the cancer incidence trends, with the ultimate goal of prevention.