英国癌症研究中心David Forman团队分析了英国近25年的癌症发病率和死亡率的趋势。相关论文于2024年3月13日发表在《英国医学杂志》上。

为了研究和解释英国所有癌症的癌症发病率和死亡率趋势，以及35-69岁成年人中最常见的癌症部位，研究组在国家统计局、威尔士公共卫生部、苏格兰公共卫生局、北爱尔兰癌症登记处、英国国家医疗服务体系和北爱尔兰总登记处中获取癌症登记数据、癌症死亡率和国家人口数据，并进行回顾性二次数据分析。共有23个癌症部位被纳入英国分析。参与者为1993年至2018年间，35-69岁被诊断患有癌症或死于癌症的男性和女性。主要结局是癌症发病率和死亡率随时间变化的年龄标准化率。

这一年龄段的癌症病例数男性增加了57%（从1993年登记的55014例增加到2018年的86297例），女性增加了48%（60187例增加到88970例），男女的年龄标准化率平均每年增加0.8%。发病率的增加主要由前列腺癌（男性）和乳腺癌（女性）的增加引起。除这两个部位外，癌症年龄标准化发病率的所有趋势都相对稳定。少数不太常见的癌症发病率呈上升趋势，例如黑色素瘤皮肤癌、肝癌、口腔癌和肾癌。

癌症死亡人数在25年期间下降了20%（从32878人下降到26322人），女性下降了17%（28516人下降到23719人）；男性和女性的年龄标准化死亡率分别降低了37%（每年2.0%）和33%（每年1.6%）。死亡率下降幅度最大的是男性的胃癌、间皮瘤和膀胱癌，以及女性的胃癌、宫颈癌和非霍奇金淋巴瘤。即使变化幅度相对较小，大多数发病率和死亡率变化也具有统计学意义。

研究结果表明，在过去25年中，35至69岁的男性和女性的癌症死亡率均大幅下降。这一下降可能反映了癌症预防（如吸烟预防政策和戒烟计划）、早期检测（如筛查计划）和改进诊断测试以及更有效的治疗方面的成功。相比之下，非吸烟风险因素患病率的增加可能是观察到的少数特定癌症发病率增加的原因。这项分析还为下一个十年提供了一个基准，其中将包括新冠肺炎对癌症发病率和结果的影响。

附：英文原文

Title: 25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

Author: Jon Shelton, Ewa Zotow, Lesley Smith, Shane A Johnson, Catherine S Thomson, Amar Ahmad, Lars Murdock, Diana Nagarwalla, David Forman

Issue&Volume: 2024/03/13

Abstract:

Objective To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years.

Design Retrospective secondary data analysis.

Data sources Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland.

Setting 23 cancer sites were included in the analysis in the UK.

Participants Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018.

Main outcome measures Change in cancer incidence and mortality age standardised rates over time.

Results The number of cancer cases in this age range rose by 57% for men (from 55014 cases registered in 1993 to 86297 in 2018) and by 48% for women (60187 to 88970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32878 to 26322) and 17% in women (28516 to 23719); age standardised mortality rates reduced for all cancers combined by 37% in men (2.0% per year) and 33% in women (1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small.

Conclusions Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

DOI: 10.1136/bmj-2023-076962

Source: https://www.bmj.com/content/384/bmj-2023-076962