中国和全球肿瘤发病率和死亡率解析.ppt

1、最新肿瘤发病率和死亡率解析,中国&全球,-2012中国肿瘤登记年报-Global Cancer Statistics 2011by IARC,Tang Jian 2013/3/12,中国肿瘤发病率和死亡率总体情况中国肿瘤发病率和死亡率（按性别）中国肿瘤发病率和死亡率（按地域）中国肿瘤发病率和死亡率（按年龄）中国排名前十肿瘤病种的发病率和死亡率全球肿瘤发病率和死亡率具体情况,目录 CONTENTS,中国肿瘤发病率和死亡率总体情况,总体肿瘤发病率和死亡率较高： 肿瘤发病率：每10万人中有286人患癌；一生中有22%的概率患癌症。 肿瘤死亡率：每10万人有181人患癌死亡；一生中有13%的概率患癌死

2、亡； 每分钟就有6人被确诊为癌症，平均每5位癌症患者有3人死亡。,中国肿瘤发病率和死亡率（按性别）,相比女性，男性癌症发病率和死亡率都高： 肿瘤发病率：男女之比1.3:1；肿瘤死亡率：男女之比1.65:1。 一生中，男性患癌症概率为26%，女性19% 一生中，男性因患癌死亡概率为17%，女性为9% 患癌人群中，因患癌而死亡的概率，男性(71%)比女性(54%)高,中国肿瘤发病率和死亡率（按地域）,城市人口与农村人口相比，癌症发病率要略高，但一生中因患癌症死亡率要低： 肿瘤发病率：城市与农村之比1.2:1；肿瘤死亡率：城市与农村之比1.02:1 。 一生中，城市患癌症概率为22.23%，农村21

3、.76%。 一生中，城市患癌死亡概率为12%，农村为15%。 患癌人群中，因患癌而死亡的概率，城市人口(60%)比农村人口(71%)低,中国肿瘤发病率和死亡率（按年龄）,肿瘤发病率随人群年龄逐渐上升，特别是50岁以上随年龄增加而大幅上升 50岁以上占全部发病的80%以上；80-85岁最高。,中国肿瘤发病率和死亡率（按年龄）,肿瘤死亡率随人群年龄逐渐上升，特别是60岁以上随年龄增加而大幅上升 60岁以上约占全部死亡的63%以上；85岁以上达到最高。,中国排名前十肿瘤病种的发病率和死亡率（总体情况）,发病率与死亡率最高的均是肺癌，排名前十病种的发病率占比76.39%。排名前十病种的死亡率占比84.

4、27%.,中国排名前十肿瘤病种的发病率（按性别）,男性发病率最高的是肺癌，其次为胃癌、肝癌。排名前十病种的发病率占比84.14%。女性发病率最高的是乳腺癌，其次为肺癌、结直肠癌。排名前十病种的发病率占比77.57%。,中国排名前十肿瘤病种的死亡率（按性别）,男性死亡率最高的是肺癌，其次为肝癌、胃癌。排名前十病种的死亡率占比88.33%。女性死亡率最高的是肺癌，其次为胃癌、肝癌。排名前十病种的死亡率占比81.12%。,全球肿瘤发病率和死亡率具体情况,Worldwide,1.1 : 1,1.26 : 1,Total: 12,700,000,Total: 7,600,000,Developed co

5、untries,Developing countries,It should also be noted that cancer tends to be diagnosed at later stages in many developing countries compared with developed countries and this, combined with reduced access to appropriate therapeutic facilities and drugs (Fig.3), has an adverse effect on survival.,Sel

6、ected CancersFemale Breast Cancer,1,Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide, accounting for 23% (1.38 million) of the total new cancer cases and 14% (458,400) of the total cancer deaths in 2008 (Fig. 2), About half the breast c

7、ancer cases and 60% of the deaths are estimated to occur in economically developing countries.,In general, incidence rates are high in Western and Northern Europe, Australia/New Zealand, and North America; intermediate in South America, the Caribbean, and Northern Africa; and low in sub-Saharan Afri

8、ca and Asia.,The factors that contribute to the international variation in incidence rates largely stem from differences in reproductive and hormonal factors and the availability of early detection services.,Reproductive factors that increase risk,1,2,3,4,5,long menstrual history,oral contraceptives

9、,late age at first birth,nulliparity,recent use of postmenopausal hormone therapy,How to reduce the risk of developing breast cancer?,Maintaining a healthy body weightIncreasing physical activity Minimizing alcohol intake Early detection strategies include the promotion of awareness of early signs a

10、nd symptoms and screening by clinical breast examination,Selected CancersColorectal Cancer,2,Colorectal cancer is the 3rd most commonly diagnosed cancer in males and the 2nd in females, with over 1.2 million new cancer cases and 608,700 deaths estimated to have occurred in 2008.,The highest incidenc

11、e rates are found in Australia and New Zealand, Europe, and North America, whereas the lowest rates are found in Africa and South-Central Asia. Rates are substantiallyhigher in males than in females.,Trends Risk Factors,Rates continue to increase in countries with limited resources and health infras

12、tructure, particularly in Eastern Europe and Eastern Asia,While decreasing in several Western countries, particularly in UnitedStates, Canada, and Australia,SmokingPhysical inactivityOverweight/ObesityRed and processed meat consumption Excessive alcohol consumption Population-based colorectal screen

13、ing programs*,* According to a recent randomized trial in the United Kingdom, a one-time flexible sigmoidoscopy screening between 55 and 64 years of age reduced colorectal cancer incidence by 33% and mortality by 43%.,Selected CancersLung Cancer,3,Lung cancer was the most commonly diagnosed canceras

14、 well as the leading cause of cancer death in males in 2008 globally. Among females, it was the 4th most commonly diagnosed cancer and the 2nd leading cause of cancer death. Lung cancer accounts for 13% (1.6 million) of the total cases and 18% (1.4 million) of the deaths in 2008.,In males, the highe

15、st lung cancer incidence rates are in Eastern and Southern Europe, North America,and Eastern Asia, while rates are low in sub-Saharan Africa. In females, the highest lung cancer incidence rates are found in North America, Northern Europe, and Australia/New Zealand.,Smoking accounts for 80% of the wo

16、rldwide lung cancerburden in males and at least 50% of the burden in females.,Male lung cancer death rates are decreasing in most Western countries, including many European countries, North America, and Australia, where the tobacco epidemic peaked by the middle of the last century.In contrast, lung

17、cancer rates are increasing in countries such as China and several other countries in Asia and Africa, where the epidemic has been established more recently and smoking prevalence continues to either increase or show signs of stability.,by applying proven tobacco control interventions that include r

18、aising the price of cigarettes* and other tobacco products, banning smoking in public places, the restriction of advertising of tobacco products, counter advertising, and treating tobacco dependence.,avoid the burden of lung cancer,Best strategy,* a 10% increase in cigarette prices has been shown to

19、 reduce cigarette consumption by 3% to 5%.,Selected CancersProstate Cancer,4,Prostate cancer is the 2nd most frequently diagnosed cancer and the 6th leading cause of cancer death in males, accounting for 14% (903,500) of the total new cancer cases and 6% (258,400) of the total cancer deaths in males

20、 in 2008。,Incidence rates vary by more than 25-foldworldwide largely because of the wide utilization of prostate-specific antigen (PSA) testing. Death rates for prostate cancer have been decreasing in many developed countries, including Australia, Canada, the United Kingdom, the UnitedStates, Italy

21、in part because of the improved treatment with curative intent.,the only well-established risk factors,Older age,Race (black),Family history,there are no establishedpreventable risk factors for prostate cancer.,Selected CancersStomach Cancer,5,A total of 989,600 new stomach cancer cases and 738,000

22、deaths are estimated to have occurred in 2008, accounting for 8% of the total cases and 10% of total deaths . Over 70% of new cases and deaths occur in developing countries. Generally, stomach cancer rates are about twice as high in males as in females.,The highest incidence rates are in Eastern Asi

23、a, Eastern Europe, and South America and the lowest rates are in North America and most parts of Africa.Regional variations in part reflect differences in dietary patterns, particularly in European countries, and the prevalence of Helicobacter pylori infection.,1,2,3,4,the increased use and availabi

24、lity of refrigeration including the increased availability of fresh fruits and vegetables, and a decreased reliance on salted and preserved foods.,Rates have decreased due to(western countries):,reductions in chronic H. pylori infection in most parts of the world.,reductions in smoking in some parts

25、 of the developed world.,In Japan, mortality rates may have declined via the introduction of screening using photofluorography.,Selected CancersLiver Cancer,6,Liver cancer in men is the 5th most frequently diagnosed cancer worldwide but the 2nd most frequent cause of cancer death. In women, it is th

26、e 7th most commonly diagnosed cancer and the 6th leading cause of cancer death. An estimated 748,300 new liver cancer cases and 695,900 cancer deaths occurred worldwide in 2008.,Half of these cases and deaths were estimated to occur in China. Globally, rates are more than twice as high in males as i

27、n females.,Risk factors accounting for liver cancer,1,2,3,4,5,chronic HBV/HCV infection,nonalcoholic fatty liver disease,obesity,alcohol-related cirrhosis,aflatoxin B1 (AFB) exposure,Liver cancer incidence rates are increasing inmany parts of the world including the United Statesand Central Europe,

28、possibly due to the obesity epidemic and the rise in HCV infection through continued transmission by injection drug users.In contrast to the trend in the low-risk areas, ratesdecreased in some historically high-risk areas, possibly due to the HBV vaccine. Universal infant hepatitis vaccination progr

29、ams in Taiwan reduced liver cancer incidence rates by about two-thirds in children and young adults.,introduced the HBV vaccine into their nationalinfant immunization schedules(Fig. 10).Preventive strategies against HCV, include screening ofdonors blood for antibodies to HCV, institutingadequate inf

30、ection control practices including the use of oral delivery of medicines where possible, and needle exchange programs among injection drug users.Crop substitution and improved grain storage practices have been shown to reduce contamination with AFB.,avoid the burden of liver cancer,Best strategy,Sel

31、ected CancersCervical Cancer,7,Cervical cancer is the 3rd most commonly diagnosed cancer and the 4th leading cause of cancer death in females worldwide, accounting for 9% (529,800) of the total new cancer cases and 8% (275,100) of the total cancer deaths among females in 2008. More than 85% of these

32、 cases and deaths occur in developing countries. India, the 2nd most populous country in the world, accounts for 27% (77,100) of the total cervical cancer deaths.,Worldwide, the highest incidence rates are in Eastern, Western, and Southern Africa, as well as South-Central Asia and South America. Rat

33、es are lowest in Western Asia, Australia/New Zealand, and North America. The disproportionately high burden of cervical cancer in developing countries and elsewhere in medically underserved populations is largely due to a lack of screening that allows detection of precancerous and early stage cervic

34、al cancer.,The most efficient and cost-effective screening techniques in low-resource countries,visual Inspection acetic acid/Lugols iodine,HPV DNA testing,A recent clinical trial in rural India, a low-resource area, found that a singleround of HPV DNA testing was associated with about a 50% reducti

35、on in the risk of developing advanced cervical cancer and associated deaths.,The expectations that vaccines which primarily protect against the most common strains of HPV infections (HPV types 16 and 18), which cause about 70% of cervical cancers, may prevent cervical cancer worldwide are at present

36、 high.However, affordable pricing is the most critical factor to facilitate the introduction of HPV vaccines in low- and medium-resource countries in the short term.It is also extremely important that women continue to receive screening services because the current vaccines are being given to adoles

37、cent girls only, and even vaccinated girls should begin screening when they reach the recommended screening age since the vaccines do not provide protection for the 30% of chronic infections by HPV types other than HPV 16, 18, 6 and 11 that cause cervical cancer.,Selected CancersEsophageal,8,Esophag

38、eal cancer usually occurs as either squamous cell carcinoma in the middle or upper one-third of the esophagus, or as adenocarcinoma in the lower onethird or junction of the esophagus and stomach.,An estimated 482,300 new esophageal cancer cases and 406,800 deaths occurred in 2008 worldwide. Incidenc

39、e rates vary internationally by nearly 16-fold, with the highest rates found in Southern and Eastern Africa and Eastern Asia and lowest rates observed in Western and Middle Africa and Central America in both males and females. Esophageal cancer is 3 to 4 times more common among males than females.,I

40、n the highest risk area, stretching from northern Iran through the central Asian republics to North-Central China, often referred to as theesophageal cancer Belt90% of cases are squamous cell carcinomas.,Esophageal Cancer Belt,Major risk factors (for squamous cell carcinomas),Poor nutritional status

41、,Low intake of fruits and vegetables,Drinking beverages at high Temperatures,Smoking/excessive alcohol consumption,In low-risk areas such as the United States and several Western countries, smoking and excessive alcohol consumption account for about 90% of the total cases of squamous cell carcinoma

42、of the esophagus.,Major risk factors (for adenocarcinoma),Smoking,Overweight/Obesity,Chronic gastroesophagealreflux disease,Barretts esophagus,Incidence rates for adenocarcinoma of the esophagus have been increasing in several western countries, in part due to increases in the prevalence of known ri

43、sk factors such as overweight and obesity. In contrast, rates for squamous cell carcinoma of the esophagus have been steadily declining in these same countries because of long-term reductions in tobacco use and alcoholconsumption.,Selected CancersBladder,9,An estimated 386,300 new cases and 150,200

44、deaths from bladder cancer occurred in 2008 worldwide. The majority of bladder cancer occurs in males and there is a 14-fold variation in incidence internationally. The highest incidence rates are found in the countries of Europe, North America, and Northern Africa. Egyptian males have the highest m

45、ortalityrates, which is twice as high as the highest rates in Europe and over 4 times higher than that in theUnited States. The lowest rates are found in thecountries of Melanesia and Middle Africa.,Smoking is the major risk factors in Western countries, whereas chronic infection with Schistosoma he

46、matobium in developing countries, particularly in Africa and the Middle East, accounts for about 50% of the total burden.,Selected CancersLip and Oral Cavity,10,An estimated 263,900 new cases and 128,000 deaths from oral cavity cancer (including lip cancer)occurred in 2008 worldwide. Generally, the

47、highest oral cavity cancer rates are found in Melanesia,South-Central Asia, and Central and Eastern Europe and the lowest in Africa, Central America, and Eastern Asia for both males and females.,1,2,3,4,Major risk factors,Smoking,Alcohol use,Smokeless tobacco/Betel quid,HPV infections,smoking accoun

48、ts for 42% of deaths,heavy alcohol consumptionfor 16% of the deaths,Having synergistic effects,Conclusion,1,The global burden of cancer,The global burden of cancer continues to increase largely because of the aging and growth of the world population and an increasing adoption of cancer-causing behav

49、iors, particularly smoking, within economically developing countries.,Conclusion,2,Disproportionate cancer burden,Female breast, lung, and colorectal cancers are occurring in high frequencies in many economically developing countries, in addition to the disproportionately high burden of cancers related to infections.,