中国和全球肿瘤发病率和死亡率解析【专业材料】.ppt

最新肿瘤发病率和死亡率解析,中国 intermediate in South America, the Caribbean, and Northern Africa; and low in sub-Saharan Africa and Asia.,22,专业知识,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.,23,专业知识,Reproductive factors that increase risk,1,2,3,4,5,long menstrual history,oral contraceptives,late age at first birth,nulliparity,recent use of postmenopausal hormone therapy,24,专业知识,How to reduce the risk of developing breast cancer?,Maintaining a healthy body weight Increasing physical activity Minimizing alcohol intake Early detection strategies include the promotion of awareness of early signs and symptoms and screening by clinical breast examination,25,专业知识,Selected Cancers Colorectal Cancer,2,26,专业知识,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.,27,专业知识,The highest incidence 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 substantially higher in males than in females.,28,专业知识,Trends Risk Factors,Rates continue to increase in countries with limited resources and health infrastructure, particularly in Eastern Europe and Eastern Asia,While decreasing in several Western countries, particularly in United States, Canada, and Australia,Smoking Physical inactivity Overweight/Obesity Red and processed meat consumption Excessive alcohol consumption Population-based colorectal screening 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%.,29,专业知识,Selected Cancers Lung Cancer,3,30,专业知识,Lung cancer was the most commonly diagnosed canceras 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.,31,专业知识,In males, the highest 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.,32,专业知识,Smoking accounts for 80% of the worldwide lung cancer burden in males and at least 50% of the burden in females.,33,专业知识,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 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.,34,专业知识,by applying proven tobacco control interventions that include raising 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 reduce cigarette consumption by 3% to 5%.,35,专业知识,Selected Cancers Prostate Cancer,4,36,专业知识,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 in 2008。,37,专业知识,Incidence rates vary by more than 25-fold worldwide 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 United States, Italy in part because of the improved treatment with curative intent.,38,专业知识,the only well-established risk factors,Older age,Race (black),Family history,there are no established preventable risk factors for prostate cancer.,39,专业知识,Selected Cancers Stomach Cancer,5,40,专业知识,A total of 989,600 new stomach cancer cases and 738,000 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.,41,专业知识,The highest incidence rates are in Eastern Asia, 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.,42,专业知识,1,2,3,4,the increased use and availability 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 of the developed world.,In Japan, mortality rates may have declined via the introduction of screening using photofluorography.,43,专业知识,Selected Cancers Liver Cancer,6,44,专业知识,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 the 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.,45,专业知识,Half of these cases and deaths were estimated to occur in China. Globally, rates are more than twice as high in males as in females.,46,专业知识,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,47,专业知识,Liver cancer incidence rates are increasing in many parts of the world including the United States and Central Europe, 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, rates decreased in some historically high-risk areas, possibly due to the HBV vaccine. Universal infant hepatitis vaccination programs in Taiwan reduced liver cancer incidence rates by about two-thirds in children and young adults.,48,专业知识,introduced the HBV vaccine into their national infant immunization schedules(Fig. 10). Preventive strategies against HCV, include screening of donors blood for antibodies to HCV, instituting adequate infection 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,49,专业知识,50,专业知识,Selected Cancers Cervical Cancer,7,51,专业知识,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 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.,52,专业知识,Worldwide, the highest incidence rates are in Eastern, Western, and Southern Africa, as well as South-Central Asia and South America. Rates 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 cervical cancer.,53,专业知识,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 single round of HPV DNA testing was associated with about a 50% reduction in the risk of developing advanced cervical cancer and associated deaths.,54,专业知识,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 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 adolescent 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.,55,专业知识,Selected Cancers Esophageal,8,56,专业知识,Esophageal 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.,57,专业知识,An estimated 482,300 new esophageal cancer cases and 406,800 deaths occurred in 2008 worldwide. Incidence 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.,58,专业知识,In 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,59,专业知识,Major risk factors (for squamous cell carcinomas),Poor nutritional status,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 of the esophagus.,60,专业知识,Major risk factors (for adenocarcinoma),Smoking,Overweight/Obesity,Chronic gastroesophageal reflux disease,Barretts esophagus,61,专业知识,Incidence rates for adenocarcinoma of the esophagus have been increasing in several western countries, in part due to increases in the prevalence of known risk 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 alcohol consumption.,62,专业知识,Selected Cancers Bladder,9,63,专业知识,An estimated 386,300 new cases and 150,200 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 mortality rates, which is twice as high as the highest rates in Europe and over 4 times higher than that in the United States. The lowest rates are found in the countries of Melanesia and Middle Africa.,64,专业知识,Smoking is the major risk factors in Western countries, whereas chronic infection with Schistosoma hematobium in developing countries, particularly in Africa and the Middle East, accounts for about 50% of the total burden.,65,专业知识,Selected Cancers Lip and Oral Cavity,10,66,专业知识,An estimated 263,900 new cases and 128,000 deaths from oral cavity cancer (including lip cancer) occurred in 2008 worldwide. Generally, the 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.,67,专业知识,1,2,3,4,Major risk factors,Smoking,Alcohol use,Smokeless tobacco/ Betel quid,HPV infections,smoking accounts for 42% of deaths,heavy alcohol consumption for 16% of the deaths,Having synergistic effects,68,专业知识,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 behaviors, particularly smoking, within economically developing countries.,69,专业知识,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.,70,专业知识,Conclusion,3,Cancer prevention,A significant proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge, and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and healthier dietary patterns.,71,专业知识,Conclusion,4,Have yet to do,Much remains to be learned about the causes of several major cancers including prostate and colorectal cancers. Implementing and sustaining such actions requires concerted efforts among private and government public health agencies and the pharmaceutical industry, as well as individual and government donors.,72,专业知识,Thanks!,PPT DESIGNED BY TIM TANG, Mar 19th, 2013,73,专业知识,