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1、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,最新中国和全球肿瘤发病率和死亡率解析,The factors that contribute to the international variation in incidence rates largely stem from differences in reproductive and hormonal factors and the a
2、vailability of early detection services.,23,最新中国和全球肿瘤发病率和死亡率解析,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,最新中国和全球肿瘤发病率和死亡率解析,How to reduce the risk of developing brea
3、st 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,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Colorectal Cancer,2,26,最新中
4、国和全球肿瘤发病率和死亡率解析,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,最新中国和全球肿瘤发病率和死亡率解析,The highest incidence rates are found in Australia and New Zealand, Europe,
5、 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,最新中国和全球肿瘤发病率和死亡率解析,Trends Risk Factors,Rates continue to increase in countries with limited resources and health infrastructure, particularly in Easter
6、n 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
7、 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,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Lung Cancer,3,30,最新中国和全球肿瘤发病率和死亡率解析,Lung cancer was the most commonly d
8、iagnosed 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
9、,最新中国和全球肿瘤发病率和死亡率解析,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 Zea
10、land.,32,最新中国和全球肿瘤发病率和死亡率解析,Smoking accounts for 80% of the worldwide lung cancer burden in males and at least 50% of the burden in females.,33,最新中国和全球肿瘤发病率和死亡率解析,Male lung cancer death rates are decreasing in most Western countries, including many European countries, North America, and Australia, w
11、here 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 sh
12、ow signs of stability.,34,最新中国和全球肿瘤发病率和死亡率解析,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 depe
13、ndence.,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,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Prostate Cancer,4,36,最新中国和全球肿瘤发病率和死亡率解析,Prostate cancer is the 2nd most frequently diagnosed cancer and the 6t
14、h 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,最新中国和全球肿瘤发病率和死亡率解析,Incidence rates vary by more than 25-fold worldwide largely because of the wide utilization of prostate-specific an
15、tigen (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,最新中国和全球肿瘤发病率和死亡率解析,the only well-established risk factor
16、s,Older age,Race (black),Family history,there are no established preventable risk factors for prostate cancer.,39,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Stomach Cancer,5,40,最新中国和全球肿瘤发病率和死亡率解析,A total of 989,600 new stomach cancer cases and 738,000 deaths are estimated to have occurred in 2008, accounti
17、ng 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,最新中国和全球肿瘤发病率和死亡率解析,The highest incidence rates are in Eastern Asia, Eastern Europe, and South Amer
18、ica 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,最新中国和全球肿瘤发病率和死亡率解析,1,2,3,4,the increased use and availability of re
19、frigeration 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 de
20、veloped world.,In Japan, mortality rates may have declined via the introduction of screening using photofluorography.,43,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Liver Cancer,6,44,最新中国和全球肿瘤发病率和死亡率解析,Liver cancer in men is the 5th most frequently diagnosed cancer worldwide but the 2nd most frequent cause
21、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,最新中国和全球肿瘤发病率和死亡率解析,Half of these cases and deaths were estimated to occur in China.
22、Globally, rates are more than twice as high in males as in females.,46,最新中国和全球肿瘤发病率和死亡率解析,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,最新中国和全球肿瘤发病率和死亡率解析,Liver cancer inc
23、idence 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 hi
24、storically 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,最新中国和全球肿瘤发病率和死亡率解析,introduced the HBV vaccine into their national infant immunization sched
25、ules(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 i
26、mproved grain storage practices have been shown to reduce contamination with AFB.,avoid the burden of liver cancer,Best strategy,49,最新中国和全球肿瘤发病率和死亡率解析,50,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Cervical Cancer,7,51,最新中国和全球肿瘤发病率和死亡率解析,Cervical cancer is the 3rd most commonly diagnosed cancer and the 4th
27、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, a
28、ccounts for 27% (77,100) of the total cervical cancer deaths.,52,最新中国和全球肿瘤发病率和死亡率解析,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 di
29、sproportionately 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,最新中国和全球肿瘤发病率和死亡率解析,The most efficient and cost-effective screenin
30、g 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 an
31、d associated deaths.,54,最新中国和全球肿瘤发病率和死亡率解析,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
32、 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 vaccin
33、ated 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,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Esophageal,8,56,最新中国和全球肿瘤发病率和
34、死亡率解析,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,最新中国和全球肿瘤发病率和死亡率解析,An estimated 482,300 new esophageal cancer cases and 406,800 deaths o
35、ccurred 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
36、 common among males than females.,58,最新中国和全球肿瘤发病率和死亡率解析,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,最新中国和全球肿瘤发病率和
37、死亡率解析,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 c
38、onsumption account for about 90% of the total cases of squamous cell carcinoma of the esophagus.,60,最新中国和全球肿瘤发病率和死亡率解析,Major risk factors (for adenocarcinoma),Smoking,Overweight/Obesity,Chronic gastroesophageal reflux disease,Barretts esophagus,61,最新中国和全球肿瘤发病率和死亡率解析,Incidence rates for adenocarcinom
39、a 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-
40、term reductions in tobacco use and alcohol consumption.,62,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Bladder,9,63,最新中国和全球肿瘤发病率和死亡率解析,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 varia
41、tion 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
42、lowest rates are found in the countries of Melanesia and Middle Africa.,64,最新中国和全球肿瘤发病率和死亡率解析,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 t
43、he total burden.,65,最新中国和全球肿瘤发病率和死亡率解析,Selected Cancers Lip and Oral Cavity,10,66,最新中国和全球肿瘤发病率和死亡率解析,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, So
44、uth-Central Asia, and Central and Eastern Europe and the lowest in Africa, Central America, and Eastern Asia for both males and females.,67,最新中国和全球肿瘤发病率和死亡率解析,1,2,3,4,Major risk factors,Smoking,Alcohol use,Smokeless tobacco/ Betel quid,HPV infections,smoking accounts for 42% of deaths,heavy alcohol
45、consumption for 16% of the deaths,Having synergistic effects,68,最新中国和全球肿瘤发病率和死亡率解析,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, partic
46、ularly smoking, within economically developing countries.,69,最新中国和全球肿瘤发病率和死亡率解析,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 ca
47、ncers related to infections.,70,最新中国和全球肿瘤发病率和死亡率解析,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 c
48、ervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and healthier dietary patterns.,71,最新中国和全球肿瘤发病率和死亡率解析,Conclusion,4,Have yet to do,Much remains to be learned about the causes of several major cancers including prostate and colorectal
49、 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,最新中国和全球肿瘤发病率和死亡率解析,Thanks!,PPT DESIGNED BY TIM TANG, Mar 19th, 2013,73,最新中国和全球肿瘤发病率和死亡率解析,