最新中国和全球肿瘤发病率和死亡率解析..ppt

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 2011》by IARCTang Jian 2013/3/12 MoticA.中国肿瘤发病率和死亡率总体情况B.中国肿瘤发病率和死亡率（按性别）C.中国肿瘤发病率和死亡率（按地域）D.中国肿瘤发病率和死亡率（按年龄）E.中国排名前十肿瘤病种的发病率和死亡率F.全球肿瘤发病率和死亡率具体情况目录￿CONTENTSMotic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Motic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Motic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21.76%￿￿￿￿￿￿￿￿￿￿￿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Motic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Motic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Motic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84.27%.Motic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%Motic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%Motic全球肿瘤发病率和死亡率具体情况MoticWorldwide1.1￿￿:￿￿11.26￿￿:￿￿1Total:￿12,700,000Total:￿7,600,000MoticDeveloped￿countriesMoticDeveloping￿countriesMoticMoticMoticIt￿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.MoticMoticSelected￿CancersFemale￿Breast￿Cancer[1]MoticBreast￿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￿cancer￿cases￿and￿60%￿of￿the￿deaths￿are￿estimated￿to￿occur￿in￿economically￿developing￿countries.￿MoticIn 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 Africa and Asia.MoticThe￿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 risk12345•long menstrual history•oral contraceptives•late age at first birth•nulliparity•recent use of postmenopausal hormone therapyMoticHow￿to￿reduce￿the￿risk￿of￿developing￿breast￿cancer?üMaintaining a healthy body weightüIncreasing physical activityü Minimizing alcohol intakeü Early detection strategies include the promotion of awareness of early signs and symptoms and screening by clinical breast examinationBest available strategiesMoticSelected￿CancersColorectal Cancer[2]MoticColorectal 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.MoticThe￿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￿substantiallyhigher￿in￿males￿than￿in￿females.MoticTrends￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿Risk￿FactorsRates￿continue￿to￿increase￿in￿countries￿with￿limited￿resources￿and￿health￿infrastructure,￿particularly￿in￿Eastern￿Europe￿and￿Eastern￿AsiaWhile￿decreasing￿in￿several￿Western￿countries,￿particularly￿in￿UnitedStates,￿Canada,￿and￿AustraliaSmokingPhysical inactivityOverweight/ObesityRed 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%.MoticSelected￿CancersLung Cancer[3]MoticLung 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.MoticIn￿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.MoticSmoking accounts for 80% of the worldwide lung cancerburden in males and at least 50% of the burden in females.MoticMale￿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.Moticby￿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 cancerBest￿strategy* a 10% increase in cigarette prices has been shown to reduce cigarette consumption by 3% to 5%.MoticSelected￿CancersProstate Cancer[4]MoticProstate￿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。

MoticIncidence 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 in part because of the improved treatment with curative intent.Moticthe￿only￿well-established￿risk￿factors Older age Race (black) Family historythere are no establishedpreventable risk factors for prostate cancer.MoticSelected￿CancersStomach Cancer[5]MoticA￿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.MoticThe￿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.Motic1234the 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.MoticSelected￿CancersLiver Cancer[6]MoticLiver￿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.MoticHalf of these cases and deaths were estimated to occur in China. Globally, rates are more than twice as high in males as in females.MoticRisk factors accounting for liver cancer12345• chronic HBV/HCV infection•nonalcoholic fatty liver disease•obesity•alcohol-related cirrhosis• aflatoxin B1 (AFB) exposureMoticLiver￿cancer￿incidence￿rates￿are￿increasing￿inmany￿parts￿of￿the￿world￿including￿the￿United￿Statesand￿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,￿ratesdecreased￿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.Moticintroduced the HBV vaccine into their nationalinfant immunization schedules(Fig. 10).Preventive strategies against HCV, include screening ofdonor’s blood for antibodies to HCV, institutingadequate 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 cancerBest￿strategyMoticMoticSelected￿CancersCervical Cancer[7]MoticCervical 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.MoticWorldwide, 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.MoticThe￿most￿efficient￿and￿cost-effective￿screening￿techniques￿in￿low-resource￿countries￿￿visual￿Inspection acetic acid/Lugol’s iodine HPV DNA testingA recent clinical trial in rural India, a low-resource area, found that a singleround of HPV DNA testing was associated with about a 50% reduction in the risk of developing advanced cervical cancer and associated deaths.MoticThe￿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.Dispute of HPVMoticSelected￿CancersEsophageal[8]MoticEsophageal 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.MoticAn￿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.MoticIn the highest risk area, stretching from northern Iran through the central Asian republics to North-Central China, often referred to as the‘esophageal cancer Belt’90% of cases are squamous cell carcinomas.Motic￿￿Major￿risk￿factors￿￿(for￿squamous￿cell￿carcinomas)￿Poor￿nutritional￿statusLow intake of fruits and vegetablesDrinking￿beverages￿at￿high￿TemperaturesSmoking/excessive alcohol consumptionIn 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.Motic￿￿￿Major￿risk￿factors￿￿￿￿￿￿￿(for￿adenocarcinoma)￿SmokingOverweight/ObesityChronic gastroesophagealreflux diseaseBarrett’s esophagusMoticIncidence￿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￿alcoholconsumption.MoticSelected￿CancersBladder[9]MoticAn 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 mortalityrates, 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.MoticSmoking 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.MoticSelected￿CancersLip and Oral Cavity[10]MoticAn 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.Motic1234Major risk factorsSmokingAlcohol useSmokeless tobacco/Betel quidHPV infectionssmoking accounts for 42% of deathsheavy alcohol consumptionfor 16% of the deathsHaving synergistic effectsMoticConclusion1The￿global￿burden￿of￿cancerThe 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.MoticConclusion2Disproportionate￿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.MoticConclusion3Cancer￿preventionA 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. MoticConclusion4Have￿yet￿to￿doMuch remains to be learned about the causes of severalmajor cancers including prostate and colorectal cancers.Implementing and sustaining such actions requiresconcerted efforts among private and government publichealth agencies and the pharmaceutical industry, aswell as individual and government donors.Thanks!PPT DESIGNED BY TIM TANG, Mar 19th, 2013。