| 摘要: |
| 我国是癌症负担最重的国家之一。2022年，我国大陆地区人口占世界人口总数的18.66%，但是新发癌症例数和癌症死亡例数分别占全球的24.17%和26.44%；其中肺癌、肝癌、胃癌、结直肠癌和食管癌的死亡率居前5位，占全部癌症死亡的67.50%。我国肝癌、胃癌和食管癌年龄标化发病率（ASIR）和年龄标化死亡率（ASMR）有下降趋势，而相应的粗率有增加趋势。肺癌的ASMR在城市地区下降、在农村地区上升，结直肠癌ASIR和ASMR持续上升，提示人口老龄化、工业污染向农村转移和生活方式改变影响了癌症负担。随着中国经济迅速转型，与现代生活方式相关的危险因素如缺乏体育运动、烟酒嗜好、代谢综合征、非健康饮食及心理问题等持续增加，而与贫穷落后相关的危险因素如环境污染、食品污染、慢性感染（包括乙型肝炎病毒、人乳头瘤病毒、幽门螺杆菌和华支睾吸虫感染等）依然存在。这两类原因推升了现阶段中国社会癌症高负担。上述这些病因可通过影响遗传和表观遗传机制直接致癌，但更多的是通过诱导慢性炎症导致炎-癌转化。针对可干预病因进行预防，通过改善生活方式、开展有氧运动以降低全身低强度炎症、提升免疫水平，有助于降低癌症的发生率和死亡率。此外，癌症筛查有助于降低结直肠癌等几种慢性进展类癌症的ASMR。应用队列研究和流行病学方法阐明病因预防、筛查及临床治疗对癌症发生和预后的影响，是癌症三级预防的关键举措。将上游预防工作和下游诊疗工作有机结合，是控制癌症所致期望寿命折损最具成本效益的有效策略。 |
| 关键词: 癌症 发病率 死亡率 危险因素 三级预防 预后 |
| DOI：10.16781/j.CN31-2187/R.20250050 |
| 投稿时间：2025-01-22修订日期：2025-02-13 |
| 基金项目:国家科技创新2030重大研究计划（2023ZD0500100），国家自然科学基金（82473715）. |
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| Cancer in China: epidemiological characteristics,current prophylaxis and treatment,and future strategy |
| CAO Guangwen* |
(Department of Navy Epidemiology, Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| China is heavily affected by cancer. In 2022, the population in Chinese mainland accounted for 18.66% of the world, but new cancer cases and cancer-related deaths accounted for 24.17% and 26.44% of the world, respectively. Lung cancer, liver cancer, gastric cancer, colorectal cancer, and esophageal cancer are the top 5 histological types, accounting for 67.50% of all cancer-related deaths. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of liver cancer, gastric cancer, and esophageal cancer keep decreasing whereas their corresponding crude rates are increasing. The ASMR of lung cancer keeps decreasing in urban areas but increasing in rural areas. The ASIR and ASMR of colorectal cancer are increasing gradually. These data indicate that aging, movement of industrial pollution to rural areas, and alterations in lifestyle seriously affect cancer burden. Due to the rapid transformation of China’s economic, modern lifestyle-related risk factors including physical inactivity, smoking and alcohol consumption, metabolic syndrome, unhealthy diet, and psychological problems continue to increase; furthermore, poverty-related risk factors including environmental pollution, food contamination, and chronic infections (including the infections with hepatitis B virus, human papillomavirus, Helicobacter pylori, and Clonorchis sinensis) still exist, both pushing up the high burden of cancers in China at this stage. These causal factors are carcinogenic either by directly interfering genetic and epigenetic mechanisms, or most frequently induce chronic inflammation to inflammation-cancer transformation. Targeted interventions to the modifiable risk factors, such as improving lifestyle and increasing physical activity can reduce systemic inflammation and improve immunity, so as to decrease cancer occurrence and cancer-related death. In addition, cancer screening is helpful in decreasing the ASMRs of several slowly progressive cancer types including colorectal cancer. Epidemiological cohort study and experimental epidemiology are key to clarify the effects of primary prophylaxis, screening, and clinical treatments on the occurrence and prognosis of cancers, which is the key for improvement of cancer tertiary prophylaxis. Optimal combination of cancer prevention and clinical diagnosis and treatment should be an effective strategy to control the cancer-caused loss of life expectancy in a cost-effective way. |
| Key words: cancer incidence mortality risk factors tertiary prevention prognosis |
