最新中国和全球肿瘤发病率和死亡率解析ppt课件

SelectedCancersCervicalCancer[7]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21.76%。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84.27%.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Worldwide1.1:11.26:1Total:12,700,000Total:7,600,000DevelopedcountriesDevelopingcountriesItshouldalsobenotedthatcancertendstobediagnosedatlaterstagesinmanydevelopingcountriescomparedwithdevelopedcountriesandthis,combinedwithreducedaccesstoappropriatetherapeuticfacilitiesanddrugs(Fig.3),hasanadverseeffectonsurvival.SelectedCancersFemaleBreastCancer[1]Breastcanceristhemostfrequentlydiagnosedcancerandtheleadingcauseofcancerdeathinfemalesworldwide,accountingfor23%(1.38million)ofthetotalnewcancercasesand14%(458,400)ofthetotalcancerdeathsin2008(Fig.2),Abouthalfthebreastcancercasesand60%ofthedeathsareestimatedtooccurineconomicallydevelopingcountries.Ingeneral,incidenceratesarehighinWesternandNorthernEurope,Australia/NewZealand,andNorthAmerica;intermediateinSouthAmerica,theCaribbean,andNorthernAfrica;andlowinsub-SaharanAfricaandAsia.Thefactorsthatcontributetotheinternationalvariationinincidencerateslargelystemfromdifferencesinreproductiveandhormonalfactorsandtheavailabilityofearlydetectionservices.Reproductivefactorsthatincreaserisk12345longmenstrualhistoryoralcontraceptiveslateageatfirstbirthnulliparityrecentuseofpostmenopausalhormonetherapyHowtoreducetheriskofdevelopingbreastcancer?MaintainingahealthybodyweightIncreasingphysicalactivityMinimizingalcoholintakeEarlydetectionstrategiesincludethepromotionofawarenessofearlysignsandsymptomsandscreeningbyclinicalbreastexaminationBestavailablestrategiesSelectedCancersColorectalCancer[2]Colorectalcanceristhe3rdmostcommonlydiagnosedcancerinmalesandthe2ndinfemales,withover1.2millionnewcancercasesand608,700deathsestimatedtohaveoccurredin2008.ThehighestincidenceratesarefoundinAustraliaandNewZealand,Europe,andNorthAmerica,whereasthelowestratesarefoundinAfricaandSouth-CentralAsia.Ratesaresubstantiallyhigherinmalesthaninfemales.TrendsRiskFactorsRatescontinuetoincreaseincountrieswithlimitedresourcesandhealthinfrastructure,particularlyinEasternEuropeandEasternAsiaWhiledecreasinginseveralWesterncountries,particularlyinUnitedStates,Canada,andAustraliaSmokingPhysicalinactivityOverweight/ObesityRedandprocessedmeatconsumptionExcessivealcoholconsumptionPopulation-basedcolorectalscreeningprograms**AccordingtoarecentrandomizedtrialintheUnitedKingdom,aone-timeflexiblesigmoidoscopyscreeningbetween55and64yearsofagereducedcolorectalcancerincidenceby33%andmortalityby43%.SelectedCancersLungCancer[3]Lungcancerwasthemostcommonlydiagnosedcanceraswellastheleadingcauseofcancerdeathinmalesin2008globally.Amongfemales,itwasthe4thmostcommonlydiagnosedcancerandthe2ndleadingcauseofcancerdeath.Lungcanceraccountsfor13%(1.6million)ofthetotalcasesand18%(1.4million)ofthedeathsin2008.Inmales,thehighestlungcancerincidenceratesareinEasternandSouthernEurope,NorthAmerica,andEasternAsia,whileratesarelowinsub-SaharanAfrica.Infemales,thehighestlungcancerincidenceratesarefoundinNorthAmerica,NorthernEurope,andAustralia/NewZealand.Smokingaccountsfor80%oftheworldwidelungcancerburdeninmalesandatleast50%oftheburdeninfemales.MalelungcancerdeathratesaredecreasinginmostWesterncountries,includingmanyEuropeancountries,NorthAmerica,andAustralia,wherethetobaccoepidemicpeakedbythemiddleofthelastcentury.Incontrast,lungcancerratesareincreasingincountriessuchasChinaandseveralothercountriesinAsiaandAfrica,wheretheepidemichasbeenestablishedmorerecentlyandsmokingprevalencecontinuestoeitherincreaseorshowsignsofstability.byapplyingproventobaccocontrolinterventionsthatincluderaisingthepriceofcigarettes*andothertobaccoproducts,banningsmokinginpublicplaces,therestrictionofadvertisingoftobaccoproducts,counteradvertising,andtreatingtobaccodependence.avoidtheburdenoflungcancerBeststrategy*a10%increaseincigarettepriceshasbeenshowntoreducecigaretteconsumptionby3%to5%.SelectedCancersProstateCancer[4]Prostatecanceristhe2ndmostfrequentlydiagnosedcancerandthe6thleadingcauseofcancerdeathinmales,accountingfor14%(903,500)ofthetotalnewcancercasesand6%(258,400)ofthetotalcancerdeathsinmalesin2008。Incidenceratesvarybymorethan25-foldworldwidelargelybecauseofthewideutilizationofprostate-specificantigen(PSA)testing.Deathratesforprostatecancerhavebeendecreasinginmanydevelopedcountries,includingAustralia,Canada,theUnitedKingdom,theUnitedStates,Italyinpartbecauseoftheimprovedtreatmentwithcurativeintent.theonlywell-establishedriskfactorsOlderageRace(black)Familyhistorytherearenoestablishedpreventableriskfactorsforprostatecancer.SelectedCancersStomachCancer[5]Atotalof989,600newstomachcancercasesand738,000deathsareestimatedtohaveoccurredin2008,accountingfor8%ofthetotalcasesand10%oftotaldeaths.Over70%ofnewcasesanddeathsoccurindevelopingcountries.Generally,stomachcancerratesareabouttwiceashighinmalesasinfemales.ThehighestincidenceratesareinEasternAsia,EasternEurope,andSouthAmericaandthelowestratesareinNorthAmericaandmostpartsofAfrica.Regionalvariationsinpartreflectdifferencesindietarypatterns,particularlyinEuropeancountries,andtheprevalenceofHelicobacterpyloriinfection.1234theincreaseduseandavailabilityofrefrigerationincludingtheincreasedavailabilityoffreshfruitsandvegetables,andadecreasedrelianceonsaltedandpreservedfoods.Rateshavedecreaseddueto(westerncountries):reductionsinchronicH.pyloriinfectioninmostpartsoftheworld.reductionsinsmokinginsomepartsofthedevelopedworld.InJapan,mortalityratesmayhavedeclinedviatheintroductionofscreeningusingphotofluorography.SelectedCancersLiverCancer[6]Livercancerinmenisthe5thmostfrequentlydiagnosedcancerworldwidebutthe2ndmostfrequentcauseofcancerdeath.Inwomen,itisthe7thmostcommonlydiagnosedcancerandthe6thleadingcauseofcancerdeath.Anestimated748,300newlivercancercasesand695,900cancerdeathsoccurredworldwidein2008.HalfofthesecasesanddeathswereestimatedtooccurinChina.Globally,ratesaremorethantwiceashighinmalesasinfemales.Riskfactorsaccountingforlivercancer12345chronicHBV/HCVinfectionnonalcoholicfattyliverdiseaseobesityalcohol-relatedcirrhosisaflatoxinB1(AFB)exposureLivercancerincidenceratesareincreasinginmanypartsoftheworldincludingtheUnitedStatesandCentralEurope,possiblyduetotheobesityepidemicandtheriseinHCVinfectionthroughcontinuedtransmissionbyinjectiondrugusers.Incontrasttothetrendinthelow-riskareas,ratesdecreasedinsomehistoricallyhigh-riskareas,possiblyduetotheHBVvaccine.UniversalinfanthepatitisvaccinationprogramsinTaiwanreducedlivercancerincidenceratesbyabouttwo-thirdsinchildrenandyoungadults.introducedtheHBVvaccineintotheirnationalinfantimmunizationschedules(Fig.10).PreventivestrategiesagainstHCV,includescreeningofdonor’sbloodforantibodiestoHCV,institutingadequateinfectioncontrolpracticesincludingtheuseoforaldeliveryofmedicineswherepossible,andneedleexchangeprogramsamonginjectiondrugusers.CropsubstitutionandimprovedgrainstoragepracticeshavebeenshowntoreducecontaminationwithAFB.avoidtheburdenoflivercancerBeststrategyCervicalcanceristhe3rdmostcommonlydiagnosedcancerandthe4thleadingcauseofcancerdeathinfemalesworldwide,accountingfor9%(529,800)ofthetotalnewcancercasesand8%(275,100)ofthetotalcancerdeathsamongfemalesin2008.Morethan85%ofthesecasesanddeathsoccurindevelopingcountries.India,the2ndmostpopulouscountryintheworld,accountsfor27%(77,100)ofthetotalcervicalcancerdeaths.Worldwide,thehighestincidenceratesareinEastern,Western,andSouthernAfrica,aswellasSouth-CentralAsiaandSouthAmerica.RatesarelowestinWesternAsia,Australia/NewZealand,andNorthAmerica.Thedisproportionatelyhighburdenofcervicalcancerindevelopingcountriesandelsewhereinmedicallyunderservedpopulationsislargelyduetoalackofscreeningthatallowsdetectionofprecancerousandearlystagecervicalcancer.Themostefficientandcost-effectivescreeningtechniquesinlow-resourcecountriesvisualInspectionaceticacid/Lugol’siodineHPVDNAtestingArecentclinicaltrialinruralIndia,alow-resourcearea,foundthatasingleroundofHPVDNAtestingwasassociatedwithabouta50%reductionintheriskofdevelopingadvancedcervicalcancerandassociateddeaths.TheexpectationsthatvaccineswhichprimarilyprotectagainstthemostcommonstrainsofHPVinfections(HPVtypes16and18),whichcauseabout70%ofcervicalcancers,maypreventcervicalcancerworldwideareatpresenthigh.However,affordablepricingisthemostcriticalfactortofacilitatetheintroductionofHPVvaccinesinlow-andmedium-resourcecountriesintheshortterm.Itisalsoextremelyimportantthatwomencontinuetoreceivescreeningservicesbecausethecurrentvaccinesarebeinggiventoadolescentgirlsonly,andevenvaccinatedgirlsshouldbeginscreeningwhentheyreachtherecommendedscreeningagesincethevaccinesdonotprovideprotectionforthe30%ofchronicinfectionsbyHPVtypesotherthanHPV16,18,6and11thatcausecervicalcancer.DisputeofHPVSelectedCancersEsophageal[8]Esophagealcancerusuallyoccursaseithersquamouscellcarcinomainthemiddleorupperone-thirdoftheesophagus,orasadenocarcinomaintheloweronethirdorjunctionoftheesophagusandstomach.Anestimated482,300newesophagealcancercasesand406,800deathsoccurredin2008worldwide.Incidenceratesvaryinternationallybynearly16-fold,withthehighestratesfoundinSouthernandEasternAfricaandEasternAsiaandlowestratesobservedinWesternandMiddleAfricaandCentralAmericainbothmalesandfemales.Esophagealcanceris3to4timesmorecommonamongmalesthanfemales.Inthehighestriskarea,stretchingfromnorthernIranthroughthecentralAsianrepublicstoNorth-CentralChina,oftenreferredtoasthe‘esophagealcancerBelt’90%ofcasesaresquamouscellcarcinomas.EsophagealCancerBeltMajorriskfactors(forsquamouscellcarcinomas)PoornutritionalstatusLowintakeoffruitsandvegetablesDrinkingbeveragesathighTemperaturesSmoking/excessivealcoholconsumptionInlow-riskareassuchastheUnitedStatesandseveralWesterncountries,smokingandexcessivealcoholconsumptionaccountforabout90%ofthetotalcasesofsquamouscellcarcinomaoftheesophagus.Majorriskfactors(foradenocarcinoma)SmokingOverweight/ObesityChronicgastroesophagealrefluxdiseaseBarrett’sesophagusIncidenceratesforadenocarcinomaoftheesophagushavebeenincreasinginseveralwesterncountries,inpartduetoincreasesintheprevalenceofknownriskfactorssuchasoverweightandobesity.Incontrast,ratesforsquamouscellcarcinomaoftheesophagushavebeensteadilydeclininginthesesamecountriesbecauseoflong-termreductionsintobaccouseandalcoholconsumption.SelectedCancersBladder[9]Anestimated386,300newcasesand150,200deathsfrombladdercanceroccurredin2008worldwide.Themajorityofbladdercanceroccursinmalesandthereisa14-foldvariationinincidenceinternationally.ThehighestincidenceratesarefoundinthecountriesofEurope,NorthAmerica,andNorthernAfrica.Egyptianmaleshavethehighestmortalityrates,whichistwiceashighasthehighestratesinEuropeandover4timeshigherthanthatintheUnitedStates.ThelowestratesarefoundinthecountriesofMelanesiaandMiddleAfrica.SmokingisthemajorriskfactorsinWesterncountries,whereaschronicinfectionwithSchistosomahematobiumindevelopingcountries,particularlyinAfricaandtheMiddleEast,accountsforabout50%ofthetotalburden.SelectedCancersLipandOralCavity[10]Anestimated263,900newcasesand128,000deathsfromoralcavitycancer(includinglipcancer)occurredin2008worldwide.Generally,thehighestoralcavitycancerratesarefoundinMelanesia,South-CentralAsia,andCentralandEasternEuropeandthelowestinAfrica,CentralAmerica,andEasternAsiaforbothmalesandfemales.1234MajorriskfactorsSmokingAlcoholuseSmokelesstobacco/BetelquidHPVinfectionssmokingaccountsfor42%ofdeathsheavyalcoholconsumptionfor16%ofthedeathsHavingsynergisticeffectsConclusion1TheglobalburdenofcancerTheglobalburdenofcancercontinuestoincreaselargelybecauseoftheagingandgrowthoftheworldpopulationandanincreasingadoptionofcancer-causingbehaviors,particularlysmoking,withineconomicallydevelopingcountries.Conclusion2DisproportionatecancerburdenFemalebreast,lung,andcolorectalcancersareoccurringinhighfrequenciesinmanyeconomicallydevelopingcountries,inadditiontothedisproportionatelyhighburdenofcancersrelatedtoinfections.Conclusion3CancerpreventionAsignificantproportionoftheworldwideburdenofcancercouldbepreventedthroughtheapplicationofexistingcancercontrolknowledge,andbyimplementingprogramsfortobaccocontrol,vaccination(forliverandcervicalcancers),andearlydetectionandtreatment,aswellaspublichealthcampaignspromotingphysicalactivityandhealthierdietarypatterns.Conclusion4HaveyettodoMuchremainstobelearnedaboutthecausesofseveralmajorcancersincludingprostateandcolorectalcancers.Implementingandsustainingsuchactionsrequiresconcertedeffortsamongprivateandgovernmentpublichealthagenciesandthepharmaceuticalindustry,aswellasindividualandgovernmentdonors.Thanks!PPTDESIGNEDBYTIMTANG,Mar19th,2013