Lacey James V, Devesa Susan S, Brinton Louise A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
Environ Mol Mutagen. 2002;39(2-3):82-8. doi: 10.1002/em.10062.
Breast cancer accounts for one-third of cancer diagnoses and 15% of cancer deaths in U.S. women. Its 192,000 cases and 40,000 deaths in 2001 make it the most common incident cancer (excluding superficial skin cancers) and second leading cause of cancer death. Over one-half of the 300,000 breast cancer deaths worldwide in 1990 (the latest year with such data) occurred in developed countries, but annual mortality rates ranged from 27/100,000 women in northern Europe to 4/100,000 women in Asia. Incidence data are less complete, although 1988-1992 rates varied threefold: low in Asia, intermediate in South America and Eastern Europe, and high in North America and Western Europe. Migrant studies suggest that lifestyle factors largely explain these international differences. U.S. incidence rates are generally 20%-40% higher in white women than in non-white women, but are higher in young (under age 40) black women than in young white women. Incidence rates rose in the 1970s, leveled off in the 1990s, and are declining for young women. Women in some areas of the northeast U.S. have twofold higher mortality than that of other U.S. women, but reproductive and socioeconomic characteristics explain much of that difference. In the 1970s and 1980s, mortality rates held steady in developed countries but rose in developing countries. Since 1987 mortality rates fell by 25% as a result of earlier detection and improved treatment. Age-period-cohort analyses indicate that changes in recognized risk factors may affect mortality patterns. Continued analysis of international and intranational trends may reveal targets for multidisciplinary intervention and prevention efforts.
在美国女性中，乳腺癌占癌症诊断病例的三分之一，癌症死亡病例的15%。2001年，美国有19.2万例乳腺癌病例和4万例死亡病例，使其成为最常见的发病癌症（不包括浅表皮肤癌），也是癌症死亡的第二大主要原因。1990年（有此类数据的最新年份）全球30万例乳腺癌死亡病例中，超过一半发生在发达国家，但年死亡率从北欧的每10万名女性27例到亚洲的每10万名女性4例不等。发病率数据不太完整，尽管1988 - 1992年的发病率相差三倍：亚洲较低，南美和东欧居中，北美和西欧较高。移民研究表明，生活方式因素在很大程度上解释了这些国际差异。美国白人女性的发病率通常比非白人女性高20% - 40%，但40岁以下的年轻黑人女性的发病率高于年轻白人女性。发病率在20世纪70年代上升，90年代趋于平稳，年轻女性的发病率正在下降。美国东北部某些地区的女性死亡率比其他美国女性高出两倍，但生殖和社会经济特征解释了这种差异的很大一部分。在20世纪70年代和80年代，发达国家的死亡率保持稳定，但发展中国家的死亡率上升。自1987年以来，由于早期发现和治疗改善，死亡率下降了25%。年龄 - 时期 - 队列分析表明，公认风险因素的变化可能会影响死亡率模式。对国际和国内趋势的持续分析可能会揭示多学科干预和预防工作的目标。
