Estève Jacques
Université Claude Bernard, CHU, Lyon (69), France.
Presse Med. 2007 Feb;36(2 Pt 2):315-21. doi: 10.1016/j.lpm.2006.12.007. Epub 2007 Jan 2.
The incidence of breast cancer increased over the last 20 years of the 20(th) century in all industrialized countries. The shape of the trend varied according to country. The increase in the prevalence of risk factors associated with a "western" lifestyle has had a major influence on this increase in countries where incidence was low at the start of the study period. Generalized screening practices, on the other hand, has played a key role in countries where incidence was already elevated in the 1970s. This evolution over time, together with the cohort effect (associated with year of birth), makes analysis and interpretation of the available international data too complex to allow us to quantify the respective contributions of screening, treatments and risk factors to mortality trends, which are beginning to decrease substantially in most countries with elevated incidence rates.
在20世纪的最后20年里,所有工业化国家的乳腺癌发病率都有所上升。趋势的形态因国家而异。与“西方”生活方式相关的风险因素患病率增加,对研究初期发病率较低的国家的这种增长产生了重大影响。另一方面,在20世纪70年代发病率就已升高的国家,广泛的筛查措施起到了关键作用。这种随时间的演变,再加上队列效应(与出生年份相关),使得对现有国际数据的分析和解读过于复杂,以至于我们无法量化筛查、治疗和风险因素对死亡率趋势的各自贡献,而在大多数发病率较高的国家,死亡率趋势已开始大幅下降。