Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.
Cancer Causes Control. 2009 Dec;20(10):2021-9. doi: 10.1007/s10552-009-9397-9.
Although gastric cancer incidence is declining in China, trends may differ from historical patterns in developed countries. Our aim was to (1) retrospectively estimate the effects of Helicobacter pylori (H. pylori) and smoking on past gastric cancer incidence and (2) project how interventions on these two risk factors can reduce future incidence.
We used a population-based model of intestinal-type gastric cancer to estimate gastric cancer incidence between 1985 and 2050. Disease and risk factor data in the model were from community-based epidemiological studies and national prevalence surveys.
Between 1985 and 2005, age-standardized gastric cancer incidence among Chinese men declined from 30.8 to 27.2 per 100,000 (12%); trends in H. pylori and smoking prevalences accounted for >30% of overall decline. If past risk factor trends continue, gastric cancer incidence will decline an additional 30% by 2050. Yet, annual cases will increase from 116,000 to 201,000 due to population growth and aging. Assuming that H. pylori prevention/treatment and tobacco control are implemented in 2010, the decline in gastric cancer incidence is projected to increase to 33% with universal H. pylori treatment for 20-year-olds, 42% for a hypothetical childhood H. pylori vaccine, and 34% for aggressive tobacco control.
The decline in gastric cancer incidence has been slower than in developed countries and will be offset by population growth and aging. Public health interventions should be implemented to reduce the total number of cases. Electronic supplementary material The online version of this article (doi:10.1007/s10552-009-9397-9) contains supplementary material, which is available to authorized users.
尽管中国的胃癌发病率正在下降，但趋势可能与发达国家的历史模式不同。我们的目的是：（1）回顾性估计幽门螺杆菌（H. pylori）和吸烟对过去胃癌发病率的影响；（2）预测这两个危险因素的干预措施如何降低未来的发病率。
我们使用基于人群的肠型胃癌模型来估计 1985 年至 2050 年期间的胃癌发病率。模型中的疾病和危险因素数据来自基于社区的流行病学研究和全国流行性病学调查。
1985 年至 2005 年期间，中国男性的年龄标准化胃癌发病率从每 100,000 人 30.8 例降至 27.2 例（下降 12%）；H. pylori 和吸烟流行率的趋势解释了总体下降的 30%以上。如果过去的风险因素趋势持续下去，到 2050 年，胃癌发病率将进一步下降 30%。然而，由于人口增长和老龄化，每年的病例数将从 116,000 例增加到 201,000 例。假设在 2010 年实施 H. pylori 预防/治疗和烟草控制，那么随着对 20 岁人群进行普遍的 H. pylori 治疗，胃癌发病率的下降预计将增加到 33%，如果假设在儿童时期使用 H. pylori 疫苗，发病率的下降将增加到 42%，如果采取积极的烟草控制措施，发病率的下降将增加到 34%。
胃癌发病率的下降速度慢于发达国家，且将被人口增长和老龄化所抵消。应实施公共卫生干预措施，以减少总病例数。
