Mumbai Cancer Registry, Indian Cancer Society, Mumbai, India.
Br J Cancer. 2011 Aug 23;105(5):723-30. doi: 10.1038/bjc.2011.301. Epub 2011 Aug 9.
Demographic, socioeconomic and cultural changes in India have increased longevity, delayed childbearing, decreased parity and resulted in a more westernised lifestyle, contributing to the increasing burden of cancer, especially among women.
We evaluated secular changes in the incidence of breast, cervical and ovarian cancer in Mumbai women aged 30-64 between 1976 and 2005. Age-standardised incidence rates were calculated and presented by site and calendar period. An age-period-cohort (APC) analysis quantified recent time trends and the significance of birth cohort and calendar period effects. The estimated annual percent change (EAPC) was obtained from the drift parameter, expressing the linear time trend common to both calendar period and birth cohort.
Over the 30-year study period, the age-standardised rates significantly increased for breast cancer (EAPC: 1.1% (95% confidence interval (CI): 1.0, 1.3)), significantly decreased for cervical cancer (EAPC: -1.8% (95% CI: -2.0, -1.6)) and there was no statistically significant change for ovarian cancer (EAPC: 0.3% (95% CI: -0.1, 0.6)). For breast and cervical cancer, the best-fitting model was the APC model.
The rates of breast, cervical and ovarian cancer remain low in comparison with western countries, and the divergent trends of breast (increasing) and cervical cancer (decreasing) in Mumbai were similar to those observed in several other Asian countries. The changing risk profile in successive generations - improved education, higher socioeconomic status, later age at marriage and at first child, and lower parity - may in combination partially explain the diverging generational changes in breast and cervical cancer in Mumbai in the last decades.
印度人口结构、社会经济和文化的变化导致了人口寿命延长、生育年龄推迟、生育次数减少，并形成了更西化的生活方式，这导致癌症负担增加，尤其是在女性中。
我们评估了 1976 年至 2005 年孟买 30-64 岁女性乳腺癌、宫颈癌和卵巢癌的发病率变化。计算了各部位和各日历期的年龄标准化发病率，并进行了展示。采用年龄-时期-队列（APC）分析量化了近期的时间趋势，以及出生队列和日历期效应的显著性。通过漂移参数得出了年估计百分比变化（EAPC），该参数表达了同时存在于日历期和出生队列的线性时间趋势。
在 30 年的研究期间，乳腺癌的年龄标准化发病率显著增加（EAPC：1.1%（95%置信区间（CI）：1.0，1.3）），宫颈癌显著下降（EAPC：-1.8%（95%CI：-2.0，-1.6）），卵巢癌无统计学意义的变化（EAPC：0.3%（95%CI：-0.1，0.6））。对于乳腺癌和宫颈癌，最佳拟合模型为 APC 模型。
与西方国家相比，孟买的乳腺癌、宫颈癌和卵巢癌的发病率仍然较低，且孟买乳腺癌（上升）和宫颈癌（下降）的发散趋势与其他几个亚洲国家的观察结果相似。在连续几代人中，风险特征的变化——受教育程度提高、社会经济地位提高、结婚和初育年龄推迟、生育次数减少——可能部分结合起来，解释了过去几十年孟买乳腺癌和宫颈癌的代际变化的分歧。
