1980 年至 2010 年 187 个国家的乳腺癌和宫颈癌：系统分析。

Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis.

机构信息

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.

出版信息

Lancet. 2011 Oct 22;378(9801):1461-84. doi: 10.1016/S0140-6736(11)61351-2. Epub 2011 Sep 14.

DOI:10.1016/S0140-6736(11)61351-2

PMID:21924486

Abstract

BACKGROUND

Breast and cervical cancer are important causes of mortality in women aged ≥15 years. We undertook annual age-specific assessments of breast and cervical cancer in 187 countries.

METHODS

We systematically collected cancer registry data on mortality and incidence, vital registration, and verbal autopsy data for the period 1980-2010. We modelled the mortality-to-incidence (MI) ratio using a hierarchical model. Vital registration and verbal autopsy were supplemented with incidence multiplied by the MI ratio to yield a comprehensive database of mortality rates. We used Gaussian process regression to develop estimates of mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the final model. Estimates of incidence with uncertainty were also generated with mortality and MI ratios.

FINDINGS

Global breast cancer incidence increased from 641,000 (95% uncertainty intervals 610,000-750,000) cases in 1980 to 1,643,000 (1,421,000-1,782,000) cases in 2010, an annual rate of increase of 3·1%. Global cervical cancer incidence increased from 378,000 (256,000-489,000) cases per year in 1980 to 454,000 (318,000-620,000) cases per year in 2010-a 0·6% annual rate of increase. Breast cancer killed 425,000 (359,000-453,000) women in 2010, of whom 68,000 (62,000-74,000) were aged 15-49 years in developing countries. Cervical cancer death rates have been decreasing but the disease still killed 200,000 (139,000-276,000) women in 2010, of whom 46,000 (33,000-64,000) were aged 15-49 years in developing countries. We recorded pronounced variation in the trend in breast cancer mortality across regions and countries.

INTERPRETATION

More policy attention is needed to strengthen established health-system responses to reduce breast and cervical cancer, especially in developing countries.

FUNDING

Susan G Komen for the Cure and the Bill & Melinda Gates Foundation.

摘要

背景

乳腺癌和宫颈癌是导致 15 岁及以上女性死亡的重要原因。我们对 187 个国家的乳腺癌和宫颈癌进行了年度特定年龄评估。

方法

我们系统地收集了 1980 年至 2010 年期间的死亡率和发病率、生命登记以及口头尸检数据的癌症登记数据。我们使用分层模型来对死亡率与发病率（MI）比值进行建模。生命登记和口头尸检数据通过发病率乘以 MI 比值进行补充，以生成死亡率综合数据库。我们使用高斯过程回归来通过年龄、性别、国家和年份来开发具有不确定性的死亡率估计值。我们使用样本外预测有效性来选择最终模型。也使用死亡率和 MI 比值生成了具有不确定性的发病率估计值。

结果

全球乳腺癌发病率从 1980 年的 641000 例（95%置信区间为 610000-750000）增加到 2010 年的 1643000 例（1421000-1782000），年增长率为 3.1%。全球宫颈癌发病率从 1980 年每年 378000 例（256000-489000）增加到 2010 年的每年 454000 例（318000-620000），年增长率为 0.6%。2010 年，乳腺癌导致 425000 名女性死亡（359000-453000），其中 68000 名（62000-74000）为发展中国家的 15-49 岁女性。宫颈癌死亡率一直在下降，但 2010 年仍有 200000 名女性死亡（139000-276000），其中 46000 名（33000-64000）为发展中国家的 15-49 岁女性。我们记录到乳腺癌死亡率在不同地区和国家之间的趋势存在明显差异。