Pritchard C, Hickish T
Professor in Psychiatric Social Work, School of Health & Social Care, Bournemouth University, UK, and Emeritus Professor, School of Medicine, University of Southampton, UK.
Ecancermedicalscience. 2008;2:80. doi: 10.3332/eCMS.2008.80. Epub 2008 Jul 28.
The successful treatment of cancer is a major health and political issue for England and Wales and the major developed countries (MDCs). All malignancy deaths by age and sex are analysed to determine how successful the MDCs were in reducing cancer mortality between the end points of 1979-81 and 2000-2, and whether there was any association between each nations 'gross domestic product expenditure on health' (GDPEH) and the reduction in their cancer deaths.
Incidence of cancer in England and Wales was examined for 1979-80 to 2003-4 to highlight the extent of the problem. The cancer mortality rates for England and Wales were compared with each MDC by age and sex, using 'WHO all malignancies mortality rates' for the periods of 1979-81 and 2000-2, and tests of significance were made. The GDPEH for each MDC was examined for 1980-2002, and Spearman rank-order correlations calculated to explore any association between declining cancer deaths and the GDPEH of each MDC.
Men's All Age malignancy incidence in England and Wales rose 48% and women's 51%, with notable rises for females aged 15-34 and 55-74 years.Every MDC increased its GDPEH substantially; it rose to 9.3% in the United Kingdom, but the United Kingdom still remains eighth of the ten MDCs and below the MDC average (9.85%).The average number of cancer related deaths for men in England and Wales (15-74 years) was third highest in 1979-81, but fell to eighth by 2000-2. This decline was significantly greater than in seven other MDCs. Average female death rates in England and Wales were highest both in 1979-81 and in 2000-2, but declined significantly more than most MDCs in every age band from 35 to 74 years.There was a significant correlation between reduced deaths and the level of GDPEH of each nation.Male death rates declined significantly more than that of female in each MDC, with the exception of Japan and Spain.
The rising incidence in cancer-related deaths poses a problem for every MDC, and the poorer women's results should be a matter of concern for most MDCs. The reduction in cancer deaths reflects well on frontline services, and the significant association between reduced cancer mortality and increased GDPEH is encouraging, but still a challenge for governments, especially if the incidence continues to rise.
癌症的成功治疗是英格兰、威尔士以及主要发达国家面临的一个重大健康和政治问题。分析按年龄和性别划分的所有恶性肿瘤死亡情况，以确定主要发达国家在1979 - 1981年至2000 - 2002年这两个时间端点之间降低癌症死亡率方面的成效，以及各国“卫生方面的国内生产总值支出”（GDPEH）与癌症死亡人数减少之间是否存在关联。
研究1979 - 1980年至2003 - 2004年英格兰和威尔士的癌症发病率，以突出问题的严重程度。利用1979 - 1981年和2000 - 2002年期间的“世界卫生组织所有恶性肿瘤死亡率”，按年龄和性别将英格兰和威尔士的癌症死亡率与每个主要发达国家进行比较，并进行显著性检验。研究1980 - 2002年每个主要发达国家的卫生方面的国内生产总值支出，并计算斯皮尔曼等级相关系数，以探究癌症死亡人数下降与每个主要发达国家的卫生方面的国内生产总值支出之间的任何关联。
英格兰和威尔士男性所有年龄段的恶性肿瘤发病率上升了48%，女性上升了51%，15 - 34岁和55 - 74岁的女性上升尤为明显。每个主要发达国家的卫生方面的国内生产总值支出都大幅增加；英国升至9.3%，但英国在十个主要发达国家中仍排名第八，低于主要发达国家平均水平（9.85%）。1979 - 1981年，英格兰和威尔士15 - 74岁男性的癌症相关死亡平均人数排名第三，到2000 - 2002年降至第八。这一下降幅度明显大于其他七个主要发达国家。英格兰和威尔士女性的平均死亡率在1979 - 1981年和2000 - 2002年都是最高的，但在35至74岁的每个年龄组中，下降幅度明显大于大多数主要发达国家。各国死亡人数减少与卫生方面的国内生产总值支出水平之间存在显著相关性。除日本和西班牙外，每个主要发达国家男性死亡率的下降幅度明显大于女性。
癌症相关死亡人数的上升给每个主要发达国家都带来了问题，女性较差的结果应引起大多数主要发达国家的关注。癌症死亡人数的减少对一线服务是一个很好的反映，癌症死亡率降低与卫生方面的国内生产总值支出增加之间的显著关联令人鼓舞，但对各国政府来说仍是一个挑战，尤其是如果发病率继续上升的话。
