Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
CA Cancer J Clin. 2015 Mar;65(2):87-108. doi: 10.3322/caac.21262. Epub 2015 Feb 4.
Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.
癌症在经济较不发达和较发达的国家都给社会带来了沉重的负担。由于人口的增长和老龄化,以及与城市化和经济发展相关的已确立的风险因素(如吸烟、超重、缺乏身体活动和生育模式的改变)的流行率增加,癌症的发病率也在不断上升。根据 GLOBOCAN 估计,2012 年全球约有 1410 万例新癌症病例和 820 万人死亡。多年来,负担已转移到较不发达国家,这些国家目前占全球病例的约 57%,癌症死亡人数的 65%。在较不发达国家和较发达国家,肺癌都是男性癌症死亡的主要原因,在较发达国家,肺癌已超过乳腺癌成为女性癌症死亡的主要原因;在较不发达国家,乳腺癌仍然是女性癌症死亡的主要原因。在较发达国家,男性和女性的结直肠癌和男性的前列腺癌也是癌症死亡的主要原因。在较不发达国家,男性的肝癌和胃癌以及女性的宫颈癌也是癌症死亡的主要原因。尽管在男性和女性中,较发达国家的所有癌症的综合发病率几乎是较不发达国家的两倍,但较发达国家的死亡率仅比较不发达国家高 8%至 15%。这种差异反映了癌症组合在区域上的差异,这受到风险因素和检测实践的影响,以及/或者治疗的可及性的影响。与癌症主要死亡原因相关的风险因素包括烟草使用(肺癌、结直肠癌、胃癌和肝癌)、超重/肥胖和缺乏身体活动(乳腺癌和结直肠癌)以及感染(肝癌、胃癌和宫颈癌)。广泛应用有效的预防措施,如控烟、疫苗接种和使用早期检测试验,可以预防相当一部分癌症病例和死亡。
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