Ryerson A Blythe, Eheman Christie R, Altekruse Sean F, Ward John W, Jemal Ahmedin, Sherman Recinda L, Henley S Jane, Holtzman Deborah, Lake Andrew, Noone Anne-Michelle, Anderson Robert N, Ma Jiemin, Ly Kathleen N, Cronin Kathleen A, Penberthy Lynne, Kohler Betsy A
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Cancer. 2016 May 1;122(9):1312-37. doi: 10.1002/cncr.29936. Epub 2016 Mar 9.
Annual updates on cancer occurrence and trends in the United States are provided through an ongoing collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This annual report highlights the increasing burden of liver and intrahepatic bile duct (liver) cancers.
Cancer incidence data were obtained from the CDC, NCI, and NAACCR; data about cancer deaths were obtained from the CDC's National Center for Health Statistics (NCHS). Annual percent changes in incidence and death rates (age-adjusted to the 2000 US Standard Population) for all cancers combined and for the leading cancers among men and women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2012 and mortality for 1975-2012) and short-term trends (2008-2012). In-depth analysis of liver cancer incidence included an age-period-cohort analysis and an incidence-based estimation of person-years of life lost because of the disease. By using NCHS multiple causes of death data, hepatitis C virus (HCV) and liver cancer-associated death rates were examined from 1999 through 2013.
Among men and women of all major racial and ethnic groups, death rates continued to decline for all cancers combined and for most cancer sites; the overall cancer death rate (for both sexes combined) decreased by 1.5% per year from 2003 to 2012. Overall, incidence rates decreased among men and remained stable among women from 2003 to 2012. Among both men and women, deaths from liver cancer increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer. Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes. Among non-Hispanic (NH) white, NH black, and Hispanic men and women, liver cancer incidence rates were higher for persons born after the 1938 to 1947 birth cohort. In contrast, there was a minimal birth cohort effect for NH Asian and Pacific Islanders (APIs). NH black men and Hispanic men had the lowest median age at death (60 and 62 years, respectively) and the highest average person-years of life lost per death (21 and 20 years, respectively) from liver cancer. HCV and liver cancer-associated death rates were highest among decedents who were born during 1945 through 1965.
Overall, cancer incidence and mortality declined among men; and, although cancer incidence was stable among women, mortality declined. The burden of liver cancer is growing and is not equally distributed throughout the population. Efforts to vaccinate populations that are vulnerable to hepatitis B virus (HBV) infection and to identify and treat those living with HCV or HBV infection, metabolic conditions, alcoholic liver disease, or other causes of cirrhosis can be effective in reducing the incidence and mortality of liver cancer. Cancer 2016;122:1312-1337. © 2016 American Cancer Society.
美国癌症协会（ACS）、疾病控制与预防中心（CDC）、国家癌症研究所（NCI）以及北美中央癌症登记协会（NAACCR）通过持续合作，提供美国癌症发病情况及趋势的年度更新。本年度报告重点关注了肝癌和肝内胆管癌（肝癌）负担的增加。
癌症发病率数据来自CDC、NCI和NAACCR；癌症死亡数据来自CDC的国家卫生统计中心（NCHS）。通过对长期趋势（1992 - 2012年发病率和1975 - 2012年死亡率）和短期趋势（2008 - 2012年）进行连接点分析，估计所有癌症合并以及男性和女性主要癌症的发病率和死亡率（年龄调整为2000年美国标准人口）的年度百分比变化。对肝癌发病率的深入分析包括年龄 - 时期 - 队列分析以及基于发病率的因该疾病导致的生命年损失估计。利用NCHS多死因数据，研究了1999年至2013年丙型肝炎病毒（HCV）与肝癌相关的死亡率。
在所有主要种族和族裔群体的男性和女性中，所有癌症合并以及大多数癌症部位的死亡率持续下降；从2003年到2012年，总体癌症死亡率（男女合并）每年下降1.5%。总体而言，从2003年到2012年，男性发病率下降，女性发病率保持稳定。在男性和女性中，肝癌死亡人数的增长速度在所有癌症部位中最高，肝癌发病率急剧上升，仅次于甲状腺癌。男性肝癌发病率是女性的两倍多，且男女发病率均随年龄增长而上升。在非西班牙裔（NH）白人、NH黑人以及西班牙裔男性和女性中，1938年至1947年出生队列之后出生的人肝癌发病率较高。相比之下，NH亚洲和太平洋岛民（API）的出生队列效应最小。NH黑人男性和西班牙裔男性肝癌死亡的中位年龄最低（分别为60岁和62岁），且每次死亡的平均生命年损失最高（分别为21年和20年）。1945年至1965年出生的死者中，HCV与肝癌相关的死亡率最高。
总体而言，男性癌症发病率和死亡率下降；尽管女性癌症发病率稳定，但死亡率下降。肝癌负担在增加，且在人群中分布不均。对易感染乙型肝炎病毒（HBV）的人群进行疫苗接种，以及识别和治疗感染HCV或HBV、患有代谢性疾病、酒精性肝病或其他肝硬化病因的人群，可能有效降低肝癌的发病率和死亡率。《癌症》2016年；122:1312 - 1337。©2016美国癌症协会。
