Massetti Greta M, Thomas Cheryll C, Ragan Kathleen R
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatrics. 2016 Nov;138(Suppl 1):S65-S77. doi: 10.1542/peds.2015-4268J.
Persistent health disparities are a major contributor to disproportionate burden of cancer for some populations. Health disparities in cancer incidence and mortality may reflect differences in exposures to risk factors early in life. Understanding the distribution of exposures to early life risk and protective factors for cancer across different populations can shed light on opportunities to promote health equity at earlier developmental stages. Disparities may differentially influence risk for cancer during early life and create opportunities to promote health equity. Potential risk and protective factors for cancer in early life reveal patterns of disparities in their exposure. These disparities in exposures can manifest in downstream disparities in risk for cancer. These risk and protective factors include adverse childhood experiences; maternal alcohol consumption in pregnancy; childhood obesity; high or low birth weight; benzene exposure; use of assisted reproductive technologies; pesticide and insecticide exposure; isolated cryptorchidism; early pubertal timing; exposure to radiation; exposure to tobacco in utero and in early life; allergies, asthma, and atopy; and early exposure to infection. Disparities on the basis of racial and ethnic minority status, economic disadvantage, disability status, sex, geography, and nation of origin can occur in these risk and protective factors. Vulnerable populations experience disproportionally greater exposure to risk factors in early life. Addressing disparities in risk factors in early life can advance opportunities for prevention, promote health equity, and possibly reduce risk for subsequent development of cancer.
持续存在的健康差异是导致某些人群癌症负担过重的主要因素。癌症发病率和死亡率方面的健康差异可能反映了早年接触风险因素的差异。了解不同人群中早年癌症风险和保护因素的暴露分布情况，有助于揭示在早期发育阶段促进健康公平的机会。差异可能对早年患癌风险产生不同影响，并创造促进健康公平的机会。早年癌症的潜在风险和保护因素揭示了其暴露方面的差异模式。这些暴露差异可表现为下游癌症风险的差异。这些风险和保护因素包括童年不良经历；孕期母亲饮酒；儿童肥胖；出生体重过高或过低；接触苯；使用辅助生殖技术；接触农药和杀虫剂；孤立性隐睾症；青春期提前；接触辐射；子宫内和早年接触烟草；过敏、哮喘和特应性；以及早期接触感染。在这些风险和保护因素方面，可能会出现基于种族和族裔少数群体地位、经济劣势、残疾状况、性别、地理位置和原籍国的差异。弱势群体在早年接触风险因素的情况格外严重。解决早年风险因素方面的差异能够增加预防机会、促进健康公平，并可能降低后续患癌风险。
