Strategic Director, Cancer Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
CA Cancer J Clin. 2018 Jan;68(1):31-54. doi: 10.3322/caac.21440. Epub 2017 Nov 21.
Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections). The numbers of cancer cases were obtained from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute; the numbers of deaths were obtained from the CDC; risk factor prevalence estimates were obtained from nationally representative surveys; and associated relative risks of cancer were obtained from published, large-scale pooled analyses or meta-analyses. In the United States in 2014, an estimated 42.0% of all incident cancers (659,640 of 1570,975 cancers, excluding nonmelanoma skin cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) were attributable to evaluated risk factors. Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively). Lung cancer had the highest number of cancers (184,970 cases) and deaths (132,960 deaths) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). These results, however, may underestimate the overall proportion of cancers attributable to modifiable factors, because the impact of all established risk factors could not be quantified, and many likely modifiable risk factors are not yet firmly established as causal. Nevertheless, these findings underscore the vast potential for reducing cancer morbidity and mortality through broad and equitable implementation of known preventive measures. CA Cancer J Clin 2018;68:31-54. © 2017 American Cancer Society.
目前有关癌症的潜在可预防比例的信息对于癌症的预防和控制的优先级设定很有用。在这里,作者估计了美国 2014 年年龄在 30 岁及以上的成年人中所有(不包括非黑色素瘤皮肤癌)和 26 种癌症类型的浸润性癌症病例和死亡人数,这些癌症归因于主要的、潜在可改变的因素(吸烟;二手烟;超重;饮酒;摄入红肉和加工肉;水果/蔬菜、膳食纤维和膳食钙摄入量低;缺乏身体活动;紫外线辐射;以及 6 种与癌症相关的感染)。癌症病例数来自疾病预防控制中心(CDC)和国家癌症研究所;死亡人数来自疾病预防控制中心;危险因素流行率估计数来自全国代表性调查;以及与癌症相关的相对风险来自已发表的大型汇总分析或荟萃分析。在美国,2014 年估计所有新发病例中有 42.0%(1570975 例中 659640 例,不包括非黑色素瘤皮肤癌)和所有癌症死亡人数的 45.1%(587521 例中 265150 例)归因于已评估的危险因素。吸烟占癌症病例(19.0%;298970 例)和癌症死亡人数(28.8%;169180 例)的比例最高,其次是超重(分别为 7.8%和 6.5%)和饮酒(分别为 5.6%和 4.0%)。肺癌是归因于已评估危险因素的癌症(184970 例)和癌症死亡人数(132960 例)最多的癌症,其次是结直肠癌(76910 例和 28290 例)。然而,这些结果可能低估了可改变因素导致的癌症的总体比例,因为所有已确定的危险因素的影响无法量化,而且许多可能的可改变危险因素尚未被确定为因果关系。尽管如此,这些发现强调了通过广泛和公平地实施已知的预防措施来降低癌症发病率和死亡率的巨大潜力。癌症杂志 2018;68:31-54。© 2017 美国癌症协会。