Newell G R, Vogel V G
University of Texas, M. D. Anderson Cancer Center, Houston 77030.
Cancer. 1988 Oct 15;62(8 Suppl):1695-701. doi: 10.1002/1097-0142(19881015)62:1+<1695::aid-cncr2820621307>3.0.co;2-r.
Epidemiologic studies have identified myriad factors related to cancer risk. Risk can be quantified on the basis of demographic factors, genetics, occupation, medical conditions, and lifestyle. Existing evidence suggests that: (1) individuals at risk often are unaware of their risk; (2) physicians may not know well those factors associated with the highest cancer risk; and (3) methods to reduce risk have been under-applied because of lack of knowledge, lack of funds, or lack of motivation among both patients and physicians. Methods to reduce risk do not follow the usual medical model in that those groups requiring risk-modification intervention usually are symptom free. Evidence indicates that elimination of tobacco use would reduce lung cancer deaths by 83% and substantially reduce the incidence of head and neck malignancies. Broad application of mammographic screening would effect a 30% reduction in breast cancer mortality. Dietary modification could potentially reduce cancer mortality by 30%. An effective program to reduce cancer risk will accomplish the following: (1) develop new and refine existing risk factor measurements to improve identification of individuals at risk; (2) apply risk factor identification and modification more completely to populations known to be at risk; (3) use combinations of risk factors to identify subpopulations at the highest risk; (4) apply existing prevention and screening modalities more broadly and uniformly; (5) identify new screening strategies with improved test performance and cost effectiveness to maximize screening efficiency; and (6) provide accurate and rapid means of risk assessment and quantification using the best available multivariate estimates of risk. An emphasis on education of primary care physicians to practice cancer prevention programs focused on personal risk profiles is reasonable since the populations these physicians serve express risk factors which represent 50% of the attributable risk for cancer in the US. A summary of site-specific risk factors which are amenable to intervention by primary care physicians is provided.
流行病学研究已经确定了无数与癌症风险相关的因素。风险可以根据人口统计学因素、遗传学、职业、医疗状况和生活方式进行量化。现有证据表明：（1）处于风险中的个体往往意识不到自己的风险；（2）医生可能并不十分了解那些与最高癌症风险相关的因素；（3）由于患者和医生缺乏知识、资金或动力，降低风险的方法尚未得到充分应用。降低风险的方法并不遵循通常的医学模式，因为那些需要进行风险修正干预的人群通常没有症状。有证据表明，戒烟可使肺癌死亡率降低83%，并大幅降低头颈部恶性肿瘤的发病率。广泛应用乳房X线筛查可使乳腺癌死亡率降低30%。饮食调整有可能使癌症死亡率降低30%。一个有效的降低癌症风险计划将实现以下目标：（1）开发新的并完善现有的风险因素测量方法，以更好地识别处于风险中的个体；（2）更全面地将风险因素识别和修正应用于已知处于风险中的人群；（3）结合风险因素来识别风险最高的亚人群；（4）更广泛、更统一地应用现有的预防和筛查方式；（5）识别具有更好检测性能和成本效益的新筛查策略，以最大限度地提高筛查效率；（6）使用现有的最佳多变量风险估计，提供准确、快速的风险评估和量化方法。鉴于初级保健医生所服务的人群中表达的风险因素占美国癌症可归因风险的50%，因此强调对初级保健医生进行教育，使其实施针对个人风险概况的癌症预防计划是合理的。本文提供了一份可由初级保健医生进行干预的特定部位风险因素总结。
