Affiliations of authors: Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1XG, Canada.
Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, Alberta T2S 3C3, Canada.
J Natl Cancer Inst. 2020 Nov 1;112(11):1105-1117. doi: 10.1093/jnci/djaa007.
Although adolescent and young adult (AYA) cancers represent a unique spectrum of malignancies, epidemiological studies of cancer incidence often group AYAs together with younger or older populations, obscuring patterns specific to this population.
We examined AYA cancer incidence trends in 41 countries over a 15-year period using the CI5plus database. Truncated age-standardized incidence rates were calculated and the annual percentage change was assessed, with statistical significance corresponding to a 95% confidence interval that does not include zero.
From 1998 to 2012, the 41 included countries contributed a total of 1 846 588 cancer cases and 3.1 billion person-years among AYAs. Although statistically significant increases in the overall cancer burden were observed in 23 countries, the magnitude varied considerably, with the greatest increase in incidence observed in South Korea (annual percentage change2002-2012 = 8.5%, 95% confidence interval = 7.6% to 9.4%) due to thyroid cancer. Notable trends included sharp increases in the incidence of obesity-related malignancies among AYAs; indeed, statistically significant increases were observed among AYAs for 10 of 11 and 9 of 11 obesity-related cancer sites in the US and UK, respectively, with at least five obesity-related cancers statistically significantly increasing in Canada, Japan, South Korea, Australia, and the Netherlands. Other striking trends were noted for thyroid and testicular cancer, with statistically significantly increasing rates observed in 33 and 22 countries, respectively, whereas statistically significant declines in incidence were observed for smoking-related cancers, cervical cancer, and Kaposi sarcoma in many countries.
Our results highlight the future health-care needs related to treatment as well as the urgency for public health initiatives that can mitigate the increasing burden of cancer in AYAs.
尽管青少年和年轻成人（AYA）癌症代表了独特的恶性肿瘤谱，但癌症发病率的流行病学研究通常将 AYA 与年轻或年长人群分组，掩盖了特定于该人群的模式。
我们使用 CI5plus 数据库检查了 15 年间 41 个国家的 AYA 癌症发病率趋势。计算了截短的年龄标准化发病率，并评估了年百分比变化，统计学意义对应于不包括零的 95%置信区间。
从 1998 年到 2012 年，41 个纳入国家共报告了 1846588 例 AYA 癌症病例和 31 亿人年。尽管在 23 个国家观察到整体癌症负担的统计学显著增加，但幅度差异很大，韩国的发病率增幅最大（2002-2012 年的年百分比变化为 8.5%，95%置信区间为 7.6%至 9.4%），这主要归因于甲状腺癌。值得注意的趋势包括 AYA 中与肥胖相关的恶性肿瘤发病率的急剧增加；事实上，在美国和英国，分别有 11 个和 11 个与肥胖相关的癌症部位中的 10 个和 9 个观察到 AYA 中发病率的统计学显著增加，加拿大、日本、韩国、澳大利亚和荷兰至少有 5 种与肥胖相关的癌症统计学上显著增加。甲状腺癌和睾丸癌也出现了其他引人注目的趋势，分别有 33 个和 22 个国家的发病率观察到统计学显著增加，而许多国家的吸烟相关癌症、宫颈癌和卡波西肉瘤的发病率则观察到统计学显著下降。
我们的研究结果强调了与治疗相关的未来医疗保健需求，以及公共卫生干预措施的紧迫性，这些措施可以减轻 AYA 中癌症负担的增加。
