Soerjomataram Isabelle, Bray Freddie
Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
Nat Rev Clin Oncol. 2021 Oct;18(10):663-672. doi: 10.1038/s41571-021-00514-z. Epub 2021 Jun 2.
Cancer is currently the first or second most common contributor to premature mortality in most countries of the world. The global number of patients with cancer is expected to rise over the next 50 years owing to the strong influence of demographic changes, such as population ageing and growth, on the diverging trends in cancer incidence in different regions. Assuming that the latest incidence trends continue for the major cancer types, we predict a doubling of the incidence of all cancers combined by 2070 relative to 2020. The greatest increases are predicted in lower-resource settings, in countries currently assigned a low Human Development Index (HDI), whereas the predicted increases in national burden diminish with increasing levels of national HDI. Herein, we assess studies modelling the future burden of cancer that underscore how comprehensive cancer prevention strategies can markedly reduce the prevalence of major risk factors and, in so doing, the number of future cancer cases. Focusing on an in-depth assessment of prevention strategies that target tobacco smoking, overweight and obesity, and human papillomavirus infection, we discuss how stepwise, population-level approaches with amenable goals can avert millions of future cancer diagnoses worldwide. In the absence of a step-change in cancer prevention delivery, tobacco smoking will remain the leading preventable cause of cancer, and overweight and obesity might well present a comparable opportunity for prevention, given its increasing prevalence globally in the past few decades. Countries must therefore instigate national cancer control programmes aimed at preventing cancer, and with some urgency, if such programmes are to yield the desired public health and economic benefits in this century.
目前，癌症是世界上大多数国家过早死亡的首要或第二大常见原因。由于人口老龄化和增长等人口结构变化对不同地区癌症发病率的不同趋势产生强烈影响，预计未来50年全球癌症患者数量将上升。假设主要癌症类型的最新发病率趋势持续下去，我们预测到2070年所有癌症的发病率相对于2020年将翻一番。预计资源匮乏地区、目前人类发展指数（HDI）较低的国家癌症发病率增长幅度最大，而随着国家HDI水平的提高，预计国家负担的增长幅度会减小。在此，我们评估了对癌症未来负担进行建模的研究，这些研究强调了全面的癌症预防策略如何能够显著降低主要风险因素的流行率，从而减少未来癌症病例的数量。我们重点深入评估针对吸烟、超重和肥胖以及人乳头瘤病毒感染的预防策略，讨论如何通过具有可实现目标的逐步的、人群层面的方法在全球避免数百万例未来癌症诊断。如果癌症预防措施没有根本性改变，吸烟仍将是可预防的首要癌症病因，鉴于超重和肥胖在过去几十年中在全球的患病率不断上升，它很可能也提供了一个类似的预防机会。因此，各国必须紧急启动旨在预防癌症的国家癌症控制计划，以便这些计划能在本世纪产生预期的公共卫生和经济效益。
