Inoue Manami, Hirabayashi Mayo, Abe Sarah Krull, Katanoda Kota, Sawada Norie, Lin Yingsong, Ishihara Junko, Takachi Ribeka, Nagata Chisato, Saito Eiko, Goto Atsushi, Ueda Kayo, Tanaka Junko, Hori Megumi, Matsuda Tomohiro
Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Division of Cohort Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Glob Health Med. 2022 Feb 28;4(1):26-36. doi: 10.35772/ghm.2021.01037.
The This study estimated the cancer burden attributable to modifiable factors in Japan in 2015 using the best available epidemiological evidence and a standard methodology. We selected the following factors for inclusion in the estimates, namely tobacco smoking (active smoking and secondhand smoking), alcohol drinking, excess bodyweight, physical inactivity, infectious agents (, hepatitis C virus, hepatitis B virus, human papilloma virus, Epstein-Barr virus, and human T-cell leukemia virus type 1), dietary intake (highly salted food, fruit, vegetables, dietary fiber, red meat, processed meat), exogenous hormone use, never breastfeeding and air pollution, given that these were considered modifiable, in theory at least. We first estimated the population attributable fraction (PAF) of each cancer attributable to these factors using representative relative risks of Japanese and the prevalence of exposures in Japanese around 2005, in consideration of the 10-year interval between exposure and cancer outcomes. Using nationwide cancer incidence and mortality statistics, we then estimated the attributable cancer incidence and mortality in 2015. We finally obtained the PAF for site-specific and total cancers attributable to all modifiable risk factors using this formula, with statistical consideration of the effect of overlap between risk factors. The results showed that 35.9% of all cancer incidence (43.4% in men and 25.3% in women) and 41.0% of all cancer mortality (49.7% in men and 26.8% in women) would be considered preventable by avoidance of these exposures. Infections and active smoking followed by alcohol drinking were the greatest contributing factors to cancer in Japan in 2015.
本研究使用现有的最佳流行病学证据和标准方法，估算了2015年日本可归因于可改变因素的癌症负担。我们选择了以下因素纳入估算，即吸烟（主动吸烟和二手烟）、饮酒、超重、缺乏身体活动、感染因子（丙型肝炎病毒、乙型肝炎病毒、人乳头瘤病毒、爱泼斯坦-巴尔病毒和1型人类T细胞白血病病毒）、饮食摄入（高盐食物、水果、蔬菜、膳食纤维、红肉、加工肉类）、外源性激素使用、从未母乳喂养和空气污染，因为至少在理论上这些因素被认为是可改变的。我们首先使用日本的代表性相对风险和2005年左右日本人的暴露流行率，考虑到暴露与癌症发生之间的10年间隔，估算了每种癌症可归因于这些因素的人群归因分数（PAF）。然后，利用全国癌症发病率和死亡率统计数据，估算了2015年可归因的癌症发病率和死亡率。最后，我们使用该公式获得了可归因于所有可改变风险因素的特定部位癌症和所有癌症的PAF，并对风险因素之间重叠的影响进行了统计学考虑。结果表明，通过避免这些暴露，所有癌症发病率的35.9%（男性为43.4%，女性为25.3%）和所有癌症死亡率的41.0%（男性为49.7%，女性为26.8%）可被认为是可预防的。感染和主动吸烟，其次是饮酒，是2015年日本癌症的最大促成因素。
