Bailar J C, Smith E M
N Engl J Med. 1986 May 8;314(19):1226-32. doi: 10.1056/NEJM198605083141905.
We assessed the overall progress against cancer during the years 1950 to 1982. In the United States, these years were associated with increases in the number of deaths from cancer, in the crude cancer-related mortality rate, in the age-adjusted mortality rate, and in both the crude and the age-adjusted incidence rates, whereas reported survival rates (crude and relative) for cancer patients also increased. In our view, the best single measure of progress against cancer is change in the age-adjusted mortality rate associated with all cancers combined in the total population. According to this measure, we are losing the war against cancer, notwithstanding progress against several uncommon forms of the disease, improvements in palliation, and extension of the productive years of life. A shift in research emphasis, from research on treatment to research on prevention, seems necessary if substantial progress against cancer is to be forthcoming.
我们评估了1950年至1982年间对抗癌症的总体进展。在美国,这些年份与癌症死亡人数增加、癌症相关粗死亡率增加、年龄调整死亡率增加以及粗发病率和年龄调整发病率增加相关,而报告的癌症患者生存率(粗生存率和相对生存率)也有所提高。我们认为,衡量对抗癌症进展的最佳单一指标是总人口中所有癌症综合的年龄调整死亡率的变化。根据这一指标,尽管在对抗几种罕见癌症形式方面取得了进展、姑息治疗有所改善以及延长了有生产能力的寿命,但我们正在输掉对抗癌症的战争。如果要在对抗癌症方面取得实质性进展,研究重点似乎有必要从治疗研究转向预防研究。