Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.
Stanford University School of Medicine, Stanford, California, USA.
CA Cancer J Clin. 2024 Sep-Oct;74(5):405-432. doi: 10.3322/caac.21858. Epub 2024 Jul 11.
In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating for and informing cancer prevention and control. Herein, based on up-to-date relative risk and cancer occurrence data, the authors estimated the proportion and number of invasive cancer cases (excluding nonmelanoma skin cancers) and deaths, overall and for 30 cancer types among adults who were aged 30 years and older in 2019 in the United States, that were attributable to potentially modifiable risk factors. These included cigarette smoking; second-hand smoke; excess body weight; alcohol consumption; consumption of red and processed meat; low consumption of fruits and vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and seven carcinogenic infections. Numbers of cancer cases and deaths were obtained from data sources with complete national coverage, risk factor prevalence estimates from nationally representative surveys, and associated relative risks of cancer from published large-scale pooled or meta-analyses. In 2019, an estimated 40.0% (713,340 of 1,781,649) of all incident cancers (excluding nonmelanoma skin cancers) and 44.0% (262,120 of 595,737) of all cancer deaths in adults aged 30 years and older in the United States were attributable to the evaluated risk factors. Cigarette smoking was the leading risk factor contributing to cancer cases and deaths overall (19.3% and 28.5%, respectively), followed by excess body weight (7.6% and 7.3%, respectively), and alcohol consumption (5.4% and 4.1%, respectively). For 19 of 30 evaluated cancer types, more than one half of the cancer cases and deaths were attributable to the potentially modifiable risk factors considered in this study. Lung cancer had the highest number of cancer cases (201,660) and deaths (122,740) attributable to evaluated risk factors, followed by female breast cancer (83,840 cases), skin melanoma (82,710), and colorectal cancer (78,440) for attributable cases and by colorectal (25,800 deaths), liver (14,720), and esophageal (13,600) cancer for attributable deaths. Large numbers of cancer cases and deaths in the United States are attributable to potentially modifiable risk factors, underscoring the potential to substantially reduce the cancer burden through broad and equitable implementation of preventive initiatives.
2018 年，作者报告了美国 2014 年可改变的潜在风险因素导致癌症数量和比例的估计值。这些数据对于倡导和告知癌症预防和控制非常有用。在此基础上，作者根据最新的相对风险和癌症发生数据，估计了美国 2019 年年龄在 30 岁及以上的成年人中，30 种癌症类型中，可归因于潜在可改变的风险因素的侵袭性癌症病例（不包括非黑色素瘤皮肤癌）和死亡病例的比例和数量。这些因素包括吸烟、二手烟、超重、饮酒、食用红肉和加工肉类、水果和蔬菜、膳食纤维和膳食钙摄入不足、缺乏身体活动、紫外线辐射以及七种致癌感染。癌症病例和死亡人数来自具有全国性覆盖范围的数据源、全国代表性调查中的风险因素流行率估计值以及来自已发表的大型汇总或荟萃分析的相关癌症相对风险。2019 年，美国 30 岁及以上成年人中，所有新发癌症（不包括非黑色素瘤皮肤癌）的 40.0%（713340 例）和所有癌症死亡的 44.0%（262120 例）可归因于评估的风险因素。吸烟是导致癌症病例和死亡的主要风险因素（分别占 19.3%和 28.5%），其次是超重（分别占 7.6%和 7.3%）和饮酒（分别占 5.4%和 4.1%）。在所评估的 30 种癌症类型中的 19 种中，超过一半的癌症病例和死亡可归因于本研究中考虑的潜在可改变的风险因素。肺癌导致的癌症病例和死亡人数最多（201660 例），其次是女性乳腺癌（83840 例）、皮肤黑色素瘤（82710 例）和结直肠癌（78440 例），归因于可改变的风险因素，其次是结直肠癌（25800 例）、肝癌（14720 例）和食管癌（13600 例）。美国大量的癌症病例和死亡可归因于潜在可改变的风险因素，这突出表明通过广泛和公平地实施预防措施，有可能大大降低癌症负担。
