Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
Lancet Public Health. 2024 Aug;9(8):e583-e593. doi: 10.1016/S2468-2667(24)00156-7.
Trends in cancer incidence in recent birth cohorts largely reflect changes in exposures during early life and foreshadow the future disease burden. Herein, we examined cancer incidence and mortality trends, by birth cohort, for 34 types of cancer in the USA.
In this analysis, we obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25-84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively. We calculated birth cohort-specific incidence rate ratios (IRRs) and mortality rate ratios (MRRs), adjusted for age and period effects, by nominal birth cohort, separated by 5 year intervals, from 1920 to 1990.
We extracted data for 23 654 000 patients diagnosed with 34 types of cancer and 7 348 137 deaths from 25 cancers for the period Jan 1, 2000, to Dec 31, 2019. We found that IRRs increased with each successive birth cohort born since approximately 1920 for eight of 34 cancers (p<0·050). Notably, the incidence rate was approximately two-to-three times higher in the 1990 birth cohort than in the 1955 birth cohort for small intestine (IRR 3·56 [95% CI 2·96-4·27]), kidney and renal pelvis (2·92 [2·50-3·42]), and pancreatic (2·61 [2·22-3·07]) cancers in both male and female individuals; and for liver and intrahepatic bile duct cancer in female individuals (2·05 [1·23-3·44]). Additionally, the IRRs increased in younger cohorts, after a decline in older birth cohorts, for nine of the remaining cancers (p<0·050): oestrogen-receptor-positive breast cancer, uterine corpus cancer, colorectal cancer, non-cardia gastric cancer, gallbladder and other biliary cancer, ovarian cancer, testicular cancer, anal cancer in male individuals, and Kaposi sarcoma in male individuals. Across cancer types, the incidence rate in the 1990 birth cohort ranged from 12% (IRR 1·12 [95% CI 1·03-1·21] for ovarian cancer) to 169% (IRR 2·69 [2·34-3·08] for uterine corpus cancer) higher than the rate in the birth cohort with the lowest incidence rate. The MRRs increased in successively younger birth cohorts alongside IRRs for liver and intrahepatic bile duct cancer in female individuals, uterine corpus, gallbladder and other biliary, testicular, and colorectal cancers, while MRRs declined or stabilised in younger birth cohorts for most cancers types.
17 of 34 cancers had an increasing incidence in younger birth cohorts, including nine that previously had declining incidence in older birth cohorts. These findings add to growing evidence of increased cancer risk in younger generations, highlighting the need to identify and tackle underlying risk factors.
American Cancer Society.
最近出生队列的癌症发病率趋势在很大程度上反映了生命早期暴露因素的变化，并预示着未来的疾病负担。在此，我们对美国 34 种癌症的出生队列的发病率和死亡率趋势进行了研究。
在这项分析中，我们从北美癌症登记协会和美国国家卫生统计中心分别获得了 2000 年 1 月 1 日至 2019 年 12 月 31 日期间 25-84 岁人群 34 种癌症的发病率数据和 25 种癌症的死亡率数据。我们根据年龄和时期效应，按名义出生队列，每隔 5 年对 1920 年至 1990 年出生的个体进行了特定出生队列的发病率比（IRR）和死亡率比（MRR）的计算。
我们从 2000 年 1 月 1 日至 2019 年 12 月 31 日期间的北美癌症登记协会和美国国家卫生统计中心分别提取了 34 种癌症的 23654000 名患者的诊断数据和 25 种癌症的 7348137 例死亡数据。我们发现，自大约 1920 年以来，出生队列中每一个连续的出生队列的发病率都呈上升趋势，其中 34 种癌症中的 8 种（p<0·050）。值得注意的是，在小肠（IRR 3·56 [95% CI 2·96-4·27]）、肾脏和肾盂（2·92 [2·50-3·42]）和胰腺（2·61 [2·22-3·07]）癌症中，1990 年出生队列的发病率大约是 1955 年出生队列的两倍至三倍，而且在男性和女性个体中；以及在女性个体中，肝脏和肝内胆管癌（2·05 [1·23-3·44]）。此外，在其余九种癌症中（p<0·050），随着年龄较大的出生队列发病率的下降，年轻出生队列的发病率呈上升趋势：雌激素受体阳性乳腺癌、子宫体癌、结直肠癌、非贲门胃癌、胆囊和其他胆道癌、卵巢癌、睾丸癌、男性个体的肛门癌和男性个体的卡波西肉瘤。在不同的癌症类型中，1990 年出生队列的发病率从卵巢癌的 12%（IRR 1·12 [95% CI 1·03-1·21]）到子宫体癌的 169%（IRR 2·69 [2·34-3·08]）不等，高于发病率最低的出生队列。女性个体的肝癌和肝内胆管癌、子宫体、胆囊和其他胆道、睾丸和结直肠癌的发病率与 IRR 同步上升，而大多数癌症类型的死亡率在年轻的出生队列中下降或稳定。
在最近的出生队列中，17 种癌症的发病率呈上升趋势，其中包括 9 种以前在较老的出生队列中发病率下降的癌症。这些发现增加了越来越多的关于年轻一代癌症风险增加的证据，强调了确定和解决潜在风险因素的必要性。
美国癌症协会。
