Goddard Katrina A B, Feuer Eric J, Mandelblatt Jeanne S, Meza Rafael, Holford Theodore R, Jeon Jihyoun, Lansdorp-Vogelaar Iris, Gulati Roman, Stout Natasha K, Howlader Nadia, Knudsen Amy B, Miller Daniel, Caswell-Jin Jennifer L, Schechter Clyde B, Etzioni Ruth, Trentham-Dietz Amy, Kurian Allison W, Plevritis Sylvia K, Hampton John M, Stein Sarah, Sun Liyang P, Umar Asad, Castle Philip E
Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Georgetown Lombardi Institute for Cancer and Aging Research and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC.
JAMA Oncol. 2025 Feb 1;11(2):162-167. doi: 10.1001/jamaoncol.2024.5381.
Cancer mortality has decreased over time, but the contributions of different interventions across the cancer control continuum to averting cancer deaths have not been systematically evaluated across major cancer sites.
To quantify the contributions of prevention, screening (to remove precursors [interception] or early detection), and treatment to cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.
DESIGN, SETTING, AND PARTICIPANTS: In this model-based study using population-level cancer mortality data, outputs from published models developed by the Cancer Intervention and Surveillance Modeling Network were extended to quantify cancer deaths averted through 2020. Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modeled data using parameters derived from multiple birth cohorts of the US population were used.
Primary prevention via smoking reduction (lung), screening for interception (cervix and colorectal) or early detection (breast, cervix, colorectal, and prostate), and therapy (breast, colorectal, lung, and prostate).
The estimated cumulative number of cancer deaths averted with interventions vs no advances.
An estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths). The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.
Over the past 45 years, cancer prevention and screening accounted for most cancer deaths averted for these causes; however, their contribution varied by cancer site according to these models using population-level cancer mortality data. Despite progress, efforts to reduce the US cancer burden will require increased dissemination of effective interventions and new technologies and discoveries.
随着时间推移，癌症死亡率有所下降，但在整个癌症控制连续统一体中，不同干预措施对避免癌症死亡的贡献尚未在主要癌症部位进行系统评估。
量化1975年至2020年期间，预防、筛查（去除癌前病变[拦截]或早期检测）和治疗对乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌避免的癌症死亡累计数的贡献。
设计、设置和参与者：在这项基于模型的研究中，使用人群水平的癌症死亡率数据，扩展了癌症干预和监测建模网络开发的已发表模型的输出，以量化到2020年避免的癌症死亡人数。模型输入基于关于风险因素、癌症发病率、癌症生存率以及其他原因导致的死亡率的国家数据，以及预防、筛查（用于拦截和早期检测）和治疗的传播及效果。使用了从美国人群的多个出生队列得出的参数的模拟或建模数据。
通过减少吸烟进行一级预防（肺癌）、进行拦截筛查（宫颈癌和结直肠癌）或早期检测（乳腺癌、宫颈癌、结直肠癌和前列腺癌）以及进行治疗（乳腺癌、结直肠癌、肺癌和前列腺癌）。
干预措施与无进展情况下避免的癌症死亡估计累计数。
乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌合计估计避免了594万例癌症死亡。癌症预防和筛查工作避免了其中十分之八的死亡（475万例避免的死亡）。每种干预措施的贡献因癌症部位而异。筛查占避免的乳腺癌死亡的25%。由于在研究期间治疗进展不大，通过筛查和去除癌症前体几乎完全避免了宫颈癌死亡。避免的结直肠癌死亡中，79%是由于筛查和去除癌前息肉或早期检测，21%是由于治疗进展。由于筛查率低且2014年前治疗大多为姑息性治疗，减少吸烟避免了大多数肺癌死亡（98%）。筛查对避免的前列腺癌死亡的贡献为56%。
在过去45年中，癌症预防和筛查占这些原因导致的避免的大多数癌症死亡；然而，根据这些使用人群水平癌症死亡率数据的模型，它们的贡献因癌症部位而异。尽管取得了进展，但减轻美国癌症负担的努力将需要增加有效干预措施以及新技术和新发现的传播。
