Saint-Jacques Nathalie, Purcell Judy, Brown Patrick E, Rainham Daniel G, Dummer Trevor J B
Nova Scotia Health Cancer Care Program, Halifax, Nova Scotia, Canada.
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS One. 2025 Jun 9;20(6):e0325523. doi: 10.1371/journal.pone.0325523. eCollection 2025.
Cancer is rapidly increasing worldwide and urgent global action towards cancer control is required. Consistent with global trends, Canada is expected to experience a near doubling in new cases and cancer deaths between 2020-2040; population growth and ageing being the primary drivers. The projected increased cancer incidence and its associated costs is expected to further exacerbate socioeconomic inequities. Focused actions to prevent cancer, to detect it earlier when more treatable, and, to lower the risk of recurrence, must be prioritized. Almost half of all cancers are preventable, caused by risk factors that are potentially avoidable and modifiable. Integrating cancer prevention with care-based models is necessary and represents the most cost-effective and sustainable approach to control cancer. To be effective, prevention efforts must consider the cancers impacting local populations and understand how community and individual factors interact within the spatial and temporal contexts in which people live. This study is part of the Nova Scotia Community Cancer Matrix project which profiles the cancers impacting communities over time; measuring associations between cancer and socioeconomic status (SES); and determining how the joint spatial distribution of cancers can be used to address inequities, identify priority populations and strengthen prevention efforts. Using Bayesian inference to model spatio-temporal variations in 58,206 cases diagnosed in 301 communities between 2001-2017, across 10 preventable cancer types, we report significant disparities in cancer risk across communities based on sex and community SES. The work highlights the utility of small-area mapping to identify at-risk communities and understand how community-SES impacts risk. It also uncovers significant inequities rooted in the differential distribution of material and social capacity, operating beyond the control of individuals. The approach is implementable to other regions to inform and strengthen prevention efforts aiming at reducing the burden of cancer or that of other diseases.
癌症在全球范围内正迅速增加，因此需要在全球范围内采取紧急行动来控制癌症。与全球趋势一致，预计2020年至2040年间加拿大的新发病例和癌症死亡人数将几乎翻一番；人口增长和老龄化是主要驱动因素。预计癌症发病率的上升及其相关成本将进一步加剧社会经济不平等。必须优先采取有针对性的行动来预防癌症，在更易治疗时更早发现癌症，并降低复发风险。几乎一半的癌症是可预防的，由潜在可避免和可改变的风险因素引起。将癌症预防与基于护理的模式相结合是必要的，这是控制癌症最具成本效益和可持续的方法。为了有效，预防工作必须考虑影响当地人群的癌症，并了解社区和个人因素如何在人们生活的时空背景下相互作用。本研究是新斯科舍省社区癌症矩阵项目的一部分，该项目描绘了随着时间推移影响社区的癌症；测量癌症与社会经济地位（SES）之间的关联；并确定如何利用癌症的联合空间分布来解决不平等问题、确定优先人群并加强预防工作。我们使用贝叶斯推理对2001年至2017年间在301个社区诊断出的58206例病例中的时空变化进行建模，涵盖10种可预防的癌症类型，报告了基于性别和社区SES的不同社区之间癌症风险的显著差异。这项工作突出了小区域绘图在识别高危社区以及了解社区SES如何影响风险方面的作用。它还揭示了源于物质和社会能力差异分布的重大不平等，这些不平等超出了个人的控制范围。该方法可应用于其他地区，为旨在减轻癌症或其他疾病负担的预防工作提供信息并加强这些工作。
