Devesa S S, Blot W J, Stone B J, Miller B A, Tarone R E, Fraumeni J F
Division of Cancer Etiology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7368, USA.
J Natl Cancer Inst. 1995 Feb 1;87(3):175-82. doi: 10.1093/jnci/87.3.175.
Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer.
We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns.
Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods.
Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons.
Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining.
Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.
据报道，美国癌症发病率一直在上升，不过不同癌症类型的趋势有所不同。
我们确定导致发病率上升的癌症类型，量化20世纪70年代中期到90年代初期发生的变化，并对比发病率和死亡率趋势，以找出这些时间模式的决定因素线索。
利用覆盖美国约10%人口的癌症登记监测、流行病学和最终结果（SEER）计划的数据，计算了1987 - 1991年与1975 - 1979年这两个5年期男性28种癌症以及女性30种癌症的性别、种族和年龄特异性及年龄调整发病率。使用国家死亡率数据计算了类似的比率。根据两个时期发病率的变化对癌症进行排名。
从1975 - 1979年到1987 - 1991年，所有癌症合并的年龄调整发病率男性增加了18.6%，女性增加了12.4%，这主要归因于男性前列腺癌以及女性乳腺癌和肺癌发病率的上升。所有癌症合并的全国死亡率上升幅度较小，男性和女性分别上升了3%和6%，主要是由肺癌死亡率的持续上升推动的，而大多数癌症的死亡率保持稳定或下降。所有年龄段的癌症总发病率都有所上升，但不同年龄段的发病率上升由不同肿瘤导致：儿童中的白血病和脑/神经系统癌症；青年和中年成年人中的睾丸癌、非黑色素瘤皮肤癌（主要是卡波西肉瘤）、非霍奇金淋巴瘤和黑色素瘤；老年人中的前列腺癌、乳腺癌和肺癌。相比之下，55岁以下男性和女性的所有癌症合并死亡率都有所下降，仅在老年人中上升。
癌症发病率和死亡率趋势不同。对于大多数癌症，发病率在上升，而死亡率总体稳定或下降。
近期癌症发病率的大部分上升可以用已知因素来解释。检测手段的改进似乎是女性乳腺癌和男性前列腺癌发病率上升的主要原因。另一方面，吸烟是女性肺癌发病率上升的主要决定因素，获得性免疫缺陷综合征导致青年和中年男性非霍奇金淋巴瘤和卡波西肉瘤发病率上升，阳光照射模式影响了黑色素瘤的趋势。然而，一些趋势仍无法解释，可能反映了尚未确定和阐明的致癌物暴露变化。
