Davis D L, Dinse G E, Hoel D G
Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC 20201.
JAMA. 1994 Feb 9;271(6):431-7.
Trends in cancer mortality, cardiovascular mortality, and cancer incidence are assessed among US whites to determine whether aging of the population and smoking patterns completely account for increased cancer rates from 1973 through 1987.
For mortality, percentage changes in age-specific rates were calculated. For cancer incidence, trends in age-specific rates across time periods and birth cohorts were assessed for several sites.
National US cardiovascular and cancer mortality rates and incidence rates for smoking-related cancer, breast cancer, and all other types of cancer in 10% of the US population covered by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program were analyzed.
From 1973 through 1987, cardiovascular mortality decreased 42% in the age group 0 to 54 years and decreased 33% in the age group 55 to 84 years; concurrently, cancer mortality decreased 17% in the younger group but increased 12% in the older group. By 1987, even though proportionally fewer people in the older age groups died, relatively more of them died of cancer. Men born in the 1940s had twice as much cancer as those born in 1888 through 1897 and more than twice as much cancer not linked to smoking; women born during this period had 50% and 30% more of these same cancers, respectively. Rates of smoking-related cancers in recent cohorts of women were five to six times greater than in those born in 1888 through 1897, while rates in men declined. Recent cohorts of women also had more than twice as much breast cancer as those born in 1888 through 1897.
In recent US birth cohorts, our model found that increases in cancer have occurred that are not solely linked to aging of the population and smoking patterns. In light of these results and similar findings in Sweden, changes in carcinogenic hazards in addition to smoking are likely to have occurred and need to be studied further.
评估美国白人的癌症死亡率、心血管疾病死亡率和癌症发病率趋势，以确定人口老龄化和吸烟模式是否能完全解释1973年至1987年期间癌症发病率的上升。
对于死亡率，计算特定年龄组死亡率的百分比变化。对于癌症发病率，评估了几个部位在不同时间段和出生队列中的特定年龄组发病率趋势。
分析了美国国立癌症研究所监测、流行病学和最终结果计划覆盖的美国10%人口中的全国心血管疾病和癌症死亡率以及与吸烟相关癌症、乳腺癌和所有其他类型癌症的发病率。
1973年至1987年期间，0至54岁年龄组的心血管疾病死亡率下降了42%，55至84岁年龄组下降了33%；与此同时，较年轻组的癌症死亡率下降了17%，而较年长组则上升了12%。到1987年，尽管老年组中按比例死亡的人数较少，但死于癌症的相对人数更多。20世纪40年代出生的男性患癌症的几率是1888年至1897年出生男性的两倍，患与吸烟无关癌症的几率更是超过两倍；这一时期出生的女性患同样癌症的几率分别高出50%和30%。近期女性队列中与吸烟相关癌症的发病率比1888年至1897年出生的女性高出五到六倍，而男性的发病率则有所下降。近期女性队列患乳腺癌的几率也比1888年至1897年出生的女性高出两倍多。
在美国近期出生队列中，我们的模型发现癌症发病率上升并非仅与人口老龄化和吸烟模式有关。鉴于这些结果以及瑞典的类似发现，除吸烟外，致癌风险可能已经发生变化，需要进一步研究。
