Winther J F, Dreyer L, Olsen J H
Institut for Epidemiologisk Kraeftforskning, Kraeftens Bekaempelse, København O.
Nord Med. 1998 Oct;113(8):257-65.
The purpose of this work is to address future possibilities for avoiding cancer. We elucidate the most important known causes of cancer in the Nordic countries during the second half of this century and provide estimates of the numbers of cancer cases that might be avoided by the year 2000 if those causes were effectively eliminated. Information on the pattern of carcinogenic exposures in each of the five Nordic countries and the associated relative risk estimates from the scientific literature were obtained. The numbers of avoidable cancers were assessed on the basis of this information together with the associated population attributable risk percent, PAR%, i.e. the proportion of a given cancer that can be avoided upon elimination of the causative factor. The main causes of cancer include smoking, alcohol consumption, exposure to occupational carcinogens, radiation, obesity and infection with human papillomavirus (HPV) and Helicobacter pylori. Annually, more than 18,000 cancers in men and 11,000 in women in the Nordic populations could be avoided by eliminating exposure to known carcinogens which is equivalent to 33 percent and 20 percent of all cancers arising in men and women, respectively, around the year 2000. Smoking habits account for a little more than half of these avoidable cases. Exposure to solar radiation, HPV and Helicobacter pylori, diagnostic and therapeutic radiation and consumption of alcohol play important roles in the causation of cancer, as each of these factors is linked with 1-5 percent of all cancers in men and women. Occupational exposures are also substantial causes in men (3 percent), and obesity is important in women (1 percent). In contrast, current knowledge is insufficient to give reliable estimates of the numbers of cancers that could be avoided by well-described modifications of dietary habits. These figures indicate that the most efficient way of reducing cancer morbidity would be to reduce the prevalence of exposure of the population to cancer-causing agents.
这项工作的目的是探讨预防癌症的未来可能性。我们阐明了本世纪下半叶北欧国家已知的最重要癌症病因，并估算了如果有效消除这些病因，到2000年可能避免的癌症病例数。我们获取了北欧五个国家中每个国家的致癌暴露模式信息以及科学文献中的相关相对风险估计值。基于这些信息以及相关的人群归因风险百分比（PAR%），即消除致病因素后可避免的特定癌症比例，对可避免的癌症数量进行了评估。癌症的主要病因包括吸烟、饮酒、接触职业致癌物、辐射、肥胖以及感染人乳头瘤病毒（HPV）和幽门螺杆菌。通过消除已知致癌物的暴露，北欧人群中每年可避免超过18,000例男性癌症和11,000例女性癌症，这分别相当于2000年左右男性和女性所有癌症病例的33%和20%。吸烟习惯占这些可避免病例的一半多一点。暴露于太阳辐射、HPV和幽门螺杆菌、诊断和治疗性辐射以及饮酒在癌症病因中起着重要作用，因为这些因素与男性和女性所有癌症的1% - 5%相关。职业暴露也是男性癌症的重要病因（3%），肥胖是女性癌症的重要病因（1%）。相比之下，目前的知识不足以可靠地估计通过合理改变饮食习惯可避免的癌症数量。这些数据表明，降低癌症发病率的最有效方法是减少人群接触致癌物质的比例。
