上海市区1973至2005年癌症的发病趋势

Cancer incidence trends from 1973 to 2005 in Shanghai

目的:分析上海市区1973至2005年常见癌症及所有癌症的发病变化趋势,评估上海市癌症负担,为制定和评价癌症预防、控制的规划和措施提供依据。方法:采用Joinpoint模型回归分析,对上海市区癌症登记资料的总体发病率、年龄标化发病率及常见癌症的年龄标化发病率(后称"标化发病率")进行趋势分析,估算总体和分阶段的年度变化百分比(annual percent change,APC)。结果:1973至2005年,上海市区人口男、女性所有部位的癌症粗发病率均呈明显持续上升。相对于1973年,2005年男性癌症粗发病率上升了46.5%,女性上升了66.0%。去除人口结构变化影响后,男性癌症年龄标化发病率实际下降了15.5%,而女性则上升了12.9%,这些变化都有统计学意义(P<0.05)。不同部位常见癌症的标化发病率有升、有降,胃癌、肝癌、食管癌和宫颈癌的标化发病率持续下降,而乳腺癌、结肠直肠癌、胰腺癌、前列腺癌、卵巢癌则持续上升,肺癌和甲状腺癌则无明显变化。不同部位的常见癌症各自在其不同时期的变化也各有特点。结论:人口老龄化是影响癌症发病率的首要原因,而癌症发病率的变化也反映了癌症危险因素的逐步变迁。目前,癌症相关危险因素仍广泛存在。制定癌症防治策略时应以减少个体行为危险因素暴露的人群策略与改善自然和社会环境的环境策略并重,减少癌症危险因素的暴露。

Objective To assess the disease burden of cancer and provide evidences for formulating a cancer- controlling plan and taking measures through the description and analysis of incidence trend of some common cancer during 1973-2005 in Shanghai. Methods The time trend of overall incidence and age-standardized incidence of cancer of all sites and common cancer for the urban population in Shanghai were analyzed with Joinpoint regression model based on the data collected by cancer registration, and the annual percentage changes （APCs） for the whole period and for the time segments were estimated. Results From 1973 to 2005, cancer incidences of all sites for male and female were increasing consistently, for male increased 46.5%, for female increased 66.0%. But the age-standardized rate for male decreased 15.5%, for female increased 12.9%. All the time trends were statistically significant （P〈0.05）. Among common cancers, stomach cancer, liver cancer, esophagus cancer and cervical cancer decreased consistently, while breast cancer, colorectal cancer, pancreas cancer, prostate cancer and ovary cancer increased consistently, whereas lung cancer and thyroid gland cancer had no significant change during the past 33 years. Conclusions Aging of population was the major cause of increase of cancer incidence in Shanghai. The time trends of cancer incidence reflect the change of cancer related risk factors. Currently, the risk factors are still widely prevalent. The cancer prevention and control strategies should be focused both on popular measures for reducing individual exposure and environment measures for improving the natural and social environment.