2014年中国女性乳腺癌发病与死亡分析

Incidence and mortality of female breast cancer in China, 2014

目的分析2017年全国肿瘤登记中心收集的2014年各肿瘤登记地区的乳腺癌数据，估计2014年中国女性乳腺癌的发病与死亡情况，为我国乳腺癌防治策略与措施的制订提供基础信息。方法提取2017年全国肿瘤登记中心收集的449个登记处2014年肿瘤登记数据中的女性乳腺癌数据，按照全国肿瘤登记中心制订的审核方法和评价标准，339个登记处的数据符合入选标准。将入选的登记处按地区（城乡）、年龄别的发病率和死亡率分层，并结合2014年全国人口数据，估计2014年全国女性乳腺癌的发病与死亡情况。中国人口标化率（中标率）和世界人口标化率（世标率）分别采用2000年全国人口普查的人口年龄构成和Segi′s标准人口的年龄构成。结果2014年339个登记处共覆盖登记人口288 243 347人，其中城市144 061 915人，农村144 181 432人。女性乳腺癌病理诊断比例为87.42%，只有死亡证明书比例为0.59%，死亡发病比为0.24。全国2014年女性乳腺癌新发病例约27.89万例，占女性恶性肿瘤发病的16.51%，位居女性恶性肿瘤发病的首位。全国女性乳腺癌发病率为41.82/10万，中标率为30.69/10万，世标率为28.77/10万，累积发病率（0～74岁）为3.12%。城市地区发病率为49.94/10万，中标发病率为34.85/10万；农村地区发病率为31.72/10万，中标发病率24.89/10万。全国2014年女性乳腺癌死亡病例约6.60万例，占女性恶性肿瘤死亡的7.82%，位居女性恶性肿瘤死亡的第5位。全国女性乳腺癌死亡率为9.90/10万，中标死亡率为6.53/10万，世标死亡率为6.35/10万，累积死亡率为0.69%。城市地区死亡率为11.48/10万，中标死亡率为7.04/10万。农村地区死亡率为7.93/10万，中标死亡率为5.79/10万。我国女性乳腺癌发病率在20岁后随年龄增长迅速上升，并于55岁年龄组达到高峰；死亡率在25岁之后上升迅速，于60岁年龄组达到第1个高峰后略有下降，70岁年龄组后再次上升，并于85岁以上年龄组达到死亡高峰。城乡年龄别发病率与死亡率曲线相近。结论乳腺癌仍是威胁中国妇女健康最常见的恶性肿瘤之一，是中国肿瘤防治的重点，乳腺癌的发病率和死亡率在城乡之间存在较大差异，且在55～60岁出现发病高峰，应当针对不同地区、不同年龄组的人群，制订相应的乳腺癌防治策略。

ObjectiveTo estimate the incidence and mortality of female breast cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry （NCCR）, and to provide support data for breast cancer prevention and control in China.MethodsThere were 449 cancer registries submitting female breast cancer incidence and deaths data occurred in 2014 to NCCR. After evaluating the data quality, 339 registries′ data were accepted for analysis and stratified by areas （urban/rural） and age group. Combined with data on national population in 2014, the nationwide incidence and mortality of female breast cancer were estimated. Chinese population census in 2000 and Segi′s population were used for age-standardized incidence/mortality rates.ResultsQualified 339 cancer registries covered a total of 288 243 347 populations （144 061 915 in urban and 144 181 432 in rural areas） in 2014. The morphology verified cases （MV%） accounted for 87.42% and 0.59% of incident cases were identified through death certifications only （DCO%）, with mortality to incidence ratio of 0.24. The estimates of new breast cancer cases were about 278 900 in China in 2014, accounting for 16.51% of all new cases in female. The crude incidence rate, age-standardized rate of incidence by Chinese standard population （ASRIC）, and age-standardized rate of incidence by world standard population （ASRIW） of breast cancer were 41.82/100 000, 30.69/100 000, and 28.77/100 000, respectively, with a cumulative incidence rate （0-74 age years old） of 3.12%. The crude incidence rates and ASRIC in urban areas were 49.94 per 100 000 and 34.85 per 100 000, respectively, whereas those were 31.72 per 100 000 and 24.89 per 100 000 in rural areas. The estimates of breast cancer deaths were about 66 000 in China in 2014, accounting for 7.82% of all the cancer-related deaths in female. The crude mortality rate, age-standardized rate of mortality by Chinese standard population（ASRMC） and age-standardized rate of mortality by world standard population （ASRMW） of breast cancer were 9.90/100 000, 6.53/100 000, and 6.35/100 000, respectively, with a cumulative mortality rate of 0.69%. The crude mortality rates and ASRMC in urban areas were 11.48 per 100 000 and 7.04 per 100 000, respectively, whereas those were 7.93 per 100 000 and 5.79 per 100 000 in rural areas. The incidence and mortality rates of breast cancer were higher in areas than those in rural areas. The age-specific incidence rates of breast cancer increased greatly after 20 years old and peaked at the age group of 55-60. The age-specific mortality rates increased rapidly with age, particularly after 25 years old. They remained at a relative stable level from 55 to 65 years of age, and then increased dramatically and peaked in the age group of 85 and above.ConclusionsBreast cancer is still one of the most common malignant tumor threatening to famale health in China. The disease is more prevalent in urban areas at the age group of 55-60. Comprehensive prevention and control strategies referring to local status and age groups should be carried out to reduce the burden of breast cancer.