上海市女性乳腺癌流行现况、回顾与比较分析

Incidence of female breast cancer in Shanghai: current evidence and a comparative retrospective study

目的:描述2002—2015年上海市女性乳腺癌发病和死亡的近期特征和趋势变化,为探寻病因学研究线索,制定和评估乳腺癌预防、研究与控制的规划和措施提供依据。方法:根据上海市恶性肿瘤病例报告登记系统收集的女性乳腺癌发病资料,描述2013—2015年期间的发病和死亡概况,并与2018年的国际数据进行比较分析,对年龄分布、诊断依据、病理类型、诊断时期别等特征进行具体描述,分析2002—2015年发病和死亡的标率与年龄别率变化趋势。结果:2013—2015年,乳腺癌仍居上海全市女性恶性肿瘤的发病首位和死亡癌谱的第4位,年均新诊断5293例,占全部女性恶性肿瘤的15.82%,发病粗率为73.34/10万,发病标率为38.45/10万,死亡发病数比为0.27;因乳腺癌死亡的女性年均1448人,占全部女性癌症死因的9.51%,死亡粗率为20.06/10万,死亡标率7.42/10万。发病粗率和死亡粗率高于世界、东亚地区和中国平均水平,低于美国,而死亡标率低于所有这些地区。20~59岁各组年龄别发病率随着年龄的增长而上升,55~74岁各组的率值相近,75岁及以后随年龄的增长出现下降;所研究各组年龄别死亡率随着年龄的增长而上升。新发病例的病理诊断比例为94.39%,诊断时期别的Ⅰ期比例为29.42%,不详比例为30.82%。2002—2015年,上海市女性乳腺癌发病标率呈现持续上升的趋势,死亡标率总体显示平稳趋势。结论:2002—2015年间,上海女性乳腺癌发病标率持续增高。死亡标率总体显示平稳趋势,提示治疗有效,生存状况改善。

Objective To analyze the current incidence and mortality of female breast cancer in Shanghai during the period 2002-2015 and to provide the reference for research on breast cancer prevention and control. Methods The data of female cases with breast cancer were collected by the Shanghai Cancer Registry. The incidence and mortality of female breast cancer in Shanghai between 2013 and 2015 were compared with those in international study in 2018. The age distribution, basis of diagnosis, pathological classification and diagnostic stage were studied. Both standardized rates and agespecific rates of incidence and mortality of breast cancer between 2002 and 2015 were analyzed. Results Breast cancer incidence lists the first rank and the mortality of breast cancer lists the 4 th rank in female cancer in Shanghai between 2013 and 2015. Averagely, 5 293 female cases with breast cancer were diagnosed each year between 2013 and 2015 in Shanghai which accounted for 15.82% of total female cancer. The crude rate of incidence was 73.34 per 100 000 and standardized rate was 38.45 per 100 000 with ratio of mortality-incidence 0.27. There were 1 448 cases of death due to breast cancer each year accounting for 9.51% of all female cancer death. The crude rate of mortality was 20.06 per 100 000 with standardized rate 7.42 per 100 000. The crude rate of incidence and mortality in Shanghai were higher than that in the world, Eastern Asia, China but lower than in USA. Standardized mortality of breast cancer in Shanghai, however, was lower than that in all including Eastern Asia, USA, China and the world. The age-specific incidences of breast cancer increased with age from 20 to 59 years old with similar incidence in the groups between 55 to 74 years old, and decreased with age increasing from 75 years old. The age-specific mortality increased with age from 20 to 85 years and older. There were94.39% of new cases of breast cancer with pathological diagnosis, 29.42% of cases on stage one and 30.82% of cases with incomplete data. Between 2002 and 2015, the age-standardized incidence of female breast cancer in Shanghai showed the trend increasing constantly and the trend of mortality without change. Conclusions The age-standardized incidence of female breast cancer increased in Shanghai between 2002 and 2015. The mortality of breast cancer without change suggests effective treatment and improvement of survival.