1990~2019年中国女性乳腺癌疾病负担及危险因素研究

Disease burden and attributable risk factors of breast cancer in Chinese females from 1990 to 2019

目的研究中国的乳腺癌流行病学现状,乳腺癌发病率和死亡率在1990~2019年间的变化趋势及预后相关的危险因素。方法提取全球疾病负担研究数据库的中国女性1990~2019年的乳腺癌发病、死亡数据,及其相关的年龄标化率(age-standardized rate,ASR)和危险因素相关数据,并从相关文献中提取了中国34个省份的乳腺癌伤残调整寿命年(disability-adjusted life years,DALY)数据。采用联结点回归模型分析ASR的变化趋势,分析各个危险因素的暴露风险及增加的乳腺癌疾病负担情况。结果1990~2019年间,中国女性乳腺癌的发病率逐年增加,从1990年的17.07/10万增加到2019年的35.61/10万,而死亡率呈现出下降、上升而后又下降,2016年后又开始呈上升的趋势(1990年的9.16/10万到2019年的9.02/10万)。在中国的34个省份中,乳腺癌疾病负担最严重的是山东省,最低的是澳门特别行政区。在与预后相关的7个危险因素中,高体质量指数(BMI)与预后风险有更明显相关。近30年来,高红肉饮食的暴露风险呈现明显增长趋势,因此高红肉饮食所致的疾病负担也在逐年增加。结论中国女性乳腺癌的发病率仍不断增加,随着社会经济水平发展及人们饮食习惯的改变,中国的乳腺癌疾病负担也可能会越来越重。因此,要做好“三早”防治,提倡健康合理的饮食和生活习惯,以降低乳腺癌疾病负担,获得更好的乳腺癌预后和生活质量。

Objective To analyze the latest epidemiological status of breast cancer in China,trends in morbidity and mortality from 1990 to 2019,and related prognostic risk factors.Methods Data on incidence and mortality of Chinese female breast cancer,their related age-standardized rates(ASRs)from 1990 to 2019,and attributable risk factors were obtained from the Global Burden of Disease(GBD)database,and data on disability-adjusted life years(DALYs)of 34 provinces in China were obtained from literature.Joinpoint regression analysis was used to analyze the trends of ASRs.The exposure levels of each attributable risk factor and the increased cancer burden were analyzed.Results The incidence of breast cancer in Chinese females increased annually,from 17.07/100000 in 1990 to 35.61/100000 in 2019,while the mortality rate initially increased and decreased,and then exhibited an upward trend after 2016 and there was no obvious variation from 1990(9.16/100000)to 2019(9.02/100000).Among the 34 provinces of China,Shandong Province had the most serious breast cancer burden,while Macao Special Administrative Region had the lowest.Among the seven prognostic risk factors,high body mass index(BMI)contributed the most to the breast cancer burden and the exposure risk of a diet high in red meat had shown a significant increasing trend in the past 30 years.Therefore,the disease burden caused by a high red meat diet would be increasing.Conclusions The incidence rate of breast cancer in Chinese females is increasing.With the development of social economy and the change of people’s dietary habits,the breast cancer burden in China trends to become heavier and heavier.Therefore,it is necessary to conduct the"three early"prevention and treatment and advocate healthy and reasonable diet and living habits to reduce the burden of breast cancer to improve prognosis and quality of life.