1990-2019年中国女性乳腺癌发病和死亡趋势的年龄-时期-队列模型分析

Trends in incidence and mortality of female breast cancer in China from 1990 to 2019 using age-period-cohort analysis model

目的 分析中国女性乳腺癌发病和死亡流行特征,为制定乳腺癌预防和控制策略提供科学依据。方法 收集全球疾病负担研究项目中1990-2019年中国女性乳腺癌发病和死亡数据。采用标化率和截缩率描述女性乳腺癌发病和死亡趋势,应用年龄-时期-出生队列(age-period-cohort models, APC)模型和内源估计算子法(intrinsic estimator, IE)评估年龄、时期和出生队列对我国女性乳腺癌发病和死亡风险。结果 2019年女性乳腺癌中国人口标化率(中标)和世界人口标化率(世标)发病率分别为35.52/10万和36.54/10万,较1990年增加了1倍,以平均每年3.33%速度递增。1990-2019年标化死亡率呈波动下降趋势,中标死亡率在2001年达到最高(8.71/10万),世标死亡率在2004年达到最高(9.30/10万)。APC模型结果显示,随年龄发病风险呈先上升后下降趋势,50~<60岁达到最高为0.70,死亡风险从20~<25岁的-0.21上升到75~<80岁的1.07;随时期发病和死亡风险上升,分别从1990-1994年的-0.53和-0.17上升到2015-2019年的0.54和0.24;随出生队列发病和死亡风险分别从1915-1919年的0.51和0.57下降到1995—1999年的-0.74和-1.09。结论 我国女性乳腺癌发病和死亡风险攀升,因此在完善早诊早治二级预防基础上,应把控制乳腺癌高危因素为基础的一级预防纳入乳腺癌防治中。

Objective To understand the trends in incidence and mortality of female breast cancer in China from1990 to 2019,and to provide scientific evidence for formulating preventive and control strategies.Methods The incidence and mortality data of breast cancer in Chinese females during 1990 and 2019 were obtained from the Global Burden of Disease project.The age-standardized and truncated rates were adopted to describe the trends of incidence and mortality of breast cancer.The age-period-cohort(APC) model and the intrinsic estimator(IE) were applied to evaluate the effects of age,period and birth cohort on incidence and mortality of breast cancer.Results In 2019,the age-standardized incidence rate of breast cancer was 35.52 per100 000 by Chinese population and was 36.54 per 100 000 by Segi’s world population,which were twice as much as in 1990 and increased by 3.33% per year on average.From 1990 to 2019,the age-standardized mortality rate fluctuated but decreased slowly.The age-standardized mortality rate by Chinese population peaked at 8.71 per 100 000 in 2001,while it peaked at 9.30 per 100 000 in 2004 by Segi’s world population.The results of the APC model showed that the incidence risk of breast cancer increased and then decreased along with age,and reached the peak of 0.70 in women aged 50-<60 years.The mortality risk showed an upward trend which increased from-0.21 in women aged 20-<25 years to 1.07 in those aged75-<80 years.The incidence and mortality risk also increased with time period,from-0.53 and-0.17 in1990—1994 to 0.54 and 0.24 in 2015—2019,respectively.However,the incidence and mortality risk decreased with birth cohort,from 0.51 and 0.57 in 1915—1919 to-0.74 and-1.09 in 1995—1999.Conclusions The incidence and mortality risks increase gradually in Chinese females,therefore,in addition to the improvement of the secondary prevention as early diagnosis and early treatment for breast cancer,the primary prevention based on the control of high risk factors of breast cancer should be included in the prevention and treatment of breast cancer.