Globalcancerstatistics(全球肿瘤统计2011)

1、CACANCERJCLIN 2011;61:69- 90Global Cancer Statistics1234Ahmedin Jemal, DVM, PhD ; Freddie Bray, PhD ; Melissa M. Center, MPH ; Jacques Ferlay, ME ;Elizabeth Ward, PhD5; David Forman, PhDAbstractThe global burden of cancercontinuesto increaselargelybecauseof the agingand growth of the world populatio

2、nalongside an increasingadoptionof cancer-causing)ehaviors,particularlysmoking,in economicallydevelopingcountries.Basedon the GLOBOCAF2008 estimates,about 12.7 milli oncan cer cases a nd 7.6 milli oncan cerdeathsare estimatedto have occurred i n 2008; of these,56%of the cases a nd 64% of the deaths

3、occurred i n the econo micallydevelop in gworld. Breast ca nceris the mostfrequentlydiagnosedcancerand theleadingcauseof cancerdeathamongfemalesaccountingfor 23%of the total cancer casesand 14%of the cancerdeaths.Lungcanceris the leadingcancersite in males,comprising17%of the total new cancer casesa

4、 nd 23%of the total can cerdeaths. Breastca nceris now also the leadi ngcauseof can cerdeath am on g females in econo micallydevelop ingsoun tries,a shift from the previousdecadeduri ngwhich the most com mon cause of can cerdeath was cer- vicalcancer.Further,the mortalityburdenforlung canceramongfem

5、alesin developingcountriesisashighasthe burdenfor cervical ca ncer,with each acco un ti ng for 11%of the total female ca ncerdeaths. Althoughoverall ca nceri ncide nce rates in the develop in gvorld are half those see nin the developedworld in both sexes,theoverallca ncermortality rates are ge neral

6、lysimilar. Can cersurvivate nds to be pooreri n develop ingcoun triesmost likelybecauseof a comb in ationof a late stageat diag no sisa nd limited accessto timely and standardtreatment. A substantialproportionof the worldwideburdenof cancercould be prevented throughthe applicationof existingcancerco

7、ntrolknowledgeand by implementingprogramsfor tobaccocontrol,vaccination(for livera ndcervicalca ncers),an d earlydetect ion an d treatme nt, as well as publichealth campaig nspro mot in gphysicalactivitya nd a healthierdietary in take.Cli nician spublic health professi on alsa nd policy makers ca n

8、playa n active role in accelerati ngthe applicationof such interventionsglobally. CACancerJCIin2011;61:69 - 902011 AmericanCancerSociety,lnc.In troductio nCancer is the leadi ng causeof death in econo mically developed co un tries and the sec on d leadi ng causeof death1in developing countries. The

9、burden of cancer is increasing in economically developing countries as a result of population aging and growth as well as, increasingly, an adoption of cancer-associatedifestyle choices including smoking, physical inactivity, and westernizdidts. 1 n this article, we provide an overview of the global

10、 cancer burden, including the estimated number of new cancercasesand deaths in 2008 and the incidence and mortality2rates by region for selectedcancersites. These statistics are basedon GLOBOCAN 2008, the standard set of worldwide estimates of ca nceri ncide nce and mortality produced by the In tern

11、 ati onal Agen cy for Research o n Can cer (IARC) for 2008. We comme nt on the rece nt in cide nce and mortality patter ns observed for a nu mber of com mon can cerforms, alon gside established preve ntive measuresthat can reducethe worldwide can cerburde n.Data Sources and MethodsIn cide nce data (

12、the nu mber of n ewly diag no sed cases each year) are derived from populati on-based cancer registries, which may cover e ntire n ati onal populati ons but more ofte n cover smaller, sub nati onal areas, a nd, particularly in developing countries, only urban environments, such as major cities. Alth

13、ough the quality ofVice President, Surveillance Research, American Cancer Society, Atlanta, GA; Deputy Head, Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; 3Epidemiologist, Surveillance Research, American Cancer Society, Atlanta, GA; 4Informatics Officer, S

14、ection of Cancer Information, International Agency for Research on Cancer, Lyon, France; National Vice President, Intramural Research, American Cancer Society, Atlanta, GA; 6Head, Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.Corresponding author: Ahmedin J

15、emal, DVM, PhD, Surveillance Research, American Cancer Society, 250 Williams Street, NW, Atlanta, GA 30303-1002; DISCLOSURES The authors report no conflicts of interest.V 2011 American Cancer Society, Inc. doi:10.3322/caac.20107.Available online at and http

16、:/VOLUME61 _NUMBER2 _ MARCH/APRIL201169Global Cancer Statistics information from most of the developing countries might beconsidered,in relative terms, of limited quality, it ofte n rema in s the only source of in formati on available on the pro?le of can cera nd assuchprovides va

17、luable information. The total number of cancer deathsby country arecollectedannually and are made available by the World HealthOrganization(WHO). The advantagesof this sourceof dataare its national coverageand Iong-term availability, although not all datasetsare of the samequality or complete- ness.

18、Provisional estimatesof the age- and sex-speci?c deathsfrom cancer(of all types) for 2008 have been used1 in regionsof the world with either no death information or where of?cial statisticsaredeemedunre- liable, an d correctedfor possible in complete ness.Incidenee and mortality rates (number of cas

19、esor deaths per 100,000 personsper year) were estimated in GLOBOCAN by country, using the most recently availabledata collected at the IARC or available in routine reports from the registries themselves. Nati onal in cide nee rates were estimated using one of several methods, dependant on the availa

20、bility and quality of data, in the following order of priority:1. National incidenee data. When historical data and a suf?cie nt nu mber of recorded cases were available, incidenee rates were projected to 2008.2. National mortality data and local registry data. Estimation of incidenee based on regre

21、ssion models, speci?c for sex, site, and age, derived from subnational or regional cancer registry data.3. Regional incidenee data from one or more ean- cer registries but no mortality data. National incidenee derived from a single set or a weighted average of local rates.4. Frequency data. Only dat

22、a on the relative frequency of different cancers(by sex, site, and age groups) available. These proportions are applied to estimates of the all-cancer incidenee rate for the country, derived from cancer registry data within the sameregion.5. No dataavailable.Country-speci?c ratesequatedto those of n

23、eighboring countriesin the sameregion. Similar procedures were used to estimate country-speci?c mortality rates, in the following order of priority:1. National mortality data. Projections to 2008 where possible.2. Sample mortality data. The age- and sex-speci?c all-ca ncer mortality en velopesprovid

24、ed n ati on ally for 2008 by the WHO were partitioned by site using the sample mortality data.3. No mortality data. National mortality was derived from incidenee and cancer- and country-speci?c survival probabilities (based on level of gross domestic product), and then scaled to the WHO all-cancer m

25、ortality envelope for 2008. Country-speci?c incidenee and mortality rates were prepared for 27 types of cancer (including Kaposi sarcoma KS for sub-SaharanAfrican countries), by sex a nd for 10 age groups (0-14, 15-39, 40-44, 45-49,70-74, a nd 75t years). A full description of the data and methods u

26、sed for each country and the corresponding results are available in GLOBOCAN 2008 (available at http:/www. globocan.iarc.fr).4 Estimates for the 20 world regions (Fig. 1) and for more and lessdeveloped regions, as de?ned by the United Nations (UN), were obtained as the population-weighted averageof

27、the incidenee and mortality rates of the component countries. These rates were age-standardized (ASRs) (per 100,000 person-years) using the World Standard Population as proposed by Segi and modi?ed by Doll et al.6,7 The cumulative risk of developing or dying from cancer before the age of 75 years (i

28、n the absenceof competing causesof death) was also calculated a nd is expressedasa perce ntage.Results and DiscussionEstimated Number of New Cancer Cases and DeathsAbout 12.7 million cancercasesand 7.6 million cancer deaths are estimated to have occurred in 2008 worldwide (Fig. 2), with 56% of the c

29、asesand 64% of the deaths i n the econo mically develop in g world. Breast can ceri n females a nd lung can cer i n males are the most frequently diagnosed cancersand the leading causeof cancerdeathfor each sexin both economically developed a nd develop in g co un tries, except l ung cancer is prece

30、ded by prostate cancerasthe most frequent can ceram ong males i n econo mically developed co untries. These cancerswere followed, without speci?c rank order, by stomach and liver cancersin males and cervix and lung cancers in females in economically develop ing coun tries and by colorectal a nd lung

31、 cancers in females and colorectal and lung or prostate cancersin malesin the economicallydevelopedworld.71CA: A Cancer Journal for CliniciansCA CANCERJ CLIN 2011;61:69- 90VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 901 Eftern Africa2 Middle Africa11 South-Eastern Aiwa12 Soutii-C

32、entral Asia3 Northern Africa4 Southern Africa5 Western Alriu6 Caribbean7 Central Amehca8 South9 Northern America10 Eastern ilteia13 Western Asia14 Central avid Eastern Europe15 rtarthem Europe16 号author沖 Europe17 Western Europe18 AjjtFalia/Nw Zealand19 Melanesia20 MIcironsia/AolynesiAVOLUME61 _NUMBE

33、R2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 9010a Japan10b Other 氐 Asia (China：! Ko rea and Mongolia)FIGURE1. Twenty World Areas.VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90Incidenee and Mortality Rates for

34、All Cancers tries compared with developed countries and this,VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90Combined and Top 22 Cancer Sites combined with reduced accessto appropriate thera-VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90While incidenee rates for

35、 all cancers combined in peutic facilities and drugs (Fig. 3), has an adverseVOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90economically developed countries are nearly twice as high asin economically developing countries in both males a nd females (Table 1), mortality rates for al

36、l cancers combined in developed countries are only 21% higher in males a nd only 2% higher in females. Such disparities in in cide nce and mortality patter ns between developed and developing countries will re?ect, for a given cancer, regional differencesin the prevalenceand distribution of the majo

37、r risk factors, detect ion practices, a nd/or the availability and use of treatment services. Prostate, colorectal, female breast, a nd lung can cerrates are 2 to 5 times higher in developed countries compared with developing countries, a result of variations in a disparate set of risk factors and d

38、iag no stic practices.The con verseis true for cancersrelated to infections suchasstomach, liver, and cervical cancers(Table 1). Table 2 shows the overall cancer incidence and mortality rates by sexaccording to world areas.The incidence rate for both sexescombined is more than 3 times ashigh in Aust

39、ralia/New Zealand asthat in Middle Africa.It should also be no ted that can cer te nds to be diagnosed at later stagesin many developing couneffect on survival. A recent comparative survey of cancer survival rates in Africa, Asia, and Central8America based on patients diagnosed in the 1990s indicate

40、s substantially lower survival rates in parts of Africa, India, and the Philippines than for those diagnosed in Singapore, South Korea, and parts of China. For example, breast cancer 5-year survival rateswere 50% or lessin the former populations and over 75% in the latter. Such comparisonswere simi-

41、9lar to those observed in the CONCORD study for an earlier time period.Selected CancersFemale Breast CancerBreast canceris the most frequently diagnosed cancer and the leading causeof cancerdeath in females worldwide, accounting for 23% (1.38 million) of the total new cancercasesand 14% (458,400) of

42、 the total cancerdeaths in 2008 (Fig. 2). About half the breast cancer casesand 60% of the deaths are estimated to occur in economically developing countries. In general, incidence rates are high in Western andVOLUME61 _NUMBER2 _ MARCH/APRIL201173CA CANCERJ CLIN 2011;61:69- 90VOLUME61 _NUMBER2 _ MAR

43、CH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90WorldwideMatafemaleMaleFemaleLung 趴:MnE 丼Breasti.i；rq S hi w：-h-. isBret1C95.2OOVriHi.hOO951rOOO458.40D山 Olldb：Cuton & rectumLiverLunq St branch lbJM)3500570,100478, ?004?7.400Colon & r*cMmCr

44、visc UteriStomiAchCoIqfi R rectum&63.6POS2%dOO4Mr4DZB8.1OTSlcnijchLung 也 bronchusColon & retlumLei m LFten&轴砂513.6OT1600275JOOLiverStomachEsaphagusStomach522 冲 CIO349P000276,100273r6OOEscphflqwiCorpus uteriProsUteLiverJ26P60Q渤1002%400217.60lhni.：i 7 ：.iclriLiver1 A,iikHriuOwary297,500225900143.700M0

45、 J00 Hodkri ITiphorr.! lyy.eooQvarv 225. BOOPancreasB8JOOEsophagus13OJD0LeutemfjThyrcrtdUnnaiy bhddeM2r300ParKreas19S.900163,000127.900Or .t|馭kryNon Hndqkm h/mphom.!15300Non liodgkin lympham17D.9 口口丽上DO113.(00AH sites but sk nAll site bul 去 inAll sites but skinAll ates but sk int，履匕loo6rOJB14004,22b

46、. /DOEnimatMl New UsesEitiimaifed DeathibMeDeveloped CountriesMlePr-oslall?648JOOLung i& brondiusCqIqh & rKtumW7D0FemaleBreastb92r200Colon 扇 rectuhi337,700Lung S bron00Lung & bronchusl8P40CColon1 S rectunn隔孕onLhinry bladderCorpus uteri!aarKreas17/eBOO142.200i10r9007100StomachStomathPmct电茁Stomach17.7

47、00WJ.OOO82r7OD70. SOOKidhfr0* 旳yLiver)111,100J0Or3O07,400铠SOONan-Hodgkkn lyniphamaMorbHodcjkin hmphomaUfinaiy bhdd电rLlwr95,700MeliKom.i cf k u85.300&4.800Meldnoma of the skin81.600Pancrp.ft8-1.200Liwr81,700AN siles twj! skim2.97S.200Pdrw e 吊80.900Cervix Uteri76.500All $ but 之 inZr90055.000f wphiiqiA

48、53J00lEHiifcetni-i:)ri-Hndkan I Fniphorii討3 工 500Corpus uteri込200All Mtes but skinV23.200VOLUME61 _NUMBER2 _ MARCH/APRIL201175CA CANCERJ CLIN 2011;61:69- 90VOLUME61 _NUMBER2 _ MARCH/APRIL2011#CA CANCERJ CLIN 2011;61:69- 90FemaleMeleFemaleDevelopmqLung 屈 bromtui*Breastl阴越 broKtiKBret ITd厂eii llltf I0

49、C512,500691, $005 39.000268.900vvUriti iSlomachtervuc uteriLiverCervix ulen46.900453J40230024Z000llwrLung & bronchmsi$ioin nphoni；aLeukerritaOrdl cavityKiarn, nerwoussyscem103.80053001.3005Df3OOAl sit bul skinAll sitts bul skinAll sik*$ bu! skinAll sdvs but din3.6540001453.6002.69Z5OO2J22r6OOFIGURE2

50、. Estimated New Cancer Cases and Deaths Worldwide for Leading Cancer Sites by Level of Economic Development, 2008. Source: GLOBOCA 2008.TABLE1. In cide nee and Mortality Rates a nd Cumulative Probability of Develop ing Can cer by Age 75 by Sex a nd Can cer Site for More Developed and Less Developed

51、Areas, 2008MORE DEVELOPEDAREASLESSDEVELOPEDAREASINCIDENCEMORTALITYINCIDENCEMORTALITYASRCUMULATIVERISK (%) AGE 0-74ASRCUMULATIVERISK (%) AGE 0-74ASRCUMULATIVERISK (%) AGE 0-74ASRCUMULATIVERISK (%) AGE 0-74MalesAll cancers* (C00-97, but C44)300.130.1143.915.0160.317.0119.312.7Bladder (C67)0.

52、0.3Brain, nervous system(C70-72)6.00.3Colorectum (C18-21)37.64.415.11.70.8Esophagus(C15)0.611.81.410.11.2Gallbladder(C23-24)1.10.1Hodgkin lymphoma (C81)0.00.1Kid ney(C64-66)1.30.1Larynx(C32)2.10.3Leukemia(C91-95)0.54.5