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1、2023年度癌症进展报告AACR成立于1907年，是全球成立最早，规模最大的致力于全面、创新和高水平癌症研究的科学组织之一。日前，AACR发布了CancerProgressReport2023,编译如下。在美国启20世纪90年代以来,癌症总死亡率一直在稳步下降J991年至2020年期间的死亡率下降避免了380多万癌症患者死亡。美国癌症总死亡率的下降是由乳腺癌、结肠癌和直肠癌、肺癌和前列腺癌死亡率的稳步下降推动的。截至2022年1月1日，超过1800万癌症幸存者生活在美国。某些癌症类型或特定癌症类型的不同亚型和不同分期，死亡率下降并不一致。在美国许多社会人口群体中，癌症负担存在明显的不平等；这些
2、不公平现象发生在癌症的整个连续过程中，主要是由社会因素驱动的。未来几十年癌症对个人和美国医疗保健系统的经济负担预计将增加，这凸显了加快癌症研究进展的迫切需求。1989 -43%ReductionInBrtCncrDeathResearch:DrivingProgressAgainstCancer研究是抗癌手段进步的支柱，因为它是每一项提高生存率和生活质量的突破以及每一项旨在改善公共卫生的新政策或计划背后的驱动力。癌症研究主要领域的探索，包括基础科学、临床科学、转化科学和人口科学，为癌症预防、检测、诊断、治疗和生存的进步奠定了基础。每一项临床进展以及每一项促进癌症研究进展的政策，都是一个复杂过程
3、的最终结果，需要在多年时间里，由许多不同利益相关者合作，致力于从根本上改变这种毁灭性疾病的现状。特别是在防治癌症方面取得的显著进展，预防、早期检测和治疗方面的改进，导致美国癌症死亡率逐年稳步下降。事实上，经年龄调整的癌症总死亡率在1991年至2020年间下降了33%,这一下降意味着避免了约380万人死于癌症。美国癌症总体死亡率的下降主要是由于肺癌死亡率的下降，近年来，由于吸烟的减少以及早期检测和治疗的进步，肺癌死亡率的下降速度加快。黑色素瘤、结直肠癌、前列腺癌和女性乳腺癌死亡率的降低，也对美国癌症死亡率的总体下降做出了贡献。研究驱动的治疗进展反映在黑色素瘤、白血病和肾癌死亡率的稳步下降。慢性粒
4、细胞白血病（CML）死亡率在1975年至2020年间下降了70%o这一进展可归因于20世纪60年代至80年代的突破性基础研究发现，这些发现确定了该疾病的机制基础，并推动了CML一系列新治疗方法的发展。在儿童（14岁或14岁以下）和青少年（15至19岁）中，1970年至2020年间，癌症的总体死亡率分别下降了70%和64%,这主要是由于治疗的改善。医学研究界：共同推动进步当致力于从根本上改变癌症负担的所有利益相关者共同努力时，对抗癌症的进展可以加快。进一步加强合作将为未来的突破注入活力。主要利益相关者包括：TheMedicalResearchCommunity:DrivingProgressTo
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7、 (RET). nmnchymaMpn factor (Ml). neurotrophic tropomyosin receptor IunaSe NmQ. and human epidermal growth factor receptor 2 (WEW2) Research has Mso shown that cancer evils evade destruction by the immune system because they have high IeveH Of proteins that cn MUch to nd tngg*r brakes on immune cells
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10、 n*rty fie IMrctnt b*twMn 2014 and 2020 (24)5-YEARRELATIVESURVIVALRATE(Allcancerscombined)ChildrenAdolescents(Ages0-14)(Ages15-19)Cancer:AnOngoingPublicHealthChallenge尽管在对抗癌症方面取得了令人难以置信的进展，但在美国和世界各地，癌症仍然是一个巨大的公共卫生挑战。仅在美国，估计2023年将诊断出1958310例新的癌症病例，609820人将死于该疾病。与女性相比，男性患多种癌症的发病率更高，包括膀胱癌、结肠癌和脑肿瘤。正在进行的
11、研究正在评估遗传、表观遗传学、代谢和免疫等一系列生物学因素在介导这些差异中的作用。不幸的是，美国许多人口群体的癌症发病率和死亡率不成比例的高，这主要归因于社会经济劣势。还应注意的是，COVID-19导致的筛查，早期检测和新发癌症的诊断严重下降的不利影响并没被充分重视，这将严重低谷当下的肿瘤疾病负担。有必要对基于癌症相关人群的数据进行持续监测，以评估新冠肺炎对美国癌症负担的长期影响。美国癌症负担中的不公平现象尽管我们在对抗癌症方面取得了前所未有的进展，但严峻的现实是，这些进展并没有平等地惠及所有人。由于美国长期存在结构性不平等和系统性不公正现象，某些人群继续承担着包括癌症在内的不良健康状况的不成
12、比例的负担。癌症差异是美国最紧迫的公共卫生挑战之一。国家癌症研究所（NCl）将癌症差异定义为癌症的不利差异，如新病例数、死亡人数、癌症相关健康并发症、癌症治疗后的存活率和生活质量、筛查率和某些人群中存在的诊断阶段。如AACR2022年癌症差异进展报告所述，少数种族和少数民族以及其他医疗服务不足的美国人口承担着不成比例的更高癌症负担。AVERAGENUMBEROFNEWCANCERDIAGNOSESDURINGTHECOVID-19PANDEMIC(Foreightcancertypescombined)表1.选定癌症的估计发病率和死亡率*EstimatedIncidenceandMortali
13、ty*forSelectedCancerskstimatid2023imcimncikstimatid2023MATX3ToUlMatoFmalTdUIMal.FmalAllSltM1.95JX)IoMU)O94XXX60942032ZoeO287.740MdndThoraxR9o*BCMSt3OO9O2829Z79O4V004幻70Tongue18.04013MO4860990MoutbI42O868061401220PMrynx207016.5405730880Otheror.cvX90520KOLaryra12.38099002480SOX)TSOlungndbroncm238.5401
14、17.550VK79O67.16059.9XEyoandorM34901900HdO240190BrainandothernervousWttGn24月10M.280K53O13207970GMtro4nettlnl(GOSystnGsophagus21.S6OIZOSO4S3016.120S2Z9O13250J0Gallbtedderandotherbiliary12.220STSO64704SX)PKrtlM64.0S033.1JO30.920SO.55OSkln,cludlrgbMndqumout)MeUnomdo1196K)S8.12O59.490TWO54202570Othernon
15、nheWsk7320469026”4480soM20Uf9V*na皿other9e(Wl0c9mkfma8470847017401740Prostate288.3002ttJ0034.700MJOOTsttt919091904X)470Pme80052J6029.440M099204970UreterendothfUnnaryoceans44702810)660990Soo390CrdocrSystocyticMCem18u74012.150661001660Acutemyeloidtekemi20380H,4K)897064404870ChfOnICmyoidIeukermo8930S190
16、37407SSOHodgkmrmphom883048S039OS40360NoA-HodgMnIymphoma80.5S044,88035怎70n,o8400Mye4oma不Tjo196015,870TWO5590OtherIeUlaefTM502032801740SlSO2060OfCMCftBomSWjOirns39702160WIO2M01200Softtissue(nckx*nghevt)IMOo740060SMO27202420(fkunMtothe11MTMtN)Mce23ne三camreon2OOS-2OT9nodee11jkrvorMggMxmMIecAstooMtoo6Cen
17、trHOnc*CMAACCtJCsUmmcOwtt4vbwdonXXM-XUOU11MfUtjrdaU.HMbOMiCmAkforHMthSUMKKCf*nfarOaMWControl*wrteXat4mo4ifhxn)哪些美国人群经历了癌症差异？根据国家癌症研究所的数据，癌症差异是癌症的不利差异，如新增病例和死亡人数、癌症相关健康并发症、癌症治疗后的生活质量、经济负担、筛查率和某些人群的诊断阶段，包括：WhichU.S.PopulationGroupsExperienceCancerDisparities?AccordingtotheNationalCancerInstitute,cance
18、rdisparitiesareadversedifferencesincancersuchasthenumberofnewcasesanddeaths,cancer-relatedhealthcomplications,qualityoflifeaftercancertreatment,financialburden,screeningrates,andstageatdiagnosisthatareshoulderedbycertainpopulationgroupsincluding:Individuals belonging tocertain ancestry, racial oreth
19、nic minority populationsIndividuals of lowsocioeconomic statusIndividuals who lack orhave inadequate healthinsurance coverageResidents in certaingeographic locations,Including rural areas校Individualswith disabilitiesIndividuals belongingto sexual and genderminoritiesLGBTQ+Adolescents andyoung adults
20、Immigrants, refugees, or asylum seekersOlder adultsActopced from 03).美国癌症不公平现象某些美国人口群体承担着不成比例的癌症负担。这里提供了不同癌症发病率和结果的最新例子。癌症护理其他方面的差异在整个报告的相关章节中得到强调。2022年癌症差异进展报告详细介绍了对癌症差异和解决这些不平等的最新进展的更深入讨论，以及行动呼吁。SIDEBARCancerInequitiesintheUnitedStatesCertainU.S.populationgroups(seeSidebar2,p.17)shoulderadispropor
21、tionateburdenofcancer.Recentexamplesofdisparatecancerincidenceandoutcomesareprovidedhere.Disparitiesinotheraspectsofcancercarearehighlightedinrelevantsectionsthroughoutthereport.Amorein-depthdiscussionofcancerdisparitiesandrecentprogressinaddressingtheseinequities,aswellasacalltoaction,isdetailedinA
22、ACRCancerDisparitiesProgressReport2022(13).HIGHERcancer deathrates2-FOLDor higher5-FOLDor higherFrom 2018 to 20 如： Black women had 1.4 times and two times higher death rates for breast and uterine cancer, respectively, compared to White women, despite having similar incidence rates; Black men had tw
23、o times higher death rates for prostate cancer, compared to White men (17). American Indian and Alaska Native men had 1.8-, 2.1-, and 2.7-times higher death rates due to cancers of the kidney, liver, and stomach, respectively, compared to White men (17). Native Hawaiian or other Pacific Islander (NH
24、OPI) 20-to 49-year-olds had the highest cancer death rates, compared to all other racial or ethnic groups of similar age range (17). Hispanic men and women had twofold higher death rates for stomach cancer, compared to White men and women (17).Compared to cisgender patients, transgender patients hav
25、e twofold or higher increased risk of death from non-Hodgkin lymphoma, prostate cancer, and bladder cancer (18).Among childhood cancer survivors, those living in neighborhoods with the highest socioeconomic deprivation are at a five-fold or higher increased risk of all-cause deaths compared to those
26、 living in the least socioeconomically disadvantaged neighborhoods (19).78%higherCongressionaldistrictsintheU.S.MidwestandAppalachiamadetheleastprogress,whilethosealongthesouthernEastCoastandthesouthernbordermadethegreatestprogressinreducingoverallcancerdeathratesbetween1996-2003and2012-2020(20).Amo
27、ngolderadultswithnewlydiagnosedcancer,ruralresidentshavea78percenthigherone-yearmortalitycomparedtourbanresidents(21).被称为健康社会决定因素（SDOH）的复杂和相互关联的因素是癌症差异的主要驱动因素。国家癌症研究所将SDOH定义为人们出生地和生活、学习、工作、玩耍和衰老地的社会、经济和身体条件，这些条件会影响他们的健康、福祉和生活质量。这些包括经济政策和制度、发展议程、社会规范、社会政策和政治制度。在美国，几个世纪以来的结构性种族主义和系统性不平等使加剧了种族和少数民族以及医疗
28、服务不足的其他群体在SDOH方面的不利差异。图中的圆圈描绘了关键的SDOH,以及它们如何在社会和社区层面以及个人层面相互联系和交叉。突出显示了包括SDOH的多水平因子的选定实例。总的来说，这些因素影响着癌症连续体的每个阶段，导致种族、结构和/或经济弱势群体的健康状况恶化。SocialDeterminantsofHealth癌症是世界范围内的一个重大公共卫生挑战，全球新诊断和死亡人数不断增加反映了这一点。根据一个国家的人类发展指数（衡量社会和经济发展的综合指标，包括人均收入、平均受教育年限和出生预期寿命），癌症的不同负担突出了实现全球健康公平的主要障碍。这里包括的例子提供了癌症全球负担的广泛观点
29、。COmPIeX and Eeneidted factors called SoCidl determinants of health (SDOH) are main drivers of cancer deparities. The National Cancer Institute defines SDOH as the social, economic, and physical conditions in the places where people are born and where they live, Ieam. work, play, and grow older that
30、 can affect their health, well-being, and quality of We. These include economic pocies and systems, development agendas, social norms, social policies and political systems (27). the United Statg centuries of structural racism and systemic inequities have perpetuated andexacerbated adverse differenc
31、es Bn SDOH for raoal and ethnic minorities and other groups that are medically undersefved.The cirde in the figure depicts key SDOH and how they interconnect and ntersect. both at societal and community leves and at the individual level Selected examples of the multilevel factors comprising SOOH are
32、 hlghbghted. Collectively, these factors ImpdCt every stage of the cancer continuum. Iead ng to worse health outcomes for people from groups that are racially, structurally. ndx economically disadvntgeded here Offer broad view of the global burden of cancer.Tracheal, bronchu and lung cc m the ladlng
33、 causes of cancer daths (34).Breast CAcf i$ t除 IMdlng cause of c*cf-rIMd deaths among WOmM (4iDtognoMS and deaths from COIOnctal can0es (51.Uw cancer 岭 among t top flv causes of oncer dth in 90 countrs. the nurnber Ofnewcasespecyearis predicted to increase by 55 percent between 2020 and 2040 (52).Sa
34、 percent OfneWCefVICaICdnCef cases in 2018 were dg)ed in Women IMn9 with KV hCy-ftv prcnt ol women with CtCVkaI cancer ndHIVBvin 3S*Mth Africa (53).实现到2047年将美国癌症总死亡率降低50%的癌症登月目标TOACHIEVETHECANCERMOONSHOTGOALOFREDUCINGOVERALLU.S.CANCERDEATHRATESBY50%BY2047Cancerdeathratesmustdeclinefaster因此，在未来几年，国会必须继续为联邦机构提供持续、强劲和可预测的投资增长，这些机构对推动癌症防治进展至关重要，尤其是NIHxNQ、FDA和CDQ这些投资将有助于医学研究界保持科技创新的势头，加快对抗癌症的步伐，以实现总统的癌症登月目标，即到2047年将美国癌症死亡率降低50%oCURRENT RATE2.3%per yearper year
