癌症流行现况病因以及营养流行病学的研究进展

癌症是一种恶性程度高、容易发生侵袭和转移且预后较差的疾病,但有效的预防和干预措施能有助于控制癌症的发生和发展,减少其疾病负担。癌症的病因非常复杂,包括来自于外部暴露的危险因素、机体自身因素和遗传易感性等。近年来,饮食和营养素与癌症之间的关系日益引起公众和流行病学家的重视。本文介绍了癌症的流行现况和外部病因以及癌症营养流行病学方面的研究进展,尤其探讨了饮食营养对癌症预防的意义,以及目前研究面临的挑战,期望为癌症的饮食营养一级预防和公共卫生决策提供参考依据。     

马来西亚肿瘤预防控制概况

文章从癌症负担、主要的预防控制策略、临床治疗和姑息治疗、防控系统建设等多角度对马来西亚肿瘤预防和控制概况予以描述。该国根据本国癌症负担制定了相应的防控策略,并取得了一定的效果,值得同为发展中国家的中国借鉴。这些成功的经验包括：严格的控烟、控酒和HPV疫苗的应用以及癌症筛查等一、二级预防措施的实施,以及非政府组织发挥的重要作用。     

国内外癌症防制现状

癌症是全球的主要疾病负担,每年约发生新病例1 100万;全球最常见的癌症发病为肺癌、乳腺癌和结直肠癌,最常见的癌症死亡为肺癌、胃癌和肝癌。中国癌症发病占全球的20.3%,每年新发病例超过220万,最常见的癌症男性为:肺癌、胃癌、肝癌、食管癌,女性为:乳腺癌、食管癌、胃癌、肺癌、肝癌、宫颈癌。全球癌症发病总体呈上升趋势,显著上升的癌症有肺癌、乳腺癌、结直肠癌;显著下降的癌症有胃癌、宫颈癌。癌症的主要危险因素包括烟草、酒精、病毒与感染、放射与辐射、膳食与营养、环境暴露、遗传易感性等。烟草和酒精消费的增加以及现代生活方式对于肺癌、消化道癌症、乳腺癌的影响正在加剧,饮食和营养的改变导致了胃癌和食道癌的下降。病毒感染的控制和乙肝疫苗、HP疫苗的应用将对肝癌、宫颈癌的下降产生积极的作用。我国癌症监测与防控体系正在形成和加强,专业研究、现场研究和多学科的协作研究将继续在癌症防控中发挥重要作用。     

以筛查为抓手，多维度合力推进食管癌防控工作

食管癌是我国主要癌症负担之一，严重威胁人民群众的生命健康。为缓解食管癌疾病负担，食管癌筛查计划已开展多年并获得一定效益，但从全国范围来看，仍然存在早诊率低、筛查覆盖面小等问题，食管癌防控形势依然严峻。为推动我国食管癌防控工作，需坚持政府为主导，社会、家庭和个人多层面协作联动，积极开展健康宣教，加强危险因素综合防控，推进人群筛查向基层医疗机构机会性筛查转变，实现病因预防和筛查的有效结合，进一步降低食管癌发病率和死亡率，确保群众受益。     

全球肺癌的流行及预防进展

世界卫生组织国际癌症研究所新近发布了《世界癌症报告——癌症预防研究》,根据该报告,对肺癌的全球和中国的流行和生存率、基因易感性、致癌物、空气污染、既往肺部疾病等主要危险因素,以及筛查等预防相关研究进展,并结合中国状况,进行概略介绍。     

癌症筛查与早诊早治的研究进展

癌症是严重威胁人类生命健康的疾病之一,已经成为全球的公共卫生问题。目前癌症患者晚期较多,导致生存率较低,如果癌症能够早期发现,会大大提高生存率,降低癌症的疾病负担。目前肿瘤的筛查与早诊早治是肿瘤二级预防的主要手段,能够早发现、早诊断和早治疗,提高患者生活质量。本文从几大高发癌种对目前癌症筛查现状、成效以及筛查方法进行阐述,以期为科学、合理选择和推广适宜的癌症筛查策略提供参考。     

河北省肿瘤防控工作50年发展历程与展望

河北省是我国上消化道癌集中高发地区之一。为有效减轻恶性肿瘤疾病负担,河北省建立了以人群为基础的肿瘤登记体系,对以上消化道癌为主的重点癌种积极采取综合防控措施,肿瘤防治成效显著。全文就河北省肿瘤登记历史发展、肿瘤登记体系的建立、癌症防控的三级预防体系建设进行了总结,并对未来河北省癌症防控形势进行思考。     

浙江省肿瘤防控工作50余年发展历程

浙江省是我国最早开展肿瘤防控工作的省份之一，始于1971年12月21日。为有效减轻恶性肿瘤疾病负担，浙江省构建完整的肿瘤防控网络，建立了完整的肿瘤登记体系，对重点癌种开展筛查及早诊早治，发起慈善救助等，防治成效显著，成为省级肿瘤防控典范。全文就浙江省肿瘤防治机构情况、肿瘤防治网络构建、肿瘤随访登记和癌症筛查工作进展等作一总结，并对未来浙江省肿瘤防控工作提供思路。     

肿瘤主要危险因素的预防控制策略

肿瘤预防控制任重道远。其中主要危险因素和致病因子的控制是较有效的方法。借鉴国际组织的癌症预防与控制策略,如何实现政府领导,多方面共同合作控制危险因素,政府、学术界及个人需通力合作。     

结直肠癌的全球流行情况、危险因素及归因疾病负担研究进展

结直肠癌是全球高发恶性肿瘤之一,其发病率持续上升,已严重危害人类健康,造成的经济负担和疾病负担不容忽视。结直肠癌是多因素共同作用且多阶段发生发展的疾病,不同地区和人群中影响结直肠癌发生发展的因素存在差异,通过掌握结直肠癌的流行特点、危险因素及归因疾病负担,有助于根据不同危险因素开展结直肠癌的精准防控。本文就全球及中国的结直肠癌流行情况、危险因素和归因疾病负担进行综述,以期为结直肠癌的防控提供参考依据。     

An Estimate of the Potential for Cancer Prevention in Japan

Cancer prevention is an important strategy in cancer control and it consists of primary prevention and secondaryprevention. Major avoidable or manageable risk factors for cancer identified from previous studies are tobacco,diet and infection. Some cancer could be prevented by controlling those risk factors. In Japan screenings for gastriccancer, cervical cancer, lung cancer, breast cancer and colo-rectal cancer have been widely conducted under the Lawof Health Maintenance for the Aged. In planning and evaluating cancer control activities in Japan, it was considereduseful to estimate the potential of primary and secondary prevention of cancer. The author estimated the potentialof cancer prevention in Japan twice previously in 1990 and 1999. In this paper the potential of cancer prevention inJapan was re-estimated by using a different method and more recent data. From the present study it was estimatedthat about 25% of cancer occurrence could be prevented by control of smoking, diet and infection, about 9-15% ofcancer deaths could be prevented by cancer screening, and about 6- 10 % of cancer deaths could be prevented byapplication of the state-of-the art diagnosis and treatment of cancer, altogether about 40-50% of cancer occurrences/deaths could be prevented if all possible measures for cancer prevention are applied to the general public and cancerpatients in Japan.     

人工智能在肿瘤三级预防中的应用 机遇与挑战

随着人工智能（artificial intelligence,AI）技术的快速发展,其在处理高通量、多维度信息方面的优势逐渐显现,为肿瘤防控带来新的机遇。将AI技术与影像学、病理学、电子健康数据和组学资料结合,将有效促进恶性肿瘤病因和危险因素识别以推动一级预防,更早且更准确地发现和诊断恶性肿瘤而增进二级预防,并对患者进行风险评估和预后预测以指导临床用药和治疗使三级预防受益。然而,AI的应用仍受限于数据库的系统完整性和可及性,在模型鲁棒性、泛化性和结果解读等方面仍面临挑战,因此限制了其在真实世界肿瘤防控中的应用。本文阐述近年来AI技术在肿瘤三级预防领域的研究进展和应用现况,介绍当前AI应用于肿瘤防控面临的挑战和进展,并对其前景进行展望。      

Environmental Cancer Risk Factors: A review

The risk of cancer in humans is increased by a wide spectrum of factors, which ranges from exposure to an identified agent, such as environmental chemicals or a virus, to a culturally determined behaviour, such as smoking, or to socio-economic conditions. We are today able to intervene on some of these factors, while others affect risk by as yet undetermined pathways. Only progress in the understanding of the mechanisms by which these factors act can lead to specific means of cancer prevention. There is no compelling reason to believe that the number of carcinogenic agents, to which humans can be exposed, is infinite, nor is it unreasonable to assume that it will eventually be possible to identify most of them. The variety of cancer risk factors of which we are presently aware implies, however, that it would be impossible to have just one simple approach to cancer control and cancer prevention. It is rather encouraging that the applicability of new laboratory methods to epidemiological surveys seems to open the way to a laboratory-integrated epidemiology.     

青岛市563例肺癌患者高危险因素的回顾性研究

目的筛查青岛地区肺癌高危险因素,以指导青岛地区人群进行肺癌综合预防工作。方法563例已确诊为原发性肺癌的患者作为病例组,按照1：1配对的方法,选择我院与病例组近亲属的同性别、同年龄的外伤患者作为健康对照组。所有病例均调查其发病前可能的危险因素,对于研究的项目,采用单因素条件Logistic回归分析和多因素条件Logistic回归分析,最终进入模型的项目为肺癌发病的独立危险因素或保护因素。结果单因素条件Logistic回归分析结果显示,共筛选出19项因素有统计学意义,最终进入模型有统计学意义的因素共6项,其中家族史、吸烟、生活应激强度大（5年内）、吃熟肉制品和抑郁等是肺癌发病的危险因素,而运动是肺癌发生的保护性因素。结论家族史、吸烟、生活应激强度大（5年内）、吃熟肉制品和抑郁等可引起青岛市人群肺癌发病增加,运动可以减少肺癌的发病风险。     

我国肺癌流行现状及其预防对策

文章描述了当前我国肺癌发病和死亡现状及其主要危险因素,强调了肺癌是可以预防和控制的,提出了我国肺癌的流行趋势与预防要点.     

Hepatitis B Knowledge and Vaccination Levels in California Hmong Youth: Implications for Liver Cancer Prevention Strategies

Although chronic infection with hepatitis B virus (HBV) is one of the major risk factors for liver cancer, the level ‍of knowledge about liver cancer risk factors and HBV transmission, as well as vaccination have not been assessed in ‍this population. We interviewed Hmong youth living in Fresno, California about liver cancer risk factors. General ‍knowledge of HBV was common, but knowledge of specific modes of transmission was low. For example, only 49% ‍knew that HBV was transmitted by sexual intercourse. We also observed very low prevalence of HBV vaccination ‍(12%), although a majority reported knowing that shots can prevent disease (68%). Liver cancer prevention and ‍control methods targeted to Hmong youth are needed.     

北京市结肠癌危险因素的病例对照研究

目的：筛选北京市结肠癌主要危险因素。方法：用1：1配对病例对照研究方法，调查150例原发性结肠癌患者，并用条件Logistic回归模型对所获资料进行单因素和多因素分析。结果：有统计意义的危险因素包括：食用油和高蛋白食品摄入过多、精神压抑等；保护因素有经常食用新鲜蔬菜和葱、醋等食品；而一些文献报道有统计意义的危险因素(如肠道慢性疾患史、家族肿瘤史等)本文未见统计意义。结论：该研究为了解北京市结肠癌的流行规律提供了参考。     

Knowledge,Attitude and Practices of Women in Maldives Related to the Risk Factors,Prevention and Early Detection of Cervical Cancer

Background: A population-based cervical cancer screening program using visual inspection with acetic acid was launched in Maldives in 2014. Our study aimed to assess the knowledge, attitude and practices of women in relation to risk factors of cervical cancer, early detection of the disease and its prevention. Materialsand Methods: The questionnaire based survey was conducted among 20 to 50 year old women, systematically sampled to represent three regions of Maldives. Trained investigators interviewed a total of 2,845 women at home. Results: The prevalence of the risk factors of cervical cancer like early age at marriage and childbirth, multiple marriages, multiple marriages of the husbands, and multiple pregnancies was high. More women knew about breast cancer than cervical cancer. Even among the small number of women who knew of cervical cancer, only 34.6% had the knowledge of at least one early symptom. Very few women knew that the cancer could be prevented by any test. Only 6.2% of the women reported having ever undergone a Pap smear. Many women had the misconception that cervical cancer was infectious. In Maldives the younger women have high literacy rate due to the policy of universal free education and those with higher levels of education had improved knowledge of cervical cancer and its risk factors. The prevalence of risk factors also reduced with improvedliteracy. Conclusions: Awareness about risk factors and prevention of cervical cancer is limited among Maldivian women in spite of having high exposure to some of the risk factors. A universal literacy program in the country has helped to improve the knowledge of cervical cancer prevention and to reduce the exposure to various risk factors in the younger population.     

河西走廊中部食管癌危险因素调查

 目的　调查分析甘肃省河西走廊中部地区食管癌高发的危险因素，为防治食管癌提供依据。 方法　应用以医院为基础的病例对照调查研究，调查分析了该地区食管癌发病的危险因素。结果　经单因素、多因素及Logistic回归模型分析，发现长期大量饮酒、少食新鲜蔬菜及肉蛋鱼、喜烫热饮食、食管癌家族史、重大精神创伤史及文化程度低等因素与食管癌发病密切相关，是河西走廊地区食管癌发病的主要危险因素。未发现吸烟、常吃酸菜和进食快等因素与食管癌的发生存在联系。结论　经调查发现该地区食管癌发病的危险因素与当地特殊的生活环境因素有关，主要表现在饮食生活习惯及精神因素等方面。这些因素的作用并非独立，而是相互影响、相互作用形成的。     

卵巢癌一级预防研究进展

卵巢癌是严重危害女性健康的恶性肿瘤之一，其死亡率居妇科恶性肿瘤首位。目前遗传易感是卵巢癌较明确的高危因素，其他可能的因素包括激素使用、疾病/生殖相关因素及生活方式等。根据卵巢癌发生的不同风险等级，可将人群分为高风险人群和普通人群，本文就两个人群的筛查策略、干预措施两方面分别进行研究进展追踪。常规筛查不能提高普通人群卵巢癌的检出率，也无法提高卵巢癌生存。加强卵巢癌高风险人群肿瘤预防意识，进行有效筛查及干预，是降低卵巢癌发病率及死亡率的重要手段。