在五种癌症类型中，预防和筛查是挽救生命的主要因素

美国国立卫生研究院 (NIH) 研究人员领导的一项模型研究表明，过去 45 年来，癌症预防和筛查的改进所避免的五种癌症死亡人数总和超过了癌症治疗的进步。这项研究于 2024 年 12 月 5 日发表在《美国医学会杂志·肿瘤学》( JAMA Oncology ) 上，研究了通过预防、筛查和治疗相结合而避免的乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌死亡病例。美国国立卫生研究院 (NIH) 下属国家癌症研究所 (NCI) 的研究人员之所以重点研究这五种癌症，是因为它们是癌症死亡的最常见原因之一，并且目前已有预防、早期发现和/或治疗策略。近年来，这五种癌症占所有新发癌症诊断和死亡病例的近一半。

“尽管许多人可能认为治疗手段的进步是这五种癌症死亡率下降的主要驱动力，但令人惊讶的是，预防和筛查对死亡率的降低贡献巨大，”联合首席研究员、NCI癌症控制和人口科学部主任Katrina AB Goddard博士说道。“过去45年里，这五种癌症导致的死亡病例中，有十分之八是由于预防和筛查的进步而避免的。”

戒烟这一预防干预措施，在避免死亡人数方面贡献了最大份额：仅肺癌死亡人数就高达345万。若单独考虑各个癌症部位，预防和筛查是避免宫颈癌、结直肠癌、肺癌和前列腺癌死亡人数的主要原因，而治疗手段的进步是避免乳腺癌死亡人数的主要原因。

“为了降低癌症死亡率，至关重要的是将有效的预防和筛查策略与先进的治疗手段相结合，”NCI主任、医学博士W. Kimryn Rathmell说道。“这项研究将帮助我们了解哪些策略在降低癌症死亡方面最有效，以便我们能够继续保持这一势头，并有望在美国推广这些策略。”

“拜登癌症登月计划正在朝着其宏伟目标迈进，即到2047年将癌症死亡率降低至少50%。” 负责癌症登月计划的总统副助理兼白宫科技政策办公室健康成果副主任丹妮尔·卡尼瓦尔博士表示。“这项研究明确指出，总统和第一夫人倡导并实施的加强预防和筛查工作对于实现这一雄心勃勃的目标至关重要。”

研究人员使用癌症干预和监测模型网络 (CISNET) 的统计模型和癌症死亡率数据来估计 1975 年至 2020 年间预防、筛查和治疗进步对避免乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌死亡的相对贡献。

模型显示，1975年至2020年间，这五种癌症总共避免了594万人死亡。其中，预防和筛查干预措施避免了475万人死亡，占80%。

预防、筛查和治疗的个体贡献因癌症部位而异：

• 在乳腺癌领域，1975 年至 2020 年间避免了 100 万人死亡（若不采取任何干预措施，死亡人数将达到 271 万人），其中四分之三的死亡是由于治疗手段的进步，其余的死亡是由于乳房 X 线检查。

• 在肺癌方面，通过控烟工作进行预防，避免了 345 万人死亡（总数为 920 万人），其中 98% 是由于治疗的进步。

• 在宫颈癌方面，避免的 160,000 例死亡（总死亡人数为 370,000 人）完全是通过宫颈癌筛查（即巴氏涂片和 HPV 或人乳头瘤病毒检测）和去除癌前病变。

• 在结肠直肠癌方面，在避免的 940,000 例死亡（总数为 345 万人）中，79％是由于筛查和切除癌前息肉，其余 21％是由于治疗的进步。

• 对于前列腺癌而言，在避免的 360,000 例死亡（总死亡人数 101 万）中，通过 PSA 检测进行筛查的贡献率为 56%，治疗进展的贡献率为 44%。

• “这些发现表明，我们需要在所有这些领域继续采取强有力的战略和方法，”戈达德博士指出。“仅仅依靠治疗的进步，或者仅仅依靠预防和筛查，并不能帮助我们降低癌症死亡率。”

作者指出，较新的预防和筛查策略，例如HPV疫苗接种和肺癌筛查，在研究期间尚未得到广泛应用，可以进一步降低癌症死亡率。其他降低癌症死亡的途径包括提高筛查的可及性，例如开展可自行采集样本的HPV检测，以及开发新的治疗方法。

作者承认，研究涉及的五种癌症部位占所有癌症死亡人数的不到一半，而且这些癌症的研究结果不一定适用于其他癌症，特别是那些没有有效预防、筛查或治疗干预措施的癌症。

“我们需要优化对这五种癌症的预防和筛查的吸收和使用，以便所有美国人都能受益，特别是服务不足的人群，并制定新的预防和筛查策略，以避免因其他非常致命的癌症（如胰腺癌和卵巢癌）导致的死亡，”联合首席研究员、NCI癌症预防部主任 Philip E. Castle 博士、公共卫生硕士说。

此外，作者指出，这些研究结果基于美国人口平均值，可能不适用于特定人群。该研究也没有考虑干预措施的潜在危害，例如筛查期间的假阳性结果和过度诊断，也没有衡量生活质量等其他结果。

参考

Goddard KAB、Feuer EJ、Mandelblatt JS 等。1975-2020 年预防、筛查和治疗措施避免的癌症死亡人数估算。《JAMA Oncol》， 2024 年 12 月 5 日。DOI：10.1001/jamaoncol.2024.538

来自：https://www.cancer.gov/news-events/press-releases/2024/cancer-deaths-averted-prevention-screening-contribution

原文：

In five cancer types, prevention and screening have been major contributors to saving lives

A factoid that reads: From 1975 to 2020, prevention and screening efforts averted 4.75 million deaths from five cancer types: breast, cervical colorectal, lung prostate.

Credit: National Cancer Institute

Improvements in cancer prevention and screening have averted more deaths from five cancer types combined over the past 45 years than treatment advances, according to a modeling study led by researchers at the National Institutes of Health (NIH). The study, published Dec. 5, 2024, in JAMA Oncology, looked at deaths from breast, cervical, colorectal, lung, and prostate cancer that were averted by the combination of prevention, screening, and treatment advancesExit Disclaimer. The researchers from NIH’s National Cancer Institute (NCI) focused on these five cancers because they are among the most common causes of cancer deaths and strategies exist for their prevention, early detection, and/or treatment. In recent years, these five cancers have made up nearly half of all new cancer diagnoses and deaths.

"Although many people may believe that treatment advances are the major driver of reductions in mortality from these five cancers combined, the surprise here is how much prevention and screening contribute to reductions in mortality," said co-lead investigator Katrina A. B. Goddard, Ph.D., director of NCI’s Division of Cancer Control and Population Sciences. “Eight out of 10 deaths from these five cancers that were averted over the past 45 years were due to advances in prevention and screening.”

A single prevention intervention, smoking cessation, contributed the lion’s share of the deaths averted: 3.45 million from lung cancer alone. When considering each cancer site individually, prevention and screening accounted for most deaths averted for cervical, colorectal, lung, and prostate cancer, whereas treatment advances accounted for most deaths averted from breast cancer.

“To reduce cancer death rates, it's critical that we combine effective strategies in prevention and screening with advances in treatment,” said W. Kimryn Rathmell, M.D., Ph.D., director of NCI. “This study will help us understand which strategies have been most effective in reducing cancer deaths so that we can continue building on this momentum and hopefully increase the use of these strategies across the United States.”

“The Biden Cancer Moonshot is making real progress towards its bold goal to reduce the cancer death rate by at least 50% by 2047,” said Danielle Carnival, Ph.D., deputy assistant to the President for the Cancer Moonshot and deputy director, Health Outcomes, White House Office of Science and Technology Policy. “This study makes clear that the increased prevention and screening efforts championed and delivered on by the President and First Lady are crucial to reaching this ambitious goal.”

The researchers used statistical models from the Cancer Intervention and Surveillance Modeling Network (CISNET) and cancer mortality data to estimate the relative contributions of prevention, screening, and treatment advances to deaths averted from breast, cervical, colorectal, lung, and prostate cancers between 1975 and 2020.

In total, the modeling showed, 5.94 million deaths were averted from these five cancers between 1975 and 2020. Of these, prevention and screening interventions accounted for 4.75 million, or 80%, of the averted deaths.

The individual contributions of prevention, screening, and treatment varied by cancer site:

In breast cancer, 1 million deaths (out of 2.71 million that would have occurred in the absence of all interventions) were averted from 1975 to 2020, with treatment advances contributing to three-quarters of the deaths averted and mammography screening contributing to the rest.

In lung cancer, prevention through tobacco control efforts accounted for 98% of the 3.45 million deaths averted (out of 9.2 million), and treatment advances accounted for the rest.

In cervical cancer, the 160,000 deaths averted (out of 370,000) were entirely through cervical cancer screening (i.e., Pap and HPV, or human papillomavirus, testing) and removal of precancerous lesions.

In colorectal cancer, of the 940,000 deaths averted (out of 3.45 million), 79% were due to screening and removal of precancerous polyps, with treatment advances accounting for the remaining 21%.

In prostate cancer, of the 360,000 deaths averted (out of 1.01 million), screening via PSA testing contributed 56% and treatment advances contributed 44%.

“These findings suggest that we need to continue to have strong strategies and approaches in all of these areas,” Dr. Goddard noted. “It's not just treatment advances alone, or prevention and screening alone, that is helping us to reduce cancer mortality.”

The authors pointed out that more recent prevention and screening strategies, such as HPV vaccination and lung cancer screening, were not in wide use during the study period and could further reduce cancer death rates. Other opportunities for reducing cancer deaths include making screening more accessible, such as with HPV tests that allow for self-collection, and developing new treatments.

The authors acknowledged that the five cancer sites included in the study account for less than half of all cancer deaths and that the findings for these cancers may not necessarily apply to other cancers, especially those for which there are not effective prevention, screening, or treatment interventions.

“We need to optimize the uptake and use of prevention and screening for these five cancers so that all Americans can benefit, especially underserved populations, as well as develop novel prevention and screening strategies to avert deaths due to other, very lethal cancers, such as those of the pancreas and ovary,” said co-lead investigator Philip E. Castle, Ph.D., M.P.H., director of NCI’s Division of Cancer Prevention.

In addition, the authors noted that the findings are based on population averages in the United States and may not be generalizable to specific population groups. The study also did not consider the potential harms of interventions, such as false-positive results and overdiagnosis during screening, nor did it measure other outcomes, such as quality of life.