The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015.
The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015.
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DOI：
10.1038/s41416-018-0029-6
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发表时间：
2018-04
影响因子：
8.8
通讯作者：
Parkin DM
中科院分区：
文献类型：
--
作者：
Brown KF;Rumgay H;Dunlop C;Ryan M;Quartly F;Cox A;Deas A;Elliss-Brookes L;Gavin A;Hounsome L;Huws D;Ormiston-Smith N;Shelton J;White C;Parkin DM
改变人口水平暴露于可改变的风险因素是改变癌症发病率的关键驱动因素。因此，了解这些变化在优先考虑降低风险政策时至关重要，以便对降低癌症发病率产生最大影响。在此更新了英国有关风险因素可归因于癌症的数字，以反映在代表性国家调查中评估的不断变化的行为以及新的流行病学证据。数字也按英国组成国家列出，因为风险因素暴露的流行率在这些国家之间存在差异。计算风险因素和癌症类型组合的人群归因分数（PAF），并有足够/令人信服的因果关系证据。在可能的情况下，从队列研究的荟萃分析中提取相对风险（RR）。风险因素的暴露率是从全国代表性人口调查中获得的。2015年的癌症发病率数据来源于国家数据发布，必要时还包括个人通信。根据年龄、性别和风险因素暴露水平对PAF计算进行分层，然后合并以创建按癌症类型、性别和国家的汇总PAF。2015年，英国近十分之四（37.7%）的癌症病例可归因于已知的风险因素。英国男性的这一比例（38.6%）比英国女性（36.8%）高出约两个百分点。与英国国家相比，苏格兰的归因比例最高（41.5%），英格兰最低（37.3%）。到目前为止，吸烟在可归因癌症病例中所占比例最大，其次是超重/肥胖，分别占2015年英国所有病例的15.1%和6.3%。对于10种癌症类型，包括英国五种最常见的癌症类型中的两种（肺癌和黑色素瘤皮肤癌），超过70%的英国癌症病例可归因于已知的风险因素。烟草和超重/肥胖仍然是可归因癌症病例的主要贡献者。吸烟的PAF最高，因为它大大增加了癌症的风险，并有大量的癌症类型与之相关。超重/肥胖的PAF第二高，因为它影响了英国人口的高比例，也与许多癌症类型。公共卫生政策可能会寻求减轻与暴露相关的伤害水平或降低暴露水平-这两种方法都可能有效地影响癌症发病率。不同国家和性别之间的PAF差异主要是由于暴露于风险因素的患病率不同以及特定癌症类型的比例不同。这种变化反过来又受到社会人口差异的影响，这些差异导致理论上可以避免的“生活方式”因素的暴露差异。联合王国国家一级的PAF以前没有，它们应该被权力下放国家的政策制定者使用。PAF是基于最佳可用数据的估计值，这些数据的局限性通常会导致PAF低估。定期收集与流行病学证据相对应的风险因素暴露流行率数据对于此类分析至关重要，应继续作为联合王国政府和权力下放政府的优先事项。
Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them. Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country. Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors. Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.
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DOI：
10.1136/bmj.i3857
发表时间：
2016-08-09
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Kyu HH;Bachman VF;Alexander LT;Mumford JE;Afshin A;Estep K;Veerman JL;Delwiche K;Iannarone ML;Moyer ML;Cercy K;Vos T;Murray CJ;Forouzanfar MH
通讯作者：
Forouzanfar MH
影响因子：
4.2
作者：
Khalifa MM;Sharaf RR;Aziz RK
通讯作者：
Aziz RK
DOI：
10.9778/cmajo.20160045
发表时间：
2017-07-07
期刊：
CMAJ open
影响因子：
--
作者：
Grundy, Anne;Poirier, Abbey E;Brenner, Darren R
通讯作者：
Brenner, Darren R
影响因子：
3.7
作者：
Khan G;Hashim MJ
通讯作者：
Hashim MJ
影响因子：
168.9
作者：
Berrington de González, A;Darby, S
通讯作者：
Darby, S