Cancer in 15-to 29-year-olds by primary site
Cancer in 15-to 29-year-olds by primary site
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DOI：
10.1634/theoncologist.11-6-590
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发表时间：
2006-06-01
期刊：
影响因子：
5.8
通讯作者：
Barr, Ronald
中科院分区：
文献类型：
--
作者：
Bleyer, Archie;Viny, Aaron;Barr, Ronald
发病率。15至30岁之间发生的癌症比生命最初15年发生的癌症常见2.7倍，但比老年人的癌症要少得多，仅占所有浸润性癌症的2%。青少年和年轻人的癌症在发生类型的分布上是独特的。霍奇金淋巴瘤、黑素瘤、睾丸癌、女性生殖道恶性肿瘤、甲状腺癌、软组织肉瘤、非霍奇金淋巴瘤、白血病、脑和脊髓肿瘤、乳腺癌、骨肉瘤和非性腺生殖细胞肿瘤占该年龄组癌症的95%。癌症类型的频率分布在15-30岁之间发生了巨大变化，因此最年轻的癌症类型与最年长的癌症类型并不相似。在过去的四分之一世纪世纪，这一年龄组的癌症发病率稳步上升。这一增长正在下降，在年龄范围的老年端，似乎正在恢复到1970年代的发病率。15至29岁年龄组的男性患癌症的风险较高，风险与年龄成正比。非西班牙裔白人在生命的这个阶段患癌症的风险最高，亚洲人，美洲印第安人和阿拉斯加原住民的风险最低。男性的预后比女性差。非裔美国人、美洲印第安人/阿拉斯加原住民的预后比非西班牙裔白色白人和亚洲人差。在上个世纪初，平均而言，15至29岁的癌症诊断相对于其他年龄段的癌症预后更好。自那时以来，与所有其他年龄段相比，大龄青少年和年轻人的生存改善缺乏进展。生存改善趋势预示着今天被诊断患有癌症的年轻人的预后比25年前更差。随着对幸存者随访时间的延长，生存缺陷增加，男性的情况更糟。在15至29岁的人群中，非西班牙裔白人的生存率最高，非裔美国人/黑人的生存率最低，5年内有20%的差异。亚洲人/太平洋岛民的生存率第二高，其次是西班牙裔和美洲印第安人/阿拉斯加原住民。总的来说，在这个年龄组中，支持环境原因或遗传易感性的数据相对较少。大多数30岁以前的癌症病例似乎是自发的，与环境中的致癌物或家族癌症综合征无关。总体而言，家庭癌症综合征似乎占该年龄组癌症病例的不到5%。黑色素瘤、宫颈癌和卡波西肉瘤、非霍奇金淋巴瘤、霍奇金和伯基特淋巴瘤占环境诱导的恶性肿瘤的大部分（分别为紫外线、人乳头瘤病毒、人免疫缺陷病毒和爱泼斯坦-巴尔病毒）。最终，更大比例的病例可能归因于特定因素或遗传易感性，但目前，该年龄组的大多数癌症似乎是散发性和随机性的。
Incidence. Cancer occurring between the ages of 15 and 30 years is 2.7 times more common than cancer occurring during the first 15 years of life, yet is much less common than cancer in older age groups, and accounts for just 2% of all invasive cancer. Cancer in adolescents and young adults is unique in the distribution of the types that occur. Hodgkin lymphoma, melanoma, testis cancer, female genital tract malignancies, thyroid cancer, soft-tissue sarcomas, non-Hodgkin lymphoma, leukemia, brain and spinal cord tumors, breast cancer, bone sarcomas, and nongonadal germ cell tumors account for 95% of the cancers in this age group. The frequency distribution of cancer types changes dramatically from age 15-30, such that the pattern at the youngest age does not resemble the one at the oldest. The incidence of cancer in this age group increased steadily during the past quarter century. This increase is declining and at the older end of the age range appears to be returning to the incidence of the 1970s. Males in the 15- to 29-year age group have been at higher risk of developing cancer, with the risk directly proportional to age. Non-Hispanic whites have had the highest risk of developing cancer during this phase of life, and Asians, American Indians and Native Alaskans the lowest. Males had a worse prognosis than females. African-Americans, American Indian/Alaska Natives had a worse prognosis than white non-Hispanics and Asians.Mortality & Survival. At the beginning of the last quarter century, the diagnosis of cancer in 15- to 29-year-olds carried a more favorable prognosis, on the average, relative to cancer at other ages. Since then, there has been a lack of progress in survival improvement among older adolescents and young adults relative to all other ages. Survival improvement trends portend a worse prognosis for young adults diagnosed with cancer today than 25 years ago. The survival deficit is increasing with longer follow-up of the survivors, and is worse in males. Among 15- to 29-year-olds, non-Hispanic whites had the best survival and African Americans/blacks had the worst survival, with a 20% difference apparent by 5 years. Asians/Pacific Islanders had the second best survival, with Hispanics and American Indians/Alaska Natives next in sequence.Risk Factors. In general, there are relatively scant data to support either an environmental causation or an inherited predisposition to cancer in this age group. The majority of cases of cancer occurring before age 30 appear to be spontaneous and unrelated to either carcinogens in the environment or family cancer syndromes. Overall, family cancer syndromes appear to account for less than 5% of the cases of cancer in the age group. Melanoma, cervical carcinoma and Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin and Burkitt lymphomas accounting for the majority of environmentally induced malignancies (ultraviolet light, human papillomavirus, human immunodeficiency virus, and Epstein-Barr virus, respectively). Ultimately, a larger proportion of cases may be attributable to specific factors or genetic predisposition, but at present, most cancer in this age group appears to be sporadic and random.