Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States.
Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States.
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DOI：
10.1001/jamaoncol.2016.0843
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发表时间：
2016-09-01
期刊：
影响因子：
28.4
通讯作者：
Giovannucci, Edward
中科院分区：
文献类型：
--
作者：
Song, Mingyang;Giovannucci, Edward
生活方式因素对癌症的发展很重要。然而，最近的一项研究被解读为干细胞分裂过程中的随机突变是人类癌症的主要贡献者。为了估计美国白人中有健康生活方式的16,531名女性和11,731名男性(低风险组)和其余73,040名女性和34,608名男性(高危组)的癌症病例和死亡比例，这些癌症是可以通过改变生活方式潜在地预防的，包括生活方式改变、前瞻性队列研究、卫生专业人员跟踪研究和国家癌症统计。健康的生活方式被定义为从不或过去吸烟，背包年限小于5年，不或中度饮酒(女性每天≤1杯，男性≤2杯/天)，身体质量指数≥18.5和27.5公斤/平方米，每周至少75次剧烈运动或150次中等强度运动。我们通过比较低风险组和高风险组的总癌症和主要单个癌症的发病率和死亡率来计算人群归因风险(PAR)。我们通过将低风险人群与美国人口进行比较，进一步评估了全国范围内的PAR。在我们的队列中，女性总癌症的发病率和死亡率分别为25%和48%，男性分别为33%和44%。对于单个癌症，女性和男性肺癌的PARs分别为82%和78%，结肠癌和直肠癌分别为29%和20%，胰腺分别为30%和29%，膀胱癌分别为36%和44%。死亡率也得到了类似的估计。乳腺癌的发病率和死亡率分别为4%和12%，致命性前列腺癌为21%。当将我们的低风险人群与普通美国人进行比较时，获得了高得多的PAR。例如，女性和男性的PAR分别为总癌症的41%和63%，结直肠癌的60%和59%。通过改变生活方式，可以预防严重的癌症负担。初级预防应该仍然是癌症控制的优先事项。
Lifestyle factors are important for cancer development. However, a recent study has been interpreted to suggest that random mutations during stem cell divisions are the major contributor to human cancer. To estimate the proportion of cases and deaths of carcinoma (all cancers except skin, brain, lymphatic, hematologic, and non-fatal prostate malignancies) among whites in the United States that can be potentially prevented by lifestyle modification Prospective cohort study Nurses’ Health Study, Health Professionals Follow-up Study, and national cancer statistics 16,531 women and 11,731 men who had a healthy lifestyle pattern (low-risk group), and the remaining 73,040 women and 34,608 men (high-risk group). The healthy lifestyle pattern was defined as never or past smoking with pack-years less than 5, no or moderate alcohol drinking (≤1 drink/day for women, ≤2 drinks/day for men), body mass index ≥18.5 and <27.5 kg/m2, and weekly aerobic physical activity of at least 75 vigorous-intensity or 150 moderate-intensity minutes. We calculated the population attributable risk (PAR) by comparing incidence and mortality of total and major individual carcinomas between the low- and high-risk groups. We further assessed the PAR at the national scale by comparing the low-risk group to the US population. Within our cohorts, the PARs for incidence and mortality of total carcinoma were 25% and 48% in women, and 33% and 44% in men, respectively. For individual cancers, the PARs in women and men were 82% and 78% for lung, 29% and 20% for colon and rectum, 30% and 29% for pancreas, and 36% and 44% for bladder. Similar estimates were obtained for mortality. The PARs were 4% and 12% for breast cancer incidence and mortality, and 21% for fatal prostate cancer. Substantially higher PARs were obtained when comparing our low-risk group to the general US population. For example, the PARs in women and men were 41% and 63% for incidence of total carcinoma, and 60% and 59% for colorectal cancer, respectively. A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.
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