神刊丨乳腺癌发病死亡生存筛查年报

从2011年开始，美国癌症学会隔年对美国女性乳腺癌统计数据进行更新，其中包括发病、死亡、生存和钼靶筛查。上次更新为2019年，本次原定于2021年更新，受到疫情的影响，推迟至2022年。

2022年10月3日，全球影响因子第一神刊、美国癌症学会《临床医师癌症杂志》在线发表美国癌症学会、埃默里大学、康奈尔大学威尔医学院的美国女性乳腺癌发病、死亡、生存和钼靶筛查统计数据更新，全文长达18页。此外，受到疫情的影响，神刊的影响因子虽然已从508.702跌至286.130，但是仍然比排名第二的英国《柳叶刀》高出83.399分。

过去40年的大部分时间，乳腺癌发病率都在上升；尤其2010～2019年，发病率每年增加0.5%，主要由于早期乳腺癌和激素受体阳性乳腺癌。

相比之下，乳腺癌死亡率自1989年达到峰值以来稳步下降，尽管近10年的下降速度（2011～2020年每年1.3%）低于前10年（2002～2011年每年1.9%）。

总体而言，1989～2020年死亡率下降43%，这意味着期间乳腺癌死亡病例减少了46万例。全部种族或民族人群女性死亡率都出现类似下降，除了美洲印第安人和阿拉斯加原住民死亡率保持稳定。

不过，虽然黑人女性与白人女性相比，乳腺癌发病率较低（10万分之127.8比133.7），但是乳腺癌死亡率高40%（2016～2020年10万分之27.6比19.7），而50岁以下成年女性乳腺癌死亡率高1倍（10万分之12.1比6.5）。

黑人女性与白人女性相比，乳腺癌各个分子亚型和分期（一期除外）5年相对生存率都较低：

因此，该研究结果表明，通过扩大联邦医疗补助覆盖范围，促进利益相关者、乳腺癌宣传组织与医疗卫生系统的合作关系，增加获得高质量筛查和治疗的机会，从而减少种族差异，可以加速降低乳腺癌死亡率的进展。

CA Cancer J Clin. 2022 Oct 3. IF: 286.130

Breast Cancer Statistics, 2022.

Giaquinto AN, Sung H, Miller KD, Kramer JL, Newman LA, Minihan A, Jemal A, Siegel RL.

American Cancer Society, Atlanta, Georgia, USA; Emory University, Atlanta, Georgia, USA; Weill Cornell Medicine, New York, New York, USA.

This article is the American Cancer Society's update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010-2019), the rate increased by 0.5% annually, largely driven by localized-stage and hormone receptor-positive disease. In contrast, breast cancer mortality rates have declined steadily since their peak in 1989, albeit at a slower pace in recent years (1.3% annually from 2011 to 2020) than in the previous decade (1.9% annually from 2002 to 2011). In total, the death rate dropped by 43% during 1989-2020, translating to 460,000 fewer breast cancer deaths during that time. The death rate declined similarly for women of all racial/ethnic groups except American Indians/Alaska Natives, among whom the rates were stable. However, despite a lower incidence rate in Black versus White women (127.8 vs. 133.7 per 100,000), the racial disparity in breast cancer mortality remained unwavering, with the death rate 40% higher in Black women overall (27.6 vs. 19.7 deaths per 100,000 in 2016-2020) and two-fold higher among adult women younger than 50 years (12.1 vs. 6.5 deaths per 100,000). Black women have the lowest 5-year relative survival of any racial/ethnic group for every molecular subtype and stage of disease (except stage I), with the largest Black-White gaps in absolute terms for hormone receptor-positive/human epidermal growth factor receptor 2-negative disease (88% vs. 96%), hormone receptor-negative/human epidermal growth factor receptor 2-positive disease (78% vs. 86%), and stage III disease (64% vs. 77%). Progress against breast cancer mortality could be accelerated by mitigating racial disparities through increased access to high-quality screening and treatment via nationwide Medicaid expansion and partnerships between community stakeholders, advocacy organizations, and health systems.

KEYWORDS: breast neoplasms, epidemiology, health disparities, incidence, molecular subtype

PMID: 36190501

DOI: 10.3322/caac.21754

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