CA: The number of cancer survivors in the United States is increasing day by day, and the gap between China is not small!

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The American Cancer Society (ACS) and the National Cancer Institute (NCI) collaborate every three years on US cancer treatment and survival statistics, estimating the most common cancers in the United States, current and future, presenting current treatment modalities and cancer survival data, and about survival. Information about the problem. The latest statistical report was published online June 11, 2019 in the “CA: A Cancer Journal for Clinicians” (IF = 244.585) US 2019 Cancer Treatment and Survival Statistics Report (Figure 1) [1]. Next, let’s take a look at what important data this book has brought to everyone! Research Highlights: Three-Year Big Data On January 1, 2019, more than 16.9 million patients with a history of cancer survived in the United States, with more than 8.13 million men and over 8.78 million women. This data continues to grow compared to the 2016 statistical report [2], with an increase of approximately 760,000 men and 630,000, respectively. According to previous estimates, by January 1, 2026, the number of women survivors of cancer will exceed 10 million; and this report is expected to increase to more than 22.1 million on January 1, 2030. The number of cancer survivors of both sexes will exceed 10 million. In 2019, the three most common cancers among American men were prostate cancer, colorectal cancer, and melanoma; the most common cancers in women were breast cancer, endometrial cancer, and colorectal cancer. This ranking is consistent with the 2016 statistical report and will remain until 2026. However, by 2030, according to the latest estimates, colorectal cancer, the third throne of female cancer survivors, will be replaced by thyroid cancer. According to statistics from 2019, one-third of cancer survivors have diagnosed cancer for less than five years, accounting for 33%, which means that more than two-thirds of survivors have exceeded the five-year limit. At the same time, nearly half of the patients have survived for more than 10 years after diagnosis, and 18% have been diagnosed with cancer for more than 20 years. Its distribution is roughly similar to the 2016 statistical report. The 2019 report shows that young cancer survivors aged 0-19 are rare, accounting for less than 1%, cancer survivors aged 20-64 are 36%, and most cancer survivors are 65 years of age or older. Although the 2016 report did not specifically calculate the proportion of people over the age of 65, the results of both reports showed that people over the age of 60 accounted for about three-quarters of cancer survivors. Cancer survivors need to withstand the physical, mental, and economic impact of cancer and its treatment, and researchers hope that this report will help this growing number of special populations by clarifying current cancer treatments and the state of survival. This report has certain implications for the diagnosis and treatment of cancer in China. The newly published “Analysis of the prevalence of malignant tumors in China in 2015” [3] shows that the most common cancers in Chinese men are lung cancer, stomach cancer and liver cancer, and the most common cancers in women are breast cancer, lung cancer and colorectal cancer. Among the many cancers, some are common problems of Chinese and American patients, while others are only a headache in China. Next, we will introduce the status of diagnosis and treatment of several types of cancer in light of the actual situation in China. Careful interpretation: comparison of self-contained true breast cancer in 2019 US statistics show that 3.8 million women in the United States are survivors of invasive breast cancer, only 208,000 women were diagnosed with breast cancer in 2019, Of these, 1.5 million women are metastatic breast cancer patients, and approximately 64% of women are over 65 years old. In China, breast cancer is the first malignant tumor in women, with an annual incidence of about 304,000 cases. In the treatment of breast cancer, nearly half of patients with stage I or II early breast cancer will undergo breast-conserving surgery with adjuvant radiation therapy, and one-third of patients will undergo mastectomy; in phase III patients, about 2/ 3 received mastectomy, most of whom also received postoperative adjuvant chemotherapy; more than half of patients in stage IV received radiotherapy and/or chemotherapy, but a quarter of patients did not receive any treatment (Figure 4). About 81% of patients who are hormone receptor positive will receive endocrine therapy.However, the treatment of triple-negative breast cancer remains a major problem, and immunotherapy and targeted therapy may bring new hope to these patients. Analysis shows that the 5-year survival rate of patients with stage I breast cancer is almost 100%, but the 5-year survival rate for patients with stage IV is only 26%. According to the data of the CONCORD study [4-6], the 5-year overall survival rate of breast cancer patients in the United States in 2010-2014 has reached 90.2%, and the data in China during the same period is only 83.2%. The gap between the two can reach 7.0. %[6]. However, this data has actually increased significantly from 75.9% in 2000-2004, and I believe there will be further improvement in the future [4,6]. Colorectal cancer Colorectal cancer is on the list of common cancers in both sexes in the United States. More than 1.5 million patients have been diagnosed with colorectal cancer, of which 145,000 new cases were diagnosed in 2019, about 3/4 Patients with colorectal cancer are over 65 years of age. In China, about 388,000 people are diagnosed with colorectal cancer each year. The treatment of colon and rectal cancer is slightly different. Most patients with stage I or stage II colon cancer undergo colectomy (84%), and two-thirds of patients with stage III receive further adjuvant chemotherapy to reduce the risk of recurrence (Figure 5). For patients with rectal cancer, the most common treatment for stage I patients is rectal/colorectal resection (61%), half of whom will receive adjuvant radiotherapy or chemotherapy after surgery; patients with stage II or III will Surgical treatment is usually performed after preoperative neoadjuvant chemoradiation (Figure 6). In addition, targeted therapy, immunotherapy can also be used for the treatment of colorectal cancer, and some patients may also need to undergo a colorectal ostomy to relieve the disease. The 5-year survival rate for colorectal cancer patients in the United States is about 65%, and the 5-year survival rate for rectal cancer is slightly higher than that for colon cancer (67% vs 64%). The 5-year survival rate for early stage I and II patients may be as high. 91% and 82%, but the 5-year survival rate of stage IV patients was only 12%. According to data from the CONCORD study, the 5-year survival rate of colorectal cancer in the United States in 2010-2014 was 64.7% and 63.9%, which is similar to the results of this report. In the same period of China, the data was 57.6% and 56.9%, which was a few percentage points higher than the 51.4% and 49.5% in 2000-2004. ▍ Prostate cancer There are currently 3.6 million men diagnosed with prostate cancer in the United States. Of these, there were approximately 174,000 newly diagnosed prostate cancers in 2019, and most (82%) survivors were over 65% older. The annual incidence of prostate cancer in China is only 72,000, and the incidence rate is lower than that of the United States, but it has recently increased gradually, which may be the new focus of prevention and control in the future [3]. The 5-year survival rate of prostate cancer in the United States has risen from 83% in the late 1980s to 99% in 2008-2014. Most (90%) of the diagnosed prostate cancers are localized, with a 5-year survival rate of almost 100%, but the 5-year survival rate of advanced prostate cancer is reduced to 30% [1]. The 2010-2014 data show that [6], the overall 5-year survival rate of prostate cancer in the United States is 97.4%, but China’s data is dwarfed, with a 5-year survival rate of only 69.2%. Although the current data has improved significantly from the 57.7% data in 2000-2004, there is still a 28.2% gap from the US level [4,6]. The treatment of prostate cancer is based on the patient’s stage of the disease, the risk of recurrence, and the patient’s personal characteristics. Active monitoring is often recommended for patients with low risk, limited tumors, or elderly and/or poor health, rather than receiving immediate treatment to avoid overtreatment. Statistics show that in the United States, the proportion of patients who choose prostate cancer screening increased in 2010-2015, while those who chose immediate surgery were reduced in patients over the age of 75, and more patients were actively monitored (Figure 7). For patients with advanced prostate cancer, androgen suppression therapy, chemotherapy, radiotherapy, etc. can be selected.Lung cancer Lung cancer is a big problem in China. It accounts for the incidence of male cancer and the second highest incidence of cancer among women. The number of newly diagnosed patients can reach 787,000, including 502,000 males and 267,000 females. In the United States, lung cancer is not the most important cancer, although the number of survivors has entered the top ten, but the position on the gender ranking is only eighth and seventh. There are currently approximately 570,000 lung cancer survivors in the United States, of which 228,000 are newly diagnosed in 2019, and approximately 3/4 of the patients are 65 years of age or older. The 5-year survival rate of lung cancer is relatively low, and more than 60% of survivors have not been diagnosed for more than 5 years. Lung cancer is mainly divided into small cell lung cancer (SCLC, 13%) and non-small cell lung cancer (NSCLC, 83%). Most patients with SCLC are no longer limited in their diagnosis, so surgery has little effect in their treatment, mainly relying on chemotherapy. For a small number of patients with stage I and II NSCLC, most will undergo wedge lobectomy, sleeve lobectomy, lobectomy or pneumonectomy; only 18% of patients with stage III NSCLC will undergo surgery. Most of these patients (62%) received chemotherapy and/or radiation (Figure 9). Immunological and targeted therapies have emerged for advanced NSCLC, but some drugs can only be used in patients with certain specific genetic mutations. Although surgical methods and chemoradiotherapy have been greatly developed, the 1-year survival rate of lung cancer patients in the United States has only increased from 34% in 1975-1977 to 47% in 2011-2014. Since early lung cancer usually has no symptoms, most (61%) lung cancers are diagnosed at stage III or IV. 21% of patients diagnosed with lung cancer in stage I had a 5-year survival rate of 57%, but patients in stage IV had only 4%. Comparing the two lung cancer subtypes, the survival rate of SCLC was significantly lower than that of NSCLC (6% vs 23%). The US lung cancer data is not very good, and the Chinese data is even worse. The 5-year survival rate of lung cancer patients from 2000 to 2004 was only 18.7%, and it was only 19.8% in 2010-2014. According to 2010-2014, the 5-year survival rate of lung cancer in the United States is only 21.2%. ▍ Liver cancer, gastric cancer, esophageal cancer China’s liver cancer, gastric cancer and esophageal cancer have a high incidence and poor prognosis, but the incidence of these three tumors in the United States is relatively low, and the corresponding number of cancer survivors is relatively small. In the US report, the specific treatment and survival of these three types of cancer were not elaborated. Instead, other tumors with high incidence and survivors in the United States, such as melanoma and testicular cancer, were selected. [1.3.7]. However, these three types of cancer are plaguing China. Recently, the epidemiological survey of malignant tumors in China shows that the incidence of these three types of cancer in China is 403,000 cases of gastric cancer, 370,000 cases of liver cancer and 246,000 cases of esophageal cancer. The incidence and death of these three types of malignant tumors account for the global Half (Figure 10). Throughout the global situation [8], the number of new cases and deaths of malignant tumors in China accounted for 23.7% and 30.2% of the world, respectively, and the global upper-middle level, mainly due to the three cancers. Future improvements: the stone of other mountains can be used to attack jade. The statistical report [1] pointed out that although the incidence of cancer in the United States continues to decline, while the incidence of cancer in women remains stable, the number of cancer survivors is increasing. This phenomenon reflects the growing population and aging, leading to an increase in newly diagnosed cancers; and the growing number of cancer survivors due to early diagnosis and advances in early treatment. The incidence of cancer in China is basically the same as in the past, but the number of new cancer cases has increased, suggesting that the current increase in cancer burden is also related to the aging of the population [3]. The incidence and mortality of malignant tumors in China continue to rise, and the difference in the incidence and mortality of malignant tumors in urban and rural areas is gradually narrowing, which may reflect the narrowing of the urban-rural gap between smoking, chronic infections, eating habits and air pollution (Figure 11).The rural medical resources are relatively scarce and the awareness of cancer prevention is relatively weak, so the mortality rate is still high. Although China’s current malignant tumor survival rate has increased by nearly 10%, it still has a gap with developed countries. The current situation is less than the early cases of clinical visits, the low rate of early diagnosis and the inconsistent clinical diagnosis and treatment of advanced cases. In addition to preventing and controlling cancer, the main focus of the US statistical report is on cancer survivors during cancer treatment and after cancer treatment, including possible quality of life and decreased body function and related adverse reactions. The health of long-term cancer survivors is not as good as age. The most common sequelae are pain, fatigue and emotional distress. For younger patients with cancer, a second cancer, neurological sequelae, cardiomyopathy, sexual development and/or sexual dysfunction and fertility may occur. damage. For health care providers, the unique medical and psychosocial needs of survivors should be understood and more supportive treatments should be provided for these patients, including psychosocial support, palliative care, and cancer rehabilitation, which can improve patients’ Pain, body function and overall quality of life. For the patients themselves, they need to have a sense of self-management of the disease and practice a healthy lifestyle, such as avoiding smoking, maintaining a healthy weight, avoiding intense ultraviolet radiation, and maintaining exercise. Currently, there are improvements in the survival of cancer survivors. Study of diet, weight and physical activity interventions. Cancer survivors – living is indeed a lucky, but a healthier life is true happiness. This article is the first: Medical Cancer Channel.
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