【文章內(nèi)容簡介】 學、疾病控制、人口學等相關(guān)領域的近四十位權(quán)威學者。日前，已有二十多位專家反饋了意見，對 《 中國成人慢病相關(guān)危險因素監(jiān)測方案（征求意見四稿） 》 給予了充分的肯定，并提出了不少寶貴意見。其余專家的意見正陸續(xù)反饋到慢病中心。 慢病中心監(jiān)測組正根據(jù)專家反饋意見對監(jiān)測方案進行修改，預計月中此項工作即可完成，并將正式啟動 2022年監(jiān)測工作。 Department of Epidemiology Public Health College of Harbin Medical University 專項的惡性腫瘤流行病學橫斷面研究，如江蘇啟東、海門地區(qū)的肝癌、揚中地區(qū)的胃癌和食管癌研究等，反映了這些消化系統(tǒng)癌癥在高發(fā)地區(qū)內(nèi)不同時間、空間和人群間的分布，為建立和檢驗消化系統(tǒng)癌癥危險因素假設提供了可靠的背景材料。 Department of Epidemiology Public Health College of Harbin Medical University 結(jié)合腫瘤登記工作開展的腫瘤危險因素監(jiān)測、腫瘤篩檢、腫瘤的生態(tài)學研究等，對探索腫瘤危險因素和病因，早期發(fā)現(xiàn)、診斷、治療腫瘤患者，有效防治腫瘤具有重要意義。 Department of Epidemiology Public Health College of Harbin Medical University ? 病例對照研究是腫瘤病因?qū)W研究的常用方法。其研究發(fā)現(xiàn)了大量的有價值的危險因素的線索。 ? 隊列研究包括前瞻性和回顧性隊列研究。國內(nèi)外隊列研究為進一步驗證腫瘤的病因假設發(fā)揮了巨大作用。 分析流行病學研究 (Analytic epidemiological study) Department of Epidemiology Public Health College of Harbin Medical University ? 山西子宮頸癌篩查研究隊列數(shù)據(jù)庫 中國醫(yī)學科學院腫瘤研究所與美國克里夫蘭醫(yī)學中心、美國 NCI合作進行。于 1998年啟動，1999年在山西襄垣開始正式試驗，共計 1997例婦女進入該隊列。試驗結(jié)果在法國獲 “ 歐羅金 ”國際獎。 2022年開始進行了更大范圍、共計九千人的篩查試驗。對子宮頸癌篩查手段進行了科學的評價，同時在病因流行病學研究亦有重要意義。可為廣大臨床科研究工作者借鑒參考。 Department of Epidemiology Public Health College of Harbin Medical University 不但有助于干預或預防腫瘤的發(fā)生，而且能為腫瘤病因?qū)W研究提供有關(guān)危險因素或病因的進一步佐證。 實驗流行病學研究 (Experimental epidemiological study) Department of Epidemiology Public Health College of Harbin Medical University 河南林縣食管癌化學干預試驗數(shù)據(jù)庫 八十年代開始，中國醫(yī)學科學院腫瘤研究所與美國 NCI合作在河南林縣開展了兩個較大規(guī)模的研究項目，包括食管癌營養(yǎng)干預試驗、早診早治及化學預防研究。營養(yǎng)干預試驗共干預人群共 32902例，至今一直對干預人群進行跟蹤隨訪及定期普查；食管癌早診早治及化學預防研究于 1998年啟動，研究人群 2213例，經(jīng)內(nèi)窺鏡檢查確定食管上皮病變，對其中輕、中度不典型增生病人進行化學藥物預防研究。以上這些研究項目在國內(nèi)外產(chǎn)生了很大的影響，不僅是食管癌防治研究極其寶貴的資源，同時也給其它疾病的防治提供經(jīng)驗 Department of Epidemiology Public Health College of Harbin Medical University 生物標志和腫瘤流行病學研究 隨著細胞生物學、免疫學、毒理學分子遺傳學等生命科學的發(fā)展，越來越多的分析測量技術(shù)拓展了分子標志物與傳統(tǒng)流行病學間的聯(lián)系。 (Biomarker and tumor epidemiological study) Department of Epidemiology Public Health College of Harbin Medical University ⑴ 內(nèi)劑量（ In doses ） ⑵生物學效應劑量（ Biological effective dose） ⑶臨床前期生物學效果（ Preclinical biological effects ） ⑷易感性標志（ Susceptibility marker ） 生物標志流行病學研究的方法學問題 生物標志種類 (Types of Biomarker) Department of Epidemiology Public Health College of Harbin Medical University Molecular Epidemiology Breaking Open the “Black Box” Department of Epidemiology Public Health College of Harbin Medical University Molecular Epidemiology Internal Dose (Agent Metabolite) Biological Effective Dose (Adducts) Preclinical Biologic Effect (SCE oncogene TSG inactivation) Exposure Disease Department of Epidemiology Public Health College of Harbin Medical University 第二節(jié) 惡性腫瘤的流行特征 (惡性腫瘤的疾病負擔 ) Epidemiological Characteristics of Malignancy Department of Epidemiology Public Health College of Harbin Medical University Measures of Cancer Frequency: Incidence ? number of new cases occurring ? can be expressed as an absolute number of cases per year or as a rate per 100,000 persons per year. ? incidence rate provides approximation to average risk of developing a cancer and is necessary to pare risk of disease between populations ? reduction in incidence is the appropriate statistics to use when considering impact of primary prevention strategies Department of Epidemiology Public Health College of Harbin Medical University Measures of Cancer Frequency: Mortality ? number of deaths occurring ? mortality rate is the number of deaths per 100,000 persons per year ? mortality rates measure average risk of dying from a specific cancer ? number of deaths is one measure of oute or impact of cancer (product of incidence and fatality of a given cancer) ? Fatality, (1survival), is probability that an individual with cancer will die from it and is generally assumed to be most severe sequelae of disease Department of Epidemiology Public Health College of Harbin Medical University ? mortality rate sometimes used as convenient proxy measure of the risk of acquiring the disease (incidence) when paring different groups, since it is more readily available ? BUT we need to assume equal survival or fatality in the populations being pared ? most of time this assumption is not correct, so it is safer to use mortality as measure of oute rather than occurrence Department of Epidemiology Public Health College of Harbin Medical University Measures of Cancer Frequency: Prevalence ? NO agreed definition of “prevalence” of cancer ? number of persons in a defined population alive at a given time who have had cancer diagnosed at some time in past ? overall prevalence not useful for health care planning purposes because resource requirements for treating newly diagnosed patients are very different from those for supporting longterm survivors, especially since a large proportion of longterm survivors can be considered cured Department of Epidemiology Public Health College of Harbin