【正文】 nd 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 Medical University Measures of Cancer Frequency: Prevalence ? partial prevalence limits number of patients to those diagnosed during fixed time in past and is more useful prevalence measure of cancer burden ? prevalence for cases diagnosed within 1, 3, 5 years are likely to be of relevance to different stages of cancer therapy: initial treatment (1 year), clinical followup (3 years) and cure (5 years) ? patients still alive 5 years after diagnosis are considered “cured” since their death rates are similar to general population (some exceptions, like breast cancer) Department of Epidemiology Public Health College of Harbin Medical University Other Measurements: Survival ? survival time defined as time that elapsed between diagnosis and death ? most basic measure of patients’ survival is the observed survival ? 5year observed survival is percentage of patients alive after 5 years of followup from date of diagnosis Department of Epidemiology Public Health College of Harbin Medical University Other Measurements: Relative Survival ? deaths from other peting causes will lower the observed survival rates and preclude parison between groups where probability of death in the general population vary ? relative survival rate can be calculated to avoid this problem ? relative survival rate is observed survival rate in a patient group divided by expected survival of a parable group in the general population with respect to age, sex, and calendar period of investigation Department of Epidemiology Public Health College of Harbin Medical University Other Measurements: PYLL ? Potential Years of Life Lost (PYLL) measures how many years of normal life span are lost due to deaths from cancer ? takes into account both number of deaths and age at which death occurs ? Ageweighting function used to increase the relative value of adults in productive ages, ., 1 year saved for someone at 20 years old is valued more than for a person aged 60 years ? varying weighting functions can be given according to quality of these lifeyears Department of Epidemiology Public Health College of Harbin Medical University 一、惡性腫瘤的分布 (Distribution of cancer) （一）時(shí)間趨勢(shì) 從世界范圍來(lái)看，惡性腫瘤發(fā)病率和死亡率逐年上升，且除宮頸癌和食管癌外，所有惡性腫瘤都呈上升趨勢(shì)。 Department of Epidemiology Public Health College of Harbin Medical University 過(guò)去十年間，全球癌癥的發(fā)病及死亡增長(zhǎng)了約 22%。在各惡性腫瘤中，多數(shù)國(guó)家肺癌的發(fā)病率和死亡率都在增長(zhǎng)，肺癌以成為全球最主要的癌癥，年發(fā)病達(dá) 120萬(wàn)，死亡110萬(wàn)。死亡順位依次為肺癌、胃癌、肝癌及結(jié)直腸癌。近 10年來(lái)，由于全球控?zé)熜袆?dòng)的開展，歐美發(fā)達(dá)國(guó)家肺癌死亡率逐漸趨于平穩(wěn)，在年輕男性人群中，肺癌發(fā)病率更呈現(xiàn)出下降趨勢(shì)。從 1990始，美國(guó)癌癥的發(fā)病率和死亡率均呈下降趨勢(shì)，在前 10位癌癥中， 8種下降或持平。 Department of Epidemiology Public Health College of Harbin Medical University Department of Epidemiology Public Health College of Harbin Medical University The lung cancer epidemic UK 01020304050607080901001968 1973 1978 1983 1988 1993age standardised rate per 100,000Sc otla nd MEn gla nd amp。 Wa les FNo rth ern I rela nd FDepartment of Epidemiology Public Health College of Harbin Medical University The lung cancer epidemic Canada 0204060801001201970 1975 1980 1985 1990 1995 2022 2022 2022 2022 2020age standardised rates per 100,000L u n g I n c M .L u n g M r t ML u n g I n c FL u n g M r t FDepartment of Epidemiology Public Health College of Harbin Medical University T r e n d s i n m o r ta l i ty fr o m C a n c e r o f th e C e r v i x024681012141955 1960 1965 1970 1975 1980 1985 1990 1995age standardized rate per 100,000D e n m a r kUKU S AC a n a d aF i n l a n dN o r w a yG e r m a