权威杂志说：因污染严重 1/5中国人死于癌症，你信吗？
凤凰城棒棒牛-118 04/13 152904.5/112
【编者凤凰城棒棒牛按】感觉这个报道有些赫然听闻。本来中国，印度，和俄罗斯的人口就占世界人口的40%。
4月11日出刊的权威医学杂志《柳叶刀》肿瘤专刊发表一份报告指出，吸菸、延迟诊断和治疗机会不平等正在给中国和印度带来一场癌症大危机。
BBC报导，在这一期的肿瘤专刊中，全世界超过40个肿瘤研究专家警告说，中国和印度这两大亚洲新兴经济大国，正面临癌症带来的巨大经济和人的代价。根据这一报告，中国每五个死亡者中就有一个死于癌症。癌症是仅次于心血管疾病的第二大杀手。
另外，中国六成的癌症病例都与「可变更的环境因素」有关，这些因素包括吸菸、水污染和空气污染。
据报导，专家们指出，公众对此风险的意识仍然特别低，在应对癌症时很多都受到宿命情绪的影响或者过分信赖传统药物的疗效。
资金也是一个重要的问题。报导称，中国目前对医疗的投入大约是欧洲国家对医疗投入比例的一半，占国民收入的5.1%，其中用于癌症的仅占其中的0.1%。
中国的癌症病人必须自己支付医疗的绝大部分开支；尽管大约一半人口生活在农村，但农村地区的癌症病床数却不到城市癌症床位的一半。
该报告负责中国部分撰稿的是美国哈佛医学院的保罗高思（Paul Goss）教授。据报导，他指出，中国占全世界癌症死亡数的四分之一，但是造成这一疾病巨大负担的一些主要因素，例如医疗资源不足和不均衡分配以及公众对这一疾病的误解等，却不在中国的国家议事日程上。
《柳叶刀》的报告指出，全世界所有新发现癌症病人总数的46%和癌症死亡病人总数的52%来自中国、印度和俄罗斯。
原文地址：
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70056-7/fulltext
标题：Challenges to effective cancer control in China, India, and Russia
概要：Collectively, China, India, and Russia account for around 40% of the world's population, experience 46% of all new cancers worldwide, and account for 52% of cancer deaths globally. However, a sizeable gap exists between disease burden and the ability of these countries to afford effective control measures. In this Commission a multidisciplinary team of health-care professionals, policy makers, and others address the challenges to providing cancer care in these countries and identify the critical steps needed to effect change。
【英文原文全文】
Strengthening cancer control in China
Cherian Varghese，Hai-Rim Shin
The Commission by Paul Goss and colleagues1 in The Lancet Oncology about confronting the burden of cancer in China, India, and Russia is an exhaustive work and presents a pragmatic approach to improvement of cancer control.
The landmark resolution of the UN General Assembly for non-communicable diseases (mainly cardiovascular diseases, cancer, diabetes, and chronic diseases, and their shared risk factors of tobacco, alcohol, unhealthy diet, and physical inactivity) has increased the global momentum for prevention and control of these disorders.2 As a follow-up, WHO—in consultation with its member states—has developed a set of nine voluntary global targets, including a reduction in premature mortality from non-communicable diseases of 25% by 2025, and targets for tobacco use, alcohol, salt consumption, and physical activity. The member states of the WHO Western Pacific Region have endorsed the Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014—20),3 aligned with the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013—20).
Data from the recently updated GLOBOCAN 20124 show that the WHO Western Pacific Region had a third of new cancer cases worldwide, two-thirds of which were in China. As noted by Goss and colleagues,1 a good picture of cancer pattern and incidence from China, which is very heterogeneous, might not be available at present. Cancer registries are in pockets that are perceived to have high rates of cancer, or are in urban areas. Expansion of cancer registration to representative populations and improvements in the quality of the registries can provide improved representation of cancer patterns and will help to prioritise interventions.
Although environmental pollution is a public health priority in China, the authors of the Commission do not adequately show its contribution to cancer. Wang and colleagues5 reported that the proportion of cancer deaths attributable to environmental causes in 2005 was only 0·7%, compared with 29·4% for infectious causes, 22·6% for tobacco smoking, 13·0% for low fruit intake, and 4·4% for alcohol drinking. Most common cancers in China for men and women have risk factors other than environmental pollution. Similarly, terms such as westernised diets also need more explanation, and the authors could have proposed viable options. China is addressing salt reduction through different strategies including awareness, reformulation, and low-sodium salt. These interventions will help to reduce high blood pressure and stomach cancer. Childhood obesity is a public health challenge and implementation of the WHO recommendations for marketing of foods and non-alcoholic beverages can address this issue to some extent. Promotion of physical activity is also a priority, and interventions to control overweight and obesity will affect rates of breast and colon cancer. Alcohol drinking is responsible for 4·4% of all cancer deaths in China, and liver and oesophageal cancer are the main alcohol-related cancers;6 reduction of harm from alcohol is a priority for cancer control in China. The country has taken positive steps to prevent drink-driving, which will help to reduce harm from alcohol.
Increased availability of monoclonal antibodies might substantially increase costs of cancer treatment without equivalent improvements in survival. Although high-income countries have 20—30 times more per-person expenditure on cancer treatment than do other countries, increased health budgets might not be the best option for governments of low-income and middle-income countries. Detection of early-stage cancer and prompt and optimum treatment can improve survival. China has programmes for screening of breast, uterine, and cervical cancers, which could be further strengthened by enhanced coverage, appropriate management, and improved referral systems.
Fatalism results from high rates of death from cancer; most people in China know someone who has died from the disease. This perception can change with increased numbers of cancer survivors in society. Chinese traditional medicine is well-established and has a large number of practitioners; skill building of this workforce could help cancer prevention, identification of early-stage disease, referral, and palliative care.
The WHO Regional Office for the Western Pacific is working with China and other member states to achieve the nine voluntary global targets for prevention and control of non-communicable diseases through a set of very cost-effective interventions, as suggested by the global and regional action plans for non-communicable diseases. In collaboration with the Government of China, a focused approach has been initiated in the provinces of Chongqing, Guanxi, and Shanxi to strengthen the prevention and control of non-communicable diseases (including cancer control) under the Western Area Health Initiative. Tobacco control is a priority for WHO and China is working towards control of tobacco products through legislation and regulation. The WHO Regional Office for the Western Pacific is working with the National Patriotic Health Campaign Committee in China to expand and scale up healthy cities as a platform for many interventions, including reduction of environmental pollution. The WHO Regional Office for the Western Pacific has developed programmes for leadership in cancer control (eg, CanLEAD), and offers country-specific support for registration, screening, and palliative care for cancer.7
A set of very cost-effective interventions are provided in the Global Action Plan to reduce tobacco and harmful alcohol use, improve unhealthy diets, and increase physical activity. These measures are mostly regulatory, legal, and fiscal interventions, and will affect rates of non-communicable diseases (including cancer) in large populations. China can further strengthen the comprehensive approach to risk-factor reduction through these interventions and expand early detection and management of cancer. Widespread coverage of vaccines for hepatitis B and human papillomavirus can help to further reduce infection-related cancers. A nationally representative cancer registry with improved quality and coverage will help to identify priorities and to track the progress of cancer control in China.
声明：
We declare that we have no competing interests. We are staff members of WHO. We are responsible for the views expressed in this Comment, and they do not necessarily represent the decisions, policy, or views of WHO.
References
1 Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014; 15: 489-538. Summary | Full Text | PDF(2246KB) | PubMed
2 UN General Assembly. Political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases (A/RES/66/2). http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf?ua=1. (accessed Feb 18, 2014)
3 WHO. Western Pacific regional action plan for the prevention and control of noncommunicable diseases (2014—2020). http://www.wpro.who.int/noncommunicable_diseases/about/WP_RAPNCD_2014-2020.pdf. (accessed Feb 18, 2014).
4 International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. (accessed Feb 18, 2014).
5 Liang H, Wang JB, Xiao HJ, et al. Estimation of cancer incidence and mortality attributable to alcohol drinking in China. BMC Public Health 2010; 10: 730. PubMed
6 WHO. Meeting report workshop on leadership and capacity-building for cancer control. http://www.wpro.who.int/noncommunicable_diseases/documents/workshop_CanLEAD/en/index.html. (accessed Feb 18, 2014).
7 Wang JB, Jiang Y, Liang H, et al. Attributable causes of cancer in China. Ann Oncol 2012; 23: 2983-2989. PubMed
a Noncommunicable Disease and Health Promotion Team, WHO Regional Office for the Western Pacific, Manila, Philippines
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