美国2019年癌症治疗与生存统计报告（英文）-2019.6-23页.pdf

CA CANCER J CLIN 2019;0:1231VOLUME 0|NUMBER 0|MONTH 2019Abstract:The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment.To assist the public health community in better serving these individuals,the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance,Epidemiology,and End Results cancer registries;vital statistics from the Centers for Disease Control and Preventions National Center for Health Statistics;and population projections from the US Census Bureau.Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types.Cancer-related and treatment-related short-term,long-term,and late health effects are also briefly described.More than 16.9 million Americans(8.1 million males and 8.8 million females)with a history of cancer were alive on January 1,2019;this number is projected to reach more than 22.1 million by January 1,2030 based on the growth and aging of the population alone.The 3 most prevalent cancers in 2019 are prostate(3,650,030),colon and rectum(776,120),and mela-noma of the skin(684,470)among males,and breast(3,861,520),uterine corpus(807,860),and colon and rectum(768,650)among females.More than one-half(56%)of survivors were diagnosed within the past 10 years,and almost two-thirds(64%)are aged 65 years or older.People with a history of cancer have unique med-ical and psychosocial needs that require proactive assessment and management by follow-up care providers.Although there are growing numbers of tools that can assist patients,caregivers,and clinicians in navigating the various phases of can-cer survivorship,further evidence-based resources are needed to optimize care.CA Cancer J Clin 2019;0:1-23.2019 American Cancer Society.Keywords:prevalence,statistics,survivorship,treatment patternsIntroductionThe number of cancer survivors continues to grow in the United States despite overall declining age-standardized incidence rates in men and stable rates in women.1 This reflects an increasing number of new cancer diagnoses result-ing from a growing and aging population as well as increases in cancer survival because of advances in early detection and treatment.Many cancer survivors must cope with the physical effects of cancer and its treatment,potentially leading to functional and cognitive impairments as well as other psychological and economic sequelae.2 To help the public health community better serve this unique population,the American Cancer Society collaborates triennially with the National Cancer Institute to estimate contemporary and future complete cancer prevalence in the United States for the most common cancers.Statistics on contemporary treatment patterns and survival,as well as information about issues related to survivorship,are also presented.Herein,“cancer survivor”refers to any person who has been diagnosed with cancer,from the time of diagnosis through the remainder of life,although it is important to recognize that not all people with a history of cancer identify as survivors.3Cancer Treatment and Survivorship Statistics,2019Kimberly D.Miller,MPH1;Leticia Nogueira,PhD,MPH2;Angela B.Mariotto,PhD3;Julia H.Rowland,PhD4;K.Robin Yabroff,PhD2;Catherine M.Alfano,PhD5;Ahmedin Jemal,DVM,PhD1,2;Joan L.Kramer,MD6;Rebecca L.Siegel,MPH11 Surveillance Research,American Cancer Society,Atlanta,Georgia;2 Health Services Research,American Cancer Society,Atlanta,Georgia;3 Surveillance Research Program,Division of Cancer Control and Population Sciences,National Cancer Institute,Bethesda,Maryland;4 Smith Center for Healing and the Arts,Washington,DC;5 Survivorship,American Cancer Society,Atlanta,Georgia;6 Department of Hematology and Medical Oncology,Emory University,Atlanta,Georgia.Corresponding author:Kimberly D.Miller,MPH,Surveillance Research,American Cancer Society,250 Williams St,NW,Atlanta,GA 30303-1002;kimberly.millercancer.orgThe last 2 authors contributed equally to this article.DISCLOSURES:Kimberly D.Miller,Leticia Nogueira,K.Robin Yabroff,Catherine M.Alfano,Ahmedin Jemal,and Rebecca L.Siegel are employed by the American Cancer Society,which receives grants from private and corporate foundations,including foundations associated with companies in the health sector for research outside the submitted work.The authors are not funded by or key personnel for any of these grants,and their salary is solely funded through the American Cancer Society.Angela B.Mariotto,Julia H.Rowland,and Joan L.Kramer report no conflicts of interest.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute.doi:10.3322/caac.21565.Available online at Treatment and Survivorship Stats,20192CA:A Cancer Journal for CliniciansMaterials and MethodsPrevalence EstimatesCancer survivor prevalence as of January 1,2019,was estimated using the Prevalence Incidence Approach Model,which calculates prevalence from cancer inci-dence and survival and all-cause mortality.4 Incidence and survival were modeled by cancer type,sex,and age group using invasive cases(except urinary bladder,which included in situ cases)diagnosed from 1975 through 2015 from the 9 oldest registries in the population-based Surveillance,Epidemiology,and End Results(SEER)program(2017 submission data).As it is possible for an individual to be diagnosed with more than one cancer,for specific cancer site estimates,incident cases included the first primary for the specific cancer site between 1975 and 2015,whereas total cancer prevalence was calculated using the first primary diagnosed in that period.Estimates do not distinguish between individuals currently undergoing initial treatment,those with clinical evidence of residual or recurrent disease,or those who are living cancer free.Mortality data for 1975 through 2015 were obtained from the National Center for Health Statistics.Population projections from 2016 through 2030 were obtained from the US Census Bureau.Projected US incidence and mor-tality for 2016 to 2030 were calculated by applying 5-year average rates for 2011 through 2015 to the respective US population projections by age,sex,race,and year.Survival,incidence,and all-cause mortality rates were assumed to be constant from 2016 through 2030.2019 Case EstimatesThe method for estimating the number of new US can-cer cases in 2019 is described in detail elsewhere.1 Briefly,the total number of cases in each state is estimated using a spatiotemporal model based on incidence data from 49 states and the District of Columbia for the years 2001 through 2015 that met the North American Association of Central Cancer Registries high-quality data standard for incidence.Then,the number of new cases nationally and in each state is temporally projected 4years ahead using vector autoregression.This method considers geographic variations in sociodemographic and lifestyle factors,medi-cal settings,and cancer screening behaviors as predictors of incidence and also accounts for expected delays in case reporting.Stage at DiagnosisSeveral different staging systems are used to classify can-cers.The American Joint Committee on Cancer(AJCC)staging system5,6 is the most common in clinical settings and is used herein for the description of stage-specific distribution and treatment patterns with the exception of prostate cancer,for which SEER Summary Stage is used because of missing AJCC staging information for a large proportion of cases.SurvivalSurvival information is presented in terms of relative sur-vival,which adjusts for normal life expectancy by compar-ing survival among patients with cancer versus that of the general population,controlling for age,race,sex,and year.The SEER 18 registries were the source for contemporary 5-year survival(diagnosis years 2008-2014),whereas long-term changes in 5-year survival are based on data from the 9 oldest SEER registries.Many of these statistics were originally published in the SEER Cancer Statistics Review,1975 to 2015.7 All additional survival analyses were con-ducted using the National Cancer Institutes SEER*Stat software(version 8.3.5).8TreatmentInitial treatment data obtained from the National Cancer Data Base(NCDB)are presented for cases diagnosed in 2016 for all selected cancers except non-Hodgkin lym-phoma(NHL)and testicular cancer,for which aggregated 2012 to 2016 data were used because of the relatively small number of cases.The NCDB is a hospital-based cancer registry jointly sponsored by the American Cancer Society and the American College of Surgeons and includes greater than 70%of all invasive cancers in the United States from more than 1500 facilities accredited by the American College of Surgeons Commission on Cancer(CoC).9,10 When appropriate,a literature review was performed to supplement NCDB treatment information presented herein,particularly for trends or cancers often diagnosed in the outpatient setting,such as prostate can-cer or leukemia.The cancer treatment modalities reported are sur-gery,radiation therapy,and systemic treatment,including chemotherapy,targeted therapy,hormonal therapy,and immunotherapy.Many common targeted therapies are classified as chemotherapy in the NCDB.For consistency and comparability,chemotherapy in this report includes targeted therapy and immunotherapies,except for dif-fuse large B-cell lymphoma(DLBCL),nonsmall cell lung cancer(NSCLC),and urinary bladder cancers,for which immunotherapy has been examined separately.For more information regarding the drug classification system used for the NCDB and other cancer registries,see the SEER-Rx website(seer.cancer.gov/tools/seerrx).Methods of drug delivery are not available in the NCDB and there-fore,topical or intravesical chemotherapy cannot be distin-guished from systemic chemotherapy.Treatment patterns CA CANCER J CLIN 2019;0:1233VOLUME 0|NUMBER 0|MONTH 2019do not include diagnostic procedures such as biopsies but do include procedures that may be simultaneously used for treatment and diagnosis,such as transurethral resection of a urinary bladder tumor(TURBT).For more information on the NCDB,please visit their website(facs.org/cancer/ncdb).Selected FindingsCancer PrevalenceMore than 16.9million Americans with a history of cancer were alive on January 1,2019,and this number is projected to grow to more than 22.1million by January 1,2030.These esti-mates do not include carcinoma in situ(CIS)of any site(except urinary bladder)or basal cell and squamous cell skin cancers.The 3 most prevalent cancers in 2019 are prostate(3,650,030),colon and rectum(776,120),and melanoma(684,470)among males,and breast(3,861,520),uterine corpus(807,860),and colon and rectum(768,650)among females(Fig.1).The dis-tribution of prevalent cancers differs from that for incident cancers because prevalent cancers reflect survival and median age at diagnosis as well as cancer occurrence.The majority of cancer survivors(68%)were diag-nosed 5 or more years ago,and 18%were diagnosed 20 or more years ago(Table 1).Nearly two-thirds(64%)are aged 65years or older,although age distribution varies by cancer type(Table 2).For example,the majority of prostate cancer survivors(82%)are aged 65years or older compared with only one-half(54%)of melanoma survi-vors(Fig.2).Selected CancersBreast(female)It is estimated that there are more than 3.8million women living in the United States with a history of invasive breast cancer,and 268,600 women will be newly diagnosed in 2019.More than 150,000 breast cancer survivors are liv-ing with metastatic disease,three-quarters of whom were originally diagnosed with stage I through III cancer.11 Approximately 64%of breast cancer survivors(more than 2.4million women)are aged 65years and older,whereas 7%are aged younger than 50years(Fig.2).The age dis-tribution of breast cancer survivors is younger than that for the other most common incident cancers in the United States(lung,colorectum,and prostate),in part because the median age at diagnosis is younger(61years).7Treatment and survivalThe most common treatment among women with early-stage(stage I or II)breast cancer is breast-conserving surgery(BCS)with adjuvant radiation therapy(49%),although 34%of patients undergo mastectomy(Fig.3).By comparison,more than two-thirds(68%)of patients with stage III disease undergo mastectomy,most of whom also receive adjuvant chemotherapy.Women diagnosed with metastatic disease(stage IV)most often receive radiation and/or chemother-apy alone(56%),with one-quarter receiving no treatment(although some of these patients receive hormonal therapy).9 Among patients with hormone receptorpositive tumors,81%receive hormonal therapy,although the percentage is slightly lower for those with metastatic disease(71%).9FIGURE 1.Estimated Number of US Cancer Survivors by Site.Estimates do not include in situ carcinoma of any site except urinary bladder and do not include basal cell or squamous cell skin cancers.Treatment and Survivorship Stats,20194CA:A Cancer Journal for CliniciansWhen BCS followed by radiation to the breast is appropriately used for localized or regional cancers,long-term survival is the same as that with mastectomy.12,13 However,some patients require mastectomy because of tumor characteristics(eg,locally advanced stage,large or multiple tumors),because adjuvant radiation is contra-indicated(eg,previously received radiation,pre-existing medical conditions such as active connective tissue dis-ease),or because of other obstacles.BCSeligible women are increasingly electing mastectomy for a variety of rea-sons,including reluctance to undergo radiation therapy and fear of recurrence.14 Younger women(aged 40years)and patients with larger and/or more aggressive tumors are more likely to be treated with mastectomy14,15 and are particularly more likely to also undergo a contralat-eral prophylactic mastectomy(CPM).16 The proportion of women undergoing surgery for nonmetastatic disease in one breast who receive CPM has increased rapidly,from 10%in 2004 to 33%in 2012 among women aged 20 to 44years and from 4%to 10%during the same time period among those aged 45years and older.16 CPM receipt is highest in the Midwest and lowest in the Northeast and West,which may reflect differences in physician beliefs and practices as well as patient-related factors.In parallel with the rise in CPM,a recent large study found that the 41%of women who underwent any mastectomy(unilateral or bilateral)received immediate breast-reconstructive pro-cedures,up from 18%in 2004.17 Women who are younger,TABLE 1.Estimated Number of US Cancer Survivors by Sex and Years Since Diagnosis as of January 1,2019YEARS SINCE DIAGNOSISMALE AND FEMALEMALEFEMALENO.PERCENTCUMULATIVE PERCENTNO.PERCENTCUMULATIVE P