2022年美国印第安人和阿拉斯加土著的癌症统计：包括早期发生结直肠癌的差异增加

SCI 17 November 2022

Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early onset colorectal cancer

 (CA Cancer J Clin, IF: 286.13)

Kratzer TB, Jemal A, Miller KD, et al. Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early onset colorectal cancer. CA Cancer J Clin 2022.

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.

美国印第安人和阿拉斯加土著(AIAN)在文化和地理上各不相同，但慢性病发病率都很高，这主要是因为获得高质量卫生保健的障碍。作者使用来自国家癌症研究所、疾病控制和预防中心和北美中央癌症登记协会的基于人群的数据，综合检查了非西班牙裔美国人个体的癌症发病率和死亡率，并与非西班牙裔白人个体进行了对比。在发病率(2014年至2018年，仅限于购买/转诊医疗服务区域的县，以减少种族错误分类)方面，亚裔个体的总体癌症发病率比白人个体高2%，但死亡率(2015年至2019年)高出18%。然而，癌症类型和地理区域的差异很大。例如，尽管亚洲人种的乳腺癌和前列腺癌发病率较低，且可进行早期检测，但这两种癌症的死亡率分别比白人高8%和31%。

在AIAN个体中，感染相关癌症(肝癌、胃癌和宫颈癌)、肾癌和土著阿拉斯加人的结直肠癌负担最高(每10万人中有91.3例对比35.5例)，他们的发病率在世界上最高。早发型结直肠癌的发病率急剧上升，从1998年至2002年的每10万例18.8例增加到2014年至2018年的每10万例34.8例，加剧了这一差距。感染相关癌症(肝癌、胃癌和宫颈癌)以及肾癌的死亡率，在AIAN个体中约为白人个体的两倍。这些发现强调了需要更有效的策略来降低慢性癌原性感染的流行率，并改善对AIAN个体的高质量癌症筛查和治疗。减轻这种不同的负担将需要扩大对部落保健的财政支持，并加强与这一边缘化人口的合作和参与。