In 2020, lung cancer will no longer be the most common cancer in the world.
Recently, the World Health Organization’s International Agency for Research on Cancer (IARC) released the latest global cancer burden data in 2020.
Data display:
In 2020, 19.3 million people will be newly diagnosed with cancer and nearly 10 million will die.
One in five people will get cancer in their lifetime;
One in every eight men and one in every eleven women will die of cancer;
Five years after cancer diagnosis, the number of survivors is about 50.6 million;
Breast cancer has become the most common cancer in the world;
It is estimated that by 2040, 28.4 million people around the world will be diagnosed with cancer.
In 2020, the incidence of female breast cancer surpassed that of lung cancer for the first time, becoming the most common cancer in the world. However, lung cancer is still the cancer with the largest number of deaths worldwide.
▲ In 2020, the types, number and proportion of major new cancers in the world (data from IARC official website)
▲ In 2020, the types, number and proportion of major cancer deaths in the world (data from IARC official website)
Lung cancer is still the largest cancer in China.
Global data:
More than 2.2 million people in the world have been newly diagnosed with lung cancer, accounting for 11.1% of the newly diagnosed cancer in the world, that is, one in every nine new cases is lung cancer.
In terms of gender, more than 1.43 million men and more than 770,000 women are newly diagnosed with lung cancer. The proportion of new cases of lung cancer in men and women is 14.3% and 8.4% respectively. Lung cancer ranks first among men and third among women.
▲ Global male cancer deaths in 2020 (data from IARC official website)
▲ The global number of female cancer deaths in 2020 (data from IARC official website)
Among the 10 million cancer deaths in the world, nearly 1.8 million are lung cancer, accounting for 18%, and almost one in every six cancer deaths is lung cancer.
In terms of gender, more than 1.18 million men and more than 600,000 women died of lung cancer, accounting for 21.5% and 13.7% of male and female lung cancer deaths respectively. Lung cancer ranks first among male cancer deaths and second among female cancer deaths.
China data:
In China, lung cancer is still the first cancer in terms of morbidity and mortality.
▲ Cancer incidence and deaths in China in 2020 (data from IARC official website)
▲ Incidence and death of male cancer in China in 2020 (data from IARC official website)
▲ Incidence and death of cancer among women in China in 2020 (data from IARC official website)
In 2020, there are more than 810,000 new cases of lung cancer in China, accounting for 17.9% of the newly diagnosed cancer cases in China, that is, one of less than six patients is lung cancer.
In terms of gender, nearly 540,000 men in China and more than 270,000 women in China were newly diagnosed with lung cancer, accounting for 21.8% and 13.2% of the cases of male and female cancers in China respectively. Lung cancer ranks first among men in China and second among women in China.
At the same time, more than 710,000 people died of lung cancer in China, accounting for 23.8% of the cancer deaths in China, and almost one in four cancer-related deaths is lung cancer.
In terms of gender, more than 470,000 men in China and 240,000 women in China died of lung cancer, accounting for 25.9% and 10.2% of the male and female cancer deaths in China, respectively, and lung cancer ranks first among the male and female cancer deaths in China.
Behind every number is the sad change of a person and a family. The best way to deal with lung cancer is still prevention and control, especially early screening for high-risk groups.
60% of the high-risk population of lung cancer in China did not undergo LDCT screening.
Practice has proved that low-dose spiral CT(LDCT) is 4-10 times more sensitive to detect early lung cancer than conventional X-ray chest film, and can detect early peripheral lung cancer.
According to the data of the International Action Plan for Early Lung Cancer, 85% of stage I peripheral lung cancer can be found in the annual screening of LDCT, and the expected survival rate of patients after 10 years is 92%. The national lung cancer screening test in the United States has proved that LDCT screening can reduce the mortality of lung cancer in high-risk groups by 20%.
However, a recent study published in the Journal of the American Medical Association showed that researchers from Henan Cancer Hospital and other institutions analyzed the data of urban cancer early diagnosis and treatment projects in Henan Province from 2013 to 2019 and found that the overall participation rate of LDCT was 40.16%, which means that nearly 60% of the high-risk population of lung cancer were not screened.
The American Cancer Society (ACS) recommends that people at high risk of lung cancer receive LDCT screening regularly every year.
The risk assessment factors of lung cancer screening proposed by national comprehensive cancer network (NCCN) guidelines include: smoking history (present and past), radon exposure history, occupational exposure history (arsenic, chromium, asbestos, nickel, cadmium, beryllium, silicon, diesel exhaust gas, soot and soot), malignant tumor history, family history of first-degree relatives with lung cancer, chronic obstructive emphysema or pulmonary fibrosis history, and passive smoking history.
According to the risk status of lung cancer, it can be divided into three groups: low risk, medium risk and high risk:
? Low risk group: Age < 50 years and smoking history < 20 packs a year (600 cigarettes/year).
? Medium-risk group: Age ≥50 years, smoking history or passive smoking contact history ≥20 years, no other risk factors.
? High risk group:
① Age 55 ~ 74 years, smoking history ≥30 packs a year (600 cigarettes/year), quitting smoking history < 15 years;
② Age ≥50 years, smoking history ≥20 packs of years, and risk factors other than passive smoking.
Suggestions on the diagnosis and treatment standard of primary lung cancer (2018 edition) in China:
High-risk group ① people should participate in LDCT lung cancer screening;
If there is a high-risk factor of lung cancer in the high-risk group, LDCT lung cancer screening should also be carried out.
Screening frequency: It is recommended that the interval of screening is 1 year, and the screening mode with an interval of more than 2 years is not recommended. If the annual screening is normal, it is recommended to continue screening every 1 ~ 2 years.
Screening management: It is suggested that nodules with diameter ≥5 mm need further examination.
Note: LDCT screening is not recommended for people who cannot tolerate possible lung cancer resection or serious life-threatening diseases.
Early lung cancer: SBRT has the same effect as surgery.
With the wide application of LDCT screening in high-risk population, more and more early lung cancer can be detected. For operable early non-small cell lung cancer (NSCLC, accounting for about 85% of all lung cancers), the standard treatment mode is radical surgery; For patients who are inoperable or refuse surgery, local radiotherapy is the standard treatment mode.
Compared with conventional radiotherapy, SBRT significantly improves the local control rate and the survival rate of patients with early NSCLC. The local control rate of SBRT in the treatment of inoperable early NSCLC is over 90%, which is equivalent to surgery.
In 2012, NCCN guidelines recommended that SBRT become the first choice for inoperable early NSCLC. In 2018, the American Association of Clinical Oncology (ASCO) officially approved SBRT as the standard treatment for early inoperable NSCLC.
SBRT has become an important radical treatment for early NSCLC, especially for patients who are inoperable or refuse surgery.
Indications of SBRT
Early inoperable NSCLC: old age, serious medical diseases, T1 ~ 2n0m0 stage.
Early NSCLC that can be operated but refuses to operate.
For early clinical lung cancer that cannot be diagnosed pathologically or refuses to be diagnosed pathologically, SBRT treatment can be considered if the following conditions are met:
(1) The definite imaging diagnosis focus gradually increased during the long-term follow-up (> 2 years), or the density and proportion of ground glass shadow increased, or accompanied by malignant features such as vascular crossing and edge burr-like changes; At least two imaging examinations (such as chest enhancement+1 ~ 3 mm thin-slice CT and whole-body PET or CT) indicate malignancy;
(2) confirmed by MDT discussion of lung cancer;
(3) Patients and their families fully informed consent.
Relative indications:
(1)T3N0M0;
(2) Simultaneous multiple primary NSCLC.
References:
1.2020-12-16 e Medicine Global Authoritative Report: In 2020, there will be 19.3 million new cancers worldwide, and lung cancer is no longer the most common cancer! 》
2. China lung cancer diagnosis and treatment standard (2018 edition)
3.2020-11-04e Drug Global "Data of more than 50,000 people in China: Nearly 60% of the high-risk population of lung cancer did not participate in the screening. What factors are affecting it? 》
4. China Expert Consensus on Stereotactic Radiotherapy for Early Non-small Cell Lung Cancer (2019 Edition)