The 2024 update to Cancer Statistics from the American Cancer Society estimates that over 2,000,000 people this year will hear the words, “you have cancer.”¹ This amounts to nearly 5500 people each day, or the equivalent to one person experiencing this every 15 seconds. This marks the first time incidence has eclipsed 2 million Americans, with more people being diagnosed at earlier stages of these diseases, when cure rates are the highest. Consequently, cancer mortality continues to decline, with an estimated 4.1 million lives saved since 1991, because of significant investments in research and screening by the National Institutes of Health, the Centers for Disease Control and Prevention, the American Cancer Society, and others. To us, four parts of the report particularly stand out.

First, historically, cancer has been a disease that disproportionally affects men. However, this report demonstrates that, whereas the cancer incidence in men has been stable since the 2013, the incidence in women has ticked up since the late 1990s, attributed to higher rates of breast and uterine corpus cancers and melanoma. Thus cancer is becoming more gender-indiscriminate, with a male-to-female incidence ratio of 1.14 (95% CI, 1.136–1.143) in all ages. Many have hypothesized that differential lifestyle and risk-taking behaviors, alongside environmental exposures, resulted in higher cancer rates in men. However, as the incidence gap between genders closes, signs may point to risk factors (e.g., obesity, sedentary lifestyle) that are similarly affecting both groups, highlighting the need for a better understanding of this phenomenon.

Second, although the overall cancer incidence is increasing, there are particular cancers and populations disproportionately affected. For example, whereas the rise in uterine corpus cancers in White women has increased by about 1% per year since the mid-2000s, the increase is in excess of 2% in Black, Hispanic, Asian American, and Pacific Islander people. Colorectal cancer (CRC) too shows a variability when age is considered; the declines noted in CRC are largely because of a lower rate in people older than 65 years; among those younger than 55 years, the rate continues to increase by 1% to 2% per year. Finally, men saw their rates stabilize for liver cancer and, potentially, for melanoma between 2015 and 2019, yet women saw their rates increase by 2% per year. Taken together, the report highlights how cancer cannot be over-simplified to one diagnosis, nor can we generalize these trends in a short bullet.

Third, although the report highlights the tremendous advances in the treatment of hematologic and advanced solid tumor malignancies, the impact of disparities cannot be overstated. Compared with White women, for example, more Black women are diagnosed at a more advanced stage (44% vs. 23%) and have a poorer prognosis (5-year survival rate estimates of 63% vs. 84%, respectively). As the authors point out, systemic factors like disparities in guideline-concordant diagnostic and treatment protocols play a big role. Even more, it is likely that self-identification categories, such as Black, White, and Asian, mask the differences in risk and outcomes among groups. Asian, for example, may include descendants or immigrants from as many as 48 distinct countries. Whereas mortality from cancer has seen a 33% drop between 1999 and 2021, the picture is driven by deaths in older adults. A closer look in adults younger than 50 years shows that, although lung cancer death rates have fallen, they coincide with a higher rate of cancer death from CRC. CRC is now the leading cause of death in younger men and the second leading cause in younger women.

Fourth, reports like this highlight the gaps and opportunities in existing databases and data-collection mechanisms. For example, as norms regarding complete data collection of sexual and gender minoritized populations evolve, so must national registries to fully appreciate the distinctive populations affected by cancer. Furthermore, we continue to have an incomplete picture of those living with metastatic disease distinct from populations considered survivors.² Across the United States, tumor registry protocols dictate that stage is assigned at the time of initial diagnosis and is not updated if someone experiences a recurrence or develops metastatic disease. Clinically, it is important because the conversation about prognosis does not occur once; it is an ongoing conversation that changes as one’s circumstances and diagnoses evolve. It is also a question that is not uncommonly asked: how many of me are there living with metastatic disease?

Importantly, there are solutions to this, but this requires an update in documentation procedures. For example, the American Joint Commission on Cancer has a designation for recurrence or re-treatment, r, in its tumor, node, metastasis (TNM) system.^{3, 4} Although someone may be diagnosed with stage I disease at diagnosis (T1N0M0), at recurrence, they could be re-staged in a way to signify the evolution of metastatic disease (rT0N0M1). However, it is not used routinely or in standard fashion but presents an opportunity for us to collect data within a registry that could be subsequently analyzed.

In summary, we continue to make progress in oncology overall, but certain ethnic, racial, age, and geographic populations face a disproportionate burden of cancer incidence and mortality. Like others, we find these health disparities wholly unacceptable and agree with the National Cancer Plan and Biden Moonshot Initiative that bold and new collaborations and thinking will be needed to produce different outcomes. As the report notes, every 15 seconds presents a real reminder of the urgency to end cancer as we know it for everyone.

美国癌症协会 2024 年癌症统计数据更新估计，今年将有超过 200 万人听到“你患有癌症”这句话。 ¹每天有近 5500 人遇到这种情况，相当于每 15 秒就有一个人经历这种情况。这标志着美国人的发病率首次超过 200 万，更多的人在这些疾病的早期阶段被诊断出来，此时治愈率最高。因此，癌症死亡率持续下降，自 1991 年以来，由于美国国立卫生研究院、疾病控制与预防中心、美国癌症协会等机构在研究和筛查方面的大量投资，估计有 410 万人的生命得到挽救。对我们来说，报告的四个部分特别引人注目。

首先，从历史上看，癌症是一种对男性影响尤为严重的疾病。然而，该报告表明，虽然男性癌症发病率自 2013 年以来一直稳定，但女性癌症发病率自 20 世纪 90 年代末以来有所上升，原因是乳腺癌、子宫体癌和黑色素瘤的发病率较高。因此，癌症变得更加不分性别，所有年龄段的男性与女性发病率之比为 1.14（95% CI，1.136-1.143）。许多人假设，不同的生活方式和冒险行为以及环境暴露导致男性癌症发病率较高。然而，随着性别之间发病率差距的缩小，有迹象可能表明危险因素（例如肥胖、久坐的生活方式）对两组人群都有同样的影响，这凸显了更好地了解这一现象的必要性。

其次，尽管总体癌症发病率正在增加，但某些特定癌症和人群受到的影响不成比例。例如，自 2000 年代中期以来，白人女性子宫体癌的发病率每年增加约 1%，而黑人、西班牙裔、亚裔美国人和太平洋岛民的发病率则超过 2%。当考虑到年龄时，结直肠癌（CRC）也表现出变异性。 CRC 的下降主要是因为 65 岁以上人群的发病率较低；在55岁以下的人群中，这一比例继续以每年1%至2%的速度增长。最后，2015 年至 2019 年间，男性的肝癌发病率稳定，并且可能还有黑色素瘤的发病率稳定，但女性的发病率每年增加 2%。总而言之，该报告强调了如何不能将癌症过度简化为一种诊断，我们也不能一言以蔽之地概括这些趋势。

第三，尽管报告强调了血液学和晚期实体瘤恶性肿瘤治疗方面的巨大进步，但差异的影响不容小觑。例如，与白人女性相比，更多的黑人女性被诊断为晚期（44% vs. 23%），且预后较差（5 年生存率估计分别为 63% vs. 84%）。正如作者指出的，系统性因素（例如符合指南的诊断和治疗方案的差异）发挥着重要作用。更重要的是，黑人、白人和亚洲人等自我​​认同类别很可能掩盖了群体之间风险和结果的差异。例如，亚洲人可能包括来自多达 48 个不同国家的后裔或移民。尽管 1999 年至 2021 年间癌症死亡率下降了 33%，但这一情况是由老年人的死亡推动的。对 50 岁以下成年人的仔细研究表明，尽管肺癌死亡率有所下降，但与结直肠癌的癌症死亡率较高相一致。结直肠癌现在是年轻男性死亡的主要原因，也是年轻女性死亡的第二大原因。

第四，此类报告强调了现有数据库和数据收集机制的差距和机遇。例如，随着有关性和性别少数群体完整数据收集的规范不断发展，国家登记处也必须充分了解受癌症影响的独特人群。此外，我们对那些与被视为幸存者的人群不同的转移性疾病患者的了解仍然不完整。 ²在美国各地，肿瘤登记协议规定分期是在初次诊断时指定的，如果某人出现复发或出现转移性疾病，则不会更新分期。在临床上，这很重要，因为关于预后的讨论不会发生一次；这是一种持续的对话，会随着个人情况和诊断的发展而变化。这也是一个很常见的问题：我中有多少人患有转移性疾病？

重要的是，对此有解决方案，但这需要更新文档程序。例如，美国癌症联合委员会在其肿瘤、淋巴结、转移 (TNM) 系统中指定了复发或再治疗r 。 ^{3, 4}尽管某人在诊断时可能被诊断为 I 期疾病 (T1N0M0)，但在复发时，他们可能会以某种方式重新分期，以表明转移性疾病的演变 (rT0N0M1)。然而，它并没有常规使用或以标准方式使用，而是为我们提供了在注册表中收集数据并随后进行分析的机会。

总之，我们在肿瘤学方面总体上继续取得进展，但某些民族、种族、年龄和地理人群面临着不成比例的癌症发病率和死亡率负担。和其他人一样，我们发现这些健康差异完全不可接受，并同意国家癌症计划和拜登登月计划，即需要大胆的、新的合作和思维来产生不同的结果。正如报告指出的那样，每 15 秒就真实地提醒我们终结癌症的紧迫性，这是众所周知的。