Objective To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years. Design Retrospective secondary data analysis. Data sources Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland. Setting 23 cancer sites were included in the analysis in the UK. Participants Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018. Main outcome measures Change in cancer incidence and mortality age standardised rates over time. Results The number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (−2.0% per year) and 33% in women (−1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small. Conclusions Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes. Data sharing may be possible for additional analyses. All code used for analyses in this paper are also available from the Cancer Research UK website and GitHub. Information on how to access the data used in this analysis are available from the Cancer Research UK website.

中文翻译：

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1993-2018年英国35-69岁成年人癌症发病率和死亡率的25年趋势：回顾性二次分析


目的 检查并解释英国 35-69 岁成年人中所有癌症的总和最常见癌症部位的癌症发病率和死亡率的趋势。设计回顾性二次数据分析。数据来源 癌症登记数据、癌症死亡率和全国人口数据来自国家统计办公室、威尔士公共卫生局、苏格兰公共卫生局、北爱尔兰癌症登记处、英格兰国民医疗服务体系和北爱尔兰综合登记办公室。分析中包括了英国的 23 个癌症部位。参与者 1993 年至 2018 年间被诊断患有癌症或死于癌症的 35-69 岁男性和女性。 主要结果指标 癌症发病率和死亡率年龄标准化率随时间的变化。结果 该年龄段男性癌症病例数增加了 57%（从 1993 年登记的 55 014 例增加到 2018 年的 86 297 例），女性增加了 48%（从 60 187 例增加到 88 970 例），年龄标准化率显示年平均癌症病例数男女均增加 0.8%。发病率的增加主要是由前列腺癌（男性）和乳腺癌（女性）的增加造成的。如果没有这两个部位，所有癌症的年龄标准化发病率趋势都相对稳定。少数不太常见的癌症的发病率呈上升趋势，例如黑色素瘤、皮肤癌、肝癌、口腔癌和肾癌。 25 年期间，癌症死亡人数下降，男性减少了 20%（从 32 878 人减少到 26 322 人），女性减少了 17%（从 28 516 人减少到 23 719 人）；所有癌症的年龄标准化死亡率合计男性降低了 37%（每年 -2.0%），女性降低了 33%（每年 -1.6%）。 男性的胃癌、间皮瘤和膀胱癌以及女性的胃癌、宫颈癌和非霍奇金淋巴瘤的死亡率下降幅度最大。即使变化幅度相对较小，大多数发病率和死亡率变化也具有统计显着性。结论 过去 25 年来，35-69 岁男性和女性的癌症死亡率均大幅下降。这种下降可能反映了癌症预防（例如，吸烟预防政策和戒烟计划）、早期检测（例如，筛查计划）和改进的诊断测试以及更有效的治疗方面的成功。相比之下，非吸烟危险因素患病率的增加可能是少数特定癌症发病率增加的原因。该分析还为未来十年提供了基准，其中包括 covid-19 对癌症发病率和结果的影响。数据共享可以用于额外的分析。本文中用于分析的所有代码也可从英国癌症研究网站和 GitHub 获取。有关如何访问此分析中使用的数据的信息可从英国癌症研究中心网站获取。