ImportanceCancer mortality has decreased over time, but the contributions of different interventions across the cancer control continuum to averting cancer deaths have not been systematically evaluated across major cancer sites.ObjectiveTo quantify the contributions of prevention, screening (to remove precursors [interception] or early detection), and treatment to cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.Design, Setting, and ParticipantsIn this model-based study using population-level cancer mortality data, outputs from published models developed by the Cancer Intervention and Surveillance Modeling Network were extended to quantify cancer deaths averted through 2020. Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modeled data using parameters derived from multiple birth cohorts of the US population were used.InterventionsPrimary prevention via smoking reduction (lung), screening for interception (cervix and colorectal) or early detection (breast, cervix, colorectal, and prostate), and therapy (breast, colorectal, lung, and prostate).Main Outcomes and MeasuresThe estimated cumulative number of cancer deaths averted with interventions vs no advances.ResultsAn estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths). The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.Conclusions and RelevanceOver the past 45 years, cancer prevention and screening accounted for most cancer deaths averted for these causes; however, their contribution varied by cancer site according to these models using population-level cancer mortality data. Despite progress, efforts to reduce the US cancer burden will require increased dissemination of effective interventions and new technologies and discoveries.

中文翻译：

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1975-2020 年预防、筛查和治疗工作避免的癌症死亡估计


重要性癌症死亡率随着时间的推移而下降，但尚未在主要癌症部位系统评估癌症控制连续体中不同干预措施对避免癌症死亡的贡献。目的量化预防、筛查 （去除前体 [拦截] 或早期检测） 和治疗对 1975 年至 2020 年乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌累计避免癌症死亡人数的贡献。设计、设置和参与者在这项使用人群水平癌症死亡率数据的基于模型的研究中，癌症干预和监测建模网络开发的已发表模型的输出被扩展以量化到 2020 年避免的癌症死亡。模型输入基于有关风险因素、癌症发病率、癌症生存率和其他原因导致的死亡率以及预防、筛查（用于拦截和早期发现）和治疗的传播和效果的全国数据。使用来自美国人口多个出生队列的参数的模拟或建模数据。干预措施通过减少吸烟（肺）、拦截筛查（宫颈和结直肠）或早期检测（乳腺癌、宫颈、结直肠和前列腺）和治疗（乳腺癌、结直肠癌和前列腺癌）进行一级预防。主要结局和措施估计的癌症死亡累积人数通过干预与无进展。结果估计乳腺癌、宫颈癌、结直肠癌、肺癌和前列腺癌共避免了 594 万例癌症死亡。癌症预防和筛查工作避免了其中 10 例死亡中的 8 例（避免了 475 万例死亡）。每种干预措施的贡献因癌症部位而异。 筛查占避免的乳腺癌死亡的 25%。由于研究期间治疗进展适中，通过筛查和去除癌症前体，几乎完全避免了避免的宫颈癌死亡。由于筛查和切除癌前息肉或早期发现，避免了 79% 的结直肠癌死亡，21% 的治疗进展。大多数肺癌死亡是通过减少吸烟 （98%） 避免的，因为在 2014 年之前筛查率低且治疗主要是姑息性治疗。筛查有助于避免 56% 的前列腺癌死亡。结论和相关性在过去的 45 年中，癌症预防和筛查占因这些原因避免的癌症死亡的大部分;然而，根据这些使用人群水平癌症死亡率数据的模型，它们的贡献因癌症部位而异。尽管取得了进展，但减轻美国癌症负担的努力仍需要增加有效干预措施和新技术和发现的传播。