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1、1Cancer in 15- to 29-Year-Olds by Primary Site作者：Archie Bleyera, Aaron Vinyb, Ronald Barrc 【关键词】 Adolescent,and,young,cancera Cancer Treatment Center, St. Charles Medical Center, Bend, Oregon, USA; b Clevelend Clinic Lerner College of Medicine, Cleveland, Ohio, USA; c Department of Pediatrics, Patho
2、logy, and Medicine, McMaster University, Hamilton, Ontario, Canada Key Words. Adolescent and young cancer ; Epidemiology ; Risk factors ABSTRACT Incidence. Cancer occurring between the ages of 15 and 230 years is 2.7 times more common than cancer occurring during the first 15 years of life, yet is m
3、uch less common than cancer in older age groups, and accounts for just 2% of all invasive cancer. Cancer in adolescents and young adults is unique in the distribution of the types that occur. Hodgkin lymphoma, melanoma, testis cancer, female genital tract malignancies, thyroid cancer, soft-tissue sa
4、rcomas, non-Hodgkin lymphoma, leukemia, brain and spinal cord tumors, breast cancer, bone sarcomas, and nongonadal germ cell tumors account for 95% of the cancers in this age group. The frequency distribution of cancer types changes dramatically from age 1530, such that the pattern at the youngest a
5、ge does not resemble the one at the oldest. The incidence of cancer in this age group increased steadily during the past quarter century. This increase is declining and at the older end of the age range appears to be returning to the incidence of the 1970s. Males in the 15- to 29-year age group have
6、 been at higher risk of developing cancer, with the risk directly proportional to age. Non-Hispanic whites have had the highest risk of developing cancer during this phase of life, and Asians, American Indians and Native Alaskans the lowest. Males had a worse prognosis than females. African-3America
7、ns, American Indian/Alaska Natives had a worse prognosis than white non-Hispanics and Asians. Mortality & Survival. At the beginning of the last quarter century, the diagnosis of cancer in 15- to 29-year-olds carried a more favorable prognosis, on the average, relative to cancer at other ages. Since
8、 then, there has been a lack of progress in survival improvement among older adolescents and young adults relative to all other ages. Survival improvement trends portend a worse prognosis for young adults diagnosed with cancer today than 25 years ago. The survival deficit is increasing with longer f
9、ollow-up of the survivors, and is worse in males. Among 15- to 29-year-olds, non-Hispanic whites had the best survival and African Americans/blacks had the worst survival, with a 20% difference apparent by 5 years. Asians/Pacific Islanders had the second best survival, with Hispanics and American In
10、dians/Alaska Natives next in sequence. Risk Factors. In general, there are relatively scant data to support either an environmental causation or an inherited predisposition to cancer in this age group. The majority of 4cases of cancer occurring before age 30 appear to be spontaneous and unrelated to
11、 either carcinogens in the environment or family cancer syndromes. Overall, family cancer syndromes appear to account for less than 5% of the cases of cancer in the age group. Melanoma, cervical carcinoma and Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin and Burkitt lymphomas accounting for the majo
12、rity of environmentally induced malignancies (ultraviolet light, human papillomavirus, human immunodeficiency virus, and Epstein-Barr virus, respectively). Ultimately, a larger proportion of cases may be attributable to specific factors or genetic predisposition, but at present, most cancer in this
13、age group appears to be sporadic and random. INTRODUCTION To our knowledge, this is the first treatise devoted exclusively to cancer in adolescents and young adults 15- to 29-years of age. A prior monograph from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer In
14、stitute (NCI) of the United States reported the epidemiology of cancer in children younger than 15 years 5of age 1. For many of the analyses in the current report, data for the age groups 015 years and 3044 years are included for comparison. The SEER incidence data included in this introductory chap
15、ter were collected mainly between 1975 and 2001. As in the prior monograph, and as routinely available in the SEER database 2, five year increments (1519 years, 2024 years, 2529 years, etc.) are utilized in most analyses. Only recently have data from SEER become available in shorter age intervals, b
16、ut with the exception of this introductory chapter, these data are not presented in this monograph. Although the pediatric cancer monograph included a chapter about 15- to 19-year-olds 3, the current monograph contains new and more varied analyses. Each disease-based chapter follows a standard outline, beginning with incidence and followed by death rates, survival information and risk factors/etiology, in that sequence. Each of the disease-based chapters is authored by
