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1、肺癌與菸害防制當今流傳迷思之探討Lung Cancer and tobacco controlDebunking the myths,臺灣醫界菸害防制聯盟發起人 國家衛生研究院 名譽研究員 温啟邦,Myth #1: Tobacco Control in Taiwan has done an excellent job, but lung cancer continued to increase Tobacco control cannot solve the lung cancer epidemic.迷思一:台灣控菸已做得很好 但肺癌持續增加，控菸無法解決肺癌。,This is a feeli
2、ng prevalent in both the public and medical community 民眾與肺癌專家相同感受:,Myth #2: Most lung cancer in Taiwan occurred in nonsmokers Tobacco control cannot solve the lung cancer epidemic.迷思二:台灣肺癌多是不吸菸，所以控菸無法解決肺癌。,不吸菸肺癌之多 是台灣的特徵,迷思三不吸菸女性得肺腺癌 多與基因遺傳有關，可從基因去篩檢肺癌。,Myth #3 Lung cancer increase is related to gen
3、etic predisposition 遺傳傾向,另一迷思 Another myth,Lung Cancer and All Cancer肺癌的增加驅動了全癌的增加,All Cancer,Lung Cancer,Cancer is a dreaded disease談癌色變,Leading cancer in Taiwan 1) Lung 肺 9,232/year (20% of all cancer) 2) Liver 肝 8,258 3) Colorectal 腸: 5,687 4) Oral口腔: 2,667 5) Stomach胃: 2,326,Leading Deaths in Ta
4、iwan 1) Cancer 腫瘤 46,829/163,574 (29% of all deaths) 2) Heart 心臟11,244 (11%) 3) Stroke 中風 6,589 (7%) 4) Diabetes 糖尿病 5,096 (5%) 5) Accidents 意外 4,853 (5%) Cancer = 2nd + 3rd + 4th + 5th,不要叫我名，叫我第一名,癌症腫瘤躍升台灣死因第一名17% Cancer became leading cause of deaths in Taiwan 1996 12+3癌症23% 超過中風(11.6%)意外(10.3%) C
5、ancer exceeded stroke and accidents, the next two causes 2002 Cancer exceeded the next three causes 12+3+4癌症27% 超過中風(9.5%)心臟病(9.0%)+糖尿病(6.9%) 2009 12+3+4+5癌症29% 超過心臟病(11%)+中風(7%) + 意外 (5%) +糖尿病(5%) Cancer deaths exceeded the next four causes Lung cancer was a major contributor 肺癌居功不少,1982,女生,4,121 3
6、,111 2,263 1,524 1,054 631 447,人口老化有關 人數增加九倍,30年,這種增加是典型 環境因子引起的 與遺傳基因關係不大 The increase is a classical environmental and not genetic,年齡別肺癌發生率,40,160,七十歲增四倍,Why the steady increase?,Smoking rate has been declining台灣的禁煙做得好 吸菸率一直在下降,2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013,2002 2003
7、2004 2005 2006 2007 2008 2009 2010 2011 2012 2013,台灣控菸已做得很好但肺癌持續增加，控菸無法解決肺癌。, Tobacco control cannot solve the lung cancer epidemic.,吸菸率在下降,肺癌 在上升,Age adjusted lung cancer incidenceMale Female,Same slope of increase 上升速度男女類似,肺癌已開始下降 Lung cancer has started to decline,2009,Lung cancer incidence, mort
8、ality and smoking rate,2009,1979,吸菸率開始下降,肺癌發生率開始下降,台灣吸菸率下降 30 年後肺癌開始下降,若吸菸率下降始自1984年 約25年後肺癌開始下降,1984,60%,Lung Cancer,30 years,1965,美國吸菸率,Most of the increase in overall cancer death rates for men prior to 1990 was attributable to the rapid increase in lung cancer deaths due to the tobacco epidemic.
9、 However, since 1990, the lung cancer death rate in men has been decreasing; this decline has accounted for over 40% of the overall decrease in cancer death rates in men since 1990.,1990,1965,美國男性肺癌死亡率 與菸品消費量之關係,1990,1965,禁煙後 25-30年見效,法國 吸菸率下降 25年後肺癌下降,菸價,肺癌死亡率,吸菸率,20-25 年,France,Lung cancer,Myth #1
10、: Tobacco control cannot solve the lung cancer epidemic.迷思一:控菸無法解決肺癌。,Fact: Lung cancer is no longer increasing after smoking declined 30 years ago 肺癌自2009已不再上升 在1979年吸菸率開始下降的 30 年後 肺癌下降 歸功於台灣的吸菸率的下降,全部 不吸菸者 輕度吸菸者重度吸菸者395,875 281,111 90,486 24,278,探討不吸菸的肺癌,台灣40萬人15年追蹤,MD Anderson Cancer Center合作,71%
11、 23% 6%,Lung cancer 47% 14% 39%,Total cohort Nonsmoker Light smoker Heavy smoker 全體 不吸菸 輕度吸菸 重度吸菸,女性肺癌不吸菸,Most lung cancer in Taiwan occurred in nonsmokers Tobacco control cannot solve the lung cancer epidemic.,Nonsmoking lung cancer 不吸菸肺癌 Male: 19% Female: 92%,1/12,1/3,1/1,70歲增12040-160increase by
12、120,不吸菸的 女性肺癌 Nonsmoking Female lung cancer,25年間節節上升 increasing pattern,40,160,70歲增250130-380increase by 250,男性 Males,吸菸的 男性肺癌 Smoking male cancer,25年間也節節上升increasing pattern,130,380,增加趨勢類似但男性幅度較大 2X 兩倍Increasing pattern similar,Males,Females,爸爸、哥哥、老公吸菸 Father, brothers or Husband smoking,60% 一手菸,一手
13、菸 vs. 二手菸Active smoking vs. Passive smoking,80% 二手菸,不吸菸女性肺癌主要來自二手菸之六理由Nonsmoking lung cancer came mainly from passive smoking,1) 女性肺癌近年增加之趨勢 與男性亦步亦趨 只是增加率少一半 The pattern of lung cancer increase in women was identical with men 2) 因男性吸菸率在60%以上女性二手菸率可達80% 3) 房子小 暴露高 With 60% active smoking, second hand
14、 smoking could have exceeded 80%, with father, brothers or husband smoking. Small indoor spaces,4) 二手菸含81種致癌物最有可能產生肺癌 (世衛組織) Second hand smoke, containing 81 carcinogens, is most likely to produce lung cancer (IARC) 5) 空氣汙染一直在減少改善,6) Hirayama BMJ 282:183 1981,二手菸的PM2.5是室外空氣汙染的10-100倍Concentration of
15、 2nd hand smoking could be 10-100 times higher than ambient outdoor,Indoor or inside the car 室內車內二手菸PM2.5 200 -2,000 m/m3 Inside,空氣汙染PM2.5的特徵,PM2.5 只代表細懸浮微粒的大小 Only represents particle size, not toxicity 不代表毒性 依來源毒性不同 Toxicity depends on sources of PM2.5,IARC classified Tobacco: 81 Carcinogens11 Gro
16、up I; 14 Group 2A; 56 Group 2B菸含81種致癌物 二手菸最會引起肺癌 second hand smoke had the most potential for causing lung cancer,空氣汙染與癌症WHO IARC 2014 報告,空氣汙染 對肺癌的貢獻度3-5%,Attributable Number of Lung Cancer Deaths for Main Risk Factors, Global Burden of Disease Project, 1990-2010,56,579,63,392,71,407,84,153,95,271,171,545,339,025,368,742,235,868,257,802,707,959,773,200,816,010,903,098,965,517,108,175,110,019,115,609,90,763,98,992,124,429
