以癌症發展模式評估台灣各地理區域乳癌、子宮頸癌、口腔癌及結直腸癌疾病負擔長期趨勢

本研究使用失能調整人年(Disability-adjusted life years, DALYs)量化2010、2015、2018、2019及2020年台灣本島19個縣市乳癌、子宮頸癌、口腔癌及結直腸癌疾病負擔長期趨勢。以台灣癌症登記資料庫蒐集四癌的死亡人數、發生人數、治療率與治癒率參數，結合三階段癌症疾病自然史模型考慮不同健康階段的失能權重與失能持續時間，分析年份、年齡組與縣市間癌症的死亡、發生和DALYs。研究結果顯示口腔癌年齡別高死亡率(Age-specific death rate, ADR)集中於75-79歲，其餘三癌皆在85+歲；年齡別高發生率(Age-specific incidence rate, AIR)與癌症期別分布，乳癌為45-49歲與第I期和第II期、子宮頸癌為35-39歲與第0期、口腔癌為50-54歲與第IV期、結直腸癌為65-69歲與第III期。高負擔縣市之五年平均年齡標準化DALYs率，乳癌每十萬女性人口於台北市(損失421人年)、台中市(損失415人年)及嘉義市(損失411人年)，子宮頸癌每十萬女性人口於台東縣(損失155人年)、花蓮縣(損失133人年)及基隆市(損失121人年)，口腔癌每十萬人口於台東縣(損失393人年)、花蓮縣(損失384人年)及雲林縣(損失369人年)，結直腸癌每十萬人口於台南市(損失325人年)、高雄市(損失317人年)及雲林縣(損失312人年)，皆凸顯縣市層面之疾病負擔差異。整體而言，全台2010-2020年每十萬人口疾病負擔由高至低與佔總DALYs率比例，依序為乳癌五年平均年齡標準化DALYs率為損失376人年(38%)，其次為結直腸癌損失285人年(29%)，口腔癌損失219人年(22%)，最後為子宮頸癌損失104人年(11%)，四癌中乳癌疾病負擔更為嚴重。而疾病負擔隨時間變化，乳癌、口腔癌與結直腸癌均有增長，子宮頸癌趨勢下降。本研究基於各縣市不同年齡組特定癌症期別發生人數的數據缺乏，假設年齡組和縣市之期別占比與全國相同推估人數，提供台灣各縣市四癌疾病負擔之長期趨勢，評估不同時間和地區死亡與發生的年齡別比率以及年齡標準化DALYs率的變化，根據結果建議各縣市持續提升四癌篩檢率與陽性個案追蹤率，並期許未來納入更多癌症別，探討各地區不同癌症疾病負擔嚴重程度或篩檢因素變化對疾病負擔的影響，作為癌症監測或政策推動的參考依據。

This study quantifies the long-term trends of disease burden for breast, cervical, oral, and colorectal cancers in 19 counties and cities in Taiwan in 2010, 2015, 2018, 2019, and 2020 by using disability-adjusted life years (DALYs) approach. Epidemiology data were obtained from the Taiwan Cancer Registry database including the number of mortality and incidence cases, the proportion treated, and the proportion cured for four cancers. We used the three-stage natural disease history model for cancer to consider disability weight (DW) and disability duration (L) at different health stages. This study also analyzes cancer mortality, incidence, and DALY rates between years, age groups, and counties and cities.The age group of 75-79 showed the highest age-specific death rate (ADR) for oral cancer, and the other three cancers were above 85 years old. The mostly noticed of highest age-specific incidence rate (AIR) and cancer stage for breast cancer was at 45-49 years and cancer stage I and II, cervical cancer was at age 35-39 and cancer stage 0, oral cancer was 50-54 years old and cancer stage IV, and colorectal cancer was 65-69 years old and cancer stage III.The five-year average age-standardized DALYs rates for the top three highest-burden counties and cities showed that the DALYs per 100,000 female population for breast cancer in Taipei City, Taichung City, and Chiayi City were 421, 415, and 411, respectively. For cervical cancer, the top three DALYs per 100,000 female population in Taitung County, Hualien County, and Keelung City were 155, 133, and 121, respectively. For oral cancer, the top three highest DALYs per 100,000 population in Taitung County, Hualien County, and Yunlin County were 393, 384, and 369, respectively. Lastly, for colorectal cancer, the DALYs per 100,000 population in Tainan City, Kaohsiung City, and Yunlin County were 325, 317, and 312, respectively, which were the top three. The results showed that there were differences in disease burden by county and city.Overall, between 2010 and 2020, the five-year average age-standardized DALYs rate per 100,000 population and the proportion of the total DALYs rate were 376 (38%), 285 (29%), 219 (22%), and 104 (11%), respectively. Among the four cancers, the breast burden was still increased and should be attention to more than the other three cancers.This study assumed the cancer stage ratios of age groups as well as counties and cities are the same as the nation, based on the lack of data on the number of incidence cases for cancer stage-specific in different age groups and regions. We provided the long-term trends of disease burden for four cancers by county and city in Taiwan and evaluated the time-dependent age-specific death rate and age-specific incidence rate as well as the change in age-standardized DALYs rates. It's recommended to increase the rates for cancer screening and follow-up for positive cases in each county and city. Further research is needed to include more cancers and explore the severity of disease burden for different cancers or the impact of changes in screening in each region, which could provide recommendations for cancer surveillance or policy promotion.