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卫报

《卫报》对50岁以下人群癌症的看法:必须正视肥胖带来的风险The Guardian view on cancers in under-50s: the risks of obesity must be confronted

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“更早的检测被认为是年轻患者增加的一个因素。” 摄影:Joe Giddens/PA‘Earlier detection is thought to be one factor behind the rise in younger patients.’ Photograph: Joe Giddens/PA

世界癌症研究基金会(WCRF)关于50岁以下人群癌症发病率上升的最新研究结果令人极度担忧。尽管癌症诊断在任何年龄段都是坏消息,但对于大多数身体健康的年轻人来说,这尤其是一个沉重打击。在英格兰、荷兰和美国观察到的趋势中,结直肠癌(或肠道癌)发病率的上升尤为令人不安。在英格兰,其他发病率上升的癌症还包括子宫癌和肾癌。

The latest findings about the rise in cancers in people under 50, from the World Cancer Research Fund (WCRF), are extremely concerning. While a cancer diagnosis is bad news at any time, it is a particular blow for those in younger age groups where most people are in good health. Overlapping trends observed in England, the Netherlands and the US include a troubling rise in the incidence of colorectal (or bowel) cancer. Other diseases that have increased in England include uterine and kidney cancers.

这些疾病在年轻人中仍然罕见:50至70岁成年人中被诊断出患癌的人数是20至40岁人群的10倍。研究人员认为,早期发现可能是年轻患者数量上升的原因之一。在英格兰,更早诊断出更多癌症是一项明确的政策目标,因为诊断延迟和筛查覆盖率低是当地死亡率高于欧洲其他地区的主要原因。

These diseases are still rare in young people: 10 times more adults in their 50s, 60s and 70s are diagnosed than those in their 20s, 30s and 40s. Earlier detection is thought to be one factor behind the rise in younger patients. Diagnosing more cancers sooner is an explicit policy goal in England, where late diagnosis and lower uptake of screening are two reasons for mortality rates that are higher than elsewhere in Europe.

然而,遗憾的是,诊断技术的进步并非病例增加的主要原因。尽管相关研究仍在进行,许多问题尚未得到解答,但现有证据表明,肥胖和不良饮食习惯不仅会导致癌症,还会引发心脏病和2型糖尿病。Prospect-UK研究目前正在招募25万名参与者,开展一项关于早发性(50岁以下)肠道癌的纵向研究。该研究将比以往更详细地分析营养相关信息,包括人们摄入减少的食物种类。

But diagnostic improvements are unfortunately not the main reason for increased cases. While research is ongoing and many questions remain, evidence points to obesity and poor diet causing cancers as well as heart disease and type 2 diabetes. The Prospect-UK trial is currently seeking 250,000 participants for a longitudinal study into early-onset (under-50) bowel cancer. It will scrutinise information about nutrition in more detail than has been done previously, including what people are eating less of.

通过针对吸烟行为来降低肺癌发病率的国际努力取得了成功,为公共卫生运动树立了有力典范。由于烟草行业的游说,这一过程耗时比预期更长。但将监管与宣传信息相结合以改变行为的做法,仍然是黄金标准。WCRF的数据表明,50岁以下人群的肺癌发病率持续下降。

The success of international efforts to cut lung cancer through targeting smoking set a powerful precedent for public health campaigning. This took longer than it should have done, due to tobacco industry lobbying. But it remains the gold standard of regulation combined with messaging, to bring about behaviour change. The WCRF data shows that lung cancer rates in under-50s have continued falling.

迄今为止,减重行动并未产生类似的效果。各地的情况并不相同;最近一项研究发现,在一些国家,肥胖率的快速上升已被停滞所取代。但英语国家的情况最为严重,而英国未能采取有力措施,则成为过去十年卫生政策中最大的失望之一。

So far, efforts to cut obesity have had nothing like the same impact. The patterns are not the same everywhere; one recent study found that in some countries a rapid rise had been replaced by a levelling-off. But English-speaking countries have some of the worst records, and the lack of strong action in the UK is among the big disappointments of health policy in the last decade.

从鲍里斯·约翰逊到韦斯·斯特里廷,多位政治家都曾承诺推行肥胖行动计划,但在食品和饮料行业的反对下,这些计划最终都被削弱了。去年,科学家们致信斯特里廷先生,抗议政府“几乎什么都没做”来提醒消费者注意培根和火腿中添加的亚硝酸盐的致癌性。

Politicians from Boris Johnson to Wes Streeting have committed to obesity action plans, only to water them down in the face of opposition from the food and drink industries. Last year, scientists wrote to Mr Streeting to protest that the government had done “virtually nothing” to alert consumers to the carcinogenic properties of the nitrites added to bacon and ham.

癌症研究和治疗取得巨大进展的同时,早期癌症发病率却在上升,这背后有一种令人不安的讽刺意味。对许多医生和患者而言,这是一个充满希望的时代。但政治家和卫生部门负责人必须警惕这样一种情况:一些群体的健康状况有所改善,而另一些群体却因社会经济劣势而面临更高的风险。

There is a grim irony in dramatic advances in cancer research and treatment coinciding with the rise in early-onset cancers. For many doctors and patients, this a period of hope. But politicians and health bosses must guard against a situation in which some groups have improved prospects, while others face increased risks linked to socioeconomic disadvantages.

就肥胖和饮食而言,其与贫困之间的密切关联表明,政府需要以整体视角看待公共支出,并认识到国家医疗服务体系(NHS)并非唯一能够改善健康的机构。尽管仍需对早期癌症开展更多研究,但现有数据已经为我们提供了大量信息。政府应当像过去应对大型烟草公司那样,在解决肥胖问题根源上同样果断。

In relation to obesity and diet, the close link with poverty points to the need for ministers to view public spending holistically, and to recognise that the NHS is not the only institution with the capacity to improve health. While more research into early-onset cancers is needed, existing data tells us a great deal. Governments should be as bold in tackling the causes of obesity as they once were in confronting big tobacco.