生物与医学2022nature.com
早发性癌症正在成为全球流行病吗？
Is early-onset cancer an emerging global epidemic?
入门 · 约 45 分钟读完前置知识：流行病学基础、癌症筛查原理
导读
这篇 Nature Reviews 的综述探讨早发性癌症（50 岁以下人群癌症）是否正在成为全球性流行病。作者指出筛查普及在一定程度上推高了检出率，但多种癌症的早发病例确实存在真实增长，而具体病因（如早期生活暴露）仍不明确，需要前瞻性队列研究和生物样本库来解答。
HN 关注点：讨论焦点在于如何区分筛查带来的检出率上升与真实的发病率增长，以及环境污染等潜在致病因素。
HN 评论精选
这几条评论里：质疑 1 补充 3
补充主张把体内化学负荷检测纳入常规体检，以数据回答早发癌症病因
论文说“个体暴露的影响仍大多未知，需要前瞻性队列研究和专门的数据采集”。这意味着体内化学负荷检测应成为医疗常规：对多氯联苯、阿特拉津除草剂、三氯乙烯等工业溶剂、溴化阻燃剂、亚硝胺、塑化剂、六价铬等物质，每年通过血液、尿液（可能还有脂肪活检和母乳）采样检测，纳入标准体检。这样积累的数据集才能回答这个问题。这并非新提议，2001 年 PBS 报道记者 Bill Moyers 的体内化学负荷检测结果时就指出：我们每个人体内都储存或流经着一定量的工业化学残留。
photochemsyn查看英文原文
> "However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies." What that means is analytical body-burden data collection should be a medical norm, for a variety of substances: polychlorinated biphenyls, triazine herbicides (atrazine), industrial solvents like trichloroethylene, brominated fire retardants, nitrosoamines, plastic-sourced phthalates, perchlorates, hydrazine, hexavalent chromium and so on. Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure. That would provide a dataset which could be used to address that question. This is hardly a new proposal, for example see this 2001 PBS report, in which journalist Bill Moyers got his body burden test results: https://www.pbs.org/tradesecrets/problem/bodyburden.html The results are not unusual. Each of us has some load of industrial chemicals stored in or passing through our bodies. These chemical residues – termed the "chemical body burden" – can be detected in blood, urine and breast milk.
质疑质疑如何区分筛查导致的检出增加与真实发病率上升
筛查越来越普遍，本来就会因为“去找”而发现更多癌症——他们如何区分这两者？医生：早期筛查提高了各种癌症的五年生存率。患者：当然提高了，但我会活得更久吗？
phkahler查看英文原文
>> Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. How do they separate these two. Early testing is becoming more common so you expect to see more cancer simply due to looking for it. Doc: Early screening has increased the 5-year survival rate for various cancers. Patient: Of course it has, but will I live any longer?
补充猜测某种环境化学物可能同时导致心理疾病和早发癌症
我感觉焦虑、抑郁等心理健康问题大幅增加，尤其是年轻人。我年轻时（80 年代末 90 年代初）这些并不是主要问题。有人说我错了，只是当时人们不谈论；但即使在亲友圈里当时也没这回事。有人归因于 9/11 后的世界或社交媒体，但我怀疑是否有某种我们暴露更多的化学物质，既导致心理疾病也导致早发癌症。
irrational查看英文原文
I feel like there has been a great increase in mental health issues: anxiety, depression, etc., especially among youth. I don’t recall these being major issues from when I was a youth in the late 80s and early 90s. I’m told that I’m wrong and people just didn’t talk about it so I wasn’t aware of it. But even amongst close family members and friends it wasn’t a thing. Now, I’ve seen some claim it is the post 9/11 world or social media, but I have to wonder if there is some chemical we are exposed to more that might be causing mental disorders in addition to early onset cancers.
补充补充猜想：新商品散发的挥发性化学物可能是诱因
如果我们要在饮食和污染之外抛出各种随机理论，那新制造商品挥发出的挥发性化学物质呢？
MonkeyMalarky查看英文原文
If we're going to throw out random theories for the cause like diet and pollution, what about all the volatile chemicals off-gassing from freshly manufactured goods?
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