Cancer is a devastating disease. It is estimated that 1.7 million Americans will be diagnosed with cancer in 2018 and approximately 610,000 will die of it. Cancer does not discriminate. It affects humans of all ages, races, and ethnicities. Although virtually everyone is at risk for developing and dying from cancer, the burden of this disease is not equal. Substantial disparities have been present for years. Bridging these disparities defines a central challenge for our nation’s cancer control efforts. Despite a 25-year decline in the cancer mortality rate, cancer is the second leading cause of death in the United States and will surpass cardiovascular disease to become the leading cause of death in the next decade. Review of the progress to date indicates that, although much good has been done, much more good can be done. Since 1991, there has been a 26% decline in the cancer death rate age adjusted to the year 2000 standard population. There are more than 15.5 million cancer survivors in the United States. Given the challenge that still exists, it is appropriate to assess where the fields of cancer control and oncology have come from and where they are going, what issues must be dealt with, and what interventions must be implemented if we are to most efficiently control cancer. Over the past 5 decades, there has been an extraordinary investment in cancer research that has led to a greater understanding of the disease. Indeed, cancer is being redefined. We are literally moving from the mid-19th century definition based on histopathology to a 21st century definition of cancer that also includes genomic information. Past investments in basic research are yielding better diagnostic and screening technologies and leading to new approaches to treatment. Molecular biology provides the foundation for new treatments in precision medicine. Decades of immunology research are showing us ways to effectively harness the patient’s immune system and encourage it to attack their cancer. At the same time, a better understanding of carcinogenesis is allowing for improved cancer prevention. In the next several issues of CA: A Cancer Journal for Clinicians, the American Cancer Society will publish a series of articles assessing trends in cancer mortality and issues and opportunities in cancer prevention, screening, and treatment. These articles summarize where we have come from, the current state of cancer in the United States, and how more consistent and equitable application of currently available interventions can further reduce the cancer incidence and death rates. When there are sufficient data to make a projection, estimates of the potential effect of cancer control interventions are included. Of course, we must continue to support scientific research and innovation, as the future promises even greater benefit. The foundation of a national cancer control plan to reduce the burden of cancer is a group of initiatives to ensure equal and full access to the combination of preventive and therapeutic measures that are already proven effective. We believe this is a moral imperative. These goals cannot be achieved, however, without recognizing that the roots of health care disparities are deep, reflecting fundamental determinants of health, such as poverty, conscious and unconscious racism, barriers to the availability of healthy foods, a “built environment” that limits opportunities for physical activity, and the lack of systems that ensure access to high-quality health care. Any national cancer control plan must include meaningful efforts to address these determinants of health. Chief Medical and Scientific Officer and Executive Vice President of Research, American Cancer Society, Atlanta, GA; Strategic Director, Pathology Research, American Cancer Society, Atlanta, GA; Chief Cancer Control Officer, American Cancer Society, Atlanta, GA.

中文翻译：

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迈向控制癌症

癌症是一种毁灭性的疾病。据估计，2018 年将有 170 万美国人被诊断出患有癌症，大约 610,000 人将死于癌症。癌症不歧视。它影响所有年龄、种族和民族的人类。尽管几乎每个人都有患癌症和死于癌症的风险，但这种疾病的负担并不相等。多年来一直存在巨大差异。弥合这些差异是我们国家癌症控制工作面临的核心挑战。尽管癌症死亡率下降了 25 年，但癌症是美国第二大死因，并将在未来十年超过心血管疾病成为主要死因。回顾迄今取得的进展表明，虽然已经做了很多好事，但还可以做得更多。自 1991 年以来，调整到 2000 年标准人口的癌症死亡率年龄下降了 26%。美国有超过 1550 万癌症幸存者。鉴于仍然存在的挑战，如果我们要最有效地控制癌症，评估癌症控制和肿瘤学领域的起源和发展方向、必须处理哪些问题以及必须实施哪些干预措施是适当的. 在过去的 5 年中，对癌症研究进行了大量投资，使人们对这种疾病有了更深入的了解。事实上，癌症正在被重新定义。我们正在从 19 世纪中叶基于组织病理学的定义转向 21 世纪还包括基因组信息的癌症定义。过去对基础研究的投资正在产生更好的诊断和筛查技术，并导致新的治疗方法。分子生物学为精准医学的新疗法奠定了基础。数十年的免疫学研究向我们展示了有效利用患者免疫系统并鼓励其攻击癌症的方法。同时，更好地了解致癌作用有助于改善癌症预防。在接下来的几期 CA：临床医生癌症杂志中，美国癌症协会将发表一系列文章，评估癌症死亡率的趋势以及癌症预防、筛查和治疗方面的问题和机遇。这些文章总结了我们从何而来，美国的癌症现状，以及如何更加一致和公平地应用当前可用的干预措施可以进一步降低癌症发病率和死亡率。当有足够的数据进行预测时，就包括对癌症控制干预措施的潜在影响的估计。当然，我们必须继续支持科学研究和创新，因为未来会带来更大的收益。减轻癌症负担的国家癌症控制计划的基础是一系列举措，以确保平等和充分地获得已经证明有效的预防和治疗措施的组合。我们相信这是道德上的必要。然而，如果不认识到卫生保健差距的根源是深刻的，反映了健康的基本决定因素，例如贫困、有意识和无意识的种族主义、健康食品供应的障碍、限制身体活动机会的“建筑环境”以及缺乏确保获得高质量医疗保健的系统。任何国家癌症控制计划都必须包括解决这些健康决定因素的有意义的努力。佐治亚州亚特兰大市美国癌症协会首席医学和科学官兼研究执行副总裁；乔治亚州亚特兰大美国癌症协会病理学研究战略总监；乔治亚州亚特兰大市美国癌症协会首席癌症控制官。任何国家癌症控制计划都必须包括解决这些健康决定因素的有意义的努力。佐治亚州亚特兰大市美国癌症协会首席医学和科学官兼研究执行副总裁；乔治亚州亚特兰大美国癌症协会病理学研究战略总监；乔治亚州亚特兰大市美国癌症协会首席癌症控制官。任何国家癌症控制计划都必须包括解决这些健康决定因素的有意义的努力。佐治亚州亚特兰大市美国癌症协会首席医学和科学官兼研究执行副总裁；乔治亚州亚特兰大美国癌症协会病理学研究战略总监；乔治亚州亚特兰大市美国癌症协会首席癌症控制官。