Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system–related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.

中文翻译：

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中等收入国家的高负担癌症：针对高危人群的预防和早期检测策略回顾

低收入国家，尤其是中等收入国家 (MIC) 的癌症发病率正在上升，主要受四种高负担癌症（乳腺癌、宫颈癌、肺癌、结直肠癌）的驱动。到 2030 年，超过三分之二的癌症死亡将发生在中等收入国家。除了努力改善获得癌症治疗的机会外，还需要进行预防和早期检测。在高收入国家降低癌症死亡率的成功策略在其他国家并不总是有效、可行或负担得起。在这篇综述中，我们评估了预防和早期发现乳腺癌、宫颈癌、肺癌和结直肠癌的策略，重点关注可改变的危险因素和高危亚群。烟草税、人乳头瘤病毒疫苗接种、宫颈癌筛查和治疗策略、减少与患者和卫生系统相关的乳腺癌和结直肠癌早期检测延迟的努力代表了在许多中等收入国家推进癌症控制的最高收益策略。最初关注高风险人群是合适的，在资源允许的情况下增加人口覆盖率。这些战略可以显着降低癌症死亡率，并作为各国制定综合癌症控制计划的基础。需要对国家癌症监测基础设施进行投资；缺乏确定高危人群的国家癌症数据仍然是制定针对具体情况的癌症控制战略的障碍。在资源允许的情况下增加人口覆盖率。这些战略可以显着降低癌症死亡率，并作为各国制定综合癌症控制计划的基础。需要对国家癌症监测基础设施进行投资；缺乏确定高危人群的国家癌症数据仍然是制定针对具体情况的癌症控制战略的障碍。在资源允许的情况下增加人口覆盖率。这些战略可以显着降低癌症死亡率，并作为各国制定综合癌症控制计划的基础。需要对国家癌症监测基础设施进行投资；缺乏确定高危人群的国家癌症数据仍然是制定针对具体情况的癌症控制战略的障碍。