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环境肿瘤学未来展望篇——《中国恶性肿瘤学科发展报告(2024)》
2025-09-05 10:41

1. 概述

研究表明,70%-90%的肿瘤发病率与环境因素相关,因此,减少可改变的环境危险因素成为减轻肿瘤负担的关键策略。环境肿瘤学是一门研究肿瘤发生内外环境因素、机制、预防、干预及诊疗措施的学科。它基于多学科交叉,整合宏观环境因素与微观分子生物学,为肿瘤防治提供新技术、新策略及新模式。

近年来,国内环境肿瘤学研究取得重要突破。在基础研究方面,揭示了空气污染、水污染、微塑料暴露、病毒感染等环境因素与肿瘤发生的关联机制;在应用研究领域,开发了基于EBV标志物的鼻咽癌早期筛查技术和环境暴露-多基因风险预测模型等创新方法。人工智能、深度学习及多组学分析等前沿技术的引入,显著提升了研究的精准性和效率。国际合作方面,环境肿瘤学在多次国际学术会议上受到广泛关注,推动了全球范围内环境肿瘤的防治研究合作交流。

在研究平台建设方面,国家癌症中心、中国医学科学院肿瘤医院、北京大学肿瘤医院及兰州大学环境肿瘤学中心等机构系统开展了肿瘤流行病学、分子病因学及精准筛查研究,构建了全国性肿瘤监测体系和高危人群筛查数据库。中国抗癌协会环境肿瘤学专业委员会推动环境肿瘤防治共建单位(基地)的建设,强化了癌症防控和环境健康监测能力。

在全球范围内,WHO、IARC、EPA、NCI等权威机构主导环境致癌物研究、风险评估和政策制定,推动了基因组学、单细胞测序、暴露组学等前沿技术在癌症早期筛查和个体化治疗中的应用。国际癌症基因组共享计划等跨学科合作项目,进一步促进了精准肿瘤防治和环境健康政策的优化。

中国政府通过《健康中国2030》规划纲要和《癌症防治行动实施方案(2023-2030年)》等政策,强化了环境健康管理、癌症早筛早诊及中西医结合创新研究。通过完善癌症监测网络、优化医疗资源配置、推进分级诊疗和健康教育,以及加强环境污染治理,为环境肿瘤学研究提供了政策保障。

未来环境肿瘤学的发展将聚焦以下方向:(1)构建全国性环境肿瘤数据库和实时监测网络,实现精准预警和风险评估;(2)深化基因-环境交互作用研究,揭示环境污染物致癌机制;(3)推动人工智能、基因组学等技术在肿瘤早筛、早诊和个性化治疗中的应用;(4)加强临床医学、基础医学、流行病学、公共卫生、环境科学以及食品药品安全等学科领域的交叉融合;(5)建设环境肿瘤防治共建单位(基地)或基地,整合多方资源,推动区域性和全国性环境肿瘤防控网络建设;(6)扩大国际合作,推动环境肿瘤防控政策的全球实施。未来五年,环境肿瘤学将向精准化、智能化和跨学科协作方向迈进,通过构建多层次、多领域协同的创新体系,为全球肿瘤防控体系建设提供科学依据和实践路径。

4.本学科未来发展趋势与对策

4.1 未来5年发展的战略需求

4.1.1 全面提升环境肿瘤认知与防治意识

提高公众和政府对环境肿瘤的认知水平是推动环境肿瘤防治工作的基础。需加强环境肿瘤健康教育,增强社会对环境因素与肿瘤发生关联的理解,提升全民自我保护意识。政府应在“健康中国战略”框架下,将环境肿瘤防治纳入国家和地方发展规划,推动政策支持与社会资源投入。为此,需整合社会各界力量,促进各级政府、学术机构和社会组织协同合作,构建完善的环境肿瘤防治机制。同时,开展多层次、多维度的科普宣传,重点普及空气污染、化学污染、噪声污染等环境危害与肿瘤风险的关联,减少公众认知盲区。

以肥胖与癌症的关联为例,最新数据显示,我国成年人超重和肥胖率分别达34.3%和16.4%,预计到2030年,成人超重肥胖率将突破70%。研究表明,肥胖与多种癌症的发生发展密切相关,近半数癌症病例与肥胖相关,肥胖已成为部分癌症的主要病因。为此,国家卫健委等16部门于2024年联合发布《“体重管理年”活动实施方案》,并于2025年持续推进三年行动,通过普及健康生活方式、设立体重门诊等措施,推动全民科学管理体重。这一政策不仅是对肥胖问题的积极应对,更是“健康中国2030”战略的重要实践,标志着健康管理从个体层面上升至国家战略高度。通过政策引导、科技支撑和社会动员,构建“预防-干预-维护”的全周期健康体系,为降低癌症等疾病风险提供了重要突破口,对提升全民健康水平具有深远意义。

4.1.2 加强环境肿瘤防治共建单位(基地)建设

环境肿瘤防治工作亟需构建跨学科研究平台,以推动环境肿瘤防治共建单位(基地)的建设。重点发展方向包括分子流行病学、环境监测与评估、基因组学、代谢组学等领域,旨在探索有效的环境干预措施。通过整合现代科技手段,如大数据分析与人工智能技术,深入研究环境致癌物的作用机制、肿瘤易感性及疾病相关生物标志物,推动肿瘤预防、早期筛查与诊断技术的创新与发展。此外,应建立全国范围的肿瘤环境高危因素监测网络,结合大数据平台构建实时监控与评估体系,实现肿瘤的精准防控与早期干预,从而提升癌症防治效果。同时,加强环境学、医学、公共卫生学等多学科的协同合作,汇聚领域内专家力量,共同推动环境肿瘤学的整体研究进展与临床应用转化。

4.1.3 制定并实施环境肿瘤学相关政策与指南

中国抗癌协会环境肿瘤学专委会应发挥重要作用,制定并推动环境肿瘤学相关指南的落实。根据地域差异、环境特征、经济发展水平等因素,制定具体的肿瘤防治措施。同时向政府积极建议,特别是在环境污染严重的区域,出台有针对性的政策和措施,限制污染物排放,减少环境致癌物的暴露。同时,推动中国抗癌协会环境肿瘤学相关指南的制定和实施,重点关注肿瘤的环境因素、相关机制以及早期筛查和诊疗技术的研究。该指南将为肿瘤防治政策的执行提供理论依据,并促进社会各界落实公共卫生政策与环境政策相结合的行动。

4.1.4 促进创新科技成果的转化应用

为实现环境肿瘤防治的创新发展,必须注重技术转化应用。应依托高水平的研究基地和科研机构,将环境肿瘤防治领域的科研成果转化为实际应用,包括研发新的预防技术、健康管理工具和肿瘤诊疗设备。具体而言,可以结合人工智能、影像学技术、信息技术等创新手段,开发适用于环境肿瘤的智能化监测设备、诊断系统以及治疗决策支持系统。此外,加强国家层面的技术创新合作,推动环境肿瘤防治技术的研发与产业化,建立由科研、产业、医疗三方合作的创新链条,实现肿瘤防治科技成果的快速转化,提升环境肿瘤防治的综合能力。

4.1.5 探索创新的环境肿瘤监测技术

建立完善的肿瘤环境监测体系,是有效预防环境肿瘤的关键之一。应探索创新的环境肿瘤监测技术,利用遥感技术、空间数据分析等手段,建立针对高风险区域和易感人群的环境监测网络。同时,发展实时监测技术,能够在不同的环境暴露水平下实时记录污染物数据,为肿瘤风险评估提供科学依据。建立和完善高危人群队列,筛选易感人群并进行定期随访,结合环境暴露因素,如饮食、生活习惯、居住环境等多方面数据,为环境肿瘤的防控提供精准的监测信息。此外,重点研究气候变化、生态系统破坏等环境因素与肿瘤发生之间的关系,以期为环境肿瘤防治提供更为科学的监测和预防手段。

4.1.6 完善肿瘤防控体系,推动政策实施

完善肿瘤防控体系是环境肿瘤防治的核心任务,需强化环境因素干预,实施早筛、早诊、早治策略,推动科研攻关。通过建立以环境肿瘤防治共建单位(基地)为核心的精准防控体系,整合国家、地方、学术和社会资源,加强跨部门协作与国际合作,借鉴国际先进经验,推动我国环境肿瘤防治模式的创新与完善。同时,注重环境政策与肿瘤防治政策的协同融合,为全面防治提供系统性支持。

国际经验表明,环境政策对降低癌症发病率具有显著效果。例如,韩国首尔市实施细沙尘季节制度后,部分环境下的肺癌发病率下降;海湾合作委员会国家通过烟草控制、健康饮食推广等措施,显著减少了烟草消费和含糖饮料购买量。沙特阿拉伯和卡塔尔禁止在中小学销售不健康食品,巴林则通过家庭医生推广健康生活方式。这些举措为我国环境肿瘤防治政策的制定提供了重要参考,有助于推动我国环境肿瘤防治体系的进一步完善。

4.2 未来5年重点发展方向

4.2.1 完善我国环境肿瘤大数据与监测体系

我国环境因素引起肿瘤的大数据平台仍然较为薄弱,与全球先进水平相比,仍有差距。尽管中国肿瘤登记中心开展了全国范围的肿瘤随访数据收集,但整体的监测体系尚未成熟。现有的国家医疗质量监测系统与地方健康信息平台连接性不足,各医疗和科研机构的数据未能实现有效共享,且数据量和质量都存在不小的挑战。尤其是在肿瘤相关环境因素的监测方面,缺乏系统性整合。因此,亟需构建完善的环境肿瘤大数据和监测平台,不仅为环境肿瘤防控提供支持,还能为肿瘤早筛、早诊和早治提供科学依据。进一步加强数据挖掘和人工智能技术应用,推动环境肿瘤监测、预警体系的建设,增强对环境暴露与健康影响的预测能力,提升肿瘤风险评估的准确性。

4.2.2 加强环境肿瘤发生机制的研究

尽管环境因素被认定为肿瘤发生的一个重要因素,但对环境因素如何影响肿瘤发生发展的机制仍然缺乏深入的理解。环境肿瘤学的研究尚处于探索阶段,尤其是涉及内外环境因素的系统性研究和机制探索仍然存在诸多空白。因此,必须加强整合医学体系在环境因素与肿瘤发病关系的应用,推动现代技术(如基因组学、二代测序)在肿瘤环境暴露研究中的应用,揭示遗传易感性与环境因素的相互作用。同时,重点研究空气、水源、土壤污染等外部环境因素以及生活方式、社会因素对肿瘤发生的影响,推动肿瘤预防策略的创新。

4.2.3 扩大环境肿瘤研究的组织架构

环境肿瘤学的防治研究尚未形成系统化的学科体系和专业团队,尽管环境肿瘤防治已得到国际关注,但国内的研究和组织发展仍显不足。近年来,随着中国抗癌协会成立环境肿瘤学专委会,环境肿瘤的防治工作进入了新的阶段,但研究体系和专业人才的缺乏仍是重大挑战。未来需通过加强学科建设,培养专业研究人员,构建环境肿瘤防治共建单位(基地),推进学术交流,提升环境肿瘤研究的整体水平。以此为基础,推动肿瘤防治的新方法与新技术开发,构建可推广的精准防控体系,支持肿瘤早诊早治,并推动科学成果转化。

4.2.4 加强环境肿瘤防治的健康指导和科普宣传

随着“健康中国战略”的实施,环境肿瘤的防治工作变得愈加重要。当前,民众对环境肿瘤的认知和防治措施的了解仍然不足,这与环境因素的预防和健康生活方式的推广有较大差距。因此,提升公众健康意识,优化健康生活方式和环境治理,成为各级政府和学术组织的重要任务。通过加强健康教育、普及科普信息,提高人民群众对环境肿瘤的认知,倡导绿色生活、良好的饮食和生活习惯,促进社会整体健康水平的提升。特别是在环境治理方面,加大力度减少污染源,为社会创造更健康的生活空间。

4.2.5 推动环境肿瘤学快速发展

环境肿瘤学作为新兴学科,未来将在多学科交叉、技术创新及国际合作中迎来重要发展机遇。研究应集中于通过现代生物学技术(如基因组学、多组学、人工智能等)解析环境暴露与肿瘤发生的关系,并发现新的分子生物标记物,推动肿瘤早筛早诊新技术的应用。加强跨学科合作,推动流行病学、环境科学、毒理学等领域的整合,为环境肿瘤的防治提供更精准的科研支持。国际间的合作也是推动该学科发展的关键,尤其是在公共卫生政策、制度建设和环境改善方面。未来的重点应包括建立环境肿瘤防治共建单位(基地),汇集多学科的技术力量,制定并实施针对特定人群的防治策略,推动环境肿瘤学的长远发展。

4.3 未来5年发展对策

未来五年,环境肿瘤学将在大数据构建、风险监测、精准防治、综合防控体系、全国环境肿瘤防治共建单位(基地)建设及多学科融合等六大关键领域加速推进,以构建更加高效、精准的防治体系。同时,学科发展将注重会员扩展、科研基金申请、专著出版、科普宣传、指南制定及模式创新,全面提升环境肿瘤学的学术影响力与社会贡献。

环境肿瘤大数据平台建设是精准防控的核心支撑。未来五年,将加快全国范围内的临床、流行病学、环境因素及基因组数据整合,以促进肿瘤早筛、诊断、治疗和预防的个体化发展。首先,应构建全国性环境肿瘤大数据系统,集中管理临床信息、环境暴露历史及分子特征数据,为精准防治提供数据支持。同时,开发智能搜索引擎与AI分析系统,深度挖掘数据,识别高危区域及基因组特征,建立肿瘤“热区”预测模型。此外,应整合分子生物学、组学数据及环境因素,建立国家级生物样本库,助力跨学科研究。在技术应用方面,可借助AI辅助早筛与早诊技术,基于多组学数据开发AI算法,提高环境相关肿瘤的早期干预能力。同时,应制定环境肿瘤早期诊断技术的质量标准,推动新技术及新药物的临床应用,提高筛查及干预的准确性。

建立智能化、高效的环境肿瘤监测与预警系统是精准识别环境因素对肿瘤发生长期影响的关键。首先,在环境肿瘤高发区开展高危人群动态监测,结合社会、职业及自然环境因素,分析其对高危人群的影响。此外,依托长期队列研究(如CHARGE),系统监测环境暴露情况,探索环境因子与癌症风险的因果关系。针对环境风险评估,应精准筛选易感人群,实施个体化干预,提升实时预防能力。同时,利用暴露组学和高通量检测技术,解析环境污染物的致癌作用,构建环境肿瘤风险地图,为政策制定提供科学依据。

结合新一代基因组学和多组学技术,深入探索环境因素与肿瘤发生发展的分子机制,为精准防治技术的发展提供理论支持。首先,整合基因组学、表观遗传学、代谢组学等数据,揭示环境致癌物的作用机制。同时,筛选环境相关肿瘤特异性生物标志物,并应用于早筛和个体化治疗。在精准防治技术方面,基于大数据和生物信息学,研发高效、低成本的早筛与干预手段。此外,应探索环境诱导肿瘤的靶向治疗策略,提高个体化精准治疗效果,并分析环境污染物对抗肿瘤药物疗效的影响,以优化治疗方案。

加强跨学科合作,建立政府、科研、医疗、社会多方联动的环境肿瘤防治体系,以推动精准防治模式的实施。首先,应构建环境肿瘤防治综合平台,整合政府、医疗机构、科研单位及社会组织,形成协同防治体系。此外,建立高危人群精准健康管理体系,为个体制定个性化监测方案,实现精细化管理。在政策与科普方面,应制定绿色健康政策,加强环境肿瘤防治知识普及,提高公众健康意识。同时,开发智能化健康管理工具,如健康监测APP,为个体提供精准的肿瘤防控建议。

在全国范围内建设环境肿瘤防治共建单位(基地),推动研究与社会需求的紧密结合。首先,应加强政府部门与科研院所、医院的合作,推动政策与资金支持,促进科研与公共卫生体系协同发展。此外,应在环境肿瘤高发地区建立区域性防治示范中心,探索适应不同地域特征的防控策略。国际合作也是未来五年的重点任务。加强与全球领先机构的合作,借鉴国际经验,提升我国在环境肿瘤防治领域的影响力。同时,基于环境肿瘤防治共建单位(基地)建设,建立全国性环境污染与肿瘤风险评估体系,并推广环保型防癌社区,减少致癌环境因素的暴露。

推动环境肿瘤学与流行病学、环境科学、分子生物学等学科的深度融合,为精准肿瘤防治提供更科学的方法论支持。首先,应结合多组学技术,探索环境因子对个体健康的深层影响。此外,应推动高通量测序、单细胞分析、AI分析工具等新兴技术的应用,提高环境污染物及致癌因子的精准识别能力。在人才培养方面,应建立环境肿瘤学跨学科人才培养体系,鼓励学科交叉研究,推动学科融合发展。同时,依托智能化数据分析平台,结合大数据与人工智能,提升环境与肿瘤关系的智能预测能力。

【主编】

李玉民     兰州大学第二医院

李兆申     海军军医大学第一附属医院

【副主编】

胡文彪     澳大利亚昆士兰科技大学

季加孚     北京大学肿瘤医院

乔 梁      悉尼大学医学院Westmead医学研究所

乔友林     中国医学科学院

汤朝晖     上海交通大学医学院附属新华医院

吴 泓      四川大学华西医院

徐 骁      浙江大学医学院附属第一医院

张学文     吉林大学第二医院

张亚玮     中国医学科学院肿瘤医院

周 俭     复旦大学附属中山医院

周文策     兰州大学第二医院

朱继业     北京大学人民医院

【编委】(按姓氏拼音排序)

曹林平     浙江大学医学院附属第一医院

陈 昊     兰州大学第二医院

陈天辉     浙江省肿瘤医院

陈耀龙     兰州大学基础医学院

陈应泰     中国医学科学院肿瘤医院

方驰华     南方医科大学珠江医院                   

甘 婷     澳大利亚昆士兰科技大学

顾艳梅     兰州大学第二临床医学院

何裕隆     中山大学附属第七医院

贺东强     兰州大学第二医院

胡建昆     四川大学华西医院

胡俊波     华中科技大学同济医学院附属同济医院

胡晓斌     兰州大学公共卫生学院

冀 明      首都医科大学附属北京友谊医院

荚卫东     中国科学技术大学附属第一医院

焦作义     兰州大学第二医院

景丽百合  兰州大学第二医院

康鹏德     四川大学华西医院

李 非     首都医科大学宣武医院

李 华     中山大学附属第三医院

李 涛     北京大学人民医院

李文涛    上海市胸科医院

李 想     兰州大学第二临床医学院

刘 蓓     兰州大学第一医院

刘昌军    湖南省人民医院

刘光琇    中国科学院西北生态环境资源研究院

刘宏斌    解放军联勤保障部940医院

刘 杰     兰州大学第二医院

刘 荣     中国人民解放军总医院

刘 涛     兰州大学第二医院

门同义    内蒙古医科大学附属医院

孟文勃    兰州大学第一医院

彭 健     中南大学湘雅医院

邵英梅    新疆医科大学第一附属医院                       

沈云志    天津大学中心医院

宋爱琳    兰州大学第二医院

宋飞雪    兰州大学第二医院

宋克薇    济宁市第一人民医院

孙维建    温州医科大学附属第一医院

孙 备    哈尔滨医科大学附属第一医院

田普训    西安交通大学第一附属医院

屠政良    浙江大学医学院附属第一医院

王保军    中国人民解放军总医院

王德贵    兰州大学基础医学院

王东升    兰州大学药学院

王 捷     中山大学附属第二医院

王俊玲    兰州大学公共卫生学院

王 艳     首都医科大学

王 正     兰州大学第二临床医学院

卫洪波    中山大学附属第三医院

吴 静     首都医科大学附属北京友谊医院

吴 健     浙江大学医学院附属第一医院

谢小冬    兰州大学基础医学院

杨克虎    兰州大学基础医学院

杨 扬     中山大学附属第三医院

张德奎    兰州大学第二医院

张 凡    兰州大学第二医院

张继军    山西医科大学第一医院

张 磊    兰州大学第一医院

张水军    郑州大学第一附属医院

张 毅    郑州大学第一附属医院

赵 军    兰州大学第二医院

郑 弘    天津市第一中心医院  

周彦明   厦门大学第一医院

朱 帆    武汉大学基础医学院

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