Changing Incidence of Uterine Cancer in Rural Egypt: Possible Impact of Nutritional and Epidemiologic Transitions

Objective: The National Central Cancer Registry estimates the cancer diseases burden in China in 2024. Methods: We incorporated the surveillance data from 919 cancer registries of year 2019 and the longitudinal surveillance data from 106 registries during 2010 to 2019. We estimated the age-standardized incidence (ASIR) and mortality rates (ASMR) of overall and 23 major cancers in China in 2024 using the age-period-cohort model, stratified by sex and area. The age-standardized incidence (ASIRC) and mortality (ASMRC) rates by Chinese population were calculated based on the age structure of the population from the national census in 2000. The age-standardized incidence (ASIRW) and mortality (ASMRW) rates by World population were calculated using Segi's world standard age structure. Results: In 2024, there were approximately 5 150 600 new cancer cases in China (2 672 000 for males and 2 478 600 for females), with an ASIRW of 207.70 per 100 000 (215.71 per 100 000 in urban areas and 193.74 per 100 000 in rural areas). The estimated number of cancer deaths in China was 2 582 200 (1 640 500 for males and 941 700 for females), with an ASMRW of 90.90 per 100 000 (87.34 per 100 000 in urban areas and 96.27 per 100 000 in rural areas). When comparing between different sexes, the cancer ASIRs for both males and females were relatively close. The ASMRs for males were 1.9 times that of females. When comparing among different areas, the crude cancer incidence rate in rural areas was higher than that in urban areas, while the ASIRs were lower than that in urban areas. Both the crude mortality rate and the ASMRs in rural areas were higher than those in urban areas. Among different cancer types, lung cancer ranked first in terms of both incidence and mortality, with 1 175 900 new cases and 743 300 deaths, accounting for 22.8% and 28.8% of all cancer cases and deaths, respectively. In both males and females, the ASIRs and ASMRs of liver, stomach and esophageal cancer in rural areas were higher than those in urban areas, while the ASIRs and ASMRs of colorectal cancer in urban areas were higher than those in rural areas. The ASIRs and ASMRs of cervical cancer in rural areas were higher than those in urban areas. The disease burden of prostate cancer and breast cancer in urban areas was higher than that in rural areas. The incidence and mortality rates of lung cancer ranked first in most provinces of China. The incidence rate of nasopharyngeal cancer was relatively high in Guangxi, Guangdong, Hainan and Jiangxi. Renal cancer was more prevalent in northern regions, and prostate cancer was more common in economically developed areas. The incidence rate of thyroid cancer ranked second in Zhejiang, Fujian and Xinjiang. The incidence rates of esophageal cancer and cervical cancer were significantly lower in Beijing, Tianjin, Shanghai and Guangdong. Conclusions: The overall burden of cancer in China remains significant. Different regions should formulate targeted prevention and control strategies based on the characteristics of regional cancer disease burdens.

Objective: To evaluate the incidence and mortality status of thyroid cancer in China, 2013. Methods: Incidence and mortality data of thyroid cancer were derived from 255 population-based cancer registries in China. Age-specific and age standardized incidence and mortality rates of thyroid cancer in different areas (urban and rural) with different gender were calculated based on the stratification of area (urban and rural), gender, age and tumor position. Chinese census in 2000 and the world Segi's population were used for age-standardized incidence/mortality rates. The incident cases and deaths were estimated using age-specific rates and national population data in 2013. Results: The estimates of new cancer incident cases and deaths were 143.9 thousand and 6 500, respectively. The crude incidence rate was 10.58/100 000 (Male 5.12/100 000, Female 16.32/100 000). Age-standardized incidence rates by Chinese standard population (ASIRC, 2000) and by world standard population (ASIRW) were 8.82/100 000 and 7.67/100 000, respectively. Male to female ratio was 1∶3.2. The crude incidence rate in urban and rural areas were 15.03/100 000 and 5.41/100 000, respectively. After adjustment by China standard population, the rate in urban areas was 2.57 times higher than that of rural areas. The crude mortality rate of thyroid cancer was 0.48/100 000 (Male 0.33/100 000, Female 0.63/100 000). Age-standardized mortality rates by Chinese standard population (ASIRC, 2000) and by world standard population (ASIRW) were 0.33/100 000 and 0.32/100 000, respectively. The crude mortality rate in urban and rural areas were 0.57/100 000 and 0.38/100 000, respectively. After adjustment by China standard population, the rate in urban areas was 1.41 times higher than that of rural areas. The cumulative incidence and mortality rates (0-74 years old) were 0.74% and 0.03%, respectively. According to the data from 255 cancer registries, papillary carcinoma is the main pathology type, which accounted for 89.9% of all malignant tumors. Conclusions: The disease burden of thyroid cancer in urban areas is higher than that in rural areas. Females have the higher incidence rate than that of males. The reasons related to the higher incidence rate of thyroid cancer should be further investigated to provide evidence for appropriate cancer control strategies and policies to be made in China.

The National Central Cancer Registry (NCCR) collected cancer registration data in 2009 from local cancer registries in 2012, and analyzed to describe cancer incidence and mortality in China. On basis of the criteria of data quality from NCCR, data submitted from 104 registries were checked and evaluated. There were 72 registries' data qualified and accepted for cancer registry annual report in 2012. Descriptive analysis included incidence and mortality stratified by area (urban/rural), sex, age group and cancer site. The top 10 common cancers in different groups, proportion and cumulative rates were also calculated. Chinese population census in 1982 and Segi's population were used for age-standardized incidence/mortality rates. All 72 cancer registries covered a total of 85,470,522 population (57,489,009 in urban and 27,981,513 in rural areas). The total new cancer incident cases and cancer deaths were 244,366 and 154,310, respectively. The morphology verified cases accounted for 67.23%, and 3.14% of incident cases only had information from death certifications. The crude incidence rate in Chinese cancer registration areas was 285.91/100,000 (males 317.97/100,000, females 253.09/100,000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 146.87/100,000 and 191.72/100,000 with the cumulative incidence rate (0-74 age years old) of 22.08%. The cancer incidence and ASIRC were 303.39/100,000 and 150.31/100,000 in urban areas whereas in rural areas, they were 249.98/100,000 and 139.68/100,000, respectively. The cancer mortality in Chinese cancer registration areas was 180.54/100,000 (224.20/100,000 in males and 135.85/100,000 in females), age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 85.06/100,000 and 115.65/100,000, and the cumulative incidence rate (0-74 age years old) was 12.94%. The cancer mortality and ASMRC were 181.86/100,000 and 80.86/100,000 in urban areas, whereas in rural areas, they were 177.83/100,000 and 94.40/100,000 respectively. Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer, pancreas cancer, encephaloma, lymphoma, female breast cancer and cervical cancer, were the most common cancers, accounting for 75% of all cancer cases in urban and rural areas. Lung cancer, gastric cancer, liver cancer, esophageal cancer, colorectal cancer, pancreatic cancer, breast cancer, encephaloma, leukemia and lymphoma accounted for 80% of all cancer deaths. The cancer spectrum showed difference between urban and rural areas, males and females. The main cancers in rural areas were cancers of the stomach, followed by esophageal cancer, lung cancer, liver cancer and colorectal cancer, whereas the main cancer in urban areas was lung cancer, followed by liver cancer, gastric cancer and colorectal cancer. The coverage of cancer registration population has been increasing and data quality is improving. As the basis of cancer control program, cancer registry plays an important role in making anti-cancer strategy in medium and long term. As cancer burdens are different between urban and rural areas in China, prevention and control should be implemented based on practical situation.

In previous studies, we have shown a three to four times higher urban incidence of breast cancer and estrogen receptor-positive breast cancers in the Gharbiah Province of Egypt. We investigated the urban-rural incidence differences of gynaecologic malignancies (uterine, ovarian and cervical cancers) to explore if they show the same trend that we found for breast cancer. Cancer registry-based incidence comparison. Gharbiah population-based cancer registry (GPCR), Tanta, Egypt. All patients with uterine, ovarian and cervical cancer in GPCR from 1999 to 2002. We calculated uterine, ovarian and cervical cancer incidence from 1999 to 2002. For each of the three cancers, we calculated the overall and age-specific rates for the province as a whole, and by urban-rural status, as well as for the eight districts of the province. Incidence of all three cancer sites was higher in urban than in rural areas. Uterine cancer showed the highest urban-rural incidence rate ratio (IRR = 6.07, 95% CI = 4.17, 8.85). Uterine cancer also showed the highest urban incidence in the oldest age group (70+ age category, IRR = 14.39, 95% CI = 4.24, 48.87) and in developed districts (Tanta, IRR = 4.14, 95% CI = 0.41, 42.04). Incidence rates by groups of cancer sites showed an increasing gradient of urban incidence for cancers related to hormonal aetiology, mainly of the breast and uterus (IRR = 4.96, 95% CI = 2.86, 8.61). The higher urban incidence of uterine cancer, coupled with our previous findings of higher incidence of breast cancer and estrogen receptor positive breast cancer in urban areas in this region, may be suggestive of possible higher exposure to environmental estrogenic compounds, such as xenoestrogens, in urban areas.

Objective: To analysis the incidence rate and mortality rate of endometrial cancer in China from 2004 to 2017 according to the data from China Cancer Registry Annual Report. Methods: The incidence and mortality data of endometrial cancer were extracted from the China Cancer Registry Annual Report 2004 to 2017, and the incidence, mortality, number of new cases, number of deaths were extracted according to the region (national, urban, rural and eastern, middle and western areas) and the age composition of population to estimate the incidence and mortality of endometrial cancer nationwide. The age-standardized incidence rate and mortality rate were calculated based on the Chinese standard population in 2000 (ASIRC, ASIRW) and Segi's world population (ASMRC, ASMRW). Join Point regression was used to calculate the annual percentage change of morbidity rate, and Cochran-Armitage trend test was used to analyze the changing trend of morbidity and mortality. Results: From 2004 to 2017, the number of women covered by the China Cancer Registry Annual Report has increased from 35 571 657 to 215 201 995, and the total population of the covered areas has increased from 5.53% to 31.39%. The crude incidence rate of endometrial cancer increased from 6.20/100 000 to 10.06/100 000, and showed an upward trend over time (P<0.001). After adjusting for age, ASIRC increased from 5.75/100 000 in 2004 to 6.79/100 000 in 2017, and ASIRW increased from 5.60/100 000 in 2004 to 6.56/100 000 in 2017, both showing an upward trend over time (all P<0.001). The crude incidence rates in urban area and rural area were respectively 10.89/100 000 and 9.25/100 000 in 2017, and the ASIRC was higher in urban than rural areas (7.14/100 000 vs 6.43/100 000) after adjusting for age. The ASIRW was higher in eastern areas than middle areas and western areas (7.16/100 000 vs 6.44/100 000 vs 5.60/100 000). The incidence rate in rural areas showed more significant growth than urban areas [annual percent change (APC): 3.2% vs 0.7%, P<0.001]. The age-specific incidence rate increased with age and reached a peak in the age group of 50-54 years (25.70/100 000). Incidence rate in the under-40 age group increased more in rural areas than in urban areas (69.84% vs-7.09%). From 2004 to 2017, the age-standardized mortality rate shows a decreasing trend, with the ASMRC from 1.83/100 000 to 1.47/100 000, and the ASMRW from 1.81/100, 000 to 1.46/100, 000. There was no significant difference between urban and rural areas in mortality of endometrial cancer. Age-specific mortality rates increased with age, reaching a peak in the age group 85 years and older (13.16/100 000). Conclusions: Recent years, there was an increasing incidence rate of endometrial cancer in China. Especially in rural areas, the incidence rate of endometrial cancer is increasing rapidly in young women under 40 years of age. There were differences between urban and rural areas and regions in the incidence rate of endometrial cancer. The incidence rates of endometrial cancer in some high-income cities have occupied the first place of female reproductive system malignant cancers. The age-standardized mortality rate of endometrial cancer shows a decreasing trend.

Estimating the incidence and mortality rate of cervical cancer became necessary to establish prevention measures and healthy policies. The aim of this study was to estimate the updated incidence and mortality rate of cervical cancer in 2013 in China. According to the evaluation criteria developed by the National Central Cancer Registry of China, the data submitted from 255 cancer registries met the required standards in 2013. Cervical cancer cases were retrieved from the national database and combined with the 2013 national population data. The age-standardized incidence and mortality rates were based on the demographic structure of the national census 2000 and Segi's world population. In 2013, the estimated number of new cases and deaths from cervical cancer were 100,700 and 26,400, respectively. The crude incidence of cervical cancer was 15.17/100,000. The age-standardized incidence rates based on the Chinese standard population (ASIRC) and the world standard population (ASIRW) were 11.30/100,000 and 10.30/100,000, respectively. The incidence of cervical cancer in urban areas was 15.62/100,000 and the ASIRC was 11.12/100,000. The incidence of cervical cancer in rural areas was 14.65/100,000 and the ASIRC was 11.47/100,000. The mortality rate of cervical cancer was 3.98/100,000. The age-standardized mortality rates based on the Chinese (ASMRC) and world standard populations (ASMRW) were 2.76/100,000 and 2.62/100,000, respectively. The mortality rate of cervical cancer in urban areas was 3.85/100,000 and in rural areas was 4.14/100,000. Cervical cancer incidence and mortality increased with age. Urban areas had a higher incidence of cervical cancer and lower mortality rates when compared with rural areas. Dynamic monitoring of cervical cancer incidence and mortality is the fundamental work of cervical cancer prevention and control. Cervical cancer is a serious issue in women's health, and prevention strategies need to be enhanced, such as human papilloma virus (HPV) vaccination and screening programs.

To evaluate the trend of cervical cancer incidence and mortality rates during 1989-2008 in Chinese women, so as to inform the development of relevant policies and strategies in China. The incidence and mortality rates of cervical cancer during 1989-2008 in urban and rural areas were calculated based on the data from the National Cancer Registry Database. Age-standardized rates were calculated using the Chinese population of 1982 and World Segi's population of 1985. Joinpoint regression analysis was performed to obtain annual percentage changes (APC) so as to assess the trend of incidence and mortality rates over the period from 1989 to 2008. The crude incidence rate of cervical cancer in Chinese women increased from 3.06/10(5) in 1989-1990 to 11.87/10(5) in 2007-2008 (from 4.96/10(5) to 11.98/10(5) in urban registration areas and from 2.39/10(5) to 11.77/10(5) in rural registration areas).The crude mortality rate slightly increased from 2.19/10(5) in 1989-1990 to 3.20/10(5) in 2007-2008 (from 3.21/10(5) to 2.56/10(5) in urban registration areas and from 1.82/10(5) to 3.75/10(5) in rural registration areas). Generally, the upward trends of crude incidence rates were shown over the year 1989-2008, with an APC of 14.4% after 1997 in urban areas and 22.5% after 1999 in rural areas.After age standardization of world population, the APC of incidence rates in recent decade in urban areas remained stable, and the one in rural areas slightly decreased.Although the overall crude and world age-standardized mortality rates had no significant changes during 1989-2008, the crude mortality rates increased by 8.1% annually after 1999.The upward trends were also shown for crude and world age-standardized mortality rates in urban areas after 2001 with an APC of 7.3%.The crude mortality rates in rural areas increased by 3.9% annually during 1989-2008, but no significant change was found after age standardization. Over the last decade, the cervical cancer incidence and mortality rates ascended by year in China. It is particularly urgent to establish a comprehensive prevention and control system that combines cervical cancer screening and human papillomavirus vaccination, so as to reduce the burden of cervical cancer in Chinese women.

To analyze the incidence and mortality trends of female breast cancer in urban and rural areas of Beijing from 2004 to 2008. The incidence and mortality data of female breast cancer from 2004 to 2008 were sorted from Beijing Cancer Registry Database, including 15 527 new diagnosed cases and 3219 deceased cases in total, covering population 29 351 258 person years; among which 11 065 new cases and 2378 deceased cases were from urban areas, covering 17 877 128 person years and 4462 new diagnosed cases and 841 deceased cases were from rural areas, covering 11 474 130 person years. The incidence cases aged 25 and above were divided into 13 age groups by 5 years. The cases under 49 years (≤ 49) and over 49 years (> 49) were separately defined as premenopausal group and postmenopausal group. Incidence and mortality rates in each year, age-specific incidence and mortality rates in urban and rural areas in Beijing were calculated. The annual standard incidence and mortality rates were adjusted by world population constitution; and the incidence rates ratio in different years related to the place of residence, urban or rural were calculated. JoinPoint software was applied to analyze the incidence trend and calculated the annual percentage of changing (APC). The age of female breast cancer patients in urban Beijing in 2004 was (55.83 ± 13.01), while it changed to (56.10 ± 12.80) in 2008, increasing by 0.27 years old. The proportion of the patients who were under 49 years declined from 38.32% (732/1910) in 2004 to 34.02% (894/2628) in 2008. While the average age of the patients in rural areas have improved 0.21 year old, from (52.15 ± 11.33) years old in 2004 to (52.36 ± 11.59) years old in 2008; and the proportion of the patients under 49 years also declined from 45.44% (314/691) in 2004 to 43.40% (454/1046) in 2008. From 2004 to 2008, the incidence and mortality rate of female breast cancer in urban areas of Beijing separately rose from 55.43/100 000 (1910/3 445 812) and 10.65/100 000 (367/3 445 812) to 70.70/100 000 (2628/3 717 436) and 15.01/100 000 (558/3 717 436). And in rural areas, those rates separately rose from 30.60/100 000 (691/2 257 953) and 5.54/100 000 (125/2 257 953) in 2004 to 44.78/100 000 (1046/2 336 040) and 7.49/100 000 (175/2 336 040) in 2008. After adjusting by world population constitution, the difference showed no statistical significance in mortality trend of female breast cancer in rural areas of Beijing (P > 0.05). In year 2004, the female breast cancer incidence rate ratio of urban to rural areas in Beijing fluctuated between 1.34 and 4.47, with the average ratio value at 1.81. In year 2008, the ratio value fluctuated between 1.15 and 2.37, with the average ratio value at 1.57. During 2004 and 2008, the peak age group of the female breast cancer incidence in urban areas was in 60 - 64 years old group, with the rate of 126.92/100 000 (998/786 300) whereas the mortality rate was increasing within aging. In rural areas the peak age groups of the incidence and mortality were separately in 50 - 54 and 80 - 84 years old groups, with the rate of 80.63/100 000 (793/983 516) and 29.17/100 000 (40/137 132) respectively. The incidence and mortality of breast cancer in urban areas in Beijing, as well as the incidence of breast cancer in rural areas in Beijing showed increasing trend annually. The gap in breast cancer incidence between rural and urban areas in Beijing was narrowing, while the incidence rate among different aging groups and the peak mortality rate showed significant difference between urban and rural areas in Beijing.

Objective Population-based cancer registration data in 2012 from all available cancer registries in Henan province were collected by Henan Office for Cancer Research and Control. The numbers of new cancer cases and cancer deaths in Henan province with compiled cancer incidence and mortality rates were estimated.Methods In 2015, all registries’ data in Henan province were qualified for the national cancer registry annual report in 2012. The pooled data were stratified by area (urban/rural), gender, age group (0, 1.4, 5.9, 10.14, …, 85+) and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding population of Henan province in 2012. The Chinese census data in 2000 and Segi’s population were applied for age-standardized rates. All the rates were expressed per 100,000 person-years.Results Qualified 19 cancer registries (4 urban and 15 rural registries) covered 16,082,688 populations of Henan province in 2012. The percentage of cases with morphologically verified (MV%) and death certificateonly cases (DCO%) were 69.84% and 2.30%, respectively, and the mortality to incidence rate ratio (M/I) was 0.64. It was estimated that there were 248,510 new cancer cases and 158,630 cancer deaths in Henan province in 2012. The incidence rate was 266.17/100,000 (288.61/100,000 in males and 241.86/100,000 in females), the age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 208.95/100,000 and 206.41/100,000 with the cumulative incidence rate (0.74 years old) of 24.30%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the cancer incidence rate in rural was higher than that in urban areas. The crude mortality of all cancers in Henan province was 169.90/100,000 (201.23/100,000 in males and 135.95/100,000 in females). The age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 131.20/100,000 and 130.80/100,000, respectively. Among the patients aged 0.74 years, the cumulative mortality rate was 15.03%. The crude cancer mortality rate in urban areas was higher than that of rural areas. However, the age-standardized rate in rural areas was higher than that of urban areas. Cancers of lung, stomach, esophagus, liver, female breast, colorectum, cervix, brain, uterus and ovary were the most common cancers, accounting for about 82.80% of all cancer new cases. Lung cancer, stomach cancer, esophageal cancer, liver cancer, colorectal cancer, female breast cancer, brain cancer, leukemia, pancreatic cancer and cervix cancer were the leading causes of cancer deaths, accounting for about 88.50% of all cancer deaths. The burden between urban and rural, males and females were different.Conclusions Registration data of Henan province was qualified to provide basic information on population-based cancer incidence, mortality for cancer prevention and control. The upper digestive tract cancer burden in Henan province, especially for males in rural areas, was higher. The incidence rate of female breast cancer was higher in urban areas. Targeted prevention, early detection and treatment programs should be carried out by health department to control the cancer burden.

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

The burden of cancer is increasing worldwide due to ageing, growing populations and increased exposure to major risk factors, including unhealthy diet, sedentary lifestyle and for many populations, tobacco smoking (Global Burden of Disease Cancer Collaboration et al., 2015). This trend is part of a wider phenomenon of increasing burden of non-communicable diseases (NCDs) (World Health Organization, 2011). Deaths from NCDs are projected to increase from 38 million to 52 million between 2012 and 2030 (World Health Organization, 2014). The NCD burden is not evenly distributed, with more than 80% of all premature NCD deaths occurring in low- and middle-income countries (LMIC). The growing burden of cancer in developing countries is due to changes in lifestyle and reproductive factors, which complement a pre-existing high burden caused by infectious diseases (Bray, Jemal, Grey, Ferlay, & Forman, 2012; Kanavos, 2006). Much of the cancer burden in developing countries is preventable through lifestyle modification, tobacco control, screening and vaccination (Kanavos, 2006). As a result of overburdened, poorly developed and fragmented health care systems, the prevailing lack of prevention, early detection and treatment interventions contributes to a disproportionately higher cancer mortality in these countries. Given many competing priorities, governments and donor agencies lack the resources and strategic direction to address the scale of the NCD challenge (Reeler & Mellstedt, 2006). Underfinanced health care facilities are not able to offer complex and expensive cancer treatments (Global Burden of Disease Cancer Collaboration et al., 2015). Another important issue is the lack of appropriate data on cancer incidence, mortality and outcomes of services. These data are necessary to understand the extent of the cancer problem across the population, and to monitor status changes in incidence and mortality, including responses to cancer control initiatives, such as treatment and preventive programmes (Bray, Znaor, et al., 2015; Parkin, 2006). In this commentary, we provide an overview of cancer epidemiology and cancer registration challenges in LMIC, with a special focus on the Pacific Islands. There were an estimated 14.1 million new incident cancer cases and 8.2 million cancer deaths globally in 2012, with 57% of new cases and 65% of the cancer deaths occurring in the less developed countries (Ferlay et al., 2013). Large increase in global cancer burden is projected by 2025 (Bray, 2014). Increases in cancer incidence are projected to be proportionally greatest in LMIC (Bray et al., 2012). According to GLOBOCAN data, the overall age-standardised cancer incidence and cancer mortality rates in less developed regions were 147.7 and 98.4 per 100 000 people in 2012 (Ferlay et al., 2013). The most frequent cancer sites were lung, breast, stomach, liver and colon/rectum. By comparison, the corresponding cancer incidence and mortality rates in more developed regions were 267.2 and 108.5 per 100 000 respectively. The smaller elevation in mortality than incidence in more developed areas reflects both a difference in mix towards less lethal cancer types and better survival. The incidence gap is closing rapidly, however, as developing countries adopt "Western" lifestyle and health behaviours (Bray, 2014). In more developed areas, breast, prostate, lung and colorectal cancers comprise approximately half of all cancers, whereas in less developed areas, stomach, liver and cervical cancers play a more important role (Ferlay et al., 2015). Infectious agents play an important role in the genesis of these cancers highlighting the greater importance of infections as a cancer cause in developing countries. Infections are responsible for an estimated 25% of cancers in developing countries, whereas the corresponding proportion is about 10% in developed countries (Plummer et al., 2016). In recent decades, a cancer transition has taken place, however, with an increasing incidence of breast, colorectal and prostate cancers also taking place in less affluent populations which historically had a lower risk of these cancers (Bray et al., 2012). Changes in reproductive, dietary, metabolic, hormonal and behavioural factors are likely to be responsible for this transition. Pacific Islands countries and territories (PICTs) comprise 20 000–30 000 islands in the Pacific Ocean (World Health Organization Western Pacific Region, 2012). PICTs vary in stage of human development, size, culture and economic resources; however, they all face the triple burden of NCDs, communicable diseases and the impact of climate change (World Health Organization Western Pacific Region, 2012). PICTs have one of the highest NCD incidence rates in the world, comprising the leading cause of mortality. Relatively small populations, large physical areas with long distances, geographic isolation, reliance on overseas assistance and weak economies complicate the provision of the health care services that would be essential to address this increasing public health challenge. The cancer burden is thought to be increasing in the PICTs, although only limited quantitative evidence is available due to a paucity of cancer incidence and mortality data (Moore et al., 2010; Varghese, Carlos, & Shin, 2014). Eight of the 22 PICTs were included in the GLOBOCAN 2012 (Fiji, French Polynesia, Guam, New Caledonia, Papua New Guinea, Samoa, Solomon Islands and Vanuatu) (Ferlay et al., 2013). Most of these PICTs had national incidence data for some diagnostic time periods, but not Papua New Guinea and Solomon Islands, where all cancer rates or rates for neighbouring countries have been used to estimate cancer incidence. Meanwhile, mortality data were missing for Guam, Papua New Guinea, Samoa, Solomon Islands, and Vanuatu, where mortality estimates were derived from estimated national incidence rates and modelled survival. None of the PICTs were reflected in or contributed to the Cancer Incidence in Five Continents Volume X (CI5-X) publication (Forman et al., 2014), indicating their relatively low availability of high quality data. According to GLOBOCAN 2012, cancer incidence was estimated to be highest in New Caledonia (age-standardised rate (ASR) of 330.7 for men and 269.3 for women per 100 000) and in French Polynesia (ASR 287.4 for men and 227.3 for women per 100 000) (Ferlay et al., 2013). Similarly, age-standardised cancer mortality rates were estimated to be highest in French Polynesia (ASR 153.9 for men and 116.3 for women per 100 000) and New Caledonia (ASR 146.0 for men and 112.0 for women per 100 000). In all other countries, cancer incidence estimates were below the World average, with cancer incidence generally higher among women than men. The most common cancers among men were estimated to be prostate, lung, stomach, liver and lip/oral cavity cancers. For women, breast cancer was ranked as the most common cancer in all countries, except in Papua New Guinea where cervical cancer was most common. Notably Papua New Guinea accounts for over a third of the total Pacific population at over 6 million, thereby increasing the contribution of cervical cancer to the cancer burden in the Pacific region. A study examining cancer incidence in four PICTs (Fiji, Tonga, Cook Islands and Niue) reported that age-standardised cancer incidence was lower in these countries than among Pacific people living in New Zealand (Foliaki et al., 2011). Under-recording is likely to have contributed to these differences. Despite relatively low (reported) cancer incidence in many PICTs, cancer is one of the leading causes of death in the region (Carter et al., 2011, 2016; Pacific Regional Central Cancer Registry, 2015). There are distinguishing features of cancer epidemiology in the PICTs, such as very high thyroid cancer incidence in New Caledonia and French Polynesia (Ferlay et al., 2013), a high burden of cervical and uterine cancers, especially in Fiji and the Cook Islands (Foliaki et al., 2011; Law et al., 2013) and a high burden of oral cavity and pharyngeal cancers linked with betel nut chewing (Moore et al., 2010; Pacific Regional Central Cancer Registry, 2015). Nuclear tests conducted by France in French Polynesia and by the US in Marshall Islands have been linked to increased thyroid cancer and leukaemia rates (Bouchardy, Benhamou, de Vathaire, Schaffar, & Rapiti, 2011; Simon, Bouville, Land, & Beck, 2010). Data collected by population-based cancer registries (PBCR) are the gold standard for providing information on cancer incidence across geographic areas and for planning population-wide cancer control programmes (Bray, Znaor, et al., 2015). Full case ascertainment and unbiased information on cancer burden is optimally achieved where there is a well-functioning health care system. Availability as well as quality of cancer incidence and mortality data tends to increase with development and infrastructure levels, with many LMIC still without cancer registration systems in place or hospital- or pathology-based registration systems that are not population-based. In addition to cancer data, population denominator data are also needed in order to provide accurate information on cancer incidence rates. These data commonly come from censuses which may be rarely or irregularly conducted in developing countries (Valsecchi & Steliarova-Foucher, 2008). Population-based cancer registries systematically collect information on all cancers occurring in a defined population using multiple data sources, whereas hospital- and pathology-based registries collect information on cases treated/diagnosed in selected institutions or laboratories (Bray, Znaor, et al., 2015). While useful, such data may not be representative of the overall population experience and may contain important statistical biases from a population perspective. While data collected from hospital- or pathology-based registries may provide a misleading cancer profile for the general population, they still can be useful for hospital administration purposes, for reviewing clinical performance and for providing information about cancer profiles of people who obtain hospital/pathology services (Bray, Znaor, et al., 2015; Valsecchi & Steliarova-Foucher, 2008). There are many challenges with cancer registration in developing countries, including weak or non-existent health care infrastructures, lack of accurate death records and population data, complicating issues related to cultural norms and problems caused by political and economic instability, and mobile populations (Parkin & Sanghvi, 1991; Valsecchi & Steliarova-Foucher, 2008). In order to register all cases of cancer, data need to be collected from multiple sources, including hospitals, laboratories and death certificates (Bray, Znaor, et al., 2015). Lack of health care networks, poorly developed communications between different stakeholders as well as inability to uniquely identify individuals complicate the collection of these data (Valsecchi & Steliarova-Foucher, 2008). Underestimation of both cancer cases and deaths is commonplace where many people lack access to basic health care services and cancers and cancer deaths go unrecorded, as may apply in particular in the rural areas. People may die at home and be buried at home or otherwise locally without reporting to government authorities (Jedy-Agba et al., 2015). Poor transportation networks and phone connections, cultural and religious constraints, preference for traditional healing and taboos and stigmas relating to cancer contribute to an underestimation of numbers of cancer and a lack of follow-up for registered cases (Valsecchi & Steliarova-Foucher, 2008). In addition to these technical challenges, a lack of financial and material resources, trained personnel and support from governments, policymakers and health professionals further complicates cancer registration. As cancer registration involves considerable costs, regional registries collecting data on sub-national samples have been considered good options in some low-resource countries (Bray, Znaor, et al., 2015). When cancer data are collected, there may be issues with quality, such as low proportions of cases confirmed microscopically due to a lack of pathology services (Bray, Ferlay, et al., 2015). Cancer diagnoses may be based on clinical examination only, with greater uncertainty (Parkin & Sanghvi, 1991). Another important indicator of poorer data quality is a high percentage of cases registered from death certificates only (DCOs), reflecting incomplete case identification (Bray, Ferlay, et al., 2015). On the other hand, a total lack of DCOs may indicate failure to use death certificate information or to link death information to the cancer registry (Curado, Voti, & Sortino-Rachou, 2009). Accuracy of diagnostic information derived from death certificates is generally suboptimal. In addition, there may be specific problems in developing countries in relation to the quality of death certification, with information on causes of death often missing/erroneous and with certificates often completed by lay-people instead of medical doctors. In addition to cancer diagnosis and death data, other essential data may be missing or incomplete, including birth date, age and place of residence (Jedy-Agba et al., 2015). Lack of co-operation and difficulties in accessing data from several data sources may be caused by general distrust of government-related activities, lack of a culture of data collection and concerns about confidentiality (Jedy-Agba et al., 2015). Making cancer a registrable disease by government regulations can mitigate challenges in data collection and increase the authority of PBCR, although success is likely to depend on availability of resources and culture and politics of the country. Continuous monitoring and mentoring involving both local and international experts and sustainable funding models are often essential for ongoing, successful registration (Jedy-Agba et al., 2015). Commonly, low cancer data quality stems from overall weakness of health care system and, therefore, wide-ranging system-level improvements would materially improve registry quality. The first cancer registry in the PICTs was established in Papua New Guinea in 1958 (Foliaki et al., 2011). According to information from the World Health Organization, many PICTs have cancer registries nowadays (World Health Organization, 2016). In addition, most PICTs have collected census information in recent years (Secretariat of the Pacific Community, 2016). There are issues, however, with quality, coverage and completeness of cancer data (Dachs et al., 2008; Moore et al., 2010; Shin, Carlos, & Varghese, 2012). Many of the registration challenges mentioned earlier in this commentary are familiar to PICTs. Lack of infrastructure, coordination and funding, poorly developed health care systems, under-recording as well as poor quality of death certificates and diagnostic information complicate the collection of cancer data in many PICTs (Palafox et al., 2004). Along with vast distances between PICTs and degree of remoteness, the high proportions of foreign contract workers in some islands, and conversely the extent to which the birth population has migrated off-island impact the development of sustainable infrastructure. Different development agencies, including funders of new programmes, often request data in formats and using software modules that are not familiar to local data custodians complicating the meaningful collection and utilisation of data at the regional level. Many PICTs have close relationships with 'host' countries (the US, New Zealand and France) and are dependent on external aid, including health development. There is an opportunity to review health development assistance platforms with one of the major initiatives being health information and monitoring. Due to natural conditions, many PICTs are dependent on imported food (World Health Organization Western Pacific Region, 2012). Financial incentives, such as the Nuclear Claims Tribunal in the Marshall Islands, may facilitate the case finding of certain cancer types, but not others. Natural and other disasters have destroyed cancer registry databases in Nauru (Palafox et al., 2004), Niue (Foliaki et al., 2011) and American Samoa (Tsark, Cancer Council of the Pacific Islands, & Braun, 2007). Due to limited treatment options, people diagnosed with cancer may die off-island and, therefore, may not be registered. The Global Monitoring Framework of WHO, subsequent to the United Nations high-level meeting to "launch and all-out attack" on NCDs in 2011, specifically mentions the recording of cancer incidence by type of cancer per 100 000 population as an indicator to monitor 2025 targets; thereby placing an onus on countries to establish PBCR. The International Agency for Research on Cancer (IARC) in collaboration with major international and national partner organisations established the Global Initiative for Cancer Registry Development (GICR) in 2011 (International Agency for Research on Cancer, 2014, 2016). The aim of the GICR is to improve the coverage, quality and networking capacities of PBCR in LMIC. The GICR is organised around Regional Hubs for providing technical support and on-site training, assessing data quality and overall capacity for development, coordinating different activities and monitoring overall progress in the region. One of these is the emerging Pacific Islands Regional Hub which will focus on supporting cancer registries and improving data collection and data utilisation for cancer control in Fiji, New Caledonia, Papua New Guinea, Solomon Islands, Vanuatu, Guam, French Polynesia and Samoa. The Hub will be governed by an Advisory Board comprising regional experts from participating PICTs, along with Australia and New Zealand, and other local experts in the use of registry data to support local service delivery and research. The Pacific Islands Regional Hub will comprise a collaboration of registry experts, local public health practitioners and administrations. The registry experts will provide support and consultancy services for existing registries, such as ongoing training and assistance with registration, quality assurance, statistical analysis and research activities, whereas local PICT public health practitioners and administrators will give direction to the use of these data for local service delivery. There is no question that the Pacific Hub initiative should be tested, along with obligations to establish PBCR. It will be critical to continually monitor progress and reassess implementation in terms of strategic approaches, steps taken, and local involvement to ensure full participation and ownership of the initiative by Pacific countries, as well as sustainability and effectiveness of the Hub activities. The US-associated PICTs (American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Belau) established the Cancer Council of the Pacific Islands and the Pacific Regional Central Cancer Registry in the early 2000s (Pacific Regional Central Cancer Registry, 2015; Tsark, Cancer Council of the Pacific Islands, & Braun, 2007). This collaboration has enabled the development of culturally appropriate cancer control strategies and activities for the US-associated PICTs, with publication of cancer incidence rates for 2007–2012. The key to the success has been culturally appropriate approaches, local capacity building and leadership, and funding support. The Pacific Islands Regional Hub seeks to build on this experience and through collaborative arrangements, provide complementary support services for other PICTs that are attuned to their needs. In order to strengthen cancer registration in the PICTs, improvements in health care systems and infrastructure are needed more generally and in quality of death certificates and diagnostic information systems. The key strategies for achieving these improvements include building governance structures which coordinate the responsibilities and actions of different stakeholders and using culturally appropriate methods in order to ensure strong local engagement and sustainability. The potential of the emerging Pacific Islands Regional Hub to serve a useful role in advancing and coordinating these activities will be tested. None to declare.

Introduction: Disparities in the incidence, mortality, and survival of cancer types between urban and rural areas in China reflect the effects of different risk factor exposure, education, and different medical availability. We aimed to characterize the disparities in the incidence, mortality, and survivals of cancer types between urban and rural areas in Shanghai, China, 2002-2015.Materials and Methods: The incidence and mortality were standardized by Segi's world standard population. Trends in the incidence and mortality of cancers were compared using annual percent change. The 5-year observed and relative survivals were calculated with life table and Ederer II methods.Results: Age-standardized incidences and mortalities were 212.55/105 and 109.45/105 in urban areas and 210.14/105 and 103.99/105 in rural areas, respectively. Female breast cancer and colorectal cancer occurred more frequently in urban than in rural areas, quite in contrast to liver cancer and cervical cancer. Cancers of lung and bronchus, liver, stomach, and colon and rectum were the leading causes of cancer death in both areas. Age-standardized incidence of female breast cancer and colorectal cancer in urban areas increased while gastric cancer and liver cancer decreased in both areas. Age-standardized mortalities of cancers of breast, esophagus, stomach, colon and rectum, liver, and lung and bronchus decreased in both areas. For all cancers combined, the 5-year observed and relative survivals of cancer patients were higher in urban than in rural areas. The 5-year observed and relative survivals of cancers of liver, pancreas, stomach, brain and central nervous system (CNS), and prostate were higher in urban than in rural areas. The 5-year observed and relative survivals of cervical cancer were higher in rural than in urban areas.Conclusions: Factors promoting female breast cancer and colorectal cancer in urban areas and liver cancer and cervical cancer in rural areas should be specifically intervened in cancer prophylaxis. Improved medical services can greatly prolong the survival of major cancers in rural areas.

This study examined temporal trends in laryngeal cancer (LC) incidence and mortality across urban and rural China from 2004–2019, with projections of disease burden through 2034. Data on incidence, death, age-standardized incidence rate (ASIR), and age-standardized death rate (ASDR) of LC were obtained from Chinese Cancer Registry Annual Report from 2004 to 2019. Joinpoint regression analysis and age-period-cohort models were used to assess trends in the incidence and mortality rates of LC and interpret its epidemiological characteristics. Decomposition analysis assessed the contributions of demographic and epidemiological factors to the evolving burden of LC. Finally, the ASIR and ASDR of LC were projected for the next 15 years using a Bayesian Age-Period-cohort model. From 2004 to 2019, the number of LC cases and deaths increased in Chinese Cancer Registry dataset. During the study period, the ASIR of LC in urban and ASDR of LC in rural showed a down trend with estimate annual percent changes (EAPC) of -1.49% (95% confidence intervals [CI]: -2.11 to -0.87) and -1.32% (95% CI: -2.38 to -0.24). The impacts of age, period, and cohort on incidence and mortality rates varied between rural and urban areas. Population growth is the main driver of increased LC deaths in urban areas, while aging is the main driver in rural areas. The forecast predicts a decline in the ASIR of LC in urban areas, while it will rise in rural areas by 2034. The ASDR of LC is expected to decrease slightly in both urban and rural areas by 2034. This study reveals the complex epidemiological characteristics of LC in urban and rural areas of China. Population growth and aging are the primary drivers of LC deaths in China. By 2034, the ASIR of LC in rural areas is projected to increase to 2.11/100,000, necessitating the management of specific risk factors and the development of targeted public health strategies. However, these findings should be interpreted with caution, as variations in cancer registry coverage over time, differences in data quality between urban and rural areas, and assumptions inherent in projection models may influence the observed temporal trends and urban–rural comparisons.

Objective: To estimate the incidence and mortality of stomach cancer in China based on the cancer registration data in 2013, collected by the National Central Cancer Registry (NCCR). Methods: There were 347 cancer registries that submitted stomach cancer incidence and deaths occurred in 2013 to NCCR. After evaluating the data quality, 255 registries' data were accepted for analysis and stratified by areas (urban/rural), sex, and age group. Combined with data on national population in 2013, the nationwide incidence and mortality of stomach cancer were estimated. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality rates. Results: Qualified 255 cancer registries covered a total of 226 494 490 populations (111 595 772 in urban and 114 898 718 in rural areas). The percentage of cases morphologically verified and death certificate-only cases were 76.27% and 1.98%, respectively, and the mortality to incidence rate ratio was 0.72. It is estimated that there were 427 000 new cases for stomach cancer nationwide, with a crude incidence rate of 31.38 per 100 000 (42.85 per 100 000 in males, 19.33 per 100 000 in females). The age-standardized incidence rates by Chinese standard population (ASR China) and by world standard population (ASR world) were 21.40 per 100 000 and 21.32 per 100 000, respectively, with a cumulative incidence rate (0-74 age years old) of 2.66%. The crude and ASR China incidence rates of stomach cancer in urban areas were 27.80 per 100 000 and 18.48 per 100 000, respectively, whereas those were 35.54 per 100 000 and 24.93 per 100 000 in rural areas. It is estimated that there were 301 000 deaths for stomach cancer nationwide, with a crude mortality rate of 22.13 per 100 000 (29.85 per 100 000 in males, 14.03 per 100 000 in females). The ASR China and ASR world mortality rates were 14.68 per 100 000 and 14.54 per 100 000, respectively, with a cumulative mortality rate (0-74 years old) of 1.70%. The crude and ASR China mortality rates were 18.94 per 100 000 and 12.20 per 100 000 in urban areas, respectively, whereas those were 25.84 per 100 000 and 17.67 per 100 000 in rural areas. Conclusions: There is still a heavy burden of stomach cancer in China. The burden and patterns of stomach cancer shows different gender and urban-rural differences. Prevention and control strategies should be implemented referring to local status.

In this study, we aimed to estimate the updated incidence and mortality rate of stomach cancer based on the cancer registration data in 2014, collected by the National Central Cancer Registry of China (NCCRC). In 2017, 339 registries' data were qualified based on the criteria of data quality control of the NCCRC. Cases of stomach cancer were retrieved from the national database. We estimated numbers of stomach cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area, sex, age-group (0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's world population were applied for age-standardized incidence and mortality rates. In 2014, 410,400 new stomach cancer cases and 293,800 cancer-associated deaths were estimated to have occurred in China. The crude incidence rate of stomach cancer was 30.00/100,000, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 19.62/100,000 and 19.51/100,000, respectively. The crude mortality rate of stomach cancer was 21.48/100,000, age-standardized mortality rates by Chinese (ASMRC) and by world standard population (ASMRW) were 13.44/100,000 and 13.30/100,000, respectively. Incidence and mortality rates in rural areas were both higher than that in urban areas. Stomach cancer has a strong relationship with gender and age. The disease has occurred more frequently among men than women with a male to female ratio of 2.4 for ASIRC. After age group of 40-44 years, incidence rates are substantially higher in men than in women, same pattern was seen for age-specific mortality rates. There is still a heavy burden of stomach cancer in China. The incidence and mortality patterns of stomach cancer show substantial gender and regional disparities. Great effort is needed to provide more accessible health services, sufficient financial resources, and adequate cancer-care infrastructure for the Chinese population, especially for people living in rural areas.