Incidence and mortality of colorectal cancer in China, 2011.

To understand the incidence and mortality of colorectal cancer in China. The data from GLOBOCAN 2012, Chinese Cancer Registry Annual Report 2012, Cancer Incidence in Five Continents (CI5), the Three National Death Cause Surveys in China and WHO Mortality Database were used to learn about the incidence and mortality of colorectal cancer and related trends in China. It was estimated by GLOBOCAN 2012 that in 2012 the age-standardized incidence of colorectal cancer in China was 16.9 per 100 000 in males and 11.6 per 100 000 in females, and the age-standardized mortality was 9.0 per 100 000 in males and 6.1 per 100 000 in females. GLOBOCAN 2012 estimated that colorectal cancer incidence and mortality would increase with the level of human development index. China's human development level was high, suggesting that the burden of colorectal cancer would be more serious in China with the development of social economy. The data from CI5 Volume IV and GLOBOCAN 2012 indicated that the incidence of colorectal cancer began to increase obviously at age of 50 years in China. Chinese Cancer Registry Annual Report 2012 showed that the incidence and mortality of colorectal cancer in urban population were two times higher than those in rural population in 2009, the proportions of colon cancer among colorectal and anus cancers, which was 49.0% in males and 54.2% in females, 53.4% in urban population and 41.7% in rural population. CI5 Volumes IV-X showed that colon cancer and rectum and anus cancer incidence in Shanghai for both males and females were increasing during the period 1973-2007. The percentage change in colon cancer and rectum and anus cancer incidence between 1973-1977 and 2003-2007 increased by 138.8% and 31.1% in males, 146.7% and 49.1% in females, respectively. The data from the Three National Death Cause Surveys showed that the crude mortality of colorectal cancer increased by 77.9% form mid 1970's (1973-1975) to mid 2000's (2004-2005). WHO Mortality Database showed that average annual percentage change (AAPC) of age-standardized colorectal cancer mortality increased by 0.7% (P < 0.05) from 1987 to 2000. More attention should be paid to the prevention and control of colorectal cancer in urban area and in male population in China. Similar to the western countries, the burden of colorectal cancer in China would continue to become serious if no population based prevention and control programs are conducted.

The National Central Cancer Registry of China (NCCR) affiliated to the Bureau of Disease Control, National Health and Family Planning Commission of China is responsible for cancer surveillance in the entire country. Cancer registration data from each local registry located in each province are collected by NCCR annually to be analyzed and published to provide useful information for policy makers and cancer researchers. Until 1st June, 2013, 219 population-based cancer registries submitted data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 145 cancer registries were selected after quality evaluation for this study. Colorectal cancer cases were selected from the database according to ICD-10 coded as "C18-C20". We calculated the crude incidence and mortality rates by sex, age groups and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age-standardized rates. The 6th National Population Census data of China was used to combined with the cancer registries' data to estimate the colorectal cancer burden in China in 2010. Colorectal cancer was the sixth most common cancer in China. It was estimated that there were 274,841 new cases diagnosed in 2010 (157,355 in males and 117,486 in females), with the crude incidence rate of 20.1/100,000, highest in males in urban areas. Age-standardized rates by China standard population of 2000 (ASRcn) and World standard population (Segi's population, ASRwld) for incidence were 16.1/100,000 and 15.9/100,000 respectively. There were 132,110 cases estimated to have died from colorectal cancer in China in 2010 (76,646 men and 55,464 women) with the crude mortality rate of 10.1/100,000. The ASRcn and ASRwld for mortality were 7.55/100,000 and 7.44/100,000 respectively, higher in males and urban areas than in females and rural areas. The incidence and mortality rates increased with age, reaching peaksin the 80-84 year old, and oldest age groups, respectively. Colorectal cancer is one of the most common incident cancers and cause of cancer death in China. Primary and secondary prevention, with attention to a health lifestyle, physical activity and screening should be enhanced in the general population.

Objective: To estimate the incidence and mortality of colorectal cancer (CRC) in China, providing basic information of treatment and prevention in CRC. Methods: In 2016, National Central Cancer Registry (NCCR) collected registration data in 2013 from local cancer registries and assessed the data according to the auditing methods and evaluation criteria formulated by NCCR. 347 cancer registries submitted data of 2013 to NCCR. Qualified data from 255 registries was pooled, analyzed and stratified by area (urban/rural), gender, and age. CRC incidence and mortality were estimated using national population in 2013. Results: In 2013, the estimate of new cases diagnosed with CRC in China was 347.9 thousands, with 9.45% of new cancer cases. The crude incidence of CRC was 25.57/100, 000 (28.64/100, 000 for male and 22.34/100, 000 for female, 30.92/100, 000 in urban areas and 19.35/100, 000 in rural areas), ranking fourth in all cancer. The age-standardized rates by China population and by world population were 17.45/100, 000 and 17.20/100, 000, respectively. Cumulative incidence of CRC in China was 2.05%. The estimated CRC deaths of China was 164, 900 in 2013, accounting for 7.39% of overall cancer deaths. The crude mortality rate for CRC was 12.11/100, 000 (13.49/100, 000 for male and 10.67/100, 000 for female, 14.41/100, 000 in urban and 9.45/100, 000 in rural), ranking fifth in all cancer. The age-standardized rates by China population and by World population for mortality were 7.87/100, 000 and 7.76/100, 000, respectively. Cumulative mortality rate of CRC in China was 0.82%. For both of incidence and mortality, males had much higher rates than females, while urban areas had much higher rates than rural areas. The incidence and mortality rates of CRC increased greatly with age, especially after 35 or 40 years old, and reached the peak in the age group of 80 or 85+ year old. Conclusion: The disease burden of CRC was still serious in China. Primary prevention and early detection of CRC in China is crucial.

BackgroundUnderstanding the temporal trends in the epidemiology of colorectal cancer (CRC) and early-onset CRC (EOCRC) in China is essential for policymakers to develop appropriate strategies to reduce the CRC burden.MethodsThe prevalence, incidence, mortality, years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC over the next 25 years were predicted.ResultsFrom 1990 to 2019, the prevalence, incidence, and mortality of total CRC and EOCRC significantly increased in males, with milder trends in females. In 2019, the number of people living with CRC (or EOCRC) in China was approximately 3.4 (0.59) million, which was over seven (five) times higher than that in 1990. The DALYs, YLDs, and YLLs moderately increased from 1990 to 2019 in both sexes. The age-standardized mortality rate (ASMR) for females has shown a stable trend in total CRC, and a downward trend in EOCRC since 2000. While the ASMR for males showed increasing trends in total CRC and EOCRC. In 2019, the highest incidence, prevalence, YLDs, YLLs, and DALYs were all observed in the 65 to 69 age group, while the highest mortality was in the 70 to 74. By 2044, the incidence and deaths of CRC are expected to reach 1310 thousand and 484 thousand, respectively. For EOCRC, the incidence will peak at about 101 thousand around 2034, and the mortality will continuously decrease to a nadir at about 18 thousand around 2044.ConclusionAlthough the age-standardized incidence and mortality of total CRC and EOCRC in China will reach a plateau, the number of incident cases and deaths of CRC have been increasing in the last three decades and will continue to increase in the next 25 years.

Annual cancer incidence and mortality in 2008 were provided by National Central Cancer Registry in China, which data were collected from population-based cancer registries in 2011. There were 56 registries submitted their data in 2008. After checking and evaluating the data quality, total 41 registries' data were accepted and pooled for analysis. Incidence and mortality rates by area (urban or rural areas) were assessed, as well as the age- and sex-specific rates, age-standardized rates, proportions and cumulative rate. The coverage population of the 41 registries was 66,138,784 with 52,158,495 in urban areas and 13,980,289 in rural areas. There were 197,833 new cancer cases and 122,136 deaths in cancer with mortality to incidence ratio of 0.62. The morphological verified rate was 69.33%, and 2.23% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 299.12/100,000 (330.16/100,000 in male and 267.56/100,000 in female) and the age-standardized incidence rates by Chinese standard population (ASIRC) and world standard population (ASIRW) were 148.75/100,000 and 194.99/100,000, respectively. The cumulative incidence rate (0-74 years old) was of 22.27%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the incidence rate in urban was lower than that in rural. The crude cancer mortality was 184.67/100,000 (228.14/100,000 in male and 140.48/100,000 in female), and the age-standardized mortality rates by Chinese standard population (ASMRC) and by world population were 84.36/100,000 and 114.32/100,000, respectively. The cumulative mortality rate (0-74 years old) was of 12.89%. Age-adjusted mortality rates in urban areas were lower than that in rural areas. The most common cancer sites were lung, stomach, colon-rectum, liver, esophagus, pancreas, brain, lymphoma, breast and cervix which accounted for 75% of all cancer incidence. Lung cancer was the leading cause of cancer death, followed by gastric cancer, liver cancer, esophageal cancer, colorectal cancer and pancreas cancer, which accounted for 80% of all cancer deaths. The cancer spectrum varied by areas and sex in rural areas, cancers from digestive system were more common, such as esophageal cancer, gastric cancer and liver cancer, while incidence rates of lung cancer and colorectal cancer were much higher in urban areas. In addition, breast cancer was the most common cancer in urban women followed by liver cancer, gastric cancer and colorectal cancer. Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer and female breast cancer contributed to the increased incidence of cancer, which should be paid more attention to in further national cancer prevention and control program. Different cancer control strategies should be carried out due to the varied cancer spectrum in different groups.

Lower Endoscopy and Prevention of Colon Cancer

To investigate the incidence and mortality of colorectal cancer in China from 1998 to 2002, and to analyze its prevalence trend. The cancer registration data in 10 cities and counties in China during the period of 1988-1992, 1993-1997 and 1998-2002 were used to investigate the incidence, mortality, and prevalence trend of colorectal cancer from 1988 to 2002. The total number of new cases of colorectal cancer in the 10 cities and counties during 1988-2002 was 62,793, accounting for 9.27% of all malignant tumors. The crude incidence rate was 20.10/10(5), and the age-standardized incidence adjusted by world population was 15.63/10(5). The total number of death of colorectal cancer in the 10 cities and counties during 1988-2002 was 35,545, accounting for 7.37% of all malignant tumors. The mortality rate was 11.38/10(5), the age-standardized mortality rate adjusted by world population was 8.70/10(5). The incidence and mortality of colorectal cancer during 1988-2002 increased by 38.56% and 15.30%, respectively, and the incidence and mortality rates in urban area was higher than that in rural area, and higher in males than in females. The crude incidence rate of colon cancer was higher than that of rectal cancer, especially in urban area, but the mortality of rectal cancer was a little bit higher than that of colon cancer. There is an increasing trend in both the incidence and mortality rates of colorectal cancer from 1988-2002 in the 10 cities and counties in China. Measures should further be taken in the prevention and treatment of colorectal cancer in the whole population of China in future.

BackgroundHenan province is an area with a serious disease burden of colorectal cancer (CRC) in China. Understanding the current incidence and mortality and the time-trend is critical to formulate and optimize prevention and control strategies for CRC. However, the current incidence and mortality and time-trend of CRC in Henan province, China have not been reported.MethodsCRC data was got from the Henan Provincial Central Cancer Registry of China in which the data was submitted from local cancer registries. Combined with the census data, the incidence, mortality, proportion, age-standardized rate by Chinese population (ASRC), age-standardized rate by world population (ASRW), and cumulative incidence and mortality (0–74 years old) of CRC by urban and rural population, gender, and age groups were estimated. The average annual percentage change (AAPC) and its 95% confidence interval (CI) of ASRC from 2010 to 2017 were analyzed.ResultsIn 2017, it was estimated that there were 20,275 new cases and 10,046 deaths of CRC in Henan province. The crude incidence was 18.73/100,000, with an age-standardized incidence rate by Chinese population (ASIRC) of 13.97/100,000 and age-standardized mortality rate by world population (ASIRW) of 13.78/100,000. The cumulative incidence was 1.66%. The mortality rate was 9.28/100,000, with an age-standardized mortality rate by Chinese population (ASMRC) of 6.49/100,000 and an age-standardized mortality rate by world population (ASMRW) of 6.45/100,000. The cumulative mortality rate was 0.69%. The ASIRC and ASMRC were higher in urban areas (15.89/100,000, 7.19/100,000) than in rural areas (13.13/100,000, 6.20/100,000), and higher in males (15.53/100,000, 7.44/100,000) than in females (12.48/100,000, 5.66/100,000). The age-specific incidence reached the peak at age of 80–84, and the age-specific mortality reached the peak at age 85. From 2010 to 2017, the overall ASIRC and ASMRC showed a steady trend (P>0.05), while an upward trend was observed in the mortality rate in urban males (AAPC =3.4, 95% CI: 0.2–6.7, P=0.040).ConclusionsThe incidence and mortality of CRC were high in Henan province, and higher in urban areas and males. It is critical to strengthen the prevention and control of CRC, carry out targeted intervention, and promote screening and early diagnosis and treatment, particularly among urban areas and males.

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

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.