Cancer Mortality In China Research Articles

Epidemiological analysis on mortality of cancer in China, 2015

Objective: To understand the distribution of cancer deaths in China in 2015 and provide reference for the prevention and control of cancer. Methods: Based on the results of Global Burden of Disease 2015, the cancer death distributions in different age groups, sex groups, provinces or by different malignant tumor in Chinese were described. Results: The age-standardized mortality rate of cancer was 159.01/100 000 in China in 2015. The mortality rate was highest in age group ≥70 years (1 102.73/100 000), and lowest in age group 5-14 years (5.40/100 000). The mortality rate in males was 2.15 times higher than that in females. The first 5 provinces with high cancer mortality rate were Anhui, Qinghai, Sichuan, Guangxi and Henan. Lung cancer, liver cancer, stomach cancer, esophageal cancer and colorectal cancer ranked 1-5 in term of mortality rate. Conclusion: The cancer mortality differed with age, gender, area and different malignant tumors, suggesting the necessity to develop targeted prevention and control strategies.

Management of pancreatic cancer in China: the Tianjin Medical University Cancer Institute and Hospital experience

Pancreatic cancer is one of the most aggressive malignancies with a dismal prognosis. The incidence and mortality of pancreatic cancer in China has been increasing dramatically during the past several decades. With the development of surgery, chemotherapy drugs and radiotherapy technologies, the prognosis of pancreatic cancer has changed greatly in recent years in China, especially in our cancer center, Tianjin Medical University Cancer Institute and Hospital. First, we will make a precise pre-surgery diagnosis in our center involves computerized tomography (CT) images, circulating tumor cell (CTC) measure and KRAS sequence. Second, according to the pre-surgery diagnosis, we will perform the en bloc resection and standard lymphadenectomy for pancreatic cancer patient. Third, multidisciplinary team (MDT) is a feature in our cancer center that choose the best therapy for different stage patients with individualized treatment. Finally, clinical trial is important characteristic in our cancer center because the new drug and target drug can be used to treat pancreatic cancer in time. This article reviews the development of pancreatic cancer diagnosis and therapy, highlights the hallmarks of management in our cancer center and discusses the future necessary efforts to improve the quality of life and prognosis for Chinese patients.

Risk Factors of Lung Cancer in Xuanwei, Yunnan Province, China

背景与目的自1970年代至今，云南省宣威市始终是我国肺癌高发地区之一，且其女性高发、地区聚集性高发的特征未发生过改变。本研究目的在于进一步关注宣威市普通居民肺癌高发危险因素暴露的变化情况，以预测未来肺癌分布特征。方法根据2010年-2012年肺癌死亡率将宣威市26个乡镇划分为高、中、低发区后，根据地形和方位选取6个乡镇（高中低发区各2个），并从每个乡镇中随机抽取4个行政村作为调查点。对调查点中居民样本人群进行肺癌危险因素面对面调查。计算高、中、低发区人群危险因素暴露率，以及性别、年龄别亚组人群暴露率，其中生活环境方面危险因素计算现在和十年前。采用标化率和标化率比较的统计学检验或卡方检验，比较区域间或两时间点暴露水平的高低。结果研究地区65%-80%的男性有吸烟史，60%-90%的从未吸烟者有二手烟暴露史。烟草使用和二手烟暴露均是在肺癌高、中发区明显严重于低发区。中发区50%的男性有煤矿工作经历，是高、低发区的2倍；而高发区15%-25%的人有其他职业烟尘暴露史，是中、低发区的3倍-5倍。从十年前到现在，中发区都有近80%的家庭每年使用2吨或更多烟煤，有超90%的家庭使用燃煤取暖，有60%多的家庭做饭时厨房油烟多，有60%的家庭日常最常使用有烟囱地炉。高发区目前倒只有20%的家庭大量使用烟煤。整个研究地区50%-75%的家庭每年使用700度或更多电，比十年前用电量大增。低发区80%的人经常吃高油脂或腌制熏制食品，高、中发区为50%-60%。结论从本次调查数据来看，目前烟煤使用情况的分布与肺癌高中低发区的分布已不一致。烟草流行包括二手烟暴露，烟煤使用，职业暴露可能是当前宣威肺癌仍旧高发的原因。炉灶类型、饮食习惯等危险因素与宣威肺癌间的相关性值得进一步研究。

Time trends of esophageal and gastric cancer mortality in China, 1991\u20132009: an age-period-cohort analysis

Esophageal and gastric cancers share some risk factors. This study aimed to compare the long-term trends in mortality rates of esophageal and gastric cancers in China to provide evidence for cancer prevention and control. Mortality data were derived from 103 continuous points of the Disease Surveillance Points system during 1991–2009, stratified by gender and urban-rural locations. Age-period-cohort models were used to disentangle the time trends of esophageal and gastric cancer mortality. The downward slope of the period effect for esophageal cancer was steeper than that for gastric cancer in rural areas. Cohort effect patterns were similar between esophageal and gastric cancers, with an inverse U-shape peaking around the late 1920s and early 1930s. A second peak, appearing around the 1950s, was weaker than the first but apparent in males, especially for esophageal cancer. The more marked changes in period effect for esophageal cancer in rural areas suggest esophageal cancer screening practices are effective in reducing mortality, and similar programs targeting gastric cancer should be implemented. The similarities of the cohort effects in these two cancers support the implication of nutrition deficiency in early childhood in the development of upper gastrointestinal cancer.

Effect of Self-efficacy Intervention on Quality of Life of Patients With Intestinal Stoma.

Colorectal carcinoma is one of the most common malignancies worldwide and the most prevalent cause of cancer mortality in China. The Miles operation and permanent colostomy are effective treatment. However, these affect the quality of life of patients as they alter normal defecation. Self-efficacy is used to define an individuals' assessments of their ability to perform a specific behavior successfully. It is regarded as an important belief that can predict health behaviors. The aim of this study was to explore the effect of a self-efficacy intervention on the quality of life of patients with a permanent colostomy. Forty-eight patients in treatment for permanent colostomy surgery were divided into the control and intervention groups. The control group received routine nursing; the intervention group was exposed to a 3-month self-efficacy intervention, as well as routine nursing. The two groups completed the Chinese version of a self-efficacy questionnaire at 10 days, 1 month, and 3 months after surgery. Three months after surgery, the two groups also completed a quality-of-life questionnaire. There were significant differences in the quality of life between the two groups. The self-efficacy intervention nursing method improved self-efficacy and the quality of life of patients with intestinal stoma and is worthy of clinical utilization and application.

Functions of endothelin-1 in apoptosis and migration in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality in China and the third leading cause of cancer mortality worldwide. The mechanisms involved in the development and progression of HCC are not well understood. In the present study, the functions of endothelin-1 (ET-1) in HCC were studied and its underlying mechanisms were investigated. ET-1, B-cell lymphoma 2 (Bcl-2), Bcl-2 related protein 4 (Bax), matrix metalloproteinase (MMP)-2 and MMP-9 expression was measured by reverse transcription-quantitative polymerase chain reaction and western blotting. Cell proliferation was measured via Cell Counting kit-8 assay. Flow cytometry was performed for cell cycle and apoptosis analysis. Migration was measured via Transwell assay. The results demonstrated that ET-1 expression significantly increased in HCC tissues compared with the normal tissues of patients in The Cancer Genome Atlas dataset (P<0.01). Furthermore, downregulation of ET-1 was able to significantly inhibit cell proliferation and growth in vitro (P<0.01) and in vivo (P<0.01), and induce cell cycle arrest (P<0.05) and apoptosis (P<0.01) in the HCC SMMC-7721 cell line. Bioinformatics analysis demonstrated that the cell apoptosis signaling pathway was activated by ET-1. The ratio of B-cell lymphoma (Bcl-2) -related protein 4 (Bax)/Bcl-2 was significantly increased by downregulation of ET-1 (P<0.01). ET-1 downregulation also inhibited migration of SMMC-7721 cells (P<0.05) via decreasing levels of matrix metalloproteinase (MMP) -2 (P<0.05) and MMP-9 (P>0.05). These results suggest that ET-1 may be able to affect the apoptosis and migration of HCC cells via modulation of the Bax/Bcl-2 ratio and expression levels of MMP-2 and MMP-9, which indicates that ET-1 maybe a potential novel target for HCC treatment.

Trends in geographical disparities for cervical cancer mortality in China from 1973 to 2013: a subnational spatio-temporal study.

This study was designed to explore the time trends in geographical variations of cervical cancer mortality in mainland China over the period 1973 to 2013, to provide subnational spatio-temporal patterns for targeted promotion of human papillomavirus vaccine in China. Data were extracted from three national retrospective death surveys and cancer registry. The rate ratio (RR) was estimated for the aggregated data for seven geographical regions using generalized linear models to evaluate time trends in geographical disparities of cervical cancer mortality. There was a significant decrease in cervical cancer mortality in China from 1973-1975 to 2004-2005, but leveled off thereafter to 2011-2013. Compared to the period 1973-1975 the RR for the three last time periods were 0.33 [95% confidence interval (95% CI): 0.30-0.37] for 1990-1992, 0.21 (95% CI: 0.19-0.24) for 2004-2005 and 0.24 (95% CI: 0.22-0.26) for 2011-2013. Females living in the Northwest China and Central China have a high risk of mortality from cervical cancer compared to the nationwide, with the RR being 2.09 (95% CI: 1.83-2.38) and 1.26 (95% CI: 1.11-1.44) respectively, while the RRs for South China, Northeast China and Southwest China were below 1.00, indicating the lower death risk. Despite the mortality rate had increased slightly from 2004 to 2013, there was an encouraging sign that the geographical disparities in cervical cancer mortality had gradually narrowed over time across China. Although cervical cancer mortality in China has reduced to very low levels, the high risk of cervical cancer in Northwest China and Central China is still noteworthy. Public health policies including the promotion of vaccine should be targeted to further reduction of geographical disparities in cervical cancer mortality.

Spatiotemporal Variations in Lung Cancer Mortality in China between 2006 and 2012: A Multilevel Analysis.

We investigated temporal trends and geographical variations in lung cancer mortality in China from 2006 to 2012. Lung cancer mortality counts for people aged over 40 years were extracted from the China Mortality Surveillance System for 161 disease surveillance points. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region. Lung cancer mortality increased in China over the study period from 78.77 to 85.63 (1/100,000), with higher mortality rates evident in men compared to women. Median rate ratios (MRRs) indicated important geographical variation in lung cancer mortality between provinces (MRR = 1.622) and counties/districts (MRR = 1.447). On average, lung cancer mortality increased over time and was positively associated with county-level urbanization (relative risk (RR) = 1.15). Lung cancer mortality seemed to decrease in urban and increase in rural areas. Compared to the northwest, mortality was higher in the north (RR = 1.98), east (RR = 1.87), central (RR = 1.87), and northeast (RR = 2.44). Regional differences and county-level urbanization accounted for 49.4% and 8.7% of provincial and county variation, respectively. Reductions in lung cancer mortality in urban areas may reflect improvements in access to preventive healthcare and treatment services. Rising mortality in rural areas may reflect a clustering of risk factors associated with rapid urbanization.

Lung Cancer Mortality Trends in China from 1988 to 2013: New Challenges and Opportunities for the Government.

Background: As lung cancer has shown a continuously increasing trend in many countries, it is essential to stay abreast of lung cancer mortality information and take informed actions with a theoretical basis derived from appropriate and practical statistical methods. Methods: Age-specific rates were collected by gender and region (urban/rural) and analysed with descriptive methods and age-period-cohort models to estimate the trends in lung cancer mortality in China from 1988 to 2013. Results: Descriptive analysis revealed that the age-specific mortality rates of lung cancer in rural residents increased markedly over the last three decades, and there was no obvious increase in urban residents. APC analysis showed that the lung cancer mortality rates significantly increased with age (20–84), rose slightly with the time period, and decreased with the cohort, except for the rural cohorts born during the early years (1909–1928). The trends in the patterns of the period and cohort effects showed marked disparities between the urban and rural residents. Conclusions: Lung cancer mortality remains serious and is likely to continue to rise in China. Some known measures are suggested to be decisive factors in mitigating lung cancer, such as environmental conservation, medical security, and tobacco control, which should be implemented more vigorously over the long term in China, especially in rural areas.

Temporal Trends in Geographical Variation in Breast Cancer Mortality in China, 1973-2005: An Analysis of Nationwide Surveys on Cause of Death.

To describe geographical variation in breast cancer mortality over time, we analysed breast cancer mortality data from three retrospective national surveys on causes of death in recent decades in China. We first calculated the age-standardized mortality rate (ASMR) for each of the 31 provinces in mainland China stratified by survey period (1973–1975, 1990–1992 and 2004–2005). To test whether the geographical variation in breast cancer mortality changed over time, we then estimated the rate ratio (RR) for the aggregated data for seven regions and three economic zones using generalized linear models. Finally, we examined the correlation between mortality rate and several macro-economic measures at the provincial level. We found that the overall ASMR increased from 2.98 per 100,000 in 1973–1975 to 3.08 per 100,000 in 1990–1992, and to 3.85 per 100,000 in 2004–2005. Geographical variation in breast cancer mortality also increased significantly over time at the regional level (p = 0.002) but not at the economic zone (p = 0.089) level, with RR being generally lower for Western China (Northwest and Southwest) and higher in Northeast China over the three survey periods. These temporal and spatial trends in breast cancer mortality were found to be correlated with per capita gross domestic product, number of hospitals and health centres’ beds per 10,000 population and number of practicing doctors per 10,000 population, and average number of live births for women aged 15–64. It may be necessary to target public health policies in China to address the widening geographic variation in breast cancer mortality, and to take steps to ensure that the ease of access and the quality of cancer care across the country is improved for all residents.

Spatial Autocorrelation of Cancer Mortality in China’s Huai River Basin

Spatial Autocorrelation of Cancer Mortality in China’s Huai River Basin

Colorectal Cancer Mortality Characteristics and Predictions in China, 1991-2011.

To identify the epidemiological characteristics of colorectal cancer mortality in China during the period of 1991-2011, and forecast the future five-year trend. Mortality data for colorectal cancer in China from 1991 to 2011 was used to describe epidemiological characteristics in terms of age group, gender, and rural/urban residence. Trend surface analysis was performed to analyze the geographical distribution of colorectal cancer. Four models including curve estimation, time series modeling, gray modeling and joinpoint regression were applied to forecast the trends for the future five years. Since 1991 the colorectal cancer mortality rate increased yearly, and our results showed that the trend would continue to increase in the ensuing 5 years. The mortality rate in males was higher than that of females and the rate in urban areas was higher than in rural areas. The mortality rate was relatively low for individuals less than 60 years of age, but increased dramatically afterwards. People living in the northeastern China provinces or in eastern China had a higher mortality rate for colorectal cancer than those living in middle or western China provinces. The steadily increasing mortality of colorectal cancer in China will become a substantial public health burden in the foreseeable future. For this increasing trend to be controlled, further efforts should concentrate on educating the general public to increase prevention and early detection by screening. More effective prevention and management strategies are needed in higher mortality areas (Eastern parts of China) and high-risk populations (60+ years old).

Characteristics and Prediction of Lung Cancer Mortality in China from 1991 to 2013.

To describe and analyze the epidemiological characteristics of lung cancer mortality in China from 1991 to 2013, forecast the future five-year trend and provide scientific evidence for prevention and management of lung cancer. Mortality data for lung cancer in China from 1991 to 2013 were used to describe epidemiological characteristics. Trend surface analysis was applied to analyze the geographical distribution of lung cancer. Four models, curve estimation, time series modeling, gray modeling (GM) and joinpoint regression, were performed to forecast the trend for the future. Since 1991 the mortality rate of lung cancer increased yearly. The rate for males was higher than that for females and rates in urban areas were higher than in rural areas. In addition, our results showed that the trend will continue to increase in the ensuing 5 years. The mortality rate increased from age 45-50 and peaked in the group of 85 years old. Geographical analysis indicated that people living in northeast China provinces and the coastal provinces in eastern China had a higher mortality rate for lung cancer than those living in the centre or western Chinese provinces. The standardized mortality rate of lung cancer has constantly increased from 1991 to 2013, and been predicted to continue in the ensuing 5 years. Further efforts should be concentrated on education of the general public to increase prevention and early detection. Much better prevention and management is needed in high mortality areas (northeastern and eastern parts of China) and high risk populations (45-50-year-olds).

Ambient air pollution and lung disease in China: health effects, study design approaches and future research.

Ambient air pollution in China has worsened following dramatic increases in industrialization, automobile use and energy consumption. Particularly bothersome is the increase in the PM2.5 fraction of pollutants. This fraction has been associated with increasing rates of cardio-respiratory disease in China and elsewhere. Ambient pollutant levels have been described in many of China's cities and are comparable to previous levels in southern California. Lung cancer mortality in China has increased since the 1970s and has been higher in men and in urban areas, the exact explanation for which has not been determined. The estimation of individual risk for Chinese citizens living in areas of air pollution will require further research. Occupational cohort and case-control designs each have unique attributes that could make them helpful to use in this setting. Other important future research considerations include detailed exposure assessment and the possible use of biomarkers as a means to better understand and manage the threat posed by air pollution in China.

Phytochemicals in Cancer Prevention and Therapy.

Despite advances in modern medicine, cancer is still the major cause of mortality in both developing and developed countries. Search for safer and more effective chemoprevention and treatment strategy is a need for the improvement of patient care in the field. Prevention may be more effective and less costly because cancer is largely a preventable disease which could be attributed to a greater extent to lifestyle. Dietary phytochemicals have been used for the treatment of cancer throughout history due to their safety, low toxicity, and general availability. Population based studies suggest that a reduced risk of cancer is associated with high consumption of vegetables and fruits. Promising phytochemicals not only disrupt aberrant signaling pathways leading to cancer but also synergize with chemotherapy and radiotherapy. Thus, the cancer chemoprevention and therapeutic potential of naturally occurring phytochemicals are of great interest. In this special issue we have collected many interesting original research articles and reviews that provide solid evidence to support the application of phytochemicals or dietary agents in prevention and treatment of cancer. This special issue contains 3 review articles and 9 original peer-reviewed papers. A. M. Harrison et al. performed a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects; X.-Y. Chen et al. explored the molecular mechanisms underlying the antimetastatic activity of black rice anthocyanins and identified its molecular targets in HER2+ breast cancer cells; the study by Y. Zeng et al. reports that Southwest China (especially Yunnan and Tibet) is the center of lowest mortality of cancers in China based on coevolution between human's anticancer activities and functional foods from crop origin center; M. Sugata et al. studied the anti-inflammatory and anticancer activities of Taiwanese purple-fleshed sweet potatoes (Ipomoea batatas L. Lam.) extracts; R. Moo-Puc et al. investigated the antiproliferative activity of bonediol, an alkyl catechol isolated from the Mayan medicinal plant Bonellia macrocarpa against human prostate tumor cells; B. Moyo and S. Mukanganyama demonstrate the antiproliferative potential of T. welwitschii extract on Jurkat T cells; C.-J. Tai et al. report the potential of ethanolic extract of Taiwanofungus camphoratus (Antrodia camphorata) to enhance the cytotoxicity of cisplatin and doxorubicin on human hepatocellular carcinoma cells; G. Wang et al. explored the molecular mechanism of total flavonoids extracted from Cotinus coggygria against glioblastoma cancer in vitro and in vivo; M. N. Mallick et al. studied the anticancer activity of hydroalcoholic extract of Picrorhiza kurroa and its fractions; M. F. Abu Bakar et al. demonstrate that the Garcinia dulcis fruit extract induced cytotoxicity and apoptosis in HepG2 liver cancer cells; G. Weng et al. reported the curcumin enhanced busulfan-induced apoptosis in leukemia stem-like KG1a cells via downregulating the expression of survivin; S. Kumar and J. Kim in their review discuss potency and selectivity of PLK-1-targeted inhibitors and their molecular interactions with PLK-1 domains. In conclusion, this special issue discussed the potential anticancer phytochemicals and dietary agents, their molecular targets, and their mechanisms of actions. The understanding of molecular mechanism of a specific plant derived compound against a particular type of cancer will lead to the invention of novel drug and drug targets for therapeutic intervention.

Abstract 1730: A study on EGFR gene amplification and protein expression in Chinese esophagus cancer patients and antitumor effect of an EGFR inhibitor in patient-derived esophagus cancer models

Abstract Esophagus cancer is the fifth most common malignancy and the fourth leading cause of cancer mortality in China. According to Chinese cancer registry annual report in 2012, esophagus cancer accounts for nearly 1 in 10 of all cancer deaths. Despite the fact that much progress has been made in diagnosis and systemic chemotherapy regimens, the overall prognosis of esophagus cancer is disappointing. The 5-year survival rate, all stages included, is around 15∼25%. There remains a significant unmet medical need for esophagus cancer treatment. EGFR expression was reported in 30∼90% esophagus cancers and overexpression of EGFR was found to be associated with poorer survival. Unlike colon cancer, K-ras mutation was less frequently found in esophagus cancer (5∼10%), suggesting EGFR pathway blockade might bring therapeutic benefit to those patients with EGFR activation or overexpression. In this study, as of November 2013, 35 surgical esophagus tumor samples were collected from a local hospital in Shanghai. 31 of the 35 samples were identified as squamous cell carcinoma. EGFR gene amplification, protein expression and K-ras mutation were studied. In addition, 9 patient derived esophagus cancer xenograft models (PDX) were developed and anti-tumor effect of a novel and highly potent EGFR inhibitor was evaluated in 6 PDX models. Positive EGFR protein expression was found in 66% (23/35) of esophageal cancer samples. EGFR gene amplifications were observed in 9% patients (3/35). In 9 established PDX models, 7 of them showed EGFR expression and 2 with EGFR gene amplification. No K-ras mutation was observed in the 9 models. A novel and highly potent EGFR inhibitor (EGFRi), developed by Hutchison and currently being evaluated in phase I clinical trials in China, demonstrated potent anti-tumor activity in several PDX models with tumor growth inhibition in a range of 70% to &amp;gt;100%. One PDX model with EGFR gene amplification and overexpression exhibited the highest sensitivity to EGFRi with remarkable tumor regression. EGFR signaling transduction was evaluated and the EGFRi inhibited phosphorylation of EGFR and downstream signaling molecules AKT and ERK. In conclusion, EGFR expression and/or gene amplification was frequently found in Chinese esophagus cancer. EGFR inhibition resulted in potent anti-tumor effect in multiple patient derived esophagus cancer models carrying EGFR amplifications or high expression, suggesting the potential benefit that anti-EGFR agents might bring to esophagus cancer patients with abnormal EGFR activation. Citation Format: Yongxin Ren, Jianming Zheng, Linfang Wang, Wei Zhang, Fang Yin, Jinghong Zhou, Xuelei Ge, Shiming Fan, Renxiang Tang, Junen Sun, Weiguo Qing, Weiguo Su. A study on EGFR gene amplification and protein expression in Chinese esophagus cancer patients and antitumor effect of an EGFR inhibitor in patient-derived esophagus cancer models. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1730. doi:10.1158/1538-7445.AM2014-1730

Epidemiological Characteristics and Prediction of Esophageal Cancer Mortality in China from 1991 to 2012

To analyze the mortality distribution of esophageal cancer in China from 1991 to 2012, to forecast the mortality in the future five years, and to provide evidence for prevention and treatment of esophageal cancer. Mortality data for esophageal cancer in China from 1991 to 2012 were used to describe its epidemiological characteristics, such as the change of the standardized mortality rate, urban-rural differences, sex and age differences. Trend-surface analysis was used to study the geographical distribution of the mortality. Curve estimation, time series, gray modeling, and joinpoint regression were used to predict the mortality for the next five years in the future. In China, the incidence rate of esophageal cancer from 2007 and the mortality rate of esophageal cancer from 2008 increased yearly, with males at 8.72/105 being higher than females, and the countryside at 15.5/105 being higher than in the city. The mortality rate increased from age 45. Geographical analysis showed the mortality rate increased from southern to eastern China, and from northeast to central China. The incidence rate and the standardized mortality rate of esophageal cancer are rising. The regional disease control for esophageal cancer should be focused on eastern, central and northern regions China, and the key targets for prevention and treatment are rural men more than 45 years old. The mortality of esophageal cancer will rise in the next five years.

The global significance of China's cancer burden and control effort.

The relationship between growing economic development and increasing cancer burden has been well recognized (1). Following three decades of economic development with unprecedented speed, the overall cancer mortality in China was estimated to have increased 83%, lung cancer mortality in particular rose 465% (2). With nearly 1.4 billion population, China plays a significant role in the global cancer burden and cancer control effort. However, accurate assessment of China’s cancer burden was difficult, due to lack of a population-based cancer registry system in China, until recent years.

Lung cancer incidence and mortality in China, 2010.

The National Central Cancer Registry of China (NCCR) is responsible for cancer surveillance. Local cancer registries in each province submit data for annual publication. The incidence and mortality of lung cancer in China in 2010 by age, gender, and area is reported in this article. In 2013, 145 of 219 population-based cancer registries' 2010 data were selected after quality evaluation. Classification included Western, Middle, and Eastern areas, and the crude incidence and mortality rates of lung cancer were calculated by age, gender, and urban and rural. Age-standardized rates were determined by China and World standard population data. The 6th National Population Census data of China was used, combined with the registries' data to estimate the lung cancer burden in China in 2010. Lung cancer had the highest incidence and mortality in China for men and women. It was estimated that 605 946 lung cancer cases were diagnosed in China in 2010, with a crude incidence rate of 46.08/100 000, and 486 555 patients died from lung cancer, with a crude mortality rate of 37.00/100 000. Age-standardized rates for incidence were 35.23/100 000 and 35.04/100 000, respectively. Incidence and mortality rates for lung cancer were higher in men and urban areas than those in women and rural areas, reaching a peak for subjects of 80-84 years old. Lung cancer has the highest incidence and mortality of all cancers in China, especially for males in urban areas. Our findings justify the need to plan and develop effective interventions, such as air pollution control and smoking deterrents, to control and prevent the spread of lung cancer in China.

Report of cancer incidence and mortality in China, 2010.

To estimate the cancer incidences and mortalities in China in 2010. On basis of the evaluation procedures and data quality criteria described in the National Central Cancer Registry (NCCR), data from 219 cancer registries were evaluated. Data from 145 registries were identified as qualified and then accepted for the 2010 cancer registry report. The incidences and mortalities of major cancers and the overall incidence and mortality were stratified by residency (urban or rural), areas (eastern, middle, and western), gender, and age. The cancer cases and deaths were estimated based on age-specific rate and national population in 2010. The China 2010 Population Census data and Segi's world population data were used for calculating the age-standardized cancer incidence/mortality rates. Data were obtained from a total of 145 cancer registries (63 in urban areas and 82 in rural areas) covering 158,403,248 people (92,433,739 in urban areas and 65,969,509 in rural areas). The percentage of morphologically verified cases (MV%) were 67.11%; 2.99% of incident cases were identified through proportion of death certification only (DCO%), with the mortality to incidence ratio of (M/I) 0.61. The estimates of new cancer cases and cancer deaths were 3,093,039 and 1,956,622 in 2010, respectively. The crude incidence was 235.23/10(5) (268.65/10(5) in males and 200.21/10(5) in females), the age-standardized rates by Chinese standard population (ASR China) and by world standard population (ASR world) were 184.58/10(5) and 181.49/10(5), and the cumulative incidence rate (0-74 age years old) was 21.11%. The cancer incidence and ASR China were 256.41/10(5) and 187.53/10(5) in urban areas and 213.71/10(5) and 181.10/10(5) in rural areas. The crude cancer mortality in China was 148.81/10(5) (186.37/10(5) in males and 109.42/10(5) in females), the age-standardized mortalities by Chinese standard population and by world standard population were 113.92/10(5) and 112.86/10(5), and the cumulative mortality rate (0-74 age years old) was 12.78%. The cancer mortality and ASR China were 156.14/10(5) and 109.21/10(5) in urban areas 141.35/10(5) and 119.00/10(5) in rural areas, respectively. Lung cancer, female breast cancer, gastric cancer, liver cancer, esophageal cancer, colorectal cancer, and cervical cancer were the most common cancers. Lung cancer, liver cancer, gastric cancer, esophageal cancer, colorectal cancer, breast cancer, and pancreatic cancer were the leading causes of cancer deaths. The coverage of cancer registration has rapidly increased in China in recent years and may reflect more accurate cancer burdens among populations living in different areas. As the basis of cancer control program, cancer registration plays an irreplaceable role in cancer surveillance, intervention evaluation, and policy-making. Given the increasing cancer burden in the past decades, China should strengthen its cancer prevention and control.