Chinese Cancer Registry Annual Report Research Articles

Trends in cancer mortality among the elderly in China, 2005-2035.

With the appearance and aggravation of the aging society, cancer has become one of the major problems that threaten the life and health of Chinese residents seriously. To explore the cancer epidemiological characteristics among the elderly in China from 2005 to 2016, and to provide strategies for cancer prevention and treatment. Stratified analysis was conducted on the cancer mortality data of the elderly aged ≥60 years in China, which were selected from the Chinese Cancer Registry Annual Report. Joinpoint regression model was used to calculted average annual percentage change (AAPC) to estimate the time trends. Age-period-cohort (APC) model was used to explore the age, period and birth cohort effect on the risk of cancer death. Bayesian age-period-cohort (BAPC) model was used to predict trends in cancer mortality among elderly by gender and region to 2035. 2005-2016, cancer mortality in the elderly in China showed a decreasing trend (AAPC = -1.2%, P<0.001). Cancer mortality in rural areas was higher than that in urban areas, but the urban-rural difference gradually narrowed (t = 6.1, P<0.01). The APC model showed that cancer mortality increased with age. The relative risk (RR) for the period effect decreased. RR was lower for the later- born cohort than that for the earlier-born cohort in rural areas. Lung cancer mortality ranked first in both male and female, and showed an increasing trend among female in the 60-64, 80-84 and ≥85 age groups (AAPC60-64 = 1.0%, AAPC80-84 = 0.8%, AAPC≥85 = 2.0%, all P<0.05). By 2035, cancer mortality for the elderly was predicted to decline nationally, by sex and in rural areas, while rising in urban areas. Cancer mortality in the elderly in China showed a decreasing trend from 2005 to 2016, but it was still higher than the world average. Early cancer screening is important, especially in the elderly male and in rural areas.

The trend of lymphoma incidence in China from 2005 to 2017 and lymphoma incidence trend prediction from 2018 to 2035: a log-linear regression and Bayesian age-period-cohort analysis.

The aims of this study were to explore the incidence characteristics and trend prediction of lymphoma from 2005 to 2035, and to provide data basis for the prevention and control of lymphoma in China. The data on lymphoma incidence in China from 2005 to 2017 were obtained from the Chinese Cancer Registry Annual Report. The Joinpoint regression model was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) to reflect time trends. Age-period-cohort models were conducted to estimate age, period, and cohort effects on the lymphoma incidence. A Bayesian age-period-cohort model was used to predict lymphoma incidence trends from 2018 to 2035. From 2005 to 2017, the incidence of lymphoma was 6.26/100,000, and the age-standardized incidence rate (ASIR) was 4.11/100,000, with an AAPC of 1.4% [95% confidence interval (CI): 0.3%, 2.5%]. The ASIR was higher in men and urban areas than in women and rural areas, respectively. The age effect showed that the incidence risk of lymphoma increased with age. In the period effect, the incidence risk of lymphoma in rural areas decreased first and then increased with 2010 as the cutoff point. The overall risk of lymphoma incidence was higher in the cohort before the 1970-1974 birth cohort than in the cohort after. From 2018 to 2035, the lymphoma incidence in men, women, and urban areas will show an upward trend. From 2005 to 2017, the incidence of lymphoma showed an increasing trend, and was different in regions, genders, and age groups in China. It will show an upward trend from 2018 to 2035. These results are helpful for the formulation and adjustment of lymphoma prevention, control, and management strategies, and have important reference significance for the treatment of lymphoma in China.

A system review of central nervous system tumors on children in China: epidemiology and clinical characteristics

BackgroundCentral nervous system (CNS) tumors are the most common solid tumors in children and the leading cause of cancer-related death in the latter. Currently, the incidence rate exceeds that of leukemia and ranks first in the incidence of malignant tumors in children.MethodsThe epidemiological data on childhood CNS tumors were collected from the Chinese Cancer Registry Annual Report. The annual percent change (APC) of incidence and mortality-rate changes were estimated via Joinpoint regression. Due to a lack of pertinent data, we performed a system review on the clinical-pathological characteristics in Chinese publications.ResultsThere was no significant increase in the incidence rate (APC: -0.1, 95% CI: -1.5 to 1.3), but there was a significant increase in the mortality rate (APC: 1.8, 95% CI: 0.3 to 3.4) for childhood CNS tumors. In the subgroup analysis, there were significant increases in both the incidence and mortality rates in rural areas (APC in the incidence: 6.2, 95% CI: 2.4 to 10.2; APC in mortality: 4.4, 95% CI: 0.4 to 8.4). The most common location and type of childhood CNS were, respectively, the cerebral hemisphere (25.5%, 95% CI: 21.7% to 29.4%) and astrocytomas (26.8%, 95% CI: 23.9% to 29.6%).ConclusionsThe epidemiological trends, and the relevant prediction, highlighted the need to pay continual attention to childhood CNS tumors, and the clinicopathology evinced its own distinctive characteristics. Timely detection and effective treatment must be further promoted regarding childhood CNS tumors with a view to decreasing the disease burden, especially in rural areas.

Epidemiological characteristics of leukemia in China, 2005–2017: a log-linear regression and age-period-cohort analysis

BackgroundLeukemia is a threat to human health, and there are relatively few studies on the incidence, mortality and disease burden analysis of leukemia in China. This study aimed to analyze the incidence and mortality rates of leukemia in China from 2005 to 2017 and estimate their age-period-cohort effects, it is an important prerequisite for effective prevention and control of leukemia.MethodsLeukemia incidence and mortality data from 2005 to 2017 were collected from the Chinese Cancer Registry Annual Report. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC) response time trend. Age-period-cohort model was constructed to analyze the effects of age, period and cohort.ResultsThe age-standardized incidence rate of leukemia was 4.54/100,000 from 2005 to 2017, showed an increasing trend with AAPC of 1.9% (95% CI: 1.3%, 2.5%). The age-standardized mortality rate was 2.91/100,000, showed an increasing trend from 2005 to 2012 with APC of 2.1% (95%CI: 0.4%, 3.9%) and then a decreasing trend from 2012 to 2017 with APC of -2.5% (95%CI: -5.3%, 0.3%). The age-standardized incidence (mortality) rates of leukemia were not only higher in males than that in females, but also increased more rapidly. The incidence of leukemia in rural areas was lower than in urban areas, but the AAPC was 2.2 times higher than urban areas. Children aged 0–4 years were at higher risk of leukemia. The risk of leukemia incidence and mortality increased with age. The period effect of leukemia mortality risk showed a decreasing trend, while the cohort effect showed an increasing and then decreasing trend with the turning point of 1955–1959.ConclusionsThe age-standardized incidence rate of leukemia in China showed an increasing trend from 2005 to 2017, while the age-standardized mortality rate increased first and then decreased in 2012 as a turning point. Differences existed by gender and region. The risk of leukemia incidence and mortality increased accordingly with age. The risk of mortality due to leukemia gradually decreased from 2005 to 2017. Leukemia remains a public health problem that requires continuous attention.

Temporal trends and projections of gynecological cancers in China, 2007–2030

BackgroundGynecological cancer will become a more important public health problem in future years but limited evidence on gynecological cancer burden in China.MethodsWe extracted age-specific rate of cancer cases and deaths during 2007–2016 from the Chinese Cancer Registry Annual Report, and estimated age-specific population size using the data released by National Bureau of Statistics of China. Cancer burden were calculated by multiplying the rates with the population size. Temporal trends of the cancer cases, incidence, deaths, and mortality during 2007–2016 were calculated by JoinPoint Regression Program, and from 2017 to 2030 were projected by grey prediction model GM (1,1).ResultsIn China, total gynecological cancer cases increased from 177,839 to 241,800, with the average annual percentage change of 3.5% (95% CI: 2.7–4.3%) during 2007–2016. Cervical, uterine, ovarian, vulva, and other gynecological cancer cases increased by 4.1% (95% CI: 3.3–4.9%), 3.3% (95% CI: 2.6–4.1%), 2.4% (95% CI: 1.4–3.5%), 4.4% (95% CI: 2.5–6.4%), and 3.6% (95% CI: 1.4–5.9%) respectively. From 2017 to 2030, projected gynecological cancer cases are changing from 246,581 to 408,314. Cervical, vulva and vaginal cancers showed evident upward trend, while uterine and ovarian cancer cases are slightly increasing. The increases for age-standardized incidence rates were similar with that of cancer cases. Temporal trends of cancer deaths and mortality were similar with that of cancer cases and incidence during 2007–2030, except that uterine cancer deaths and mortality were declined.ConclusionsWith the aging of population and other increased risk factors, the burden of gynecological cancers in China is likely to be grew rapidly in the future, comprehensive gynecological cancer control should be concerned.

Estimation of cancer mortality attributable to excess body weight during 2006–2015 in China

BackgroundCancer is one of the most common causes of death. Excess body weight (EBW), a risk factor for cancer, is highly prevalent in China. We aimed to estimate the number and proportion of cancer deaths attributed to EBW and their changes during 2006–2015 in China. MethodsPopulation attributable fractions in 2006, 2010, and 2015 were calculated with 1) prevalence of overweight/obesity, exacted from the China Health and Nutrition Survey conducted in 8–9 provinces of China in 1997, 2000, and 2004; 2) relative risks for EBW and site-specific cancers, obtained from previous studies; 3) data on cancer deaths in 2006, 2010, and 2015, originated from the Chinese Cancer Registry Annual Report. ResultsIn 2015, EBW contributed to 45,918 (3.1% of all) cancer deaths in China, with 24,978 (2.6%) in men and 20,940 (3.8%) in women. By region, the fraction of cancer deaths attributable to EBW ranged from 1.6% (West) to 4.1% (Northeast). Cancers of liver, stomach, and colorectum were the main EBW-attributable cancers. The fractions of cancer deaths attributable to EBW were 2.4% (95%CI: 0.8–4.2%) in 2006, 2.9% (95%CI: 1.0–5.2%) in 2010, and 3.1% (95%CI: 1.0–5.4%) in 2015, respectively, and increased for all gender, region, and cancer site during 2006–2015. ConclusionsThe proportion of cancer deaths attributed to EBW was higher in women and Northeastern China, with an upward trend in the recent decade. A combination of comprehensive and individualized measures is necessary to reduce the prevalence of EBW and related cancer burden in China.

Trends of cancer incidence among Chinese older adults from 2005 to 2016: A log-linear regression and age-period-cohort analysis.

To study the corresponding strategies for controlling cancer in older adults aged 60 and above in China, a comprehensive assessment of disease burden is required. Therefore, we will introduce the cancer epidemiological characteristics of older adults in China over a recent 12 year period. The age-period-cohort model was constructed using the cancer incidence data from the Chinese Cancer Registry Annual Report published in 2008-2019. The annual change percentage (APC) was estimated by log-linear regression to reflect the time trend. The data from the GLOBOCAN 2020 database was selected for worldwide comparative analysis. The cancer incidence in older adults aged 60 and above in China showed a decreasing trend (APC = -0.73%, P = 0.009). The urban/rural ratio of cancer incidence increased from 0.94 to 1.07 (t = 3.52, P < 0.05), while the sex ratio (male/female) showed a significant decreasing trend only in rural areas (t = -6.77, P < 0.05), and the ratio decreased from 2.02 to 1.72. The results of the age-period-cohort model showed that the cancer incidence increased with age in both males and females, urban and rural areas. The RR of period effect increased from 2005 to 2010, then decreased from 2010 to 2015, and the downward trend was more obvious. The RR of the later-born cohort was lower than that of the earlier-born cohort in rural areas. Lung, gastric, colorectal, esophageal, liver, and breast cancers were common cancers in Chinese older adults. Lung cancer incidence ranked first in males, and it decreased with time in the 75-79 and 80-84 age groups (APC75 - 79 = -1.10%, APC80 - 84 = -0.88%, all P < 0.05). Breast cancer incidence ranked first among female in the 60-64 age group and showed an increasing trend (APC60 - 64 = 1.52%, P < 0.05). The cancer incidence in Chinese older adults aged 60 and above showed a decreasing trend, but it was still at a relatively high level. The key targets of prevention and treatment should be males, urban areas, younger people, older adults aged 60-69, lung, gastrointestinal, and breast cancers in the future.

Temporal Trends and Projection of Cancer Attributable to Human Papillomavirus Infection in China, 2007-2030.

Information on temporal trends of cancer attributable to human papillomavirus (HPV) in China is limited. Cancer incidence and mortality during 2007 to 2015 were extracted from the Chinese Cancer Registry Annual Report and the national population from the National Bureau of Statistics. HPV-attributable cancer burden and the average annual percentage change during 2007 to 2015 were estimated and cancer burden during 2016 to 2030 was projected. HPV-attributable cancer cases have increased by 3.8% [95% confidence interval (CI), 2.9%-4.8%] annually from 85,125 to 113,558 and age-standardized incidence rate (ASIR) rose by 3.0% (95% CI, 2.5%-3.5%) from 4.67 to 5.83 per 100,000 persons during 2007 to 2015. Cervical, female anal, and vulva cancer cases have increased by 3.8% (95% CI, 2.8%-4.7%), 6.5% (95% CI, 1.2%-12.2%), and 3.7% (95% CI, 1.6%-5.8%) per year. Male anal and oropharyngeal cancer cases have elevated by 7.5% (95% CI, 2.8%-12.5%) and 4.4% (95% CI, 2.4%-6.3%) annually. The increases of cervical and anal cancer were most rapid among those aged 50 and older. HPV-attributable cancer deaths and mortality rate have risen by 4.7% (95% CI, 2.9%-6.7%) and 3.3% (95% CI, 0.9%-5.8%) respectively. HPV-attributable cancer cases and ASIR are projected to reach 214,077 and 9.35 of 100,000 persons by 2030 respectively, with 87.7% being cervical cancer, and anal cancer cases are expected to triple. HPV-attributable cancer burden has largely increased in the past and will keep rising for the next decade. Cervical cancer control should be the priority and anal cancer prevention should be addressed. This study supplies fundamental evidence for policy-making on HPV-attributable cancer control.

Colorectal Cancer Incidence and Mortality Trends and Analysis of Risk Factors in China from 2005 to 2015.

PurposeThis study aimed to analyze incidence and mortality trends and risk factors of colorectal cancer (CRC) in China during 2005–2015.Materials and MethodsPatient cases were extracted from the Chinese Cancer Registry Annual Report. Joinpoint regression and Poisson regression were applied to analyze incidence and mortality trends and risk factors of CRC. Age-period-cohort model was used to evaluate the age, period and cohort effects on CRC.ResultsThe standardized incidence and mortality rate of CRC in China showed a decreasing trend during 2005–2015. The incidence in men (APC=−1.22%, P<0.05) decreased from 2005 to 2015 and decreased in women (APC =−3.55%, P<0.05) from 2005 to 2013, then increased during 2013–2015 (APC =18.77%, P<0.05). The incidence and mortality in urban areas were higher than those in rural (The incidence in urban: APC =−0.97%, P<0.05; rural: APC =1.94%, P<0.05; the mortality in urban: APC =−0.67%, P<0.05; rural: APC =0.29%). For age-specific rates, the incidence begins to increase significantly at 40–45 age group and reached a peak at 75; the mortality increased significantly at 45–50. The age effect increased with age in general. The 1920 birth cohort had the highest risk of colorectal cancer incidence and death. Poisson regression showed region, gender and age were independent risk factors of CRC.ConclusionThe age-adjusted standardized incidence rate (ASIR) and age-adjusted standardized mortality rate (ASMR) of CRC in China during 2005–2015 were decreasing. A great concern on men, rural areas and people aged over 75 should be aroused to prevent colorectal cancer.

Trends in the age-related incidence of colon and rectal cancers in China, 2005–2015

BackgroundRecent evidences showed that the incidence of colorectal cancer decreased among older adults, yet this decline didn't appear in adults younger than 50 years. Our aim was to evaluate age-related incidence trends of colon and rectal cancers in China during 2005-2015. MethodsA retrospective study of colon and rectal cancers was conducted using population-based data from the Chinese Cancer Registry Annual Report. Age at diagnosis was analyzed in five sub-groups (0–19, 20–34, 35–49, 50–64 and 65 years). Data including new cases, incidence, and age-standardized rates (ASRs) were classified by sex and area. Temporal trends of ASRs were determined with Joinpoint regression analysis. ResultsFrom 2005 to 2015, colon cancer incidence decreased by -2.2% (95%CI: -3.1, -1.3) per year. A more steady decrease was seen in rectal cancer with AAPC of -0.9% (95%CI: -1.4, -0.4). Stratified by age at diagnosis, incidence trends followed a similar pattern, without age-related disparity. Females showed pronounced declines relative to males. The exception was that rural individuals showed opposite increasing trends, with 2.7% of AAPCs for colon cancer and 2.0% for rectal cancer. ConclusionA slight decline was observed in colon and rectal cancers during 2005–2015, regardless of age at diagnosis.

Disease burden of liver cancer in China: an updated and integrated analysis on multi-data source evidence

Objective: To analyze the disease burden of liver cancer in China. Methods: Based on eight data sources, including the series of Chinese Cancer Registry Annual Report, three national death cause surveys in China, China Health Statistical Yearbook, China Death Cause Surveillance Datasets, GLOBOCAN, Cancer Incidence in Five Continents (CI5), WHO Mortality Database and the Global Burden of Disease (GBD), the information on incidence, mortality and disability-adjusted life year (DALY) of liver cancer, were extracted for the analysis on the past, current and future disease burden caused by liver cancer in China. Results: 1) Past situation: The long-term data from 1973 to 2012 reported by the CI5 showed that in urban populations in China (taking Shanghai as an example), the incidence rate of liver cancer in males and females decreased by 41.3% and 36.3%, respectively, and that in rural areas (taking Qidong as an example) decreased by 32.3% and 12.2%, respectively. The Chinese Cancer Registry Annual Reports showed that the national incidence and mortality rates of liver cancer decreased by 8.1% and 12.8% respectively from 2005 to 2015. The Joinpoint analysis based on the data from the China Health Statistics Yearbook also showed a declining trend: the average annual percentage change of liver cancer mortality in China from 2002 to 2017 was -3.0% (P<0.05), and that in rural areas was -3.1% (P<0.05). 2) Current status: GLOBOCAN estimates that the rates of incidence, mortality and prevalence of liver cancer in China in 2018 were 18.3 per 100 000, 17.1 per 100 000 and 10.8 per 100 000, respectively. According to the latest annual report, the incidence and mortality rates of liver cancer in cancer registration areas in 2015 were 17.6 per 100 000 and 15.3 per 100 000, respectively, and both increased with age. The mortality rate was similar to that reported in 2017 (16.7 per 100 000) by the China Death Cause Surveillance Datasets, and the male to female ratio of live cancer deaths was estimated as 3.1. The GBD 2017 reports that the DALYs caused by liver cancer in China reached 11 153.0 thousand in 2017 (accounting for 53.7% of the global DALYs) and hepatitis B virus infection was always the leading cause. 3) Prediction: The GLOBOCAN 2018 predicts that, by 2040, the number of liver cancer cases and deaths in China would reach 591 000 and 572 000 (with an increase of 50.5% and 54.9%, respectively, compared with those in 2018), with a more significant increase in people over 70 years old. 4) Economic burden: According to the literature review of economic burden data on liver cancer, the direct medical expenditure per patient with liver cancer generally showed a rising trend. Conclusions: Multiple data sources indicate that the incidence and mortality rates of liver cancer in populations in China decreased in the past decades, indicating the effect of population interventions. However, the population-level disease burden are still substantial, and comprehensive intervention strategies need to be continually strengthened and optimized, especially the primary and secondary prevention.

Disease burden of colorectal cancer in China: any changes in recent years?

Objective: To update the disease burden of colorectal cancer (CRC) in Chinese population by integrating the latest multi-source evidences. Methods: Groups of data from GLOBOCAN, series of Chinese Cancer Registry Annual Report (annual report), Cancer Incidence in Five Continents (CI5), Global Burden of Disease Project 2017 (GBD), China Death Cause Surveillance Datasets and China Health Statistical Yearbooks (yearbook) were used to extract the information. Data on incidence, mortality, disability-adjusted life year (DALY) and percentage distribution of sub-location of CRC were used to analyze the latest disease burden in China, and age-standardized rates by world standard population were mainly used. Joinpoint Trend Analysis Software 4.7.0.0 was applied for time trend analysis. Data related to the economic burden of CRC in China were gathered by literature review. Results: (1) Current status: according to the latest annual report, the incidence and mortality rates of CRC were 17.1 per 100 000 and 7.9 per 100 000, respectively among the covered registration sites in 2015. The incidence ratios of male to female and that of urban to rural were 1.5 and 1.4, with the mortality ratios were 1.6 and 1.4, respectively. Similar to data from the annual report, the mortality rate was reported as 6.9 per 100 000 in 2017 by the surveillance data sets. Data from the GBD project showed that, the DALYs caused by CRC in China in 2017 was 4.254 million person years (doubled compared with that of 1990), accounting for 22.4% of the global burden of CRC. (2) Time trends: according to the annual reports, from 2009 to 2015, the incidence rate and mortality rate of CRC in China decreased by 10.2% and 9.5%, respectively. The same trend was also observed in urban sites, but was opposite in rural areas (increased 20.0% in incidence and 15.2% in mortality). Results from the Joinpoint analysis showed that the averaged annual percentage change (AAPC) was estimated as -1.6% (P<0.05) in the national mortality rate. Similarly, in the incidence and mortality rates of urban sites appeared as AAPC=-1.5% and -1.4% (all P<0.05), but inversely in the incidence rate from the rural sites as AAPC=3.3% (P<0.05). The yearbook data showed a 9.8% increase in urban and 20.6% increase in rural on the mortality in 2017 when compared with 2004, but the Joinpoint analysis showed no statistical significance (P<0.05). (3) Distribution of sub-location of CRC: the annual report showed that among all the new CRC cases in China in 2015, colon, rectal and anal cancer accounted for 49.6%, 49.2% and 1.2%, respectively, while the proportions were 51.3%, 47.6% and 1.1%, respectively in 2009. The proportion of colon cancer was continuously higher in the urban (>52%) than that in the rural areas (<44%). The CI5 Ⅺ data showed that ascending and sigmoid colons were more commonly seen among all the colon cancers. (4) Economic burden: the average annual growth rate of the medical expenditure per CRC patient in China ranged from 6.9% to 9.2%, and the 1-year out-of-pocket expenditure of a newly diagnosed patient accounted for about 60% of their previous-year household income. Conclusions: In China, the overall disease burden of CRC might have been decreased slightly but generally remained stable in the last several years, however, the rising burden appeared in the rural areas should not be ignored. In consistent with findings from a previous review, men and people from the urban areas are considered the target populations for CRC. The finding of higher proportion of colon cancer in urban areas suggests the impact of development of socioeconomic and medical technologies on CRC development and detection. The economic burden of CRC continued to grow.

Thyroid cancer: incidence and mortality trends in China, 2005-2015.

Understanding secular trends of thyroid cancer is critical to plan strategies for cancer prevention and control. Our aim was to estimate the incidence and mortality trends of thyroid cancer in China during 2005-2015. A retrospective cohort evaluation of thyroid cancer cases and deaths during 2005-2015 was performed using population-based data from the Chinese Cancer Registry Annual Report. The incidence and mortality rates of thyroid cancer were stratified by gender, age group (0, 1-4, 5-9, 10-14…80-84, 85-), and area (urban or rural). A Joinpoint regression model was used to examine secular trends. In China, the age-standardized incidence was 3.21/105 in 2005, and increased to 9.61/105 in 2015. Besides, a significant increase incidence rate was observed with the average annual percent change (AAPC) of 12.4% (95% CI: 10.5%-14.4%) in the period 2005-2015. The age-standardized mortality was 0.30/105 in 2005 and 0.35/105 in 2015, and the AAPC was 2.9% (95% CI: 1.3%-4.5%). For both incidence and mortality, the rates of thyroid cancer were much higher in females than in males, and in urban areas rather than rural areas; however, the rates of increasing trends showed no significant differences. With respect to the highest age-specific rates, it appeared in the age group of 50-54 years old for incidence and in the age group of 80-84 years old for mortality. Notably, the rate of increasing incidence trend was lower in older age groups, especially for people aged 70-79 years old. A rapid increase in incidence and a moderate increase in mortality of thyroid cancer were observed from 2005 to 2015 in our study. Effective measures and tailored programs should be taken to curb the growth trend and reduce the disease burden.

Study on the disease burden of cancer attributed to the dietary inorganic arsenic exposure in Chinese population in 2013

Objective: To estimate the burden attributed to the dietary inorganic arsenic exposure with lung cancer, bladder cancer and skin cancer as end points. Methods: Inorganic arsenic, food or diet were used as Chinese keywords and arsenic, food and China were used as English keywords to search for literatures related to the dietary inorganic arsenic exposure published by China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and PubMed Database. Using the data from the China National Nutrition and Health Survey (CNNHS) in 2002 to estimate the dietary inorganic arsenic exposure in Chinese residents. The annual cancer cases attributed to the dietary inorganic arsenic exposure were calculated based on the data from Chinese Cancer Registry Annual Report in 2013. The disability adjusted life year (DALY) was calculated using tools built by WHO. Results: The total DALY of cancer caused by the dietary inorganic arsenic exposure was 419.4 thousand, and the DALY rate was 31.47 per 100 000. The DALY of lung cancer in males and females was 237.7 thousand and 102.5 thousand. The DALY of bladder cancer in males and females was 13.2 thousand and 3.9 thousand. The DALY of skin cancer in males and females was 29.4 thousand and 32.8 thousand. Conclusion: In 2013, the Chinese population had a lower burden of cancer due to the dietary exposure to inorganic arsenic.

Cancer burden attributable to human papillomavirus infection by sex, cancer site, age, and geographical area in China.

BackgroundHuman papillomavirus (HPV) attributable cancer burden is currently unknown in China, which is essential to evaluate the potential benefit of existing HPV https://www.sciencedirect.com/topics/medicine-and-dentistry/vaccine and to inform cancer control policy.MethodsWe extracted data of cancer incidence and mortality in 2014 from Chinese Cancer Registry Annual Report, and data of national population from National Bureau of Statistics. HPV‐attributable cancer burden was estimated by incorporating cancer rates and population forecasts by sex, cancer site, age and geographical area, and then combined to corresponding population attributable fractions.ResultsWe estimated that there were 110 894 HPV‐attributable new cancer cases in China in 2014, including 99 253 cervical cancers, 4449 noncervical cancers in females and 7192 cancers in males. The age‐standardized incidence of HPV‐attributable cancers in China was 5.69 per 100 000 persons, being slightly higher in rural than urban areas. Specifically, 51.1% of HPV‐attributable cervical cancers were diagnosed in women aged 40‐54 years, while 75.8% of noncervical cancers were diagnosed at 45‐79 years of age. Among males, 53.4% of cancers were diagnosed at 55‐74 years of age. Thirty five thousand six hundred and eighty three HPV‐attributable cancer deaths were estimated, including 29 683 due to cervical cancer, and 2307 and 3693 due to noncervical cancer in females and males, respectively.ConclusionsThe cancer burden attributable to HPV in China is substantial. HPV vaccination and cervical screening should be prioritized.

Baseline Characteristics of 412 Hodgkin's Lymphoma Patients Diagnosed between July 2015 and May 2018: A Report from China Lymphoma Patient Registry (CLAP)

IntroductionLymphoma is the most common hematologic tumor with about 88000 newly diagnosed cases in China in 2015 (Chen et.al, CA Cancer J Clin 2016). To better understand the epidemiology, treatment and prognosis of lymphoma in China, Beijing Cancer Hospital and other four hospitals jointly launched China Lymphoma Patient Registry (CLAP) study (NCT03313271) in early 2017. By the end of March 2018, a total of 3458 lymphoma patients, including 412 Hodgkin's Lymphoma (HL) cases and 3046 Non-Hodgkin's Lymphoma (NHL) cases, had been prospectively and retrospectively recruited. Here we report the baseline characteristics and initial treatment of HL patients diagnosed between July 2015 and March 2018.MethodThis is an observational bi-directional cohort study based on medical records of hospitalized lymphoma patients. Inclusion criteria of this study include: 1) newly diagnosed as HL after July 2015 in five participating hospitals; 2) age >=18 yrs old at time of disease diagnosed; 3) given informed consent if prospective follow-up is needed. This study has been approved by Institutional Review Board (IRB) of all study sites. Medical records of newly diagnosed adult HL patients in five participating hospitals were systematically reviewed. Study data, including patient demographic information, disease baseline characteristics, treatment options and prognosis were manually entered or directly transferred into a predesigned electronic database with the support of Medbanks Network Technology Co., Ltd. In this study, descriptive analysis was used to understand the distribution of patient demographic information (age, gender, medical history, etc.), disease baseline characteristics (symptom, score, stage, etc.) and initial treatment option (if ABVD) for HL population as a whole as well as by subtype stratification.ResultA total of 412 HL patients were identified between July 2015 and March 2018. Among all HL patients, nodular sclerosis type of classic Hodgkin's lymphoma (NSCHL) was the most common subtype (53.6%) followed by mixed cell type of classic Hodgkin's lymphoma (MCCHL) (23.1%)(Figure1). All classic subtypes accounted for over 93% of all HL patients. Male is more common than female (60.4%vs39.6%), especially for nodular lymphocytes predominant type of HL (NLPHL). However, no statistical significant gender difference was observed across different subtypes. Age of NSCHL patients was relative younger than patients with other subtypes with a median age of 31. The general health status of most HL patients was relative good at first diagnosis, the percentage (excluding missing) of patient with recorded B symptoms and ECOG score >=2 were 42.4% and 2%, respectively. The distribution of clinical staging was 4.9%, 46.1%, 18.2% and 26.5% for I-IV respectively. Doxorubicin, Bleomycin, Vincristine, Dacarbazine (ABVD) contained regimen was the most common initial treatment regimen and was received by 72% of HL patients and no statistical significant difference was observed in term of ABVD use across HL subtypes (Table1). Hypertension was the most common comorbidity and 7% HL patients had reported concomitant hypertension followed by diabetes (4.4%), hepatitis B (1.9%) and tuberculosis (1.0%) (Figure2). Previous personal history of cancer and family history of cancer were reported by 1.7% and 9.2% of study subjects, respectively (Figure3).ConclusionCompared with Non-Hodgkin's Lymphoma, HL is less common, less aggressive and attracts less attention from researchers. In 2013, only about 700 HL newly diagnosed cases were reported, accounting for 5.4% of total lymphoma patients in the country (He, Chen, Chinese Cancer Registry Annual Report 2016). Although some multi-center studies had reported the pathology distribution of HL (Sun et.al, Am J Clin Pathol 2012; Cao et.al, Ann Diagn Pathol. 2018), very few of them have more detailed information on disease characteristics and treatment. As one of the biggest observational studies focus on HL in the country as well as in the region, this registry provides a unique opportunity and platform to understand the whole picture of HL diagnosis, treatment and prognosis in real world. DisclosuresSong:Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zhu:Beijing Cancer Hospital: Employment.

Baseline Characteristics of 3046 Non-Hodgkin's Lymphoma Patients Diagnosed between July 2015 and May 2018: A Report from China Lymphoma Patient Registry (CLAP)

IntroductionLymphoma is the most common hematologic tumor. In 2015 about 88000 new cases was estimated diagnosed in China (Chen et.al, CA Cancer J Clin 2016). China Lymphoma Patient Registry (CLAP) (NCT03313271) is an observational bi-directional cohort study launched in five hospitals in early 2017, aiming to better understand the epidemiology, treatment and prognosis of lymphoma in the country. By the end of March 2018, a total of 3458 lymphoma patients, including 412 Hodgkin's Lymphoma (HL) cases and 3046 Non-Hodgkin's Lymphoma (NHL) cases, had been prospectively and retrospectively recruited. Here we report the demographic and disease baseline characteristics of 3046 NHL patients diagnosed between July 2015 and March 2018.MethodThis is an observational bi-directional cohort study based on medical records of hospitalized lymphoma patients in five CLAP hospitals. In order to be eligible for this particular analysis, patients need to be 1) newly diagnosed as NHL between July 2015 and March 2018 in five participating hospitals; 2) age >=18 yrs old at time of disease diagnosis; 3) given informed consent if prospective follow-up is needed. This study has been approved by Institutional Review Board (IRB) from all study sites. Medical records of newly diagnosed NHL patients were systematically reviewed and study data were manually entered or directly transferred into a predesigned electronic database with the support of Medbanks Network Technology Co., Ltd. Descriptive analysis was used to understand the distribution of patient demographic information (age, gender, medical history, etc.), disease baseline characteristics (symptoms, score, stage, etc.) and initial treatment options (if Rituximab) for NHL population as a whole as well as by subtype stratification.ResultA total of 3046 newly diagnosed NHL patients were identified between July 2015 and March 2018, and diffuse large B cell lymphoma (DLBCL) was the most common subtype (48.2%)(Figure1). Males accounted for 55.4% of the total study population and were very dominant in mantle cell lymphoma (MCL) (79.8%), but females were more common in Follicular lymphoma (FL) (53.7%) and Marginal zone lymphoma (MZL) (52.8%). The median age of all study subjects was 58yrs old (range 18-95) and patients with FL (51yrs) and T-cell lymphoma (TCL) (52yrs) was relative younger compared with other subtypes. The general health status of most NHL patients was relative good at first diagnosis, the percentage (excluding missing) of patient with recorded B symptoms, ECOG-PS score >=2 and IPI score3-5 were 39.0%, 4.8% and 26.8%, respectively. Among B-cell lymphoma (BCL), Rituximab was most frequently used in patients with FL (63.4%) followed by DLBCL (61.1%), and MCL (58.5%) (table1). Hypertension was the most common comorbidity and over 16% NHL patients had reported concomitant hypertension followed by diabetes (7.9%), hepatitis B (4.4%), coronary heart disease (3.3%) and tuberculosis (1.4%) (Figure2). Previous personal history of cancer and family history of cancer were reported by 2.8% and 12.5% of study subjects, respectively (Figure3).ConclusionAmong all CLAP participants, NHL accounts for nearly 90% of all lymphoma patients, which is consistent with the report from national cancer registry (He, Chen, Chinese Cancer Registry Annual Report 2016) and demonstrates a well representativeness of NHL patients in China. NHL is a composite of many types of lymphoma and each subtype had unique histological, clinical and prognostic characteristics. Although previous studies had reported the pathology distribution of NHL in China (Sun et.al, Am J Clin Pathol 2012; Cao et.al, Ann Diagn Pathol. 2018), very few have more detailed information on disease characteristics and treatment. As a big observational study focus on lymphoma, this registry provides a unique opportunity and platform to understand the whole picture of NHL diagnosis, treatment and prognosis in real world. DisclosuresSong:Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zhu:Beijing Cancer Hospital: Employment.

The risk of cancer in patients with connective tissue diseases but without dermatomyositis or polymyositis: A multicenter cohort study conducted over 15 years in China

ObjectivesTo investigate the relative risk of cancer in Chinese patients with connective tissue diseases (CTD) associated with and without dermatomyositis or polymyositis. MethodsA retrospective, multicenter cohort study investigated 32,380 CTD patients (2334 diagnosed with dermatomyositis or polymyositis) without a history of malignancies treated from January 1, 1997, to December 31, 2011. Standardized incidence ratios (SIR) of cancers determined the incidence of malignancies during follow-up. The data was compared with the cancer morbidity of the general population from the Chinese Cancer Registry Annual Report of National Central Cancer Registry. ResultA total of 113 patients (348.98 per 100,000) developed cancer during follow-up, 75 (249.62 per 100,000) were patients with CTD without dermatomyositis or polymyositis. The risk of cancer among patients with CTD was increased (SIR=1.45, 95% confidence interval [CI] 1.22–1.71), and this risk increased with age (<40 years: SIR=1.00 [95%CI 0.45–2.21]; 41–60 years: SIR=1.53 [95%CI 1.17–2.00]; and >60 years SIR=2.34 (95%CI 0.93–2.77]) and the time of follow-up (<1year: SIR=1.22 [95%CI 0.88–1.70]; 1–5 years: SIR=1.14 [95%CI 0.79–1.65]; and 6–10 years SIR=1.70 [95%CI 1.34–2.85]), but was similar between genders (male SIR=1.60 [95%CI 1.10–2.31] and female SIR=1.25 [95%CI 1.01–1.55]). The cancer risk among CTD patients without dermatomyositis or polymyositis was not affected (SIR=0.93, 95%CI 0.75–1.16), regardless of gender, age, or follow-up. ConclusionThe cancer risk for patients with CTD without dermatomyositis or polymyositis was not increased or decreased, but it was increased when patients with dermatomyositis or polymyositis were included.

Disease burden of famale breast cancer in China

To analyze the data on burden of female breast cancer in China. The data from Chinese Cancer Registry Annual Report 2012, three national death cause surveys in China, Disease Surveillance Points system(DSP), China Health Statistics Yearbook, GLOBOCAN 2012, Cancer Incidence in Five Continents(CI5), WHO Mortality Database and Global Burden of Disease(GBD)2013 were used to extract the incidence, mortality and disability-adjusted life years(DALY)of female breast cancer and analyze related trends in China. The data from three national death cause surveys showed that the crude mortality of breast cancer doubled from year 1973-1975 to year 2004-2005, the increase was higher in urban area(127.4%)than in rural area(75.2%). WHO Mortality Database showed that average annual percentage change(AAPC)of breast cancer crude mortality increased by 3.1%(P<0.05)from 1987 to 2000, and China Health Statistics Yearbook showed that the AAPC in urban females increased by 2.7% from 2002 to 2013(P<0.05), whereas the AAPC in rural females showed no significant change(P>0.05). It was estimated by GLOBOCAN 2012 that in 2012 the age-standardized incidence and age-standardized mortality of breast cancer in China was 22.1 per 100 000 and 5.4 per 100 000, respectively. The age-specific incidence began to increase obviously at age of 40 years and peaked at age 45-59 years(GLOBOCAN 2012). Chinese Cancer Registry Annual Report 2012 showed that breast cancer incidence and mortality were 2-fold and 1.5-fold higher in urban females than in rural females in 2009. It was estimated that the breast cancer case number and death number in females in China would increase to 251 600 and 75 900, respectively, more increose in age group ≥65 years. Only GBD 2013 reported DALY, the DALY caused by breast cancer in China was 1 666.0 thousand in 2013, accounting for 12.7% of global DALY, and increased by 56.7% from 1990(1 062.6 thousand), the peak age-specific DALY rate was at 50 to 59 years, and national average ratio of years lived with disability(YLD)was 8.7%(ranging from 8.1% to 9.0% at provincial level). Burden of disease caused by female breast cancer is becoming increasingly severe in China, especially in urban areas. It is necessary to strengthen the population-based prevention and control programs and further studies may focus on DALY.

China experts consensus on icotinib for non-small cell lung cancer treatment (2015 version).

According to Chinese Cancer Registry Annual Report in 2011, the incidence rate of lung cancer was 48.32/100,000 and the mortality rate was 39.27/100,000 in China in 2011, being the highest among all cancers (1). Most patients with nonsmall cell lung cancer (NSCLC) which accounts for 85% of all lung cancers have entered the advanced stage at the first visit to hospital and thus missed the opportunity for surgery. As the main treatment for advanced NSCLC, chemotherapy has reached a plateau in its efficacy and has been restricted in clinical application due to adverse reactions. In recent years, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), thanks to their definite efficacy, mild adverse reaction and convenience for oral use, have broken the bottleneck of traditional chemotherapeutic drugs and become an essential treatment for advanced NSCLC.