National Central Cancer Registry Research Articles

Cancer incidence and mortality in China, 2022

Objective: The National Central Cancer Registry estimates the number of new cancer cases and deaths in China in 2022, using incidence and mortality data collected by the National Cancer Center. Methods: According to the data of 700 cancer registries in 2018 and the data of 106 cancer registries from 2010 to 2018, the age-period-cohort model was used to estimate the incidence rate and mortality rate of all cancers and 23 types of cancer in 2022, stratified by gender and urban and rural areas. We estimated the number of new cancer cases and deaths in China in 2022 based on the estimated rate and population data in 2022. Results: The estimated results showed that in 2022, there were approximately 4 824 700 new cancer cases in China (2 533 900 in males and 2 290 800 in females), with an age-standardized incidence rate of Chinese population (ASIR) of 208.58 per 100 000 (212.67 per 100 000 for males and 208.08 per 100 000 for females). Approximately 2 903 900 new cancer cases occurred in urban areas, with an ASIR of 212.95 per 100 000. It was estimated about 1 920 800 new cancer cases in rural areas, and the ASIR was 199.65 per 100 000. The top five cancers (lung cancer 1 060 600, colorectal cancer 517 100, thyroid cancer 466 100, liver cancer 367 700 and female breast cancer 357 200) accounted for 57.4% of all new cases. The estimated number of deaths from cancer in China in 2022 was 2 574 200 (1 629 300 in males and 944 900 in females), with an age-standardized mortality rate of Chinese population (ASMR) of 97.08 per 100 000 (127.70 per 100 000 in males and 68.67 per 100 000 in females). The number of deaths from cancer in urban and rural areas was about 1 400 600 and 1 173 400, with the ASMR of 92.37 and 103.97 per 100 000 in urban and rural areas, respectively. The top five leading cause of cancers death (lung cancer 733 300, liver cancer 316 500, gastric cancer 260 400, colorectal cancer 240 000 and esophageal cancer 187 500) accounted for 67.5% of all cancer deaths. Lung cancer ranked first in the incidence and mortality in men and women. The incidence rate in urban areas was higher than that in rural areas, while the mortality rate was lower than that in rural areas. Conclusions: The burden of cancer in China is still relatively heavy, with significant differences in cancer patterns in gender, urban-rural, and regional. The burden of cancer presents a coexistence of developed and developing countries, and the situation of cancer prevention and control is still serious in China.

Primary malignant bone tumors incidence, mortality, and trends in China from 2000 to 2015.

Primary malignant bone tumors are uncommon, and their epidemiological features are rarely reported. We aimed to study the incidence and death characteristics of bone tumors from 2000 to 2015. Population-based cancer registries submitted registry data to National Central Cancer Registry of China (NCCRC). The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of primary bone tumor were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi's world population. The annual percentage change (APC) in rate was calculated using the Joinpoint Regression Program. Data from 368 registries met quality control criteria, of which 134 and 234 were from urban and rural areas, respectively. The data covered 309,553,499 persons. The crude incidence, age-standardized incidence, and crude mortality rates were 1.77, 1.35, and 1.31 per 100,000, respectively. Incidence and mortality rates were higher in males than those in females; they showed downward trends, with declines of 2.2% and 4.8% per year, respectively, and the rates in urban areas were lower than those in rural areas. Significant declining trends were observed in urban areas. Stable trends were seen in rural areas during 2000 to 2007, followed by downward trends. Age-specific incidence and mortality rates showed stable trends in the age group of 0 to 19 years, and downward trends in the age group elder than 19 years. The incidence and mortality rates of primary malignant bone tumors in rural areas were higher compared to those in urban areas. Targeted prevention measures are required to monitor and control bone tumor incidence and improve the quality of life of affected patients. This research can provide a scientific basis for the prevention and control of bone tumors, as well as basic information for follow-up research.

Cancer statistics in China, 2016

Objective: Data for 2016 from cancer registries were used to estimate cancer incidence and mortality in China in 2016. Methods: According to the quality control process of the National Central Cancer Registry, the data from 683 cancer registries submitted by each province were evaluated, and the data of 487 cancer registries were qualified and included in the final analysis. Age-specific incidence and mortality rates were calculated by area (urban/rural), sex, age and cancer site, combined with national population data to estimate cancer incidence and mortality in China in 2016. Chinese population census in 2000 and Segi's population were used for age-standardized incidence and mortality rates. Results: Total population covered by 487 cancer registries was 381 565 422 (192 628 370 in urban and 188 937 052 in rural areas). The percentages of morphologically verified (MV%) and death certificate-only cases (DCO%) accounted for 68.31% and 1.40%, respectively, and the mortality to incidence ratio was 0.61. It was estimated about 4 064 000 new cases occurred in China in 2016, with the crude incidence rate being 293.91/100 000 (the rates of males and females were 315.52/100 000 and 271.23/100 000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 190.76/100 000 and 186.46/100 000, with the cumulative incidence rate (0-74 years old) being 21.42%. The crude incidence and ASIRC were 314.74/100 000 and 196.38/100 000 in urban areas, whereas in rural areas, they were 265.90/100 000 and 182.21/100 000, respectively. It was estimated about 2 413 500 cancer deaths occurred in China in 2016, the crude mortality rate was 174.55/100 000 (216.16/100 000 in males and 130.88/100 000 in females), the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 106.00/100 000 and 105.19/100 000, and the cumulative mortality rate (0-74 years old) was 11.85%. The crude mortality and ASMRC were 180.31/100 000 and 104.44/100 000 in urban areas, whereas in rural areas, they were 166.81/100 000 and 108.01/100 000, respectively. The most common cancer cases include lung, colorectal, stomach, liver and female breast cancers. The top five cancers accounted for about 57.27% of all cancer cases. The most common cancer deaths included lung, liver, stomach, colorectal and esophageal cancers. The top five cancers accounted for about 69.25% of all cancer deaths. Conclusions: The burden of cancer shows a continuous increasing trend in China. Regional and gender differences in cancer burden are obvious. The cancer patterns still show the coexistence of cancer patterns in developed countries and developing countries. The situation of cancer prevention and control is still serious in China.

Patterns and trends in esophageal cancer incidence and mortality in China: An analysis based on cancer registry data

BackgroundEsophageal cancer poses a significant global burden, while its patterns and trends remain to be clarified. The aim of this study is to provide an update on the incidence and mortality rates of esophageal cancer and their trends in China based on data from the National Cancer Registry. MethodsWe extracted data from the National Central Cancer Registry (NCCR) of China from 2000 to 2016 and performed comprehensive quality control. We calculated age-standardized rates of China (ASR China) and world (ASR world) using the Chinese population in 2000 and the Segi's world standard population, and performed a joinpoint regression analysis to examine the trend in incidence and mortality of esophageal cancer. The annual percent change (APC) and weighted average APC (AAPC) over the entire study period were estimated to measure the changing trend. Subgroup analyses were conducted by sex, region and pathological type. ResultsA total of 487 eligible cancer registries were included in the data analysis and 22 registries with uninterrupted registration data were used for trend analysis. In 2016, there were an estimated of 184,500 incident cases of esophageal cancer and 142,300 deaths in China. The crude incidence, ASR China and ASR world were 25.25/100,000, 11.00/100,000 and 11.13/100,000, respectively. And the crude mortality, ASR China and ASR world were 19.38/100,000, 8.25/100,000 and 8.28/100,000, respectively. Esophageal squamous cell carcinoma (ESCC) was the most common histological type, accounting for 85.79% of all cases, followed by esophageal adenocarcinoma (EAC) (11.00%) and others (3.21%). There was a decreasing trend of ASR world in incidence and mortality during 2000–2016 with the AAPC of -4.6% (95% CI: -5.7%, -3.4%) and -4.6% (95% CI: -5.2%, -3.9%). The pattern and trend of esophageal cancer differ in sex, region and pathological type. ConclusionsThe burden of esophageal cancer in China remains high with sex, regional and subtype differences. The incidence and mortality of esophageal cancer have continued to decline over the past decade, which was due in part to the reductions in risk factor exposure and the implementation of screening.

Cancer statistics in Chinese older people, 2022: current burden, time trends, and comparisons with the US, Japan, and the Republic of Korea.

Largely due to population ageing, the cancer burden from older people has been rising, which imposed considerable pressure on current Chinese healthcare system. We provide comprehensive information about cancer burden of Chinese older people based on the most recent data from National Central Cancer Registry of China. The logarithmic linear regression was used to project the current cancer burden in 2022, and Joinpoint regression was used for temporal trend analysis from 2000 to 2017. We also estimated cancer statistics of older people in the US, Japan and the Republic of Korea for comparisons. It is estimated that 2.79 million cases and 1.94 million deaths occur for Chinese older people, representing 55.8% and 68.2% of cases and deaths in all population in 2022. The overall cancer incidence rate gradually increased among older women, while the mortality rates declined for both sexes. Notably, approximately 10.0% of all cases and 17.7% of all deaths are from people aged over 80 years, and cancer incidence and mortality in this age group showed upward trends for women. Lung cancer and digestive cancers are the leading cancer types for Chinese older people. Compared with other countries, China has lower incidence rates but higher mortality rates for older people. The rapidly growing burden of prostate cancer, breast cancer, colorectal cancer, and declines in esophageal cancer, stomach cancer, and liver cancer among older people indicate the cancer pattern in China is being in a transition stage to that in developed countries. Our findings imply that it should be the national health priority to meet the growing demands for cancer diagnosis, treatment and care services from the older people as the rapid population ageing in next few decades.

Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration?

Over the past four decades, the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration. In order to shine a new light on better cancer prevention strategies in China, we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented. We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975, 1990-1992, 2004-2005, and the latest cancer registration data published by National Central Cancer Registry of China. The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population (Segi's population). The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China. From 1973 to 2016, China witnessed an evident decrease in mortality rate of stomach, esophageal, and cervical cancer, while a gradual increase was recorded in lung, colorectal, and female breast cancer. A slight decrease of mortality rate has been observed in liver cancer since 2004. Lung and liver cancer, however, have become the top two leading causes of cancer death for the last twenty years. From the three national surveys, similar profiles of leading causes of cancer death were observed among both urban and rural areas. Lower mortality rates from esophageal and stomach cancer, however, have been demonstrated in urban than in rural areas. Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975. Additionally, rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005. Moreover, stomach, esophageal, and liver cancer showed specific geographical distributions. Although mortality rates have decreased at most of the hotspots of these cancers, they were still higher than the national average levels during the same time periods. Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.

Pancreatic cancer incidence and mortality patterns in 2006-2015 and prediction of the epidemiological trend to 2025 in China.

BACKGROUNDDue to dietary patterns, the aging population, and other high-risk factors, the occurrence of pancreatic cancer (PC) has been rapidly increasing in China.AIMTo present the epidemiological trends of PC in China over the past decade and the estimated trend in 2025 and to compare the international differences in PC morbidity and mortality.METHODSThis study used a series of nationally representative data from the National Central Cancer Registry of China (NCCR), the International Agency for Research on Cancer and the Institute for Health Metrics and Evaluation databases. Age-standardized data of the PC incidence and mortality from 2006 to 2015 in China were extracted from the NCCR database. Linear regression models were used to estimate the incidence and mortality rates of PC in 2025.RESULTSThe age-standardized rates of PC in China increased from 3.65 per 100000 in 2006 to 4.31 per 100000 in 2015 and were estimated to reach up to 5.52 per 100000 in 2025. The mortality went from 3.35 per 100000 in 2006 to 3.78 per 100000 in 2015, estimated to reach up to 4.6 per 100000 in 2025. The number of new cases and deaths was low before 45 years and the peak age of onset was 85-89 years. The incidence and mortality rates in men were higher than those in women regardless of the region in China. In addition, the incidence and mortality rates in China were higher than the average level around the world. Likewise, disability-adjusted life years attributed to PC in China were 197.22 years per 100000, above the average level around the world.CONCLUSIONThis study presented an increasing trend of PC in China and differences in morbidity, mortality and disability-adjusted life years between Chinese and global populations. Efforts need to be made to decrease the PC incidence and improve patient outcomes.

Incidence and mortality of cervical cancer in China in 2015

ObjectiveTo estimate the incidence and mortality of cervical cancer in China based on the cancer registration data in 2015, collected by the National Central Cancer Registry (NCCR). MethodsThere were 501 cancer registries that submitted data to the NCCR, whose data were the basis for estimating the incidence and mortality of cervical cancer in China in 2015. After evaluating the data quality, 368 registries’ data were accepted for the analysis and stratified by area (urban/rural) and age group. Combined with data on the national population in 2015, the nationwide incidence and mortality of cervical cancer were estimated. Cervical Cancer cases of 22 cancer registries were applied for temporal trends from 2000 to 2015. The Chinese population census in 2000 and Segi's population were used to calculate age-standardized incidence and mortality rates. ResultsAn estimated 111,000 new cases were attributed to cervical cancer in China in 2015, accounting for 6.24% of all female new cancer cases in that year in China. The crude rate (CR) of incidence and age-standardized incidence rates by the China standard population (ASIRC) and by Segi's world standard population (ASIRW) of cervical cancer were 16.56/100,000, 11.78/100,000, and 10.86/100,000, respectively. The cumulative incidence rate from birth to 74 years old was 1.15%, whereas the calculation of incidence rates over the truncated age range of 35-64 years by Segi's world standard population (T-ASIRW) was 27.66/100,000. The estimates of cervical cancer deaths were about 33,800 and 3.94% of all female cancer-related deaths in China in 2015, with a crude mortality rate of 5.04/100,000. The age-standardized mortality rates adjusted by the Chinese standard population (ASMRC) and by world Segi's population (ASMRW) were 3.29/100,000 and 3.15/100,000, respectively, with a cumulative mortality rate (0-74 years old) of 0.35%. Both the incidence and mortality were higher in rural than in urban areas. The age-specific cervical cancer incidence significantly increased with age, particularly after age 25 years, and peaked at 50–54 years old, whereas age-specific mortality increased rapidly after 35 years old, peaking at 80–84 years old. The age-standardized incidence rates increased by about 8.6 (95% CI: 6.9, 10.3) per year during the period of 2000−2015. The age at diagnosis of patients with cervical cancer tended to be younger. In rural areas, the mean age at diagnosis decreased about 3.22 years from 2000 to 2015 (β = –0.33, P < 0.001). ConclusionsChina has a high burden of cervical cancer and important disparities among different regions. Especially in the middle and western areas and rural areas, cervical cancer is a serious issue in women's health, and prevention strategies need to be enhanced. Prevention and control strategies need to be enhanced and implemented with reference to local status, such as human papillomavirus (HPV) vaccination and screening programs.

Burden of cancer and changing cancer spectrum among older adults in China: Trends and projections to 2030

BackgroundCancer creates considerable challenges for China with its aging population. This analysis aimed to estimate the burden of cancer and transition in cancer spectrum among older adults in China by 2030. MethodsUsing data from the National Central Cancer Registry of China, we estimated annual percent change (APC) in cancer incidence and mortality rates among adults aged 60 years and above between 2006 and 2015 using joinpoint regression. We further estimated the number of new cancer cases and deaths from 2020 to 2030 based on the APC and population projections. ResultsAlthough cancer incidence and mortality rates have been decreasing among older adults in China between 2006 and 2015, there were marked increases in the incidence and mortality rates of cervical (incidence: APC = 9.2%, mortality: APC = 7.6% all p < 0.05) and thyroid cancers (incidence: APC = 9.3%, p < 0.05) in older women. Between 2015 and 2030, the number of new cancer cases is projected to increase by 46% from 2.2 million to 3.2 million; cancer deaths will increase by 31% from 1.6 million to 2.1 million among older Chinese adults. In 2015, the 3 most common cancers were lung, colorectal and breast cancer in women, and lung, colorectal and stomach cancer in men. By 2030, cervical cancer is projected to be the most common cancer in women, followed by lung and thyroid cancer; prostate cancer will surpass stomach cancer to become the third most common cancer in men. In both sexes, lung, liver and stomach cancer were the top 3 leading causes of cancer deaths in 2015. In women, cervical cancer will surpass lung cancer as the leading cause of cancer deaths by 2030. ConclusionThe growing burden of cervical, thyroid and prostate cancer among older Chinese adults represents a major shift in cancer spectrum in this population.

Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020.

BackgroundBreast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries. This study aimed to evaluate the global patterns of breast cancer incidence and mortality and analyze its temporal trends for breast cancer prevention and control.MethodsBreast cancer incidence and mortality data in 2020 were obtained from the GLOBOCAN online database. Continued data from the Cancer Incidence in Five Continents Time Trends, the International Agency for Research on cancer mortality and China National Central Cancer Registry were used to analyze the time trends from 2000 to 2015 through Joinpoint regression, and annual average percent changes of breast cancer incidence and mortality were calculated. Association between Human Development Index and breast cancer incidence and mortality were estimated by linear regression.ResultsThere were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020. Its incidence and mortality varied among countries, with the age‐standardized incidence ranging from the highest of 112.3 per 100,000 population in Belgium to the lowest of 35.8 per 100,000 population in Iran, and the age‐standardized mortality from the highest of 41.0 per 100,000 population in Fiji to the lowest of 6.4 per 100,000 population in South Korea. The peak age of breast cancer in some Asian and African countries were over 10 years earlier than in European or American countries. As for the trends of breast cancer, the age‐standardized incidence rates significantly increased in China and South Korea but decreased in the United States of America (USA) during 2000‐2012. Meanwhile, the age‐standardized mortality rates significantly increased in China and South Korea but decreased in the United Kingdom, the USA, and Australia during 2000 and 2015.ConclusionsThe global burden of breast cancer is rising fast and varies greatly among countries. The incidence and mortality rates of breast cancer increased rapidly in China and South Korea but decreased in the USA. Increased health awareness, effective prevention strategies, and improved access to medical treatment are extremely important to curb the snowballing breast cancer burden, especially in the most affected countries.

Whether iodized salt consumption increases thyroid cancer incidence.

This study aimed to explore the correlation between population-based iodine intake from iodized salt (iodine-IS) and thyroid cancer (TC) incidence. The TC incidence data were collected from the annual reports issued by China's National Central Cancer Registry. The iodine- IS data were extracted from the National Iodized Salt Surveys and National IDD Surveys (NIDDs). The time lag effect of iodine-IS on TC incidence was examined by using a polynomial distributed lag (PDL) model. Iodine-IS consumption peaked in 1999, declined to approximately 60% of 1999 in 2018, but remained close to 142.2 μg/person/day. After 2000, TC incidence increased notably on an annual basis. Iodine-IS and the age-standardized rate adjusted to the world population of TC incidence were significantly negatively correlated (p<0.05). The PDL model revealed that iodine-IS had a significant 6-year time lag effect on TC incidence (p<0.05). Iodine nutrition, as indicated by iodine-IS, exhibited a steady decline. The populationbased iodine-IS was adequate, however, TC incidence continued increasing. Although the 6-year cumulative effect of iodine-IS was considered, a negative correlation between iodine-IS and TC incidence was observed. Iodine- IS may not be a major risk factor for TC because universal salt iodization is maintaining adequate iodine nutrition in the population. The increasing TC incidence may reduce public willingness to consume iodized salt.

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030.

Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000–2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.

Cancer incidence and mortality of kidney and unspecified urinary organs in China, 2015

Objective: To estimate cancer incidence and mortality of kidney and unspecified urinary organs in China using cancer registry data in 2015. Methods: The cancer registry data from 501 local cancer registries in China were collected, checked and assessed based on the criteria of data quality control of the National Central Cancer Registry of China (NCCRC), and data from 368 registries were qualified for the analysis. Cancer incidence and mortality rates of kidney and unspecified urinary organs stratified by geographical location (eastern, middle, western areas), gender, age groups were calculated. Population data of 2015 was used to estimate the cancer cases and deaths of kidney and unspecified urinary organs in China. Chinese standard population in 2000 and Segi's world population were used for the calculation of age-standardized incidence and mortality rates. Results: A total of 74.2 thousand new cancer cases of kidney and unspecified urinary organs were diagnosed in 2015, 46.9 thousand of them were male, while 27.3 thousand were female, with a crude incidence rate of 5.40/10(5). The age-standardized incidence rates by Chinese (ASIRC) and world standard population (ASIRW) were 3.57/10(5) and 3.56/10(5), respectively. A total of 53.4 thousand and 20.8 thousand new cases were diagnosed in urban and rural area, with incidence rates of 6.93/10(5) and 3.45/10(5), respectively. The ASIRC of urban area was higher than that of rural area. There were 39.2 thousand, 20.6 thousand, and 14.4 thousand new cases diagnosed in eastern, middle, and western areas of China, respectively. The crude incidence rates were 7.60/10(5), 4.47/10(5), and 3.63/10(5), respectively, with a descend ASIRC of each area. A total of 27.1 thousand death cases reported, of them 16.9 thousand were male, while 10.2 thousand were female, with a crude mortality rate of 1.97/10(5), both of the ASIRC and ASMRW were 1.21/10(5). The deaths of urban and rural area were 19.5 thousand and 7.6 thousand cases, with the crude mortality rates of 2.53/10(5) and 1.26/10(5), respectively. The ASIRC of urban area was higher than that of rural area. There were 13.4 thousand, 8.4 thousand, and 5.1 thousand death cases reported in eastern, middle, and western areas, respectively, the crude mortality rates were 2.61/10(5), 1.83/10(5) and 1.30/10(5), respectively, with a descend ASIRC of each area. Conclusion: The disease burden of kidney cancer differs between urban area and rural area, and differs among eastern, middle, and western areas of China, therefore, different prevent and treatment strategies should be taken in different areas of China.

Bone Cancer Incidence, Mortality, and Trends in Rural and Urban China

Background: Studies on bone cancer (BC) in the Chinese population are few, as BC is rare. Herein, we analyzed the incidence and mortality rates of BC in China using data from the National Central Cancer Registry of China (NCCRC), 2015. And for the first time, the incidence and mortality trends of bone cancer from 2000 to 2015 were studied. Methods: In 2019, 501 cancer registries from 31 provinces in China submitted the 2015 data to the NCCRC, including 173 cities (i.e., urban areas) and 328 counties and county-level areas (i.e., rural areas). The age-standardized incidence and mortality rates, cumulative risk of cancer development before the age of 75 years, and trends were measured. Results: In 2015, 24,200 cases of primary BC and 17,900 associated deaths were recorded in China. The crude incidence of BC was 1.77/100,000. Age-standardized incidence rate in world populations was 1.32/100,000. The crude mortality rate was 1.31/100,000, and age-standardized mortality rate in the world populations was 0.89/100,000. The age-specific incidence and mortality curves were bimodally distributed with age. Male patients had higher crude and age-standardized incidence and mortality rates than female patients. Morbidity and mortality rates were higher in rural areas than in cities. The age-standardized incidence and mortality of BC decreased annually by 2.2% (95% confidence interval [CI], 1.4% to 3.0%) and 4.8% (95% CI, 3.9% to 5.7%), respectively. Conclusions: Primary BC was more common in men than in women and followed a bimodal distribution with age. The age-standardized incidence and mortality of BC have shown downward trends since 2000. Funding Statement: National Key RD CAMS Innovation Fund for Medical Sciences (CIFMS) (2018-I2M-3-003)]. Declaration of Interests: The authors have no conflicts of interest to declare.

Metal/metalloid levels and variation in lifetime cancer risks among tissues

Extreme variation in lifetime cancer risk among tissues has been a riddle of cancer etiology. Considering that cancer risks were found to be contributed heavily by environmental factors, levels of environmental carcinogens, such as metal/metalloid in tissues, may be an explanation of the variation. We analyzed the correlations between metal/metalloid concentrations in different tissues and the lifetime cumulative cancer risks of the corresponding tissues using the data of National Health Standards and National Central Cancer Registry of China. Cadmium (Cd) and rubidium (Rb) were found to be correlated with the lifetime cancer risks in a positive linear relationship while a U-shaped relationship was observed for cesium (Cs) and tin (Sn). A positive linear trend between the mixture of metals/metalloids and lifetime cancer risks was observed and cadmium (Cd) may be the main driving element. Our results indicated that Cd-based metal/metalloid levels may be an explanation for the variation in lifetime cancer risk among tissues. Furthermore, the analytical strategy may in turn help identify environmental factors involved in cancer etiology.

Incidence and mortality of oral and oropharyngeal cancer in China, 2015.

ObjectiveTo report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population.MethodsData were taken from a population-based cancer registry collected by the National Central Cancer Registry of China (NCCRC) in 2015. The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of oral and oropharyngeal cancer were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population.ResultsIn 2015, it was estimated that there were 51,765 oral and oropharyngeal cancer incident cases and 23,830 deaths in China. The crude incidence rate of oral and oropharyngeal cancer was 3.77/100,000, and the age-standardized incidence rate by Chinese standard population and by Segi’s world standard population were 2.55/100,000 and 2.49/100,000, respectively. The crude mortality rate and the age-standardized mortality rates by Chinese standard population and by Segi’s world standard population were 1.73/100,000, 1.09/100,000 and 1.08/100,000, respectively. Both incidence and mortality rates of oral and oropharyngeal cancer were higher in males and in urban areas. Residents in eastern areas had the highest incidence and mortality rates, followed by those from middle areas and western areas. The rates of oral and oropharyngeal cancer increased greatly with age, especially after the age of 40 years.ConclusionsThis study reports the latest incidence and mortality rates of oral and oropharyngeal cancer in China. Prevention intervention including early detection, treatment, and regular follow-ups is encouraged to be set up to reduce incidence and mortality rates of oral and oropharyngeal cancer in the future.

Epidemiological characteristics of gastric cancer in China, 2015

Objective: To estimate the morbidity and mortality of gastric cancer and its distribution in China in 2015 and provide information for future cancer prevention and control study and policy decision. Methods: In 2018, a total of 501 cancer registry systems reported data to the office of National Central Cancer Registry, and the data from 368 cancer registry systems met the criteria. The overall, gender specific, age specific and area specific morbidity and mortality rates of gastric cancer in China were estimated based on national population data in 2015. Chinese standard population in 2000 and World Segi's population data were used to calculate the age-standardized rates (ASR) of morbidity and mortality, including ASR of China and the world. Results: In 2015, the qualified 368 cancer registry system covered a total of 309 553 499 population in China, including 156 934 140 males and 152 619 359 females. We estimated that there were 403 000 new gastric cancer cases, with the crude morbidity rate of 29.31 per 100 000, ASR China of 18.68 per 100 000, ASR world of 18.57 per 100 000, and a cumulative rate of 2.29% for 0-74 years. There were 290 900 new gastric cancer deaths, with the crude mortality rate of 21.16 per 100 000, ASR China of 13.08 per 100 000, ASR world of 12.92 per 100 000, and a cumulative rate of 1.5% for 0-74 years. Gastric cancer ranked second as the most common cancers and third as the most common cancer causes of death in China. In general, both the morbidity rate (ASR China, male: 26.54 per 100 000; female: 11.09 per 100 000; rural area: 21.82 per 100 000; urban area: 16.37 per 100 000) and mortality rate (ASR China, male: 18.75 per 100 000; female: 7.72 per 100 000; rural area: 15.84 per 100 000; urban area: 11.05 per 100 000) were higher in males than those in females, and higher in rural area than those in urban area. The morbidity and mortality rates of gastric cancer increased from the age of 40 years and peaked in age group of 80-years. The case number of gastric cancer significantly increased from the age group of 50-years, peaked at 60-70 years, and the majority of cases occured in age group of 55-80 years. There was an overall consistent trend of the age-specific morbidity and mortality rates across different subgroups by sex and geographic areas, with the rates were higher in males than those in females, and higher in rural area than that in urban area. Conclusions: The incidence of gastric cancer varied with sex, age and areas (urban area and rural area). The present analysis provides the latest data on the prevalence of gastric cancer in China, which can help optimize the current screening guidelines and the prevention and control strategies of gastric cancer to reduce the disease burden caused by gastric cancer in China.

Report of breast cancer incidence and mortality in China registry regions, 2008-2012

Objective: The registration data of local cancer registries from 2008 to 2012 were collected by National Central Cancer Registry to estimate the incidence and mortality of female breast cancer in China. Methods: Data from 135 registries were qualified and selected in the final analysis, and each registry at least has submitted data from 2010 to 2012. Cancer incidence and mortality analyses were stratified by area (urban/rural, eastern/middle/western areas) and age group. The age composition of standard population of Chinese census in 2000 and Segi's population were used for age-standardized incidence and mortality in China and worldwide, respectively. Results: A total of 135 registries were recruited in the analysis, covering 629 333 910 person-years (382 669 450 in urban and 246 664 460 in rural). About 13, 258 cases of female breast cancer were diagnosed and 32 205 cases were dead between 2008 and 2012. Female breast cancer incidence was 42.67/100, 000 and age-standardized rate calculated by worldwide standard population was 28.87/100, 000. The crude incidence of urban area was 51.85/100, 000, higher than 28.29/100, 000 of rural area, and the crude incidence of eastern area was 46.35/100, 000, higher than 36.38/100, 000 of middle area and 27.60/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age 55-59 (96.36/100, 000), and declined at age 60. The age-standardized incidence rate by Chinese standard population increased 30.56% from 2003 to 2012. The increase rate of rural area was 72.32%, faster than 23.48% of urban area. Female breast cancer mortality was 10.36/100, 000 and the age-standardized rate calculated by worldwide standard population was 6.61/100, 000. The crude mortality of urban area was 11.64/100, 000, higher than 8.36/100, 000 of rural area, and the crude mortality of eastern area was 10.81/100, 000, higher than 7.38/100, 000 of middle area and 9.90/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age above 85 (61.25/100, 000). Age-standardized incidence rate by Chinese standard population remained stable during the period of 2003-2012 (6.23%). The mortality rate mainly increased in rural area (54.94%), while decreased 2.32% in urban area over the 10 years. Conclusions: Although the incidence and mortality of breast cancer in China are comparatively low worldwide, in China the incidence and mortality of female breast cancer have rose to the first and sixth place respectively among all the female cancers. The disease burden of breast cancer is very different between urban and rural area. Therefore, the targeted measure and strategy of control and prevention according to the area difference are needed.

Incidence and mortality of esophagus cancer in China, 2008−2012

ObjectiveTo analyze the incidence and mortality rates of esophagus cancer in China from 2008 to 2012.MethodsIncident and mortality cases of esophagus cancer were retrieved from the National Central Cancer Registry (NCCR) database collecting from 135 cancer registries in China during 2008−2012. The incidence and mortality rates of esophagus cancer were calculated by area (urban/rural), region (eastern, middle, western), gender and age group (0, 1−4, 5−84 by 5 years and 85+ years). China census in 2000 and Segi’s world population were applied for age-standardized rates. Joinpoint model was used for time-trend analysis.ResultsThe crude incidence rate of esophagus cancer was 22.57/100,000. The age-standardized incidence rates by China standard population (ASIRC) and by world standard population (ASIRW) were 14.58/100,000 and 14.80/100,000, respectively. The crude mortality rate of esophagus cancer was 17.19/100,000. The age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 10.80/100,000 and 10.86/100,000 respectively. Incidence and mortality rates of esophagus cancer were higher in males than in females and higher in rural areas than in urban areas. The crude incidence rate in middle areas was the highest among all areas, followed by western areas and eastern areas. The age-specific incidence rate of esophagus cancer was relatively low in age groups before 40 years old and then increased after 45 years old. It peaked in the age group of 80−84 years. The patterns of age-specific mortality rates of esophagus cancer were close to those of age-specific incidence rates. The ASIRC of esophagus cancer decreased dramatically by 29.87% between 2003 and 2012, from 14.33/100,000 to 10.05/100,000. The esophagus cancer incidence rate decreased by 3.76% per year (P>0.05). The mortality rate of esophagus cancer decreased annually over the decades from 2003 to 2012 in China (P>0.05). In females, the annual percentage change (APC) of mortality rate was −5.43% [95% confidence intervals (95% CI): −6.50%, −4.30%] (P<0.05) and the mortality rate of esophagus cancer in rural females was statistically significant (APC: −3.20%, 95% CI: −4.20%, −2.20%) (P<0.05).ConclusionsThe focus of prevention and treatment for esophagus cancer is strengthening primary prevention of esophageal cancer, and promoting esophagus cancer secondary prevention to reduce incidence and mortality rates of esophagus cancer, prolong survival rate of patients and decline the burden of esophagus cancer in China.

Incidence and mortality of thyroid cancer in China, 2008-2012.

ObjectiveTo analyze the incidence and mortality rates of thyroid cancer (TC) in China from 2008 to 2012.MethodsIncident and death cases of TC were retrieved from the National Central Cancer Registry (NCCR) database collecting from 135 cancer registries in China during 2008−2012. The crude incidence and mortality rates of TC were calculated by area (urban/rural), region (eastern, middle, western), gender and age group (0, 1−4, 5−9, …, 85+). China census in 2000 and world Segi’s population were applied for age-standardized rates. Joinpoint (Version 4.6.0.0) model was used for time-trend analysis.ResultsThe crude incidence rate of TC was 7.56/100,000 which ranked the seventh in overall cancers. The age-standardized incidence rates by China population (ASIRC) and by World population (ASIRW) were 6.25/100,000 and 5.52/100,000, respectively. The crude mortality of TC in China was 0.52/100,000. The age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 0.34/100,000 and 0.32/100,000, respectively. Incidence and mortality rates of TC were higher in females than in males and higher in urban areas than in rural areas. Eastern areas had the highest incidence followed by middle and western areas. TC incidence increased dramatically after age of 15 years, then peaked at 14.08/100,000 in the group of 50−54 years and finally decreased sharply after 55 years old. TC mortality increased with age in population, reaching the peak of 5.09/100,000 in sub-population aged 85 years or older. TC incidence increased by 4.73 times from 2.40/100,000 in 2003 to 13.75/100,000 in 2012 with an average annual increase of 20%, while TC mortality only increased slightly around 0.32/100,000 from 0.26/100,000 to 0.36/100,000.ConclusionsAppropriate targeted prevention, early detection and treatment programs can be carried out to curb the rapid growth trend of TC and control the disease burden.