Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

Assessing cross-country inequalities in global burden of gastrointestinal cancers: slope and concentration index approach

PURPOSE

New cases and deaths of gastrointestinal cancers are predicted to increase significantly by 2040. This study aims to explore cross-country inequalities and trends in global burdens of colon and rectum cancer (CRC), esophageal cancer (EC) and gastric cancer (GC).

METHODS

Data from the Global Burden of Diseases Study 2019 were analyzed to examine trends in disability-adjusted life-years (DALYs) for three gastrointestinal cancers with estimated annual percentage change (EAPC) and Joinpoint analysis. Inequality in their DALYs rates was assessed with the slope index of inequality and the concentration index, based on the Socio-Demographic Index (SDI).

RESULTS

From 1990 to 2019, the age standardized DALYs rate of CRC decreased in these countries from high and high-middle SDI regions, with the EAPC values of - 1.018% and - 0.161%, respectively, but increased among low, low-middle and middle SDI regions (EAPC = 1.035%, 0.926% and 0.406%, respectively). The age standardized DALYs rates of EC and GC decreased in all SDI regions. Moreover, the slope index changed from 358.42 (95% confidence interval 343.28 to 370.49) to 245.13 (217.47 to 271.24) for CRC, from - 63.88 (- 87.48 to - 48.28) to - 1.36 (- 32.44 to 25.87) for EC, and from 126.37 (101.97 to 146.47) to 58.04 (20.54 to 96.12) for GC. The concentration index for CRC moved from 29.56 (28.99 to 29.84) to 23.90 (23.19 to 24.26), from - 9.47 (- 10.30 to - 9.24) to - 14.64 (- 15.35 to - 14.24) for EC, and from 8.44 (7.85 to 8.72) to - 6.42 (- 7.65 to - 6.12) for GC.

CONCLUSION

This study suggests strong heterogeneity in global DALYs for gastrointestinal cancers across different SDI regions. Higher SDI regions faced a greater burden of CRC, while the burdens of EC and GC were more prevalent in lower SDI regions.

Trends of Prostate Cancer Morbidity in Low-Incidence Countries from 1990-2019

BACKGROUND

Our study was designed to elucidate the morbidity trends of prostate cancer in low-incidence countries.

METHODS

Data on prostate cancer were extracted from the 2019 Global Burden of Disease study. A cluster analysis of growth rates stratified by age was conducted, and correlation analyses were performed between age-standardized incidence rates (ASIR), estimated annual percent change (EAPC), and socio-demographic index (SDI).

RESULTS

Among 35 low-incidence countries for prostate cancer, predominantly located in Asia and North Africa, the SDI ranged from low to high-middle levels. Higher SDI regions exhibited considerably higher ASIR. With the exception of Kyrgyzstan, Kiribati, and Samoa that experienced a decrease in ASIR, the remaining 32 countries displayed an upward morbidity trend since 1990, with all their EAPCs exceeding the global average. In addition, men ages 90 years and above consistently exhibited the highest ASIR for prostate cancer. The most notable growth rate of ASIR was observed in individuals ages 20 to 44 years.

CONCLUSIONS

Overall, low-incidence countries generally witnessed an increase in prostate cancer morbidity, albeit at levels lower than those seen in Western countries. Individuals ages 90 years and above consistently maintained the highest ASIR since 1990. Notably, more substantial increase of ASIR in younger age was also observed in low-incidence countries.

IMPACT

This study offers a comprehensive overview of prostate cancer morbidity in low-incidence countries worldwide from 1990 to 2019. Future research should delve into the associations between incidence, clinical stages, PSA screening, environmental factors, lifestyle, and genetic risk in these low-incidence countries.

Spatial investigation of the links between aflatoxins legislation, climate, and liver cancer at the global scale

Aflatoxins are carcinogenic toxins produced by fungi, and many countries legislate limits in food. Previous research suggests elevated liver cancer (LC) mortality in some areas may be due to aflatoxin exposure, but this has not been investigated spatially. We investigate links between aflatoxin legislation, climate, and LC mortality and other covariates globally. Comparison tests of LC mortality showed expected patterns with legislation and climate. They also showed associations between high LC mortality and high Hepatitis, low alcohol consumption, low health expenditure and high family agriculture rates. Spatial analysis showed latitudinal trend with significant clusters of low LC mortality in Europe and high rates in West Africa, Central America, East and South-East Asia. Only health expenditure and Hepatitis were significant in spatial regression, but climate and family agriculture were also significant in multiple linear regression (MLR). Results suggest that aflatoxin education and legislation should be expanded, particularly in hot/wet climates.

Secular Trends of Liver Cancer Mortality and Years of Life Lost in Wuhan, China 2010-2019

BACKGROUND

Liver cancer has caused a heavy burden worldwide. This study aimed to estimate the trends in the mortality and years of life lost (YLL) due to liver cancer and decompose the total deaths into three contributors: population growth, population aging, and mortality change.

METHODS

Our study used data from the cause-of-death surveillance system in Wuhan. The mortality and YLL rates were standardized according to the sixth national population census in China. This study calculated the estimated annual percentage change (EAPC) to estimate the trends in the age-standardized mortality rate (ASMR) and age-standardized YLL rate (ASYR). Meanwhile, a decomposition analysis was used to explore the effect of population growth, population aging, and age-specific mortality change on the change in liver cancer deaths.

RESULTS

The ASMR of liver cancer declined at an annual rate of 4.6% from 30.87 per 100,000 people in 2010 to 20.29 per 100,000 people in 2019, while the ASYR was at an annual rate of 5.6% from 969.35 per 100,000 people in 2010 to 581.82 per 100,000 people in 2019. Similar downward trends were seen in men and women. The decomposition analysis found that total deaths number changed by -12.42% from 2010 to 2019, of which population growth and population aging caused the total death numbers to increase by 9.75% and 21.15%, while the age-specific mortality change caused the total death numbers to decrease by 43.32%.

CONCLUSION

Although the ASMR of liver cancer has declined in recent years in Wuhan, it still causes a heavy burden with the increasing population and rapid population aging and remains an essential public health issue. The government should take measures to reduce the burden of liver cancer, especially among men.

Colorectal Cancer Screening With High Risk-Factor Questionnaire and Fecal Immunochemical Tests Among 5, 947, 986 Asymptomatic Population: A Population-Based Study

Background

The recent uptrend in colorectal cancer (CRC) incidence in China is causing an increasingly overwhelming social burden. And its occurrence can be effectively reduced by sensitizing CRC screening for early diagnosis and treatment. However, a large number of people in China do not undergo screening due to multiple factors. To address this issue, since 2012, a CRC screening program has been initiated in Tianjin.

Methods

Residents aged 40-74 years were eligible for CRC screening. The first was to complete the high-risk factor questionnaire (HRFQ) and undergo fecal immunochemical test (FIT). Then those with a positive result in any of the two screening methods were recommended for a free colonoscopy.

Results

The detection rate of intestinal diseases increased with age, had a male predominance, and was higher in residents from central urban areas and those with primary school above education level. The sensitivity of predicting CRC after colonoscopy in the high-risk group was 76.02%; the specificity was 25.33%.A significant decrease in the detection rate of intestinal disease, CRC and advanced adenoma was observed from positive FIT, the high-risk group and positive HRFQ, 47.13%, 44.79%, 42.30%; 3.15%, 2.44%, 1.76%; 7.72%, 6.42%, 5.08%, in that order, while no inter-group difference was found for the detection of polyps. In addition, the different combinations of HRFQ and FIT can enroll more high-risk population than FIT or (and) HRFQ only, and thus detect more intestinal diseases (include CRC/AA/Polyp).

Conclusion

The superimposition of different screening method for HRFQ and FIT is an effective strategy for the detection of CRC, AA, and Polyp, compared to HRFQ or FIT alone. However, further improvements in screening and interventions are needed to promote colonoscopy compliance.

Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis

OBJECTIVES

Breast cancer is the leading cause of death in women around the world. Its occurrence and development have been linked to genetic factors, living habits, health conditions, and socioeconomic factors. Comparisons of incidence and mortality rates of female breast cancer are useful approaches to define cancer-related socioeconomic disparities.

METHODS

This was a retrospective observational cohort study on breast cancer of women in several developed countries over 30 years. Effects of socioeconomic factors were analyzed using a path diagram method.

RESULTS

We found a positive, significant association of public wealth on incidence and mortality of breast cancer, and the path coefficients in the structural equations are -0.51 and -0.39, respectively. The unemployment rate (UR) is critical and the path coefficients are all 0.2. The path coefficients of individual economic wealth to the rates of breast cancer are 0.18 and 0.27, respectively.

CONCLUSION

The influence of social pressure on the incidence and mortality of breast cancer was not typical monotonous. The survival rate of breast cancer determined by the ratio of mortality rate to incidence rate showed a similar pattern with socioeconomic factors.

Application of ultrasound-guided placement of markers for locating axillary lymph nodes of breast cancer

BACKGROUND

With the continuous improvement of pathological complete response (pCR) rate after neoadjuvant therapy (NAT), it is necessary to locate the tumor bed and axillary lymph nodes (ALNs) for subsequent surgery. Therefore, breast tissue markers emerge. This study aims to evaluate the feasibility and accuracy of ultrasound (US)-guided placement of markers for locating ALNs of breast cancer.

METHODS

A total of 285 patients who received US-guided placement of markers for locating ALNs in our hospital were selected. Among these patients, 87 patients were in the early breast cancer (EBC) group with negative ALNs and 198 ones were in the NAT group with positive ALNs. Data including the basic information of patients, position and size of ALN, process of US-guided marker placement, placement success rate, complications, detection rate of marker by imaging, and shift rate were recorded.

RESULTS

All patients were successfully undergone US-guided marker placement. And the average operation time was 2 minutes with no adverse reactions. All the patients underwent surgery successfully. US, computer tomography (CT) and magnetic resonance imaging (MRI) were used to detect the marker. The detection rate of markers by US and CT/MRI were 100% (87/87) in EBC group, and 98.5% (195/198) and 100% (198/198) by US and CT/MRI, respectively, in NAT group. The postoperative marker shift rate was 2.1% (6/285), including 3.4% (3/87) marker shift rate in EBC group and 1.5% (3/198) in NAT group, with no statistically significant difference between them.

CONCLUSIONS

US-guided marker placement in ALNs of breast cancer is simple and safe, with firm positioning and low shift rate, which is convenient for clinical promotion.

Historical trends in breast Cancer among women in China from age-period-cohort modeling of the 1990-2015 breast Cancer mortality data

Background

Evidence on historical trends extracted embedded in recent data can advance our understanding of the epidemiology of breast cancer for Chinese women. China is a country with significant political, socioeconomic, and cultural events since the 1900s; however, no such studies are reported in the literature.

Methods

Age-specific mortality rates of breast cancer during 1990–2015 in China were analyzed using APC modeling (age-period-cohort modeling) method. Net effect from birth cohort was derived to measure cancer mortality risk during 1906–1990 when no mortality data were collected, and net effect from time period was derived to measure cancer mortality risk during 1990–2015 when data were collected. Model parameters were estimated using intrinsic estimator, a novel method to handle collinearity. The estimated effects were numerical differentiated to enhance presentations of time/age trend.

Results

Breast cancer mortality rate per 100,000 women increased from 6.83 in 1990 to 12.07 in 2015. After controlling for age and period, the risk of breast cancer mortality declined from 0.626 in 1906–10 to − 1.752 in 1991–95 (RR = 0.09). The decline consisted of 3 phases, a gradual phase during 1906–1940, a moderate phase with some fluctuations during 1941–1970, and a rapid phase with large fluctuations during 1971–1995. After controlling for age and cohort, the risk of breast cancer mortality increased from − 0.141 in 1990 to 0.258 in 2015 (RR = 1.49) with an acceleration after 2005. The time trends revealed by both the cohort effect and the period effect were in consistency with the significant political and socioeconomic events in China since the 1900s.

Conclusions

With recent mortality data in 1990–2015, we detected the risk of breast cancer mortality for Chinese women over a long period from 1906 to 2015. The risk declined more than 90% from the highest level in 1906–10 to the lowest in 1990–95, followed by an increase of 49% from 1990 to 2015. Findings of this study connected historical evidence with recent data, supporting further research to exam the relationship between development and risk of breast cancer for medical and health decision-making at the population level and prevention and treatment at the individual level.

Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study

BACKGROUND

Resilience was correlated with psychological outcomes and quality of life in lung cancer patients. But the resilience process and its protective factors remained uncertain.

PURPOSE

To investigate and analyze resilience process and its protective factors in long-term survivors after lung cancer surgery.

METHODS

This qualitative study included 19 patients who had survived at least 5 years after lung cancer surgery. Colaizzi's method of phenomenology was used for data analysis.

RESULTS

Analysis of this study was divided into the resilience process and protective factors. The resilience process was summarized into three stages, including initial stress, adaptation to disease, and personal growth. Five themes were regarded contributing to their own resilience in this process, including excellent psychological qualities, good social support, regular lifestyle and exercise, participating in social activities, and Chinese medicine.

CONCLUSION

This study showed the dynamic process of resilience and its protective factors in long-term survivors after lung cancer surgery. Future studies could identify average length of time of each stage and how patients transfer between stages during resilience process. Besides, interventions could be carried out to educate patients diagnosed with cancer about normal stages of change in body and resilience through time and strategies on adaptation and adjustment of lung cancer.

A Correlation Study of the Colorectal Cancer Statistics and Economic Indicators in Selected Balkan Countries

Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms. The aim of the study was to evaluate and correlate most important epidemiological and economic indicators of CRC in 11 selected Balkan countries. The number of new CRC cases was 56,960, and the highest 5-year CRC prevalence was in Slovenia, Croatia, and Greece. Age-standardized CRC incidence rates were highest in Slovenia, Serbia, and Croatia, and age-standardized mortality rates were highest in Croatia, Serbia, and Bulgaria. Current Health Expenditure as % of Gross Domestic Product was the highest in Bosnia and Herzegovina and Serbia. The GDP per capita levels have shown positive correlation with the CRC incidence rate and prevalence. Absolute numbers of new and death-related CRC cases and 5-year prevalence in absolute numbers have shown strong positive correlation with GDP in million current US$. It has been shown that various economic indicators can be linked to the rate of incidence and prevalence of the CRC patients in the selected Balkan countries. Therefore, economic factors can influence the epidemiology of CRC, and heavy CRC burden in the Balkan region may be one of the indexes of the economic development.

Socioeconomic Status in Relation to Risks of Major Gastrointestinal Cancers in Chinese Adults: A Prospective Study of 0.5 Million People

BACKGROUND

Low socioeconomic status (SES) is associated with higher risk of certain gastrointestinal (e.g., colorectal, pancreatic, and liver) cancers in Western populations. Evidence is very limited in China, where correlates and determinants of SES differ from those in the West.

METHODS

The prospective China Kadoorie Biobank recruited 512,715 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) regions. During 10 years of follow-up, 27,940 incident cancers (including 3,061 colorectal, 805 pancreatic, and 2,904 liver) were recorded among 510,131 participants without prior cancer at baseline. Cox regression was used to estimate adjusted HRs for specific cancers associated with area-level (e.g., per capita gross domestic product, disposable income) and individual-level (e.g., education, household income) SES.

RESULTS

Area-level SES and household income showed positive associations with incident colorectal and pancreatic cancers and inverse associations with liver cancer (P _trend < 0.05). Education showed no association with colorectal cancer but inverse associations with pancreatic and liver cancers, with adjusted HRs comparing university to no formal schooling being 1.05 [95% confidence interval (CI), 0.85-1.29], 0.49 (95% CI, 0.28-0.85), and 0.61 (95% CI, 0.47-0.81), respectively. Potential risk factors (e.g., smoking, alcohol) partly explained the inverse associations of education with pancreatic and liver cancers (17.6% and 60.4%), respectively.

CONCLUSIONS

Among Chinese adults, the associations of SES with gastrointestinal cancers differed by cancer type and SES indicator. Potential risk factors partially explained the inverse associations of education with pancreatic and liver cancers.

IMPACT

The different associations between SES with gastrointestinal cancers may inform cancer prevention strategies.

Area socioeconomic status is independently associated with esophageal cancer mortality in Shandong, China

Esophageal cancer (EC) is a leading cause of cancer death in China. Within Shandong Province, a geographic cluster with high EC mortality has been identified, however little is known about how area-level socioeconomic status (SES) is associated with EC mortality in this province. Multilevel models were applied to EC mortality data in 2011–13 among Shandong residents aged 40+ years. Area-level SES factors consisted of residential type (urban/rural) of the sub-county-level units (n = 262) and SES index (range: 0–10) of the county-level units (n = 142). After adjustment for age and sex, residents living in rural areas had a 22% (95% CI: 13–32%) higher risk of dying from EC than those in urban areas. With each unit increase in the SES index, the average risk of dying from EC reduced by 10% (95% CI: 3–18%). The adjustment of area-level SES variables had little impact on the risk ratio of EC mortality between the high-mortality cluster and the rest of Shandong. In conclusion, rural residence and lower SES index are strongly associated with elevated risks of EC death. However, these factors are independent of the high mortality in the cluster area of Shandong. The underlying causes for this geographic disparity need to be further investigated.

The diagnostic efficacy of amide proton transfer imaging in grading gliomas and predicting tumor proliferation

Glioma is the most common primary intracranial tumor. Molecular neuropathology was introduced into the new 2016 WHO classification of brain tumor. Among the molecular biomarkers, Ki-67 antigen is the most important one, which reflects the proliferation rate and invasive ability of tumor cells. The amide proton transfer imaging, as a novel functional MR technique, can detect the free protein and polypeptide noninvasively, which might be a novel imaging method for predicting the WHO grading of glioma. In our study, the asymmetric magnetization transfer ratio (MTRasym) of high-grade gliomas (4.5%±2.3%) was significantly higher than of low-grade gliomas (2.9±1.1%), and the high-grade gliomas also showed higher expression of Ki-67 (38.9±21.0%) than did low-grade gliomas (4.3±2.8%). The MTRasym was positively correlated with Ki-67 values (r=0.25, P<0.001). The area under the receiver operating characteristic curve of MTRasym was 0.719. Furthermore, the diagnosis efficiency of MTRasym is better than that of the apparent diffusion coefficient (area under the receiver operating characteristic curve=0.682). This prospective study demonstrates that amide proton transfer may help in grading gliomas and has great potency in predicting tumor cell proliferation.

Interactions between life expectancy and the incidence and mortality rates of cancer in China: a population-based cluster analysis

BACKGROUND

The relationship between cancer and life expectancy is well established in both developed and developing countries. China is a vast country with significant geographical differences in population structure and healthcare, and thus provides a unique opportunity to analyze the complex relationship between life expectancy and cancer incidence and mortality rates.

METHODS

Cancer data were extracted for a total of 255 units (cities or counties) from the 2013 National Central Cancer Registry. Life expectancy data at the unit level were obtained from the National Centers for Disease Control and Prevention. Linear regression analysis was used to analyze the relationship between life expectancy and crude incidence and mortality rates of cancer. In a separate analysis, life expectancy was rated as low (< 76.0 years), middle (76-80 years), or high (> 80 years).

RESULTS

Overall, the cancer incidence and mortality rates positively correlated with life expectancy in both sexes (R at 0.37 and 0.50, P < 0.001). The correlation was significant for the following cancers: lung, colorectal, prostate, bladder and pancreas, as well as for lymphoma in men (R 0.36-0.58, P < 0.001), lung, breast, colorectal, thyroid, uterus, and ovary in women (R 0.18-0.51, P < 0.001). We failed to observe an association between upper gastrointestinal cancer and life expectancy. The number of cities/counties with low, middle and high life expectancy levels were 110, 101 and 44, respectively. The highest age-standardized cancer incidence rate was observed in areas with a high life expectancy level (192.83/100,000). The highest age-standardized mortality rate was in areas with the lowest life expectancy (118.44/100,000). Cancers of the stomach, liver and esophagus are major cancer types in areas with low and middle life expectancy. In contrast, areas with high life expectancy had high incidence and mortality rates of colorectal cancer, breast cancer in women and prostate cancer in men.

CONCLUSIONS

Longer life expectancy is associated with higher overall cancer incidence and mortality in China. The cancer pattern also varies substantially across areas with different life expectancy levels. Life expectancy levels must be considered when developing strategies to prevent and treat cancers.

Incidence and mortality of stomach cancer in China, 2014

OBJECTIVE

In this study, we aimed to estimate the updated incidence and mortality rate of stomach cancer based on the cancer registration data in 2014, collected by the National Central Cancer Registry of China (NCCRC).

METHODS

In 2017, 339 registries' data were qualified based on the criteria of data quality control of the NCCRC. Cases of stomach cancer were retrieved from the national database. We estimated numbers of stomach cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area, sex, age-group (0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's world population were applied for age-standardized incidence and mortality rates.

RESULTS

In 2014, 410,400 new stomach cancer cases and 293,800 cancer-associated deaths were estimated to have occurred in China. The crude incidence rate of stomach cancer was 30.00/100,000, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 19.62/100,000 and 19.51/100,000, respectively. The crude mortality rate of stomach cancer was 21.48/100,000, age-standardized mortality rates by Chinese (ASMRC) and by world standard population (ASMRW) were 13.44/100,000 and 13.30/100,000, respectively. Incidence and mortality rates in rural areas were both higher than that in urban areas. Stomach cancer has a strong relationship with gender and age. The disease has occurred more frequently among men than women with a male to female ratio of 2.4 for ASIRC. After age group of 40-44 years, incidence rates are substantially higher in men than in women, same pattern was seen for age-specific mortality rates.

CONCLUSIONS

There is still a heavy burden of stomach cancer in China. The incidence and mortality patterns of stomach cancer show substantial gender and regional disparities. Great effort is needed to provide more accessible health services, sufficient financial resources, and adequate cancer-care infrastructure for the Chinese population, especially for people living in rural areas.

Health-related quality of life among rural residents aged 45-69 years in Hua County, Henan Province, China: Results of ESECC Trial for esophageal cancer screening with endoscopy

Objective

There have been few population-based studies evaluating health related quality of life (HRQOL) in rural populations in China, and this study aimed to assess the current status of and risk factors for HRQOL in a general rural population in high risk region of esophageal cancer in China.

Methods

From November 2015 to September 2016, 12,085 permanent residents aged 45-69 years from 257 villages in the Endoscopic Screening for Esophageal Cancer in China (ESECC) trial (ClinicalTrials.gov: NCT01688908) randomly selected from Hua County, Henan Province, China were interviewed. The EQ-5D-3L, a generic measure of HRQOL, and a questionnaire were used to assess their HRQOL and potential risk factors.

Results

Among all the participants, 30.62% of the participants reported problems in at least one EQ-5D dimension. Pain/discomfort (25.52%) was the most frequently reported problem followed by anxiety/depression (7.97%), mobility (5.82%), usual activities (2.61%) and self-care (1%). These rural residents had a mean EQ-5D index score of 0.948, and lower EQ-5D index scores were associated with older age, female gender, lower levels of household annual per capita income, living alone, using shallow wells as main source of drinking water, exposure to family members smoking, testiness, unhealthy dietary habits, overweight or obesity, upper gastrointestinal cancer related symptoms and chronic diseases.

Conclusions

Rural residents in China have a relatively low quality of life. Health promotion programs in this population should focus on the elderly, especially elderly women and the elderly living alone. Improving basic living circumstances and primary medical care services should be priorities. Results of this study will also serve as the basis for the cost-utility evaluation in our ESECC screening trial.