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Feng R, Su Q, Huang X, Basnet T, Xu X, Ye W. Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration? CANCER COMMUNICATIONS (LONDON, ENGLAND) 2022; 43:75-86. [PMID: 36397729 PMCID: PMC9859730 DOI: 10.1002/cac2.12393] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.
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Affiliation(s)
- Ruimei Feng
- Department of EpidemiologySchool of Public HealthShanxi Medical UniversityTaiyuanShanxiP. R. China,Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Qingling Su
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Xiaoyin Huang
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Til Basnet
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Xin Xu
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Weimin Ye
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China,Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
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Ma K, Lin Y, Zhang X, Fang F, Zhang Y, Li J, Yao Y, Ge L, Tan H, Wang F. Spatiotemporal Distribution and Evolution of Digestive Tract Cancer Cases in Lujiang County, China since 2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127451. [PMID: 35742697 PMCID: PMC9223376 DOI: 10.3390/ijerph19127451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
This study aims to analyze the spatiotemporal distribution and evolution of digestive tract cancer (DTC) in Lujiang County, China by using the geographic information system technology. Results of this study are expected to provide a scientific basis for effective prevention and control of DTC. The data on DTC cases in Lujiang County, China, were downloaded from the Data Center of the Center for Disease Control and Prevention in Hefei, Anhui Province, China, while the demographic data were sourced from the demographic department in China. Systematic statistical analyses, including the spatial empirical Bayes smoothing, spatial autocorrelation, hotspot statistics, and Kulldorff's retrospective space-time scan, were used to identify the spatial and spatiotemporal clusters of DTC. GM(1,1) and standard deviation ellipses were then applied to predict the future evolution of the spatial pattern of the DTC cases in Lujiang County. The results showed that DTC in Lujiang County had obvious spatiotemporal clustering. The spatial distribution of DTC cases increases gradually from east to west in the county in a stepwise pattern. The peak of DTC cases occurred in 2012-2013, and the high-case spatial clusters were located mainly in the northwest of Lujiang County. At the 99% confidence interval, two spatiotemporal clusters were identified. From 2012 to 2017, the cases of DTC in Lujiang County gradually shifted to the high-incidence area in the northwest, and the spatial distribution range experienced a process of "dispersion-clustering". The cases of DTC in Lujiang County will continue to move to the northwest from 2018 to 2025, and the predicted spatial clustering tends to be more obvious.
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Affiliation(s)
- Kang Ma
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
| | - Yuesheng Lin
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
| | - Xiaopeng Zhang
- Hefei Center for Disease Control and Prevention, Hefei 230022, China; (X.Z.); (J.L.)
| | - Fengman Fang
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
- Correspondence: ; Tel.: +86-(0553)-5910687
| | - Yong Zhang
- Department of Geological Sciences, University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Jiajia Li
- Hefei Center for Disease Control and Prevention, Hefei 230022, China; (X.Z.); (J.L.)
| | - Youru Yao
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
| | - Lei Ge
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
| | - Huarong Tan
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
| | - Fei Wang
- Key Laboratory of Earth Surface Processes and Response in the Yangtze-Huaihe River Basin, School of Geography and Tourism, Anhui Normal University, Wuhu 241002, China; (K.M.); (Y.L.); (Y.Y.); (L.G.); (H.T.); (F.W.)
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Chen JG, Zhu J, Zhang YH, Chen YS, Lu JH, Zhu YR, Chen HZ, Shen AG, Wang GR, Groopman JD, Kensler TW. Liver cancer mortality over six decades in an epidemic area: what we have learned. PeerJ 2021; 9:e10600. [PMID: 33604165 PMCID: PMC7866902 DOI: 10.7717/peerj.10600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIMS Liver cancer is one of the most dominant malignant tumors in the world. The trends of liver cancer mortality over the past six decades have been tracked in the epidemic region of Qidong, China. Using epidemiological tools, we explore the dynamic changes in age-standardized rates to characterize important aspects of liver cancer etiology and prevention. METHODS Mortality data of liver cancer in Qidong from 1958 to 1971 (death retrospective survey) and from 1972 to 2017 (cancer registration) were tabulated for the crude rate (CR), and age-standardized rate and age-birth cohorts. The average annual percentage change was calculated by the Joinpoint Regression Program. RESULTS The natural death rate during 1958-2017 decreased from 9‰ to 5.4‰ and then increased to 8‰ as the population aged; cancer mortality rates rose continuously from 57/105 to 240/105. Liver cancer mortality increased from 20/105 to 80/105, and then dropped to less than 52/105 in 2017. Liver cancer deaths in 1972-2017 accounted for 30.53% of all cancers, with a CR of 60.48/105, age-standardized rate China (ASRC) of 34.78/105, and ASRW (world) of 45.71/105. Other key features were the CR for males and females of 91.86/105 and 29.92/105, respectively, with a sex ratio of 3.07:1. Period analysis showed that the ASRs for mortality of the age groups under 54 years old had a significant decreasing trend. Importantly, birth cohort analysis showed that the mortality rate of liver cancer in 40-44, 35-39, 30-34, 25-29, 20-24, 15-19 years cohort decreased considerably, but the rates in 70-74, and 75+ increased. CONCLUSIONS The crude mortality rate of liver cancer in Qidong has experienced trends from lower to higher levels, and from continued increase at a high plateau to most recently a gradual decline, and a change greatest in younger people. Many years of comprehensive prevention and intervention measures have influenced the decline of the liver cancer epidemic in this area. The reduction of intake levels of aflatoxin might be one of the most significant factors as evidenced by the dramatic decline of exposure biomarkers in this population during the past three decades.
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Affiliation(s)
- Jian-Guo Chen
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
- Department of Epidemiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jian Zhu
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Yong-Hui Zhang
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Yong-Sheng Chen
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Jian-Hua Lu
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Yuan-Rong Zhu
- Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People’s Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Hai-Zhen Chen
- Department of Epidemiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ai-Guo Shen
- Department of Epidemiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Gao-Ren Wang
- Department of Epidemiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - John D. Groopman
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Thomas W. Kensler
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
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