An analysis of esophageal cancer incidence in Cixian county from 1974 to 1996

AIM: To describe the incidence of esophageal cancer (EC)in Cixian, a county of Hebei province during 1974-1996. Weanalyzed the sex and age characteristics as well as thegeographic distribution of EC, in order to determine theimpact so that methods of preventing and controlling EC inCixian can be put in place.METHODS: Since the early 1970s, the cancer registrysystem has been established, which collects the cancerincidence in Cixian county. The malignant tumors were codedaccording to International Classification of Disease IX (ICD-9). All the data were checked and analyzed using EPIINFO.RESULTS: The trend of the incidence rate of EC from 1974to 1996 had declined, (229.9/100 000 vs 178.5/100 000, Oddsratio= 1.47, 95 % CI: 1.32～1.63, X2=52.89. trend X2=26.54,P＜0.001). The incidence rate of males declined significantly(281.81/100 000 vs 157.96/100 000, Odds ratio=1.61, 95 %CI: 1.41～1.84, X2=47.85. Trend X2=44.86, P＜0.001),whereas, the females remained steady (157.96/100 000 vs133.41/100 000, odds ratio=1.28, 95 % CI:1.17～1.49,X2=9.26. trend X2=2.69, P＞0.05). Male average annualincidence rate was 142.80/100 000 and the female's was95.18/100 000. The sex ratio (males to females) was 1.50:1.The incidence rate was increasing along with the age. As tothe geographic distribution, the incidence rate in mountainousareas and hilly areas showed a significantly declining trend(mountainous areas, trend X2=149.93, P＜0.001; hilly areas,trend X2=42.70, P＜0.001). The incidence rate of EC in plainareas had increased (trend X2=22.39, P＜0.001).CONCLUSION: The incidence rate of EC in Cixian countyshows a trend and has declined after two decades, especiallyin mountainous area. But compared to other regions in theworld, Cixian county still had a high incidence rate of EC.

Research and control of well water pollution in high esophageal cancer areas

AIM: In order to detect risk factors for esophageal cancer,a national research program was carried out during the Eighth Five-Year Plan (from 1991 to 1995). METHODS: Cixian County and Chichen County in Hebei Province were selected as the index and the control for the study fields with higher or lower incidence of esophagus cancer in China, respectively. In these areas, we investigated the pollution of three nitrogenous compounds in well water for drinking and the use of nitrogen fertilizer in farming. RESULTS: In well water, nitrate nitrogen, nitrite nitrogen and ammonia nitrogen were 8.77 mg/L, 0.014 mg/L and 0.009 mg/L in Cixian County in 1993, respectively. They were significantly higher than their levels (3.84 mg/L, 0.004 mg/L and 0.004 mg/L) in Chichen County (P＜0.01, t=6.281,t=3.784,t=3.775). There was a trend that the nitrogenous compounds in well water increased from 1993 to 1996.The amount of nitrogen fertilizer used in farming was 787.6 kg per hectare land in Cixian County in 1991, significantly higher than 186 kg per hectare in Chichen County (t=9.603,P＜0.001). CONCLUSION: These investigations indicate that the poilution of nitrogenous compounds in well water for drinking is closely related to the use of nitrogen fertlizer in farming, and there is a significantly positive correlation between the level of three nitrogenous compounds in well water and the mortality ofesophageal cancer (correlation coefficient =0.5992). We suggest that improvement of well system for drinking water quality should be an effective measure for esophageal cancer prevention and control in rural areas.

Endoscopic survey of esophageal cancer in a high-risk area of China

AIM: To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China. METHODS: A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol's staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software. RESULTS: Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2013),0.1% (3/2013) and 0.9% (18/2013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2013), 1.6% (33/2013) and 0.2% (2/2013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2013), 7.8% (157/2013) and 2.6% (53/2013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2013),0.2% (4/2013) and 0.7% (14/2013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2013) and 11.5% (232/2013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2013) and 0.8% (17/2013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2013) and 0.8% (17/2013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2013/2725). CONCLUSION: Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.

A Survey of Esophageal Cancer in Cixian County of Hebei Province

OBJECTIVE To characterize the histologic types of esophageal cardiac mucosa by endoscopic survey in a high-risk cancer area of China. METHODS An endoscopic survey with Lugol,s staining was carried out in Cixian County, Hebei Province from December 2001 to May 2002. The data were processed using computer SPSS 10.0 software. RESULTS The incidences of mild esophagitis, moderate esophagitis, and severe esophagitis were for 2013 cases, 34.9%(703), 1.6%(33) and 0.1% (2)respectively; those with mild dysplasia, moderate dysplasia, severe dysplasia of the esophagus were 8.6% (172), 7.8% (157) and 2.6% (53) respectively; those with carcinoma in situ, intramucosal carcinoma, invasive squamous carcinoma of the esophagus were 2.5%(50), 0.2% (4) and 0.7%(14) respectively. The histologic-detecting rates of non-atrophic gastritis, and atrophic gastritis of the cardia were 36.3%(730), 11.5% (232) respectively; those with mild dysplasia, severe dysplasia of the cardia were 2.5%(51), 0.8%(17) respectively; those with intramucosal adenocarcinoma, invasive adenocarcinoma of the cardia were 0.1% (3), 0.8%(17) respectively. The early-detection rate of esophageal cancer was 79.4%(54/68). The survey rate(examined population to covered population) was 73.8% (2013/2725). CONCLUSIONS Esophageal endoscopic screening with Lugol's solution staining has an advantage over esophageal balloon cytology, in that the histological diagnoses of esophageal cardiac diseases can be obtained, thus contributing to the prevention of subsequent disease. In using the staining method the detection rate of early esophageal cancer is higher than that revealed by balloon cytology.