Esophageal cancer global burden profiles, trends, and contributors

Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.

Attributable liver cancer deaths and disability-adjusted life years in China and worldwide: profiles and changing trends

Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.

Comparative yield and efficiency of strategies based on risk assessment and fecal immunochemical test in colorectal cancer screening:A cross-sectional population-based analysis

Objective:Integration of risk stratification into fecal immunochemical test(FIT)might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer(CRC)screening.A comparative study was conducted to evaluate the participation and diagnostic yield of the parallel combination of questionnaire-based risk assessment(QRA)and FIT,FIT-only and QRA-only strategies in a CRC screening program in China.Methods:The study included 29,626 individuals aged 40-74 years and invited to participate in a CRC screening program in China.Participants were first invited to undertake QRA and one-time FIT(OC-sensor).Participants with positive QRA or FIT were deemed to be high-risk individuals who were recommended for subsequent colonoscopy.Participation,detection rate,and resource demand for colonoscopy were calculated and compared.Results:Of the 29,626 invitees,20,203 completed the parallel combination,8,592 completed the QRA-only,and11 completed the FIT-only strategy.For the parallel combination,FIT-only,and QRA-only strategies,the overall positivity rates were 10.2%(2,928/28,806),5.4%(1,096/20,214),and 6.8%(1,944/28,795),respectively;the yield of advanced neoplasm per 10,000 invitees were 46.9[95%confidence interval(95%CI):39.8-55.4],36.8(95%CI:30.5-44.4),and 12.2(95%CI:8.8-16.8),respectively;the positive predictive values for detecting advanced neoplasms among participants who completed colonoscopy were 4.7%(95%CI:4.0%-5.6%),9.9%(95%CI:8.3%-11.9%),and 1.9%(95%CI:1.3%-2.6%),respectively;the number of colonoscopies required to detect one advanced neoplasm was 11.4(95%CI:9.8-13.4),5.7(95%CI:4.8-6.7),and 28.4(95%CI:20.7-39.2),respectively.Conclusions:The parallel combination of QRA and FIT did not show superior efficacy for detecting advanced neoplasm compared with FIT alone in this CRC screening program.

Comparative study of cancer profiles between 2020 and 2022 using global cancer statistics(GLOBOCAN)

Background:The International Agency for Research on Cancer(IARC)released the latest estimates of the global burden of cancer.We present a comparison of cancer profiles between 2020 and 2022,leveraging data from the Global Cancer Statistics(GLOBOCAN).Methods:Cancer incidence and mortality data were sourced from two different years,2020 and 2022,in the GLOBOCAN database.We tracked changes in age-standardized incidence and mortality rates,as well as estimated numbers of new cancer cases and deaths of the 15 most common cancer types globally and in China between 2020 and 2022.Additionally,we conducted comparisons to assess alterations in the cancer burden and variations in mortality-to-incidence ratio(MIR)across different regions and countries for both 2020 and 2022.Results:Lung cancer remained the most common cancer and the leading cause of cancer death worldwide.The new cases of thyroid cancer witnessed a sharp increase in 2022.Conversely,the numbers of new cancer cases and deaths from stomach and esophageal cancer decreased significantly in 2022.The geographic distribution of cancer incidence and mortality across six continents in 2022 largely mirrored that of 2020.Higher Human Development Index(HDI)levels in countries corresponded with elevated rates of cancer incidence and mortality,consistent with the previous year.Among 185 countries or territories,China’s age-standardized incidence rate(ASIR)ranked 64th and its age-standardized mortality rate(ASMR)ranked 68th,aligning with global averages.Lung cancer continued to impose the greatest burden of incidence and mortality.Stomach,breast,and esophageal cancers showed declines in both case counts and ASIR.Noteworthy reductions in both ASMR and absolute mortality numbers were observed in liver,stomach,and esophageal cancers.The global MIR decreased from 0.516 in 2020 to 0.488 in 2022.MIR trends indicated an upward trajectory with decreasing HDI levels in both 2022 and 2020.While Canada,Germany,India,Italy,Japan,and the United Kingdom demonstrated increasing MIRs,China exhibited the most significant decrease,followed by Russia and the United States.Conclusions:The global landscape of cancer incidence and mortality in 2022 reflects ongoing trends observed in 2020.Cancer burdens vary notably across countries with differing socioeconomic statuses.Decreases in stomach,liver,and esophageal cancer cases and deaths signify progress in cancer control efforts.The decrease in the global MIRs highlights potential improvements in cancer management.

Burden of liver cancer:From epidemiology to prevention

In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.

Population-level economic burden of lung cancer in China:Provisional prevalence-based estimations,2017-2030

Objective:Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future.However,little is known about the economic burden of lung cancer in China.Methods:A prevalence-based approach was adopted to estimate the economic burden of lung cancer,including direct expenditure(medical and non-medical)and indirect cost(disability and premature death).Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys.Other parameters were obtained from literatures and official reports.Projections were conducted based on varying parameters.All expenditure data were reported in United States dollars(USD)using 2017 value(exchange rate:1 USD=6.760 CNY),with the discount rate of 3%.Results:The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017(0.121%of gross domestic productivity,GDP).The estimated direct expenditure was 11,098 million USD,up to1.43%of total healthcare expenditure for China,covering 10,303 million USD and 795 million USD for medical and non-medical expenditure,respectively.The estimated indirect cost was 13,971 million,including 1,517 million USD due to disability and 12,454 million USD due to premature death.Under current assumptions,the projected total economic burden would increase to 30.1 billion USD,40.4 billion USD,and 53.4 billion USD in 2020,2025,and 2030,accounting for 0.121%,0.131%,and 0.146%of China's GDP,respectively.However,if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030,the total economic burden in 2030 would be 31.9 billion USD,0.087%of China's GDP.Conclusions:The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future.Policy makers need to take urgent actions in budget making for health systems.The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.

Attributable deaths of liver cancer in China

Objective:There is little information about contributions of the well-known risk factors to the liver cancer burden.We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors.Methods:Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in2014.Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International.Population attributable fraction(PAF)by age,sex,and province was calculated using multiple formulas.Results:In total,72.4%of liver cancer deaths could be attributable to the studied risk factors.Hepatitis B virus(HBV)was responsible for the largest fraction of liver cancer burden in both genders(PAF=55.6%in males,PAF=46.5%in females).PAFs for liver cancer burden attributable to smoking(15.7%vs.4.8%),and alcohol drinking(10.3%vs.1.6%)were significantly higher in males than in females.The burden of HBV-attributable deaths was the highest in Qinghai province.Conclusions:HBV still contributes to the majority of liver cancer burden than any other risk factors.Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.

Contemporary trends on expenditure of hospital care on total cancer and its subtypes in China during 2008-2017

Objective:To describe the contemporary trends in total,inpatient,and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in China's Mainland.Methods:Home page of Inpatient Medical Records(HIMRs)and Hospital Annual Reports(HARs)were used to estimate hospital care expenditure on cancer.Inpatient payments and their share of cancer were calculated with the top-down method.Kriging spatial interpolation methods were used at the county level and summed at the province level.Outpatient expenditure was estimated with inpatient expenditure and the ratios of outpatient to inpatient payments in specialized cancer hospitals,stratified by province.Total expenditure on cancer was the sum of both payments.Log-linear regression was applied to estimate annual percentage change(APC)of expenditure.Results:Total expenses for cancer of Chinese residents reached up to 304.84 billion Chinese Yuan(CNY)in2017,accounting for 5.8%of the total health expenses(THE).After adjusting for consumer price index(CPI),medical expenses for cancer have increased from 63.30 billion CNY in 2008 to 249.56 billion CNY in 2017[APC:15.2%,95%confidence interval(95%CI):13.4%-17.0%].The APC was slightly higher than THE around 2013,while was lower after 2013.During 2008-2017,the ratio of inpatient to outpatient costs for cancer decreased from4.3:1 to 3.8:1.The inpatient payments for cancer mainly happened in grade 3 general hospitals,East China,and among lung,colorectal,and stomach cancer;while the fastest increase was found in West China,and among thyroid,prostate,and colorectal cancer.Conclusions:During 2008-2017,the rapid growth trend of medical expenses for cancer has been effectively controlled with the continuous deepening of medical reform and improvements of residents’health care.More attention should be paid to potential increases of medical costs caused by technological progress and demand release.Socialized and multi-channel insurance financing modes should be explored in the future.

The epidemiology of colorectal cancer in China

Objective:Colorectal cancer(CRC)is one of the most common cancers and the major cause of cancer death in China.The aim of this study was to estimate the burden of CRC in China.Materials and methods:Data from the National Cancer Center(NCC)of China was used and stratified by area(urban/rural),sex(male/female)for analyzing the age-speci c incidence and mortality rates.Time trend of colorectal cancer was calculated based on the 22 high-quality cancer registries in China.National new cases and deaths of colorectal cancer were estimated using age-speci c rates multiplied by the corresponding national population in 2014.The Chinese population in 2000 and Segi’s world population were used to calculate age-standardized rates of colorectal cancer in China.Results:Overall,370,400 new colorectal cancer cases and 179,600 deaths were estimated in China in 2014,with about 214,100 new cases in men and 156,300 in women.Meanwhile,104,000 deaths cases of colorectal cancer were men and 75,600 deaths were women,which accounted for 9.74%and 7.82%of all cancer incidence and deaths in China,separately.Relatively higher incidence and mortality was observed in urban areas of China.And the Eastern areas of China showed the highest incidence and mortality.The age-standardized incidence and mortality rate of colorectal cancer has increased by about 1.9%per year for incidence and about 0.9%per year for mortality rate from 2000 to 2014.Conclusion:With gradually higher incidence and mortality rate in the past 15 years,colorectal cancer became a major challenge to China’s public health.E ective control strategies are needed in China.

Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.

Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea

Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.

Cancer screening in the aging population:Where do we stand and what can we do?

1.Background.The world’s population is aging,a process by which the age struc-ture shifts toward older ages.The number of older adults,defined as persons aged over 60,1 had exceeded one billion worldwide in 2020 and is projected to double by 2050,moving from 12% to 22% in pro-portion of the total population.2 Chronic diseases,such as stroke,car-diovascular disease,and cancer,are the most common health problems of the elderly.The incidence and mortality rates for cancer climb with advancing age.

Trends in high-risk rates and screening rates for the population-based cancer screening program on esophageal,stomach and liver cancer in China,2010-2016

Background:A population-based cancer screening program in rural China,targeting three types of cancer that are most prevalent in these areas,including esophageal,stomach,and liver cancer was awarded by the government in China since 2007.A two-step design with cancer risk assessment based on questionnaire interview and HBsAg test strip and subsequent clinical intervention for high-risk populations was adopted with free of charge at the local hospitals designated in the program.The participate rate including high-risk rates and screening rates was important to find appropriate strategies to improve the overall awareness of the program.Methods:Data from the cancer screening program between 2010 and 2016 were used to calculate higher rate(high-risk population/participants recruited)and screening rate(participants received screening/high-risk pop-ulation).Results:From 2010 to 2016,1,637,429 residents were recruited in the program and filled the questionnaires,350,646(21.4%)for esophagus cancer,273,715(16.7%)for stomach cancer and 1,013,068(61.9%)for liver can-cer.471,974 participants were assessed as high-risk population including 114,786(24.3%)high risk for esophagus cancer,161,809(34.3%)high risk for stomach cancer and 195,379(41.4%)high risk for liver cancer,respec-tively.249,185(52.8%)participants who were assessed as high risk received clinical screening.There were 64,710(26.0%)for esophagus cancer screening,71,365(28.6%)for stomach cancer screening and 113,110(45.4%)for liver cancer screening,respectively.Conclusion:Our findings will provide important references for designing effective population-based screening strategies to enhance the screening acceptance by health action plan in the future.

Efficacy of ctDNA methylation combined with traditional detection modality to detect liver cancer among high-risk patients:A multicenter diagnostic trial

Objective:Circulating tumor DNA(ctDNA)and alpha-fetoprotein(AFP)plus ultrasound(US)have been considered to have high diagnostic accuracy for cancer detection,however,the efficacy of ctDNA methylation combined with the traditional detection modality of liver cancer has not been tested in a Chinese independent cohort.Methods:The high-risk individuals aged between 35 and 70 years who were diagnosed with liver cirrhosis or had moderate and severe fatty liver were eligible for inclusion.All participants were invited to receive a traditional examination[referring to AFP plus US],and ctDNA methylation,respectively.The sensitivity and specificity of different diagnostic tools were calculated.The logistic regression model was applied to estimate the area under the curve(AUC),which was further validated by 10-fold internal cross-validation.Results:A total of 1,205 individuals were recruited in our study,and 39 participants were diagnosed with liver cancer.The sensitivity of AFP,US,US plus AFP,and the combination of US,AFP,and ctDNA methylation was33.33%,56.41%,66.67%,and 87.18%,respectively.The corresponding specificity of AFP,US,US plus AFP,and the combination of all modalities was 98.20%,99.31%,97.68%,and 97.68%,respectively.The AUCs of AFP,US,US plus AFP,and the combination of AFP,US,and ctDNA methylation were 65.77%,77.86%,82.18%,and92.43%,respectively.The internally validated AUCs of AFP,US,US plus AFP,and the combination of AFP,US,and ctDNA methylation were 67.57%,83.26%,86.54%,and 93.35%,respectively.Conclusions:The ctDNA methylation is a good complementary to AFP and US for the detection of liver cancer.

The NCC mathematical modeling framework for decision-making of six major cancers

Objective:Mathematical modeling and simulation is a useful research method to inform decision-making.This article aims to describe the National Cancer Center(NCC)modeling framework and how well it reproduces observed empirical data for six major cancers.Methods:We developed the NCC modeling framework for six major cancers in China(lung,liver,stomach,colorectal,esophageal,and breast),which simulates the life-histories represented by states among normal,pre-cancerous lesion,stage-specific invasive cancer,and death for six cancers separately.Each NCC simulation model could be illustrated as an integrated framework of 3 modules:a demography module,natural history module,and screening module.Combined with costs and health utilities data,the models could have many detailed outputs for informing decisions,including the harm of screening(e.g.,false positives,complications,and overdiagnosis),healthcare costs,and benefits(quality-adjusted life years gained,cancer incidence and mortality,and investment returns).We calibrated the models to Chinese population-based observations on cancer incidence,mortality,and stage distribution.All models are validated by comparing model simulated results to data observed from nationwide cancer registration and a large prospective cohort study.Results:The simulated results from the calibrated models consistently match the epidemiological patterns in six major cancer incidence,mortality,and stage distributions in China.Model projected age-specific cancer incidence and mortality were close to the observed data in the national cancer registration.The NCC modeling framework reproduced the cumulative cancer cases and deaths observed in the prospective cohort study at 7.0 and 10.8 years of follow-up.Model estimated net survival rates also consistent with population-based statistics.Conclusion:The NCC modeling framework’s ability to reproduce the observed population-level cancer statistics and the cancer cases in a prospective cohort study suggests its results are reliable to inform decision-making related to six major cancers in China.

Lung cancer risk in non-smoking females with a familial history of cancer:a multi-center prospective cohort study in China

Familial risk of lung cancer has been widely studied but whether this association holds in non-smoking females is largely unknown.We sought to determine the relationship between a family history of cancer and lung cancer risk among Chinese non-smoking females based on a multi-center prospective population-based cohort study involving 547,218 individuals between 2013 and 2019.A total of 1620 lung cancer cases occurred during a median follow-up of 3.9 years.Multivariable Cox regression showed that a family history of lung cancer in first-degree relatives significantly increased the risk of lung cancer(HR:1.50,95%CI:1.29,1.75,P<0.001).Relative to those with no relatives affected,the risk of lung cancer was 51%higher in females with one relative affected(HR:1.51,95%CI:1.29-1.76,P<0.001),123%higher in females with two relatives affected(HR:2.23,95%CI:1.57-3.15,P<0.001)and 143%higher in females with three or more relatives affected(HR:2.43,95%CI:1.21-4.91,P=0.013).Two nested case control studies stratified by age at diagnosis were conducted to verify potential disparities in this association between the early or late onset of lung cancer.A family history of lung cancer in first-degree relatives was significantly correlated with an elevated risk of lung cancer for both cases before and after age 65(OR:1.36,95%CI:1.07-1.74,P=0.013;OR:1.64,95%CI:1.15-2.33,P=0.006).Our analysis confirmed the importance of familial history of cancers on lung cancer risk in non-smoking females and highlighted the possibility of interaction between genetic and environmental effect on lung cancer.

Survey of hepatitis B virus infection for liver cancer screening in China:A population-based,cross-sectional study

Background:Hepatitis B virus(HBV)infection is the primary cause of hepatocellular carcinoma(HCC)in China.The target population for HCC screening comprises individuals who test positive for hepatitis B surface antigen(HBsAg).However,current data on the prevalence of HBV infection among individuals who are eligible for HCC screening in China are lacking.We aimed to assess the seroepidemiology of HBV infection among Chinese individuals eligible for HCC screening to provide the latest evidence for appropriate HCC screening strategies in China.Methods:Questionnaires including information of sex,age,ethnicity,marital status,educational level,source of drinking water,as well as smoking and alcohol consumption history and serum samples were collected from females aged 45-64 years and males aged 35-64 years in 21 counties from 4 provinces in eastern and central China between 2015 and 2023.Enzyme-linked immunosorbent assay methods were used to detect the serum HBV marker HBsAg.Results:A total of 603,082 individuals were enrolled,and serum samples were collected for analysis from January 1,2015 to December 31,2023.The prevalence of HBsAg positive in the study population was 5.23%(31,528/603,082).The prevalence of HBsAg positive was greater in males than in females(5.60%[17,660/315,183]vs 4.82%[13,868/287,899],χ^(2)=187.52,P<0.0001).The elderly participants exhibited a greater prevalence of HBV infection than younger participants(χ^(2)=41.73,P<0.0001).Birth cohort analysis revealed an overall downward trend in HBV prevalence for both males and females.Individuals born in more recent cohorts exhibited a lower prevalence of HBV infection as compared to those born earlier.Conclusions:The current prevalence of HBV infection remains above 5%in populations eligible for HCC screening in China.Further efforts should be made to increase the accessibility of HCC screening among individuals with HBV infection.

Current cancer burden in China: epidemiology, etiology, and prevention

Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.

Liver cancer incidence and mortality in China: Temporal trends and projections to 2030

Objective: Liver cancer is one of the most common cancers and major cause of cancer deaths in China,which accounts for over 50% of new cases and deaths worldwide.The systematic liver cancer statistics including of projection through 2030 could provide valuable information for prevention and control strategies in China,and experience for other countries.Methods: The burden of liver cancer in China in 2014 was estimated using 339 cancer registries’ data selected from Chinese National Cancer Center(NCC).Incident cases of 22 cancer registries were applied for temporal trends from 2000 to 2014.The burden of liver cancer through 2030 was projected using age-period-cohort model.Results: About 364,800 new cases of liver cancer(268,900 males and 95,900 females) occurred in China,and about 318,800 liver cancer deaths(233,500 males and 85,300 females) in 2014.Western regions of China had the highest incidence and mortality rates.Incidence and mortality rates decreased by about 2.3% and 2.6% per year during the period of 2000-2014,respectively,and would decrease by more than 44% between 2014 and 2030 in China.The young generation,particularly for those aged under 40 years,showed a faster down trend.Conclusions: Based on the analysis,incidence and mortality rates of liver cancer are expected to decrease through 2030,but the burden of liver cancer is still serious in China,especially in rural and western areas.Most cases of liver cancer in China can be prevented through vaccination and more prevention efforts should be focused on high risk groups.

Colorectal cancer burden,trends and risk factors in China:A review and comparison with the United States

Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.