Upper gastrointestinal cancer burden in Hebei Province, China: A population-based study

AIM To investigate the incidence and mortality rates of upper gastrointestinal cancer(UGIC) in Hebei Province, China, and to identify high-risk populations to improve UGIC prevention and control.METHODS Data for UGIC patients were collected from 21 population-based cancer registries covering 15.25% of the population in Hebei Province. Mortality data were extracted from three national retrospective death surveys(1973-1975, 1990-1992 and 2004-2005). The data were stratified by 5-year age groups, gender and area(high-risk/non-high-risk areas) for analysis. The age-period-cohort and grey system model were used.RESULTS The crude incidence rate of UGIC was 55.47/100000, and the adjusted rate(Segi's population) was 44.90/100000. Males in rural areas had the highest incidence rate(world age-standardized rate = 87.89/100000). The crude mortality rate of UGIC displayed a decreasing trend in Hebei Province from the 1970 s to 2013, and the adjusted rate decreased by 43.81% from the 1970s(58.07/100000) to 2013(32.63/100000). The mortality rate declined more significantly in the high-risk areas(57.26%) than in the non-high-risk areas(55.02%) from the 1970 s to 2013. The median age at diagnosis of UGIC was 65.06 years in 2013. There was a notable delay in the median age at death from the 1970s(66.15 years) to 2013(70.39 years), especially in the high-risk areas. In Cixian, the total trend of the cohort effect declined, and people aged 65-69 years were a population at relatively high risk for UGIC. We predicted that the crude mortality rates of UGIC in Cixian and Shexian would decrease to 98.80 and 133.99 per 100000 in 2018, respectively.CONCLUSION UGIC was the major cause of cancer death in Hebei Province, and males in rural areas were a high-risk population. We should strengthen early detection and treatment of UGIC in this population.

Evaluation of routine biopsies in endoscopic screening for esophagogastric junction cancer

AIM:To explore whether routine biopsies at the high incidence spot of esophagogastric junction(EGJ)cancer are justified in endoscopic screening.METHODS:This was a multicenter population-based study conducted in eight high-risk areas in China.A total of 37396 participants underwent endoscopic examination.Biopsies were obtained from visible mucosal abnormalities or from normal-appearing mucosa at the high incidence spot of esophagogastric junction cancer when no abnormality was detected.Specimens showing high-grade intraepithelial neoplasia(HIN)or higher grade lesions were deemed as pathologically"positive".The ratios of positive pathologic diagnosis between participants with abnormal and normal-appearing mucosa were compared using the Pearsonχ2 test.Odds ratios and 95%confidence intervals,adjusted for potential confounders,were calculated using logistic regression.RESULTS:A total of 37520 individuals participated in this study and 37396(99.7%)participants had full information and were suitable for analysis.During endoscopic examinations,9.11%(3405/37396)participants were found to have visible mucosal lesions.Of the participants who had normal-appearing mucosa at the EGJ,only 0.28%(94/33991)were diagnosed with HIN or higher grade lesions,whereas 6.05%(206/3405)of participants with abnormalities at the EGJ had a positive pathologic result.After controlling for other variables,visible abnormal mucosa detected under endoscopy strongly predicted a positive pathologic result(OR=32.51,95%CI:23.96-44.09).The proportion of participants with"positive"pathologic diagnoses increased as the total number of endoscopic examinations performed by the doctors increased(<5000 cases vs5000-10000 cases vs>10000 cases,Z=-2.7207,P=0.0065,Cochran Armiger trend test).The same trend was found between the proportion of participants with positive pathologic diagnoses and the total number of years the doctors performed endoscopy(<5 years vs5-10 years vs>10 years,Z=-10.3222,P<0.001,Cochran Armiger trend test).CONCLUSION:Additional routine biopsies from the high incidence spot of EGJ cancer are of limited value and are unjustified.