STATISTICAL TESTS FOR THE COMPARISON OF THE INCIDENCE OR MORTALITY RATES IN CANCER REGISTRY AND DESCRIPTIVE EPIDEMIOLOGY──A MICROCOMPUTER PROGRAM IN BASIC

This paper describes the statistical methods of the comparison of the incidence or mortality rates in cancer registry and descriptive epidemiology, and the features of microcomputer program (CANTEST) which was designed to perform the methods. The program was written in IBM BASIC language. Using the program CANTEST we presented here the user can do several statistical tests or estimations as follow: 1. the comparison of the adjusted rates which were calculated by directly or indirectly standardized methods, 2. the calculation of the slope of regression line for testing the linear trends of the adjusted rates, 3. the estimation of the 95% or 99%conndence intervals of the directly adjusted rates, of the cumulative rates (0-64 and 0-74), and of the cumulative risk. Several examples are presented for testing the performances of the program.

National cancer incidence and mortality in China, 2012

Background： Population-based cancer registration data in 2012 from all available cancer registries were collected by the National Central Cancer Registry （NCCR）. NCCR estimated the numbers of new cancer cases and cancer deaths in China with compiled cancer incidence and mortality rates. Methods： In 2015, there were 261 cancer registries submitted cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the NCCR criteria of data quality. Qualified data from 193 registries were used for cancer statistics analysis as national estimation. The pooled data were stratified by area （urban/rural）, gender, age group [0, 1-4, 5-9, 10-14, ..., 85＋] and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding national population in 2012. The Chinese census data in 2000 and Segi＇s population were applied for age-standardized rates. All the rates were expressed per 100,000 person-year. Results： Qualified 193 cancer registries （74 urban and 119 rural registries） covered 198,060,406 populations （100,450,109 in urban and 97,610,297 in rural areas）. The percentage of cases morphologically verified （NIV%） and death certificate-only cases （DCO%） were 69.13% and 2.38%, respectively, and the mortality to incidence rate ratio （M/I） was 0.62. A total of 3,586,200 new cancer cases and 2,186,600 cancer deaths were estimated in China in 2012. The incidence rate was 264.85/100,000 （289.30/100,000 in males, 239.15/100,000 in females）, the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 191.89/100,000 and 187.83/100,000 with the cumulative incidence rate （0-74 age years old） of 21.82%. The cancer incidence, ASIRC and ASIRW in urban areas were 277.17/100,000, 195.56/100,000 and 190.88/100,000 compared to 251.20/100,000, 187.10/100,000 and 183.91/100,000 in rural areas, respectively. The cancer mortality was 161.49/ 100,000 （ 198.99/100,000 in males, 122.06/ 100,000 in females）, the age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 112.34/100,000 and 111.25/100,000, and the cumulative mortality rate （0-74 years old） was 12.61%. The cancer mortality, ASMRC and ASMRW were 159.00/100,000, 107.23 1/100,000 and 106.13/100,000 in urban areas, 164.24/100,000, 118.22/100,000 and 117.06/100,000 in rural areas, respectively. Cancers of lung, stomach, liver, eolorectum, esophagus, female breast, thyroid cervix, brain tumor and pancreas were the most common cancers, accounting for about 77.4% of all cancer new cases. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, pancreatic cancer, female breast cancer, brain tumor, leukemia and lymphoma were the leading causes of cancer death, accounting for about 84.5% of all cancer deaths. The cancer spectrum showed difference between urban and rural, males and females both in incidence and mortality rates. Conclusions： Cancer surveillance information in China is making great progress with the increasing number of cancer registries, population coverage and the improving data quality. Cancer registration plays a fundamental role in cancer control by providing basic information on population-based cancer incidence, mortality, survival and time trend. The disease burden of cancer is serious in China, so that, cancer prevention and control, including health education, health promotiou, cancer screening and cancer care services in China, should be enhanced.

Report of incidence and mortality in China cancer registries, 2009

Objective： The National Central Cancer Registry （NCCR） collected cancer registration data in 2009 from local cancer registries in 2012, and analyzed to describe cancer incidence and mortality in China. Methods： On basis of the criteria of data quality from NCCR, data submitted from 104 registries were checked and evaluated. There were 72 registries＇ data qualified and accepted for cancer registry annual report in 2012. Descriptive analysis included incidence and mortality stratified by area （urban/rural）, sex, age group and cancer site. The top 10 common cancers in different groups, proportion and cumulative rates were also calculated. Chinese population census in 1982 and Segi＇s population were used for age-standardized incidence/mortality rates. Results： All 72 cancer registries covered a total of 85,470,522 population （57,489,009 in urban and 27,981,513 in rural areas）. The total new cancer incident cases and cancer deaths were 244,366 and 154,310, respectively. The morphology verified cases accounted for 67.23%, and 3.14% of incident cases only had information from death certifications. The crude incidence rate in Chinese cancer registration areas was 285.91/100,000 （males 317.97/100,000, females 253.09/100,000）, age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 146.87/100,000 and 191.72/100,000 with the cumulative incidence rate （0-74 age years old） of 22.08%. The cancer incidence and ASIRC were 303.39/100,000 and 150.31/100,000 in urban areas whereas in rural areas, they were 249.98/100,000 and 139.68/100,000, respectively. The cancer mortality in Chinese cancer registration areas was 180.54/100,000 （224.20/100,000 in males and 135.85/100,000 in females）, age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 85.06/100,000 and 115.65/100,000, and the cumulative incidence rate （0-74 age years old） was 12.94%. The cancer mortality and ASMRC were 181.86/100,000 and 80.86/100,000 in urban areas, whereas in rural areas, they were 177.83/100,000 and 94.40/100,000 respectively. Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer, pancreas cancer, encephaloma, lymphoma, female breast cancer and cervical cancer, were the most common cancers, accounting for 75% of all cancer cases in urban and rural areas. Lung cancer, gastric cancer, liver cancer, esophageal cancer, colorectal cancer, pancreatic cancer, breast cancer, encephaloma, leukemia and lymphoma accounted for 80% of all cancer deaths. The cancer spectrum showed difference between urban and rural areas, males and females. The main cancers in rural areas were cancers of the stomach, followed by esophageal cancer, lung cancer, liver cancer and colorectal cancer, whereas the main cancer in urban areas was lung cancer, followed by liver cancer, gastric cancer and colorectal cancer. Conclusions： The coverage of cancer registration population has been increasing and data quality is improving. As the basis of cancer control program, cancer registry plays an important role in making anti- cancer strategy in medium and long term. As cancer burdens are different between urban and rural areas in China, prevention and control should be implemented based on practical situation.

Incidence and mortality of laryngeal cancer in China, 2011

Objective： Laryngeal cancer is the common cancer of the upper aerodigestive tract. We aimed to use the national cancer registration data in 2011 to estimate the incidence and mortality of laryngeal cancer within China. Methods： Comparable, high-quality data from 177 population-based cancer registries were qualified for analysis. The pooled data were stratified by area, sex and age group. National new cases and deaths of laryngeal cancer were estimated using age-specific rates and national population in 2010. All incidence and death rates were age-standardized to the 2000 Chinese standard population and Segi＇s population, which were expressed per 100,000 populations. Results： All 177 cancer registries covered a total of 175,310,169 population （98,341,507 in urban and 76,968,662 in rural areas）, accounting for 13.01% of the national population. The data quality indicators of proportion of morphological verification （MV%）, percentage of cancer cases identified with death certification only （DCO%） and mortality to incidence ratio （Mr/） were 77.98%, 2.62% and 0.55, respectively. Estimated 20,875 new cases of laryngeal cancer were diagnosed and 11,488 deaths from laryngeal cancer occurred in China in 2011. The crude incidence rate of laryngeal cancer was 1.55/100,000 （2.69/100,000 in males and 0.35/100,000 in females）. Age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 1.13/100,000 and 1.14/100,000, respectively. Laryngeal cancer is much rarer in females than in males. The incidence rate was higher in urban areas than that in rural areas. The crude mortality rate of laryngeal cancer was 0.85/100,000 （1.42/100,000 in males and 0.25/100,000 in females）. Age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were both 0.61/100,000. The mortality rate in males was much higher than that in females. There was no definite difference in mortality rates of laryngeal cancer between urban and rural areas. Conclusions： Larynx is a specialized area and cancer of larynx significantly affects the quality of life for the patients. Comprehensive measures should be carried out to prevent the ascent of laryngeal cancer.

Report of Incidence and Mortality in China Cancer Registries,2008

Objective： Annual cancer incidence and mortality in 2008 were provided by National Central Cancer Registry in China, which data were collected from population‐based cancer registries in 2011. Methods： There were 56 registries submitted their data in 2008. After checking and evaluating the data quality, total 41 registries＇ data were accepted and pooled for analysis. Incidence and mortality rates by area （urban or rural areas） were assessed, as well as the age‐ and sex‐specific rates, age‐standardized rates, proportions and cumulative rate. Results： The coverage population of the 41 registries was 66,138,784 with 52,158,495 in urban areas and 13,980,289 in rural areas. There were 197,833 new cancer cases and 122,136 deaths in cancer with mortality to incidence ratio of 0.62. The morphological verified rate was 69.33%, and 2.23% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 299.12/100,000 （330.16/100,000 in male and 267.56/100,000 in female） and the age‐standardized incidence rates by Chinese standard population （ASIRC） and world standard population （ASIRW） were 148.75/100,000 and 194.99/100,000, respectively. The cumulative incidence rate （0-74 years old） was of 22.27%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the incidence rate in urban was lower than that in rural. The crude cancer mortality was 184.67/100,000 （228.14/100,000 in male and 140.48/100,000 in female）, and the age‐standardized mortality rates by Chinese standard population （ASMRC） and by world population were 84.36/100,000 and 114.32/100,000, respectively. The cumulative mortality rate （0-74 years old） was of 12.89%. Age‐adjusted mortality rates in urban areas were lower than that in rural areas. The most common cancer sites were lung, stomach, colon‐rectum, liver, esophagus, pancreas, brain, lymphoma, breast and cervix which accounted for 75% of all cancer incidence. Lung cancer was the leading cause of cancer death, followed by gastric cancer, liver cancer, esophageal cancer, colorectal cancer and pancreas cancer, which accounted for 80% of all cancer deaths. The cancer spectrum varied by areas and sex in rural areas, cancers from digestive system were more common, such as esophageal cancer, gastric cancer and liver cancer, while incidence rates of lung cancer and colorectal cancer were much higher in urban areas. In addition, breast cancer was the most common cancer in urban women followed by liver cancer, gastric cancer and colorectal cancer. Conclusion： Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer and female breast cancer contributed to the increased incidence of cancer, which should be paid more attention to in further national cancer prevention and control program. Different cancer control strategies should be carried out due to the varied cancer spectrum in different groups.

Cancer incidence and mortality in China, 2014

Background： National Central Cancer Registry of China（NCCRC） updated nationwide cancer statistics using population-based cancer registry data in 2014 collected from all available cancer registries.Methods： In 2017, 449 cancer registries submitted cancer registry data in 2014, among which 339 registries＇ data met the criteria of quality control and were included in analysis. These cancer registries covered 288,243,347 population, accounting for about 21.07% of the national population in 2014. Numbers of nationwide new cancer cases and deaths were estimated using calculated incidence and mortality rates and corresponding national population stratified by area, sex, age group and cancer type. The world Segi＇s population was applied for agestandardized rates.Results： A total of 3,804,000 new cancer cases were diagnosed, the crude incidence rate was 278.07/100,000（301.67/100,000 in males, 253.29/100,000 in females） and the age-standardized incidence rate by world standard population（ASIRW） was 186.53/100,000. Calculated age-standardized incidence rate was higher in urban areas than in rural areas（191.6/100,000 vs. 179.2/100,000）. South China had the highest cancer incidence rate while Southwest China had the lowest incidence rate. Cancer incidence rate was higher in female for population between20 to 54 years but was higher in male for population younger than 20 years or over 54 years. A total of 2,296,000 cancer deaths were reported, the crude mortality rate was 167.89/100,000（207.24/100,000 in males,126.54/100,000 in females） and the age-standardized mortality rate by world standard population（ASMRW） was106.09/100,000. Calculated age-standardized mortality rate was higher in rural areas than in urban areas（110.3/100,000 vs. 102.5/100,000）. East China had the highest cancer mortality rate while North China had the lowest mortality rate. The mortality rate in male was higher than that in female. Common cancer types and major causes of cancer death differed between age group and sex.Conclusions： Heavy cancer burden and its disparities between area, sex and age group pose a major challenge to public health in China. Nationwide cancer registry plays a crucial role in cancer prevention and control.

Cancer incidence and mortality in China in 2013：an analysis based on urbanization level

Objective： To explore the cancer patterns in areas with different urbanization rates（URR） in China with data from 255 population-based cancer registries in 2013, collected by the National Central Cancer Registry（NCCR）.Methods： There were 347 cancer registries submitted cancer incidence and deaths occurred in 2013 to NCCR.All those data were checked and evaluated based on the NCCR criteria of data quality, and qualified data from 255 registries were used for this analysis. According to the proportion of non-agricultural population, we divided cities/counties into 3 levels： high level, with URR equal to 70% and higher; median level, with URR between 30%and 70%; and low level, with URR equal to 30% and less. Cancer incidences and mortalities were calculated,stratified by gender and age groups in different areas. The national population of Fifth Census in 2000 and Segi＇s population were applied for age-standardized rates.Results： Qualified 255 cancer registries covered 226,494,490 populations. The percentage of cases morphologically verified（MV%） and death certificate-only cases（DCO%） were 68.04% and 1.74%, respectively,and the mortality to incidence rate ratio（M/I） was 0.62. A total of 644,487 new cancer cases and 399,275 cancer deaths from the 255 cancer registries were submitted to NCCR in 2013. The incidence rate was 284.55/100,000（314.06/100,000 in males, 254.19/100,000 in females）, and the age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 190.10/100,000 and 186.24/100,000 with the cumulative incidence rate（0–74 age years old） of 21.60%. The cancer mortality was 176.28/100,000（219.03/100,000 in males, 132.30/100,000 in females）, and the age-standardized mortality rates by Chinese standard population（ASMRC） and by world standard population（ASMRW） were 110.91/100,000 and 109.92/100,000, and the cumulative mortality rate（0–74 age years old） was 12.43%. Low urbanization areas were high in crude cancer incidence and mortality rates, middle urbanization areas came next to it followed by high urbanization areas. After adjusted by age, there was a U-shaped association between age-standardized incidence（ASIRC and ASIRW） and the urbanized ratio with the middle urbanization areas having the lowest ASIRC and ASIRW. Unlike with the agestandardized incidence, the sort order of age-standardized mortality（ASMRC and ASMRW） among three urbanization areas was reversed completely from the crude mortality. Lung cancer was the most common cancer in all areas of 255 cancer registries, followed by stomach cancer, liver cancer, colorectal cancer and esophageal cancer with new cases of 130,700, 76,200, 63,800, 60,900 and 50,200 respectively. Lung cancer was also the leading cause of cancer death in all areas of 255 cancer registries for both males and females with the number of deaths of 72,200 and 34,100, respectively. Other cancer types with high mortality in males were liver cancer, stomach cancer,esophageal cancer and colorectal cancer. In females, stomach cancer was the second cause of cancer death, followed by liver cancer, colorectal cancer and breast cancer.Conclusions： Along with the development of socioeconomics associated with urbanization, as well as the agingpopulation, the incidence and mortality keep increasing in China. Cancer burden and patterns are different in each urbanization level. Cancer control strategies should be implemented referring to local urbanization status.

Estimates of cancer incidence and mortality in China,2013

Introduction: Population-based cancer registration data are collected by the National Central Cancer Registry in China every year. Cancer incident cases and cancer deaths in 2013 were analyzed.Methods: Through the procedure of quality control, reported data from 255 registries were accepted to establish the national database for cancer estimates. Incidences and mortalities were calculated with stratification by area(urban/rural), sex(male/female), age group(0,1-4,5-9,10-14... 80-84, and 85-year-old and above), and cancer site.The structure of Segi's population was used for the calculation of age-standardized rates(ASR).Top 10 most common cancers and leading causes of cancer deaths were listed.Results: In 2013,3,682,200 new cancer cases and 2,229,300 cancer deaths were estimated in China based on the pooled data from 255 cancer registries, covering 16.65% of the national population. The incidence was270.59/100,000, with an ASR of 186.15/100,000; the mortality was 166.83/100,000, with an ASR of 108.94/100,000.The top 10 most common cancer sites were the lung, stomach, liver, colorectum, female breast, esophagus, thyroid, cervix, brain, and pancreas. The ten leading causes of cancer deaths were lung cancer, liver cancer, gastric cancer, esophageal cancer, colorectal cancer, pancreatic cancer, female breast cancer, brain tumor, leukemia, and lymphoma.Conclusions: Cancer leaves serious disease burden in China with high incidence and mortality. Lung cancer was the most common cancer and the leading cause of cancer death in China. Efficient control strategy is needed, especially for major cancers.

Incidence and mortality of colorectal cancer in China, 2011

Objective： Colorectal cancer is the third most common type of cancer and the fourth leading cause of cancer-related death in the world. This article provides the most up-to-date overview of colorectal cancer burden in China. Methods： Totally 234 cancer registries submitted data of 2011 to the National Central Cancer Registry （NCCR）. Qualified data from 177 registries was pooled and analyzed. The crude incidence and mortality rates of colorectal cancer were calculated by age, gender and geographic area. The numbers of new cases and deaths were estimated using the 5-year age-specific cancer incidence/mortality rates and the corresponding populations. China census in 2000 and Segi＇s world population were applied for age standardized rates. Results： The estimate of new cases diagnosed with colorectal cancer of China in 2011 was 310,244 （178,404 for males and 131,840 for females, 195,117 in urban areas and 115,128 in rural areas）, accounting for 9.20% of overall new cancer cases. The crude incidence of colorectal cancer ranked fourth in all cancer sites with rate of 23.03/100,000 （25.83/100,000 for males and 20.08/100,000 for female, 28.25/100,000 in urban areas and 17.54/100,000 in rural areas）. The age-standardized rates by China population and by World population were 16.79/100,000 and 16.52/100,000, respectively. The estimated number of colorectal cancer deaths of China in 2011 was 149,722 （86,427 for males and 63,295 for females, 91,682 in urban areas and 58,040 in rural areas）, accounting for 7.09% of overall cancer deaths. The crude mortality rate for colorectal cancer ranked fifth leading cause of cancer-related death in all cancer sites with rate of 11.11/100,000 （12.51/100,000 for males and 9.64/100,000 for female, 13.27/100,000 in urban areas and 8.84/100,000 in rural areas）. The age-standardized rates by China population and by World population for mortality were 7.77/100,000 and 7.66/100,000, respectively. For both of incidence and mortality, the rates of colorectal cancer were much higher in males than in females, and in rural areas than in urban areas. The rate of colorectal cancer increased greatly with age, especially after 40 or 45 years old. Conclusions： Colorectal cancer is a relative common cancer in China, especially for males in urban areas. Targeted prevention and early detection programs should be carried out.

Cancer Incidence and Mortality in China,2007

Objective： Cancer incidence and mortality data collected from population-based cancer registries were analyzed to present the overall cancer statistics in Chinese registration areas by age, sex and geographic area in 2007. Methods： In 2010, 48 cancer registries reported cancer incidence and mortality data of 2007 to National Central Cancer Registry of China. Of them, 38 registries＇ data met the national criteria. Incidence and mortality were calculated by cancer sites, age, gender, and area. Age-standardized rates were described by China and World population. Results： The crude incidence rate for all cancers was 276.16/100,000 （305.22/100,000 for male and 246.46/100,000 for female; 284.71/100,000 in urban and 251.07/100,000 in rural）. Age-standardized incidence rates by China and World population were 145.39/100,000 and 189.46/100,000 respectively. The crude mortality rate for all cancers was 177.09/100,000 （219.15/100,000 for male and 134.10/100,000 for female; 173.55/100,000 in urban and 187.49/100,000 in rural）. Age-standardized mortality rates by China and World population were 86.06/100,000 and 116.46/100,000, respectively. The top 10 most frequently common cancer sites were the lung, stomach, colon and rectum, liver, breast, esophagus, pancreas, bladder, brain and lymphoma, accounting for 76.12% of the total cancer cases. The top 10 causes of cancer death were cancers of the lung, liver, stomach, esophagus, colon and rectum, pancreas, breast, leukemia, brain and lymphoma, accounting for 84.37% of the total cancer deaths. Conclusion： Cancer remains a major disease threatening people＇s health in China. Prevention and control should be enhanced, especially for the main cancers.

Pancreatic cancer incidence and mortality patterns in China, 2011

Objective： The National Central Cancer Registry （NCCR） collected population-based cancer registration data in 2011 from all cancer registries in China. The incidence and mortality rates for pancreatic cancer were compiled and pancreatic cancer incident new cases and deaths were estimated. Methods： A total of 234 cancer registries submitted cancer data to NCCR. Data from 177 cancer registries were qualified and compiled for cancer statistics in 2011. Pancreatic cancer cases were extracted and analyzed from the national database. The pooled data were stratified by area （urban/rural）, gender and age group （0, 1-4, 5-9, 10-14...85＋）. Pancreatic cancer incident cases and deaths were estimated using age-specific rates and national population in 2010. The national census in 2000 and Segi＇s population were used for age- standardized rates. Results： All 177 cancer registries （77 in urban and I00 in rural areas） covered 175,310,169 populations （98,341,507 in urban and 76,968,662 in rural areas）. The morphology verified pancreatic cancer cases （MV%） accounting for 40.52% and 4.33% of pancreatic cancer incident cases were identified through death certifications only （DCO%） with mortality to incidence ratio （M/I） of 0.91. The estimated number of newly diagnosed pancreatic cancer cases and deaths were 80,344 and 72,723 in 2011, respectively. The crude incidence rate was 5.96/100,000 （males 6.57/100,000, females 5.32/100,000）. The age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 4.27/100,000 and 4.23/100,000 respectively, ranking 10th among all cancers. Pancreatic cancer incidence rate and ASIRC were 7.03/100,000 and 4.94/100,000 in urban areas whereas they were 4.84/100,000 and 3.56/100,000 in rural areas. The incidence rate of pancreatic cancer of 33 cancer registries increased from 3.24/I00,000 in 2003 to 3.59/100,000 in 2011 with an annual percentage change （APC） of 1.44. The pancreatic cancer mortality rate was 5.40/100,000 （males 5.88/100,000, females 4.89/100,000）, ranking 6th among all cancers. The age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 3.81/100 000 and 3.79/100 000. The pancreatic cancer mortality and ASMRC were 6.47/100,000 and 4.48/100,000 in urban areas, and 4.27/100,000 and 3.08/100,000 in rural areas, respectively. The mortality rates of pancreatic cancer showed an approximately 1.14-fold increase, from 2.85/100,000 in 2003 to 3.26/100,000 in 2011, with an APC of 1.68. Conclusions： The burden of pancreatic cancer is increasing in China. Identification of high-risk population and adequate treatment and prevention are important.

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

Objective：In this research,the patterns of cancer incidence and mortality in areas with different gross domestic product per capita（GDPPC）levels in China were explored,using data from population-based cancer registries in 2013,collected by the National Central Cancer Registry（NCCR）.Methods：Data from 255 cancer registries were qualified and included in this analysis.Based on the GDPPC data of 2014,cities/counties were divided into 3 levels：high-,middle-and low-GDPPC areas,with 40,000 and 80,000 RMB per year as cut points.We calculated cancer incidences and mortalities in these three levels,stratified by gender and age group.The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates.Results：The crude incidence and mortality rates as well as age-standardized incidence rate（ASIR）showed positive associations with GDPPC level.The age-standardized mortality rate（ASMR）nevertheless showed a negative association with GDPPC level.The ASMR in high-,middle-and low-GDPPC areas was 103.12/100,000,112.49/100,000 and 117.43/100,000,respectively.Lung cancer was by far the most common cancer in all three GDPPC levels.It was also the leading cause of cancer death,regardless of gender and GDPPC level.Negative associations with GDPPC level were found for the ASIRs of lung,stomach,esophageal and liver cancer,whereas colorectal and breast cancer showed positive associations.Except for breast cancer,the ASMRs of the other five cancers were always higher in middle-and low-GDPPC areas than in high-GDPPC areas.Conclusions：The economic development is one of the main factors of the heavy cancer burden on Chinese population.It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

Pancreatic cancer incidence and mortality patterns in 2006-2015 and prediction of the epidemiological trend to 2025 in China

BACKGROUND Due to dietary patterns,the aging population,and other high-risk factors,the occurrence of pancreatic cancer(PC)has been rapidly increasing in China.AIM To present the epidemiological trends of PC in China over the past decade and the estimated trend in 2025 and to compare the international differences in PC morbidity and mortality.METHODS This study used a series of nationally representative data from the National Central Cancer Registry of China(NCCR),the International Agency for Research on Cancer and the Institute for Health Metrics and Evaluation databases.Agestandardized data of the PC incidence and mortality from 2006 to 2015 in China were extracted from the NCCR database.Linear regression models were used to estimate the incidence and mortality rates of PC in 2025.RESULTS The age-standardized rates of PC in China increased from 3.65 per 100000 in 2006 to 4.31 per 100000 in 2015 and were estimated to reach up to 5.52 per 100000 in 2025.The mortality went from 3.35 per 100000 in 2006 to 3.78 per 100000 in 2015,estimated to reach up to 4.6 per 100000 in 2025.The number of new cases and deaths was low before 45 years and the peak age of onset was 85-89 years.The incidence and mortality rates in men were higher than those in women regardless of the region in China.In addition,the incidence and mortality rates in China were higher than the average level around the world.Likewise,disabilityadjusted life years attributed to PC in China were 197.22 years per 100000,above the average level around the world.CONCLUSION This study presented an increasing trend of PC in China and differences in morbidity,mortality and disability-adjusted life years between Chinese and global populations.Efforts need to be made to decrease the PC incidence and improve patient outcomes.

Incidence, Mortality, and Epidemiology of Leukemia in South Asia: An Ecological Study

Background: Nowadays cancer is a buzzword in every corner of the world. Back a few decades, cancer was not that much known to the people of South Asia let alone known of Leukemia. Many countries in the South Asian region are designated as developing countries. Hence, the deficiency of diagnosis system, treatment, management, and lack of knowledge about leukemia in this region are major problems. Therefore, the incidence rate, mortality rate, and several deaths are increasing day by day. Methods: This cross-sectional study is aimed to investigate the incidence and mortality of leukemia in South Asian Countries for the year 2020 by acquiring data from the global cancer project (GLOBOCAN2020) accessible at https://gco.iarc.fr. Results: In South Asia, 1,733,573 cancer cases were documented in 2020 where 62,163 cases were leukemia related. The highest incidence rate was reported in Pakistan (4.3 in 1,000,000) and Sri Lanka (4.1 in 1,000,000) and the lowest in Bangladesh (1.8 in 1,000,000) and Nepal (2.0 in 1,000,000). On the other hand, 1,124,875 death had been reported in 2020, where 45,707 (4.1%) death was associated with leukemia. Pakistan (3.4 in 1,000,000) and Maldives (3.1 in 1,000,000) had the highest death and lowest in Bangladesh (1.4 in 1,000,000) and Nepal (1.5 in 1,000,000). Adults aged from 60 - 85 years old have the highest rate of incidence and mortality rate in all countries except Nepal. Conclusions: Leukemia is one of the major concerning cancer of all ages people in South Asia, the situation and related risk factors information can be helpful to reduce death through proper treatment.

Oral cancer incidence and mortality in China, 2011

Objective： To descript the incidence and mortality rates of oral cancer among Chinese population in 2011, and provide valuable data for oral cancer prevention and research. Methods： Data from 177 population-based cancer registries distributed in 28 provinces were accepted for this study after evaluation based on quality control criteria, covering a total of 175,310,169 populations and accounting for 13.01% of the overall national population in 2011. Incidence and mortality rates were calculated by area, gender and age groups. The numbers of new cases and deaths were estimated using the 5-year age-specific cancer incidence/mortality rates and the corresponding populations. The Chinese population in 2000 and World Segi＇s population were used for age-standardized rates. Results： The estimate of new cases diagnosed with oral cancer was 39,450 including 26,160 males and 13,290 females. The overall crude incidence rate for oral cancer was 2.93/100,000. The age-standardized rates by China （ASRcN） population and by World population （ASRwld） were 2.22/100,000 and 2.17/100,000, respectively. Among subjects aged 0-74 years, the cumulative incidence rate was 0.25%. The estimated number of oral cancer deaths of China in 2011 was 16,933, including 11,794 males and 5,139 females. The overall crude mortality rate was 1.26/I00,000, accounting for 0.80% of all cancer deaths. The ASRcN and ASP^Id for mortality were 0.90/100,000 and 0.89/100,000, respectively. Among subjects aged 0-74 years, the cumulative mortality rate was 0.10%. The incidence and mortality rates of oral cancer were much higher in males and urban areas than in females and rural areas. In addition, the incidence and mortality rates were increased by the raising of ages. Conclusions： Results in the study may have important roles for oral cancer prevention and research. Although oral cancer burden of China is not high, we must pay attention to this malignancy as well. In addition, further researches need to be done for primary and secondary prevention research of oral cancer, especially for the high risk population.

Liver cancer incidence and mortality in China, 2009

Liver cancer is a common cancer and a leading cause of cancer deaths in China. To aid the government in establishing a control plan for this disease, we provided real-time surveillance information by analyzing liver cancer incidence and mortality in China in 2009 reported by the National Central Cancer Registry. Liver cancer incidence and cases of death were retrieved from the national database using the ICD-10 topography code "C22". Crude incidence and mortality were calculated and stratified by sex, age, and location (urban/rural). China's population in 1982 and Segi (world) population structures were used for age-standardized rates. In cancer registration areas in 2009, the crude incidence of liver cancer was 28.71/100,000, making it the fourth most common cancer in China, third most common in males, and fifth most common in females. The crude mortality of liver cancer was 26.04/100,000, making it the second leading cause of cancer death in China and urban areas and the third leading cause in rural areas. Incidence and mortality were higher in males than in females and were higher in rural areas than in urban areas. The age-specific incidence and mortality were relatively low among age groups under 30 years but dramatically increased and peaked in the 80 -84 years old group. These findings confirm that liver cancer is a common and fatal cancer in China. Primary and secondary prevention such as health education, hepatitis B virus vaccination, and early detection should be carried out both in males and females, in urban and rural areas.

Incidence and mortality of liver cancer in China in 2011

Background: Liver cancer is a common cancer with poor prognosis in China. In this study, the national population?based cancer registration data were used to evaluate and analyze liver cancer incidence and mortality in China in 2011 and provide a reference for liver cancer prevention and control.Methods: We collected and evaluated the incidence and mortality data of liver cancer in 2011 from 177 cancer registries with qualiied data. These data were used in the inal analysis including calculating crude, standardized, and truncated incidences and mortalities, and estimated new liver cancer cases and deaths using age?speciic rates and the corresponding populations. The national census in 2000 and Segi's population were used for age?standardized rates.Results: The estimates of new liver cancer cases and deaths were 355,595 and 322,416, respectively, in China in 2011. The crude incidence, age?standardized rate of incidence by Chinese standard population(ASRIC), and age?stand?ardized rate of incidence by world standard population(ASRIW) of liver cancer were 26.39/100,000, 19.48/100,000, and 19.10/100,000, respectively; the crude mortality, age?standardized rate of mortality by Chinese standard popula?tion(ASRMC), and age?standardized rate of mortality by world standard population(ASRMW) of liver cancer were 23.93/100,000,17.48/100,000, and 17.17/100,000, respectively. The incidence and mortality were higher in rural areas than in urban areas and higher in males than in females. The age?speciic incidence and mortality of liver cancer increased greatly with age, particularly after 30 years and peaked at 80–84 or 85+ years.Conclusions: Liver cancer is a common cancer in China, particularly for males and residents in rural areas. Targeted prevention, early detection, and treatment programs should be carried out.

Incidence And Mortality Trend of Cervical Cancer in 11 Cancer Registries of China

Objective：In many countries,the cervical cancer prevalence has declined but less information about the changes is available in China.This study aims to understand the epidemiological characteristics and trend of cervical cancer in China.Methods：Cervical cancer data of 11 cancer registries during 1988-2002 in China were analyzed.The age and urban/rural differences and trend of cervical cancer incidence and mortality were described and discussed.Results：During 1988-2002,a total of 6007 incidence cases and 3749 mortality cases of cervical cancer were reported in the 11 cancer registries.The incidence crude rate of cervical cancer was 3.80/100,000 and the world age adjusted rate was 2.78/100,000.In the same period,the mortality crude rate was 2.37/100,000 and the world age adjusted rate was 1.66/100,000.Declined incidence and mortality trends were observed during this period in urban as well as in rural areas.When calculating the rates by age group,we found that the declining trends were only for older women and increasing trends for younger women,especially for women in the rural areas.Conclusion：The incidence and mortality rates declined during the period of 1988-2002 in China for older women.The younger women showed an increasing trend during the same period,especially for women in rural area.

Incidence and mortality of esophagus cancer in China, 2008-2012

Objective: To analyze the incidence and mortality rates of esophagus cancer in China from 2008 to 2012.Methods: Incident and mortality cases of esophagus cancer were retrieved from the National Central Cancer Registry(NCCR) database collecting from 135 cancer registries in China during 2008-2012. The incidence and mortality rates of esophagus cancer were calculated by area(urban/rural), region(eastern, middle, western), gender and age group(0, 1-4, 5-84 by 5 years and 85+ years). China census in 2000 and Segi’s world population were applied for age-standardized rates. Joinpoint model was used for time-trend analysis.Results: The crude incidence rate of esophagus cancer was 22.57/100,000. The age-standardized incidence rates by China standard population(ASIRC) and by world standard population(ASIRW) were 14.58/100,000 and14.80/100,000, respectively. The crude mortality rate of esophagus cancer was 17.19/100,000. The agestandardized mortality rates by Chinese standard population(ASMRC) and by world standard population(ASMRW) were 10.80/100,000 and 10.86/100,000 respectively. Incidence and mortality rates of esophagus cancer were higher in males than in females and higher in rural areas than in urban areas. The crude incidence rate in middle areas was the highest among all areas, followed by western areas and eastern areas. The age-specific incidence rate of esophagus cancer was relatively low in age groups before 40 years old and then increased after 45 years old. It peaked in the age group of 80-84 years. The patterns of age-specific mortality rates of esophagus cancer were close to those of age-specific incidence rates. The ASIRC of esophagus cancer decreased dramatically by 29.87% between 2003 and 2012, from 14.33/100,000 to 10.05/100,000. The esophagus cancer incidence rate decreased by 3.76% per year(P>0.05). The mortality rate of esophagus cancer decreased annually over the decades from 2003 to 2012 in China(P>0.05). In females, the annual percentage change(APC) of mortality rate was-5.43%[95% confidence intervals(95% CI):-6.50%,-4.30%](P<0.05) and the mortality rate of esophagus cancer in rural females was statistically significant(APC:-3.20%, 95% CI:-4.20%,-2.20%)(P<0.05).Conclusions: The focus of prevention and treatment for esophagus cancer is strengthening primary prevention of esophageal cancer, and promoting esophagus cancer secondary prevention to reduce incidence and mortality rates of esophagus cancer, prolong survival rate of patients and decline the burden of esophagus cancer in China.

Incidence and mortality of thyroid cancer in China, 2008-2012

Objective: To analyze the incidence and mortality rates of thyroid cancer(TC) in China from 2008 to 2012.Methods: Incident and death cases of TC were retrieved from the National Central Cancer Registry(NCCR)database collecting from 135 cancer registries in China during 2008-2012. The crude incidence and mortality rates of TC were calculated by area(urban/rural), region(eastern, middle, western), gender and age group(0, 1-4, 5-9,…, 85+). China census in 2000 and world Segi's population were applied for age-standardized rates. Joinpoint(Version 4.6.0.0) model was used for time-trend analysis.Results: The crude incidence rate of TC was 7.56/100,000 which ranked the seventh in overall cancers. The agestandardized incidence rates by China population(ASIRC) and by World population(ASIRW) were 6.25/100,000 and 5.52/100,000, respectively. The crude mortality of TC in China was 0.52/100,000. The age-standardized mortality rates by Chinese standard population(ASMRC) and by world standard population(ASMRW) were0.34/100,000 and 0.32/100,000, respectively. Incidence and mortality rates of TC were higher in females than in males and higher in urban areas than in rural areas. Eastern areas had the highest incidence followed by middle and western areas. TC incidence increased dramatically after age of 15 years, then peaked at 14.08/100,000 in the group of 50-54 years and finally decreased sharply after 55 years old. TC mortality increased with age in population,reaching the peak of 5.09/100,000 in sub-population aged 85 years or older. TC incidence increased by 4.73 times from 2.40/100,000 in 2003 to 13.75/100,000 in 2012 with an average annual increase of 20%, while TC mortality only increased slightly around 0.32/100,000 from 0.26/100,000 to 0.36/100,000.Conclusions: Appropriate targeted prevention, early detection and treatment programs can be carried out to curb the rapid growth trend of TC and control the disease burden.