Epidemiology, Diagnosis and Survival of Breast Cancer: Data from the Population-Based Cancer Registry of the City of Parakou from 2017 to 2021

Background: Breast cancer mortality remains high in the majority of developing countries. The Ministry of Health has established two population-based cancer registries in Benin: the first one in Cotonou in 2014 and the second one in Parakou in 2017. However, there is a scarcity of data on breast cancer survival and prognosis in Benin Republic. Objective: This study sought to investigate epidemiological, diagnostic, and survival aspects of breast cancer in Parakou, based on data from its population-based cancer registry from 2017 to 2021. Method: For descriptive and analytical purposes, we used a retrospective cohort design. From January 24, 2022 to August 31, 2022, data were collected in all health facilities covered by the Parakou population-based cancer registry using an individual questionnaire. Survival and prognosis analysis were performed using KAPLAN MEIER method and David COX proportional hazard model respectively. Result: A total of 81 patients have been included in this study. The incidence rate of breast cancer in Parakou was 17.5 per 100,000 person-years with a mortality rate of 2.76 per 100,000 person-years. The median age at diagnosis was 44.50 years with extremes ranging from 19 to 76 years and a predominance of 40 - 50 years age group. The median survival time was estimated at 30 months with an overall 5-year survival of 47%. Young age at diagnosis (p-value = 0.002) and advanced stage at diagnosis (p-value = 0.000) had a negative impact on survival in women. The combination of surgery and chemotherapy improved survival (p-value = 0.018). Conclusion: Breast cancer is still a public health issue in Parakou. It comes out mandatory that resources be made available to make screening, early diagnosis and appropriate treatment of breast cancer affordable.

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.

Secular decreasing trends in gastric cancer incidence in Taiwan:A population-based cancer registry study

BACKGROUND Gastric cancer remains a leading cause of cancer death worldwide.In Taiwan,gastric cancer is the sixth leading cause of cancer mortality in both males and females.AIM To evaluate secular trends in gastric cancer incidence according to age,sex,and Helicobacter pylori(H.pylori)treatment in Taiwan.METHODS In this population-based study,we used the national Taiwan Cancer Registry database.Annual percent changes in incidence rates were used to describe secular trends in incidence rates and sex ratios of gastric cancer in Taiwan.Pearson’s product-moment correlation coefficients were used to analyze the correlation between annual age-adjusted incidence rates and the annual number of patients treated with antibiotic therapy for H.pylori infection.RESULTS The annual percent changes showed continuously decreasing rates of gastric cancer among both males and females.However,the decreasing trends differed by sex,with an annual percent change of-2.58%in males and-2.14%in females.The age-specific incidence rates increased with age.Within the same age group,more recent time periods showed lower incidence rates than greater time periods.Similarly,the sex ratio was lower in later birth cohorts than in earlier birth cohorts.Age-adjusted incidence rates substantially decreased with increasing numbers of patients being treated with antibiotic therapy for H.pylori infection during 2005 to 2016(r=0.72).CONCLUSION We observed steadily decreasing trends with differential sex ratios in the incidence of gastric cancer in Taiwan.These results support H.pylori eradication programs in Taiwan.

Synergetic role of integrating the departments of cancer registry and clinical research at an academic comprehensive cancer center

Integration of the cancer registry and clinical research departments can have a significant impact on the accreditation process of a Commission on Cancer(Co C) Program.Here in we demonstrate that the integration of both departments will benefit as there is increased knowledge, manpower and crossover in job responsibilities in our Co C-accredited Academic Comprehensive Cancer Center.In our model this integration has led to a more successful cooperative interaction among departments, which has in turn created an enhanced combined effect on overall output and productivity.More manpower for the cancer registry has led to increased caseloads, decreased time from date of first contact to abstraction, quality of data submissions, and timely follow-up of all patients from our reference date for accurate survival analysis along with completeness of data.In 2016, our Annual Facility report showed an additional 163 cases over prediction by the state of Maryland Cancer Registry and a 39% increase in case completeness.As proof of the synergetic effectiveness of our model within one year of its implementation, the cancer center was able to apply for, and was awarded membership from Alliance for Clinical Trials in Oncology, Central IRB, and in turn led to increased clinical trial accrual from 2.8% in 2014 compared to 13.2% currently.Our cancer registry in year one submitted over 150 more cases than predicted, improved quality outcome measures displayed by our Cancer Program Practice Profile reports and had more timely and complete data submissions to national and state registries.This synergetic integration has led to a better understanding, utilization and analysis of data by an integrated team with Clinical Research expertise.

Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?

BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.

Non-participation of asymptomatic candidates in screening protocols reduces early diagnosis and worsens prognosis of colorectal cancer

The Agatsuma et al’s study shows that despite the evidence of the benefits of an early colorectal cancer(CRC)diagnosis,through screening in asymptomatic subjects,up to 50%of candidates reject this option and many of those affected are diagnosed later,in advanced stages.The efficacy of screening programs has been well-established for several years,which reduces the risk of CRC morbidity and mortality,without taking into account the test used for screening,or other tools.Nevertheless,a significant proportion of patients remain unscreened,so understanding the factors involved,as well as the barriers of the population to adherence is the first step to possibly modify the participation rate.These barriers could include a full range of social and political aspects,especially the type of financial provision of each health service.In Japan,health services are universal,and this advantageous situation makes it easier for citizens to access to these services,contributing to the detection of various diseases,including CRC.Interestingly,the symptomatic CRC group had a lower early-stage diagnosis rate than the patients detected during follow-up for other comorbidities,and symptomatic and cancer screening groups showed similar early-stage diagnosis.

Global patterns of breast cancer incidence and mortality:A population-based cancer registry data analysis from 2000 to 2020

Background:Breast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries.This study aimed to evaluate the global patterns of breast cancer incidence and mortality and analyze its temporal trends for breast cancer prevention and control.Methods:Breast cancer incidence and mortality data in 2020 were obtained from the GLOBOCAN online database.Continued data from the Cancer Incidence in Five Continents Time Trends,the International Agency for Research on cancer mortality and China National Central Cancer Registry were used to analyze the time trends from 2000 to 2015 through Joinpoint regression,and annual average percent changes of breast cancer incidence and mortality were calculated.Association between Human Development Index and breast cancer incidence and mortality were estimated by linear regression.Results:There were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020.Its incidence and mortality varied among countries,with the age-standardized incidence ranging from the highest of 112.3 per 100,000 population in Belgium to the lowest of 35.8 per 100,000 population in Iran,and the age-standardized mortality from the highest of 41.0 per 100,000 population in Fiji to the lowest of 6.4 per 100,000 population in South Korea.The peak age of breast cancer in some Asian and African countries were over 10 years earlier than in European or American countries.As for the trends of breast cancer,the age-standardized incidence rates significantly increased in China and South Korea but decreased in the United States of America(USA)during 2000-2012.Meanwhile,the age-standardized mortality rates significantly increased in China and South Korea but decreased in the United Kingdom,the USA,and Australia during 2000 and 2015.Conclusions:The global burden of breast cancer is rising fast and varies greatly among countries.The incidence and mortality rates of breast cancer increased rapidly in China and South Korea but decreased in the USA.Increased health awareness,effective prevention strategies,and improved access to medical treatment are extremely important to curb the snowballing breast cancer burden,especially in the most affected countries.

Annual report on status of cancer in China, 2011

Objective： The National Central Cancer Registry （NCCR） collected population-based cancer registration data in 20l 1 from all cancer registries. National cancer incidence and mortality were compiled and cancer incident new cases and cancer deaths were estimated. Methods： In 2014, there were 234 cancer registries submitted cancer incidence and deaths occurred in 2011. All datasets were checked and evaluated based on the criteria of data quality from NCCR. Total 177 registries＇ data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by area （urban/rural）, gender, age group （0, 1-4, 5-9, 10-14...85＋） and cancer type. Cancer incident cases and deaths were estimated using age-specific rates and national population in 2011. All incidence and death rates are age-standardized to the 2000 Chinese standard population and Segi＇s population expressed per 100,000 persons. Results： All 177 cancer registries （77 in urban and 100 in rural areas） covered 175,310,169 populations （98,341,507 in urban and 76,968,662 in rural areas）. The morphology verified cases （MV%） accounting for 70.14% and 2.44% of incident cases were identified through death certifications only （DCO%） with mortality to incidence ratio of 0.63. The estimates of new cancer incident cases and cancer deaths were 3,372,175 and 2,113,048 in 2011, respectively. The incidence rate was 250.28/100,000 （males 277.77/100,000, females 221.37/100,000）, and the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 186.34/100,000 and 182.76/100,000 with the cumulative incidence rate （0-74 years old） of 21.20%. The cancer incidence and ASIRC in urban areas were 261.38/100,000 and 189.89/100,000 compared to 238.60/100,000 and 182.10/100,000 in rural areas, respectively. The cancer mortality was 156.83/100,000 （194.88/100,000 in males and 116.81/100,000 in females）, the age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 112.88/100,000 and 111.82/100,000, and the cumulative mortality rate （0-74 years old） was 12.69%. The cancer mortality and ASMRC were 154.37/100,000 and 108.20/100,000 in urban areas, and 159.42/100,000 and 117.97/100,000 in rural areas, respectively. Cancers of lung, female breast, stomach, liver, colon and rectum, esophageal, cervix, uterus, prostate and ovary were the most common cancers, accounting for about 75% of all cancer new cases. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, female breast cancer, pancreatic cancer, brain tumor, cervical cancer and leukemia were the leading causes of cancer death, accounting for about 80% of all cancer deaths. The cancer incidence, mortality and spectrum showed difference between urban and rural areas, males and females. Conclusions： The coverage of cancer registration population had a greater increase than that in the last year. The data quality and representativeness are gradually improved. As the basic work of cancer prevention and control, cancer registry is playing an irreplaceable role. The disease burden of cancer is increasing, and the health department has to take effective measures to contain the increased cancer burden in China.

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.

Annual report on status of cancer in China,2010

Objective：Population-based cancer registration data in 2010 were collected,evaluated and analyzed by the National Central Cancer Registry （NCCR） of China.Cancer incident new cases and cancer deaths were estimated.Methods：There wvere 219 cancer registries submitted cancer incidence and death data in 2010.All data were checked and evaluated on basis of the criteria of data quality from NCCR.Total 145 registries＇ data were qualified and accepted for cancer statistics in 2010.Pooled data were stratified by urban/rural,area,sex,age group and cancer site.Cancer incident cases and deaths were estimated using age-specific rates and national population.The top ten common cancers in different groups,proportion and cumulative rate were also calculated.Chinese census in 2000 and Segi＇s population were used for age-standardized incidence/ mortality rates.Results：All 145 cancer registries （63 in urban and 82 in rural） covered a total of 158,403,248 population （92,433,739 in urban and 65,969,509 in rural areas）.The estimates of new cancer incident cases and cancer deaths were 3,093,039 and 1,956,622 in 2010,respectively.The morphology verified cases （MV％） accounted for 67.11％ and 2.99％ of incident cases were identified through death certifications only （DCO％） with mortality to incidence ratio （M/I） of 0.61.The crude incidence rate was 235.23/100,000 （268.65/100,000 in males,200.21/100,000 in females）,age-standardized incidence rates by Chinese standard population （ASIRC,2000） and by world standard population （ASIRW） were 184.58/100,000 and 181.49/100,000 with the cumulative incidence rate （0-74 years old） of 21.l 1％.The cancer incidence and ASIRC were 256.41/100,000 and 187.53/100,000 in urban areas whereas in rural areas,they were 213.71/100,000 and 181.10/100,000,respectively.The crude cancer mortality in China was 148.81/100,000 （186.37/100,000 in males and 109.42/100,000 in females）,age-standardized incidence rates by Chinese standard population （ASMRC,2000） and by world standard population （ASMRW） were 113.92/100,000 and 112.86/100,000,and the cumulative incidence rate （0-74 years old） was 12.78％.The cancer mortality and ASMRC were 156.14/100,000 and 109.21/100,000 in urban areas,whereas in rural areas,they were 141.35/100,000 and 119.00/100,000 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.Conclusions：The coverage of cancer registration population had a rapid increase and could reflect cancer burden in each area and population.As the basis of cancer control program,cancer registry plays an irreplaceable role in cancer epidemic surveillance,evaluation of cancer control programs and making anticancer strategy.China is facing serious cancer burden and prevention and control 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.

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.

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.

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030

Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015.The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry.Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015.A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer(205,100 from urban areas and 98,500 from rural areas)and 70,400 breast cancer deaths(45,100 from urban areas and 24,500 from rural areas)occurred in China in 2015.Urban regions of China had the highest incidence and mortality rates.The most common histological subtype of breast cancer was invasive ductal carcinoma,followed by invasive lobular carcinoma.The age-standardized incidence and mortality rates increased by 3.3%and 1.0%per year during 2000–2015,and were projected to increase by more than 11%until 2030.Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3%and 22.9%,whereas deaths are predicted to increase by 13.1%and 40.9%,respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China.There are no signs that this trend will stop by 2030,particularly in rural areas.Effective breast cancer prevention strategies are therefore urgently needed in China.

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.

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.

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.

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.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background： Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods： Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group （0, 1-4, 5-9, 10-14...80＋）. Incidence and mortality rates were age-standardized to World Segi＇s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results： The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 （males, 42.18/100,000 and females, 24.31/100,000）. The age-standardized rate by world standard population （ASRW） was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 （males, 31.40/100,000 and females, 18.45/100,000）, ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 （ASRW =48.69/100,000） to 2004-2005 （ASRW =28.02/100,000）, with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes （APC） of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Conclusions： Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

Cancer incidence and mortality in Shandong province,2012

Objective： Population-based cancer registration data in 2012 from all available cancer registries in Shandong province were collected by Shandong Center for Disease Control and Prevention （SDCDC）. SDCDC estimated the numbers of new cancer eases and cancer deaths in Shandong province with compiled cancer incidence and mortality rates. Methods： In 2015, there were 21 cancer registries submitted data of cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the National Central Cancer Registry （NCCR） criteria of data quality. Qualified data from 15 registries were used for cancer statisties analysis as provincial estimation. The pooled data were stratified by area （urban/rural）, gender, age group （0, 1-4, 5-9, 10-14, ..., 85＋ years） and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding provincial 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 15 cancer registries （4 urban and 11 rural registries） covered 17,189,988 populations （7,486,039 in urban and 9,703,949 in rural areas）. The percentage of cases morphologically verified （MV%） and death certificate-only cases （DCO%） were 66.12% and 2.93%, respectively, and the mortality to incidence rate ratio （M/I） was 0.60. A total of 253,060 new cancer cases and 157,750 cancer deaths were estimated in Shandong province in 2012. The incidence rate was 263.86/100,000 （303.29/100,000 in males, 223.23/100,000 in females）, the age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 192.42/100,000 and 189.50/100,000 with the cumulative incidence rate （0-74 years old） of 22.07%. The cancer incidence, ASIRC and ASIRW in urban areas were 267.64/100,000, 195.27/100,000 and 192.02/100,000 compared to 262.32/100,000, 191.26/100,000 and 188.48/100,000 in rural areas, respectively. The cancer mortality was 164.47/100,000 （207.42/100,000 in males, 120.23/100,000 in females）, the age-standardized incidence rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were 117.54/100,000 and 116.90/100,000, and the cumulative mortality rate （0-74 years old） was 13.53%. The cancer mortality, ASMRC and ASMRW were 141.59/100,000, 101.17/100,000 and 100.33/100,000 in urban areas, and 173.79/100,000, 124.20/100,000 and 123.64/100,000 in rural areas, respectively. Cancers of the lung, stomach, liver, esophagus, coloreetum, female breast, brain, leukemia, bladder and pancreas were the most common cancers, accounting for about 82.12% of all cancer new cases. Lung cancer, stomach cancer, liver cancer, esophageal cancer, colorectal cancer, female breast cancer, pancreatic cancer, brain tumor, leukemia and lymphoma were the leading causes of cancer death, accounting for about 89.01% 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 Shandong province 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 Shandong province, and so cancer prevention and control in Shandong province should be enhanced including health education, health promotion, cancer screening and cancer care services.