Esophageal cancer global burden profiles, trends, and contributors

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

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

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

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

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

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

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

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

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

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

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

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

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

Burden of liver cancer:From epidemiology to prevention

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

Attributable deaths of liver cancer in China

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

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

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

The epidemiology of colorectal cancer in China

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

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

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

Lung cancer burden and trends from 2000 to 2018 in China:Comparison between China and the United States

Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.

Efficacy of image-enhanced endoscopy for colorectal adenoma detection:A multicenter,randomized trial

BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.

Cancer profiles in China and comparisons with the USA:a comprehensive analysis in the incidence,mortality,survival,staging,and attribution to risk factors

China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.

Socioeconomic inequalities in cancer incidence and mortality:An analysis of GLOBOCAN 2022

Background:Given the recent updates in cancer burden estimates by GLOBOCAN 2022,this study was undertaken to provide pertinent perspectives within the context of the Human Development Index(HDI)and major world economies.Methods:Datasets sourced from GLOBOCAN encompassed cancer cases and deaths across all cancer types in 2022,alongside projections up to 2050.Cancer incidences and deaths of the top 10 cancers within China and four distinct HDI-classified regions were compared using descriptive analyses.Age-standardized incidence rates(ASIRs)and mortality rates(ASMRs)worldwide for the most prevalent cancers in 2022 across ten largest economies and four-tier HDIs were examined.The top five cancer types concerning both incidence and mortality in China were delineated by sex and age group.Results:In males,prostate cancer predominated in countries with low,high(except China),and very high HDI.Prostate and liver cancers were prominent causes of death in countries with low HDI.In females,breast and cervical cancers predominated in countries with low-to-medium HDI.Lung and colorectal cancer incidence and deaths increased with high HDI for both sexes.ASIRs and ASMRs for breast,prostate,lung,and colorectal cancers in the top 10 economies were higher than the global average.However,liver,stomach,and cervical cancers in most Western countries exhibited lower rates.In China,hematologic malignancies(43%)were prevalent among children aged 0-14 years,whereas thyroid cancer led among adolescents and young adults aged 15-39 years.Regarding incidence and mortality,lung cancer predominated for individuals over 40 years,except for females aged 40-59 years,in whom breast cancer predominated.Projected trends indicated substantial increases in new cancer cases(76.6%)and deaths(89.7%)over the next three decades.Conclusions:Infection-and poverty-related cancer burdens are offset by increased prostate,breast,colorectal,and lung cancer incidence associated with rapid societal and economic transitions.Cancer incidence and mortality patterns in China feature characteristics of developed and developing countries,necessitating tailored,evidence-based,and comprehensive strategies for effective cancer prevention and control.

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

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

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

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

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

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

No expenditure difference among patients with liver cancer at stageⅠ-ⅣV:Findings from a multicenter cross-sectional study in China

Objective:The number of liver cancer patients in China accounts for more than half of the world.However,China currently lacks national,multicenter economic burden data,and meanwhile,measuring the differences among different subgroups will be informative to formulate corresponding policies in liver cancer control.Thus,the aim of the study was to measure the economic burden of liver cancer by various subgroups.Methods:A hospital-based,multicenter and cross-sectional survey was conducted during 2012・2014,covering 39 hospitals and 21 project sites in 13 provinces across China.The questionnaire covers clinical information,sociology,expenditure,and related variables.All expenditure data were reported in Chinese Yuan(CNY)using 2014 values.Results:A total of 2,223 liver cancer patients were enrolled,of whom 59.61%were late-stage cases(III-IV),and 53.8%were hepatocellular carcinoma.The average total expenditure per liver cancer patient was estimated as 53,220 CNY,including 48,612 CNY of medical expenditures(91.3%)and 4,608 CNY of non-medical expenditures(8.7%).The average total expenditures in stage I,H,m and stage IV were 52,817 CNY,50,877 CNY,50,678 CNY and 54,089 CNY(P>0.05),respectively.Non-medical expenditures including additional meals,additional nutrition care,transportation,accommodation and hired informal nursing were 1,453 CNY,839 CNY,946 CNY,679 CNY and 200 CNY,respectively.The one-year out-of-pocket expenditure of a newly diagnosed patient was 24,953 CNY,and 77.2%of the patients suffered an unmanageable financial burden.Multivariate analysis showed that overall expenditure differed in almost all subgroups(P<0.05),except for sex,clinical stage,and pathologic type.Conclusions:There was no difference in treatment expenditure for liver cancer patients at different clinical stages,which suggests that maintaining efforts on treatment efficacy improvement is important but not enough.To fiirtherly reduce the overall economic burden from liver cancer,more effort should be given to primary and secondary prevention strategies.