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

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Science China(Life Sciences) 2024年第1期67卷 122-131页

作者： Siyi He changfa xia He Li Maomao Cao Fan Yang Xinxin Yan Shaoli Zhang Yi Teng Qianru Li Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

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.

关键词： cancer burden survival rate neoplasm staging risk factors China

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Cancer statistics for young adults aged 20 to 49 years in China from 2000 to 2017:a population-based registry study

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Science China(Life Sciences) 2024年第4期67卷 711-719页

作者： Yi Teng changfa xia He Li Maomao Cao Fan Yang Xinxin Yan Siyi He Mengdi Cao Shaoli Zhang Qianru Li Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries.We aimed to report cancer profiles and trends among young adults in China.Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults(ages 20–49 years)in China in 2017,and an age-period-cohort model was employed to estimate the average annual percent change(AAPC)in incidence and mortality from 2000 to 2017.All 25 cancer types were grouped into obesity-or overweight-associated cancers(12 cancer types)and additional cancers(13 cancer types).In 2017,there were 681,178new cases and 214,591 cancer deaths among young adults in China.Among young adults,the most common cancers were thyroid,breast,cervical,liver,lung,and colorectal cancer,and the leading causes of cancer deaths were liver,lung,cervical,stomach,breast,and colorectal cancer.From 2000 to 2017,the cancer incidence increased for all cancers combined among young adults,with the highest AAPC(1.46%)for adults aged 20–24 years,while cancer mortality decreased,with the highest AAPC(-1.63%)for those aged 35–39 years.In conclusion,the cancer incidence in China has increased among young adults,while cancer mortality has decreased for nearly all ages.Cancer control measures,such as obesity control and appropriate screening,may contribute to reducing the increasing cancer burden among young adults.

关键词： young adults incidence mortality trends China

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Global trajectories of liver cancer burden from 1990 to 2019 and projection to 2035

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Chinese Medical Journal 2023年第12期136卷 1413-1421页

作者： Fan Yang Dianqin Sun changfa xia He Li Maomao Cao Xinxin Yan Siyi He Shaoli Zhang Wanqing Chen Office of Cancer Screening National Cancer CenterNational Clinical Research Center for CancerCancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Background:Large disparities exist in liver cancer burden trends across countries but are poorly understood.We aimed to investigate the global trajectories of liver cancer burden,explore the driving forces,and predict future trends.Methods:Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)trajectories were defined using growth mixture models.Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories.A Bayesian age-period-cohort model was used to predict future trends through 2035.Results:Three trajectories of liver cancer burden were identified:increasing,stable,and decreasing groups.Almost half of the American countries were classified in the decreasing group(48.6%for ASIR and ASMR),and the increasing group was the most common in the European region(ASIR,49.1%;ASMR,37.7%).In the decreasing group,the decrease of liver cancer due to hepatitis B contributed 63.4%and 60.4%of the total decreases in ASIR and ASMR,respectively.The increase of liver cancer due to alcohol use,hepatitis C,and hepatitis B contributed the most to the increase in the increasing group(30.8%,31.1%,and 24.2%for ASIR;33.7%,30.2%,and 22.2%for ASMR,respectively).The increasing group was associated with a higher sociodemographic index,gross domestic product per capita,health expenditure per capita,and universal health coverage(all P<0.05).Significant variations in disease burden are predicted to continue through 2035,with a disproportionate burden in the decreasing group.Conclusion:Global disparities were observed in liver cancer burden trajectories.Hepatitis B,alcohol use,and hepatitis C were identified as driving forces in different regions.

关键词： Global liver cancer Long-term trajectories Risk factors

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

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Chinese Journal of Cancer Research 2023年第1期35卷 58-65页

作者： Maomao Cao Jufang Shi changfa xia He Li Wei Cai xianyun Qi Chunyun Dai Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Prevention and Control of Chronic Noncommunicable Diseases Binhai County Center for Disease Control and PreventionBinhai 224521China Chronic Noncommunicable Diseases Prevention and Treatment Department Yingdong District Center for Disease Control and PreventionFuyang 236142China Department for Chronic Noncommunicable Diseases Control Sheyang Center for Disease Control and PreventionSheyang 224300China

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.

关键词： Liver cancer detection ctDNA methylation diagnostic performance

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

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Cancer Biology & Medicine 2022年第8期19卷 1121-1138页

作者： Maomao Cao He Li Dianqin Sun Siyi He Xinxin Yan Fan Yang Shaoli Zhang changfa xia Lin Lei Ji Peng Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and ImplementBeijing 100021China Department of Cancer Prevention and Control Shenzhen Center for Chronic Disease ControlShenzhen 518020China

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.

关键词： Cancer burden risk factor prevention China

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

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Chinese Journal of Cancer Research 2023年第6期35卷 675-685页

作者： Hao Chen Xuelian Zhao Shangying Hu Tingting You changfa xia Meng Gao Mingjie Dong Youlin Qiao Fanghui Zhao Department of Cancer Epidemiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Center for Global Health School of Population Medicine and Public HealthChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

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 Chi

关键词： Squamous intraepithelial lesion cervical cancer economic burden medicare catastrophic health expenditures

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Cancer statistics in China and United States,2022:profiles,trends,and determinants

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Chinese Medical Journal 2022年第5期135卷 584-590页

作者： changfa xia Xuesi Dong He Li Maomao Cao Dianqin Sun Siyi He Fan Yang Xinxin Yan Shaoli Zhang Ni Li Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Background:The cancer burden in the United States of America(USA)has decreased gradually.However,China is experiencing a transition in its cancer profiles,with greater incidence of cancers that were previously more common in the USA.This study compared the latest cancer profiles,trends,and determinants between China and USA.Methods:This was a comparative study using open-source data.Cancer cases and deaths in 2022 were calculated using cancer estimates from GLOBOCAN 2020 and population estimates from the United Nations.Trends in cancer incidence and mortality rates in the USA used data from the Surveillance,Epidemiology,and End Results program and National Center for Health Statistics.Chinese data were obtained from cancer registry reports.Data from the Global Burden of Disease 2019 and a decomposition method were used to express cancer deaths as the product of four determinant factors.Results:In 2022,there will be approximately 4,820,000 and 2,370,000 new cancer cases,and 3,210,000 and 640,000 cancer deaths in China and the USA,respectively.The most common cancers are lung cancer in China and breast cancer in the USA,and lung cancer is the leading cause of cancer death in both.Age-standardized incidence and mortality rates for lung cancer and colorectal cancer in the USA have decreased significantly recently,but rates of liver cancer have increased slightly.Rates of stomach,liver,and esophageal cancer decreased gradually in China,but rates have increased for colorectal cancer in the whole population,prostate cancer in men,and other seven cancer types in women.Increases in adult population size and population aging were major determinants for incremental cancer deaths,and case-fatality rates contributed to reduced cancer deaths in both countries.Conclusions:The decreasing cancer burden in liver,stomach,and esophagus,and increasing burden in lung,colorectum,breast,and prostate,mean that cancer profiles in China and the USA are converging.Population aging is a growing determinant of incremental cancer burden.Progre

关键词： Cancer Incidence Mortality Trends Aging China USA

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Burden of liver cancer:From epidemiology to prevention

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Chinese Journal of Cancer Research 2022年第6期34卷 554-566页

作者： Qianru Li Maomao Cao Lin Lei Fan Yang He Li Xinxin Yan Siyi He Shaoli Zhang Yi Teng changfa xia Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Cancer Prevention and Control Shenzhen Center for Chronic Disease ControlShenzhen 518020China

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.

关键词： Liver cancer China epidemiology risk factors prevention

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Stomach cancer burden in China: Epidemiology and prevention

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Chinese Journal of Cancer Research 2023年第2期35卷 81-91页

作者： Xinxin Yan Lin Lei He Li Maomao Cao Fan Yang Siyi He Shaoli Zhang Yi Teng Qianru Li changfa xia Wanqing Chen Offce of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Cancer Prevention and Control Shenzhen Center for Chronic Disease ControlShenzhen 518020China

In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.

关键词： Stomach cancer burden China risk factors prevention

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

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Chinese Journal of Cancer Research 2023年第6期35卷 618-626页

作者： Yi Teng changfa xia Maomao Cao Fan Yang Xinxin Yan Siyi He Mengdi Cao Shaoli Zhang Qianru Li Nuopei Tan Jiachen Wang Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

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.

关键词： China lung cancer incidence mortality trends

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