1、Cancer Statistics in China,2015Wanqing Chen,PhD,MD1;Rongshou Zheng,MPH2;Peter D.Baade,PhD3;Siwei Zhang,BMedSc4;Hongmei Zeng,PhD,MD5;Freddie Bray,PhD6;Ahmedin Jemal,DVM,PhD7;Xue Qin Yu,PhD,MPH8,9;Jie He,MD10With increasing incidence and mortality,cancer is the leading cause of death in China and is a
2、 major public health problem.Because of Chinas massive population(1.37 billion),previous national incidence and mortality estimates have been limited tosmall samples of the population using data from the 1990s or based on a specific year.With high-quality data from an additionalnumber of population-
3、based registries now available through the National Central Cancer Registry of China,the authors ana-lyzed data from 72 local,population-based cancer registries(2009-2011),representing 6.5%of the population,to estimate thenumber of new cases and cancer deaths for 2015.Data from 22 registries were us
4、ed for trend analyses(2000-2011).Theresults indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015,with lung cancer being the most common incident cancer and the leading cause of cancer death.Stomach,esophageal,andliver cancers were also commonl
5、y diagnosed and were identified as leading causes of cancer death.Residents of rural areashad significantly higher age-standardized(Segi population)incidence and mortality rates for all cancers combined than urbanresidents(213.6 per 100,000 vs 191.5 per 100,000 for incidence;149.0 per 100,000 vs 109
6、.5 per 100,000 for mortality,respectively).For all cancers combined,the incidence rates were stable during 2000 through 2011 for males(10.2%per year;P5.1),whereas they increased significantly(12.2%per year;P.05)among females.In contrast,the mortality rates since2006 have decreased significantly for
7、both males(21.4%per year;P.05)and females(21.1%per year;P.05).Many of theestimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors,while increasing theeffectiveness of clinical care delivery,particularly for those living in rural areas and in disadvantaged po
8、pulations.CA Cancer JClin 2016;66:115-132.VC2016 American Cancer Society.Keywords:cancer,China,health disparities,incidence,mortality,survival,trendsIntroductionCancer incidence and mortality have been increasing in China,making cancer the leading cause of death since 2010 and amajor public health p
9、roblem in the country.1Much of the rising burden is attributable to population growth and ageing and tosociodemographic changes.Although previous estimates of the national incidence rates have been reported,they either repre-sented a small sample of the Chinese population(2%)2or were based on data f
10、rom a specific year.3,4This has a bearing onthe uncertainty of the estimates and their degree of national representativeness and,thus,would potentially limit the evidenceavailable to develop appropriate policies for effective cancer control.Because the previous Program of Cancer Prevention andContro
11、l in China(2004-2010)5was released more than 10 years ago,a more complete picture of the national and regionalscale and profile in China would provide greater clarity in prioritizing and developing specific policies and programs across thespectrum of cancer control aimed at reducing the burden and s
12、uffering from the disease at the national level.Additional supporting information may be found in the online version of this article.Correction added on 3 February 2016,after first online publication:the definition of“ASR”has been corrected in the footnote of Table 3.1Deputy Director,National Office
13、 for Cancer Prevention and Control,National Cancer Center,Beijing,China;2Associate Researcher,National Office forCancer Prevention and Control,National Cancer Center,Beijing,China;3Senior Research Fellow,Cancer Council Queensland,Brisbane,Queensland,Australia;4Associate Professor,National Office for
14、 Cancer Prevention and Control,National Cancer Center,Beijing,China;5Associate Professor,National Office for Cancer Prevention and Control,National Cancer Center,Beijing,China;6Head,Section of Cancer Surveillance,International Agencyfor Research on Cancer,Lyon,France;7Vice President,Surveillance and
15、 Health Services Research Program,American Cancer Society,Atlanta,GA;8Research Fellow,Cancer Council New South Wales,Sydney,New South Wales,Australia;9Adjunct Lecturer,Sydney School of Public Health,Universityof Sydney,Sydney,New South Wales,Australia;10Director,National Cancer Center,Beijing,China.
16、The last 2 authors contributed equally to this article.Corresponding author:Jie He,MD,Director,National Cancer Center,No.17 Pan-jia-yuan South Lane,Chaoyang District,100021 Beijing,China;We thank the Bureau of Disease Control,National Health and Family Planing Commission and Cancer Institute&Hospita
17、l,Chinese Academy of Medical Sciencesfor their support to this study.We would like to express our gratitude to all staff of the contributing cancer registries who have made a great contribution to thestudy,especially on data collection,supplements,auditing,and cancer registration database management
18、.DISCLOSURES:This study is supported by a National Program Grant to the Cancer Registry from the National Health and Family Planning Commission of Chinaand by a Program Grant in Fundamental Research from the Ministry of Science and Technology(no.2014FY121100).The authors report no conflicts of inter
19、est.doi:10.3322/caac.21338.Available online at VOLUME 66_NUMBER 2_MARCH/APRIL 2016115CA CANCER J CLIN 2016;66:115132This study reports the most recent cancer incidence,mortality,and survival estimates nationally;the most recentincidence and mortality patterns for several major cancersby geographic a
20、rea in China;and temporal trends for somemajor cancers as well as the implications of this informationfor cancer control in China.Data Sources and MethodsCancer Registration in ChinaThe National Central Cancer Registry of China(NCCR),established in 2002,is responsible for the collection,evalua-tion,
21、and publication of cancer data in China.Cancer diagno-ses are reported to local cancer registries from multiplesources,including local hospitals and community health cen-ters as well as the Urban Resident Basic Medical Insuranceprogram and the New Rural Cooperative Medical Scheme.Since 2002,the impl
22、ementation of standard registration prac-tices has seen a marked improvement in the quality of cancerregistration in China.In 2008,the National Program ofCancer Registries was launched by the Ministry of Health ofChina through a central financing mechanism.Since then,the number of local population-b
23、ased registries in China hasincreased from 54 in 2008(population coverage of 110 mil-lion)to 308(population coverage of 300 million)in 2014.3Not all of these registries currently have sufficiently highdata quality for reporting purposes.The quality of submitteddata for each local registry was checke
24、d and evaluated by theNCCR based on the Guidelines for Chinese Cancer Registra-tion6and International Agency for Research on Cancer/Inter-national Association of Cancer Registries(IARC/IACR)data-quality criteria.7The assessments of quality measuresinclude,but are not limited to,the proportion of mor
25、phologicverification(MV%),the percentage of cancer cases identifiedwith death certification only(DCO%),the mortality(M)toincidence(I)ratio(M/I),the percentage of uncertified cancer(UB%),and the percentage of cancer with undefined orunknown primary site(CPU%).Only data from those localregistries that
26、 consistently met appropriate levels of qualitywere included in these analyses.Detailed quality categories ofthe registry data can be found in a previous publication(Table1).8Dataclassified as category A or B were deemed acceptablefor inclusion in this study.The proportions of cancer registriesthat
27、submitted data sets and were accepted for inclusion var-ied by year of submission,from 69.2%(72 of 104 registries)in2009,9to 66.2%(145 of 219 registries)in 2010,4and 75.6%(177 of 234 registries)in 2011.3We included data from the72 cancer registries that were available for all 3 years.Cancer Incidenc
28、e DataTo estimate the numbers of new cancers in China in 2015,we used the most recent data(cancer cases registered during2009-2011)from 72 local population-based cancer registries(Table 1),providing a population coverage of about 85.5million people,about 6.5%of the national population.Amuch smaller
29、number of registries(n 5 22)(Table 1),whichprovided a population coverage of 44.4 million,had data ofsufficient quality over the 12-year period(2000-2011)forinclusion in incidence trend analyses.The locations of these2 sets of cancer registries can be found in Figure 1.We included invasive tumors on
30、ly in this study,and multi-ple primary cancers were defined using the international rulesTABLE 1.List of Population-Based Cancer Registries inChina Used for Incidence/Mortality Estimates,Temporal Trends,or Survival EstimatesPROVINCEREGISTRYPROVINCEREGISTRYBeijingBeijing*,JilinDehuiHebeiQianxiYanjiSh
31、exianZhejiangHangzhouCixian*,Jiaxing*,BaodingJiashan*,ShanxiYangquanHaining*,Yangcheng*ShangyuInner MongoliaChifengXianjuLiaoningShenyangAnhuiFeixiDalian,MaanshanZhuangheTonglingAnshanFujianChangle,BenxiXiamenDandongJiangxiZhanggong District,GanzhouDonggangShandongLinquHeilongjiangDaoli District,Har
32、binWenshangNangang District,Harbin*,Feicheng,ShangzhiHenanYanshiShanghaiShanghai*,Linzhou,JiangsuJintanXipingSuzhouHubeiWuhan,HaianYunmengQidong*,HunanHengdongHaimenGuangdongGuangzhouLianyungangSihui,DonghaiZhongshan*,GuanyunGuangxiLiuzhouHuaian District,HuaianFusuiHuaiyin District,HuaianChongqingJi
33、ulongpo District,ChongqingXuyiSichuanQingyang District,ChengduJinhuZiliujing District,ZigongSheyangYanting*JianhuGansuJingtaiDafengLiangzhou District,WuweiGanyu,QinghaiXiningYangzhongXinjiangXinyuanTaixing*These are registries from which data were accepted by the InternationalAgency for Research on
34、Cancer for the most recent publication of CancerIncidence in Five Continents(2014).These data were used for temporal trends analyses.These data were used for survival analyses.All registry data were used to estimate incidence and mortality in 2015except data from Ganyu.Cancer Statistics in China,201
35、5116CA:A Cancer Journal for Cliniciansfor multiple primary cancers.10Incidence data were extractedfrom the NCCR database.Although cancer site informationis available through codes from both the InternationalClassifi-cation of Diseases for Oncology,3rd revision(ICD-O-3),andthe International Classific
36、ation of Diseases,10th revision(ICD-10),we have reported incidence data using the ICD-10classification for consistency,with mortality data that wereonly available in the ICD-10 classification.The variablesextracted were sex,age,date of birth,year of diagnosis,cancersite,morphology,residence(urban an
37、d rural areas),and region(North China,Northeast,East China,Central China,SouthChina,Southwest,NorthwestChina).Forage-specificFIGURE 1.Maps of the 2 Sets of Contributing Cancer Registries and Geographic Regions in China.Dots indicate the locations of the cancer registries.(A)This is a map for 22 canc
38、er registries(data from 2000 to 2011).(B)This is a map for 72 cancer regis-tries(data from 2009 to 2011).CA CANCER J CLIN 2016;66:115132VOLUME 66_NUMBER 2_MARCH/APRIL 2016117incidence analysis,5 broad age groups were used(youngerthan 30 years,30-44 years,45-59 years,60-74 years,and 75years or older)
39、.Cancer Mortality DataMortality data compiled by 72 local cancer registries wereused to estimate the numbers of cancer deaths in China in2015.To estimate trends in mortality because of cancerbetween 2000 and 2011,mortality data were obtained fromthe same 22 local registries that were used in the inc
40、idencetrend analyses.These registries compile data on cancer deathsfrom local hospitals,community health centers,vital statistics(including data from the national Disease Surveillance PointsDSP system),and the Civil Administration Bureau.11TheDSP system,which was established by the Ministry of Healt
41、hin the early 1980s,routinely collects information on deathsbased on the death certificate provided by hospitals orobtained from the next of kin by a household visit if a deathcertificate was unavailable.11While the DSP uses a nationallyrepresentative sample of sites,these cover only a very small(?1
42、%)proportion of the population.12,13Cancer SurvivalIn the absence of precise follow-up information from the72 cancer registries,estimates of 5-year relative survival inChina for 2015 are presented in this report using the com-plement of the cancer M/I ratio(1-M/I)from these regis-tries,a method that
43、 has been used previously.14,15Wepresent these survival estimates only for all cancers com-bined,because survival from certain cancer types may haveled to an overestimation or underestimation using thisproxy measure.14We calculated the M/I ratio for all cancerscombined by assuming that the ratio bet
44、ween incidence andmortality has not changed between 2009 to 2011 and 2015,so we divided the age-standardized mortality rate(2009-2011)by the age-standardized incidence rate(2009-2011).Population DataNational population data by 5-year age group and sex wereobtained from statistics or public security
45、census( April 20,2014).8Individual registries pro-vided population data in the respective areas to the NCCR.These data were sourced from local Statistical or PublicSecurity Bureaus or from calculations based on census data.Statistical AnalysisWe estimated the numbers of new cases in China in 2015 fo
46、rall cancers combined and for 26 individual cancer types by sexby applying age-specific incidence rates from 72 cancer regis-tries(2009-2011)to the projected age-specific population inChina in 2015.We estimated the numbers of cancer deaths inChina in 2015 using the same method.For the 10 mostcommon
47、cancers,these estimated numbers of new cases andcancer deaths were further stratified by urban/rural registriesand by 7 administrative regions that cover China.Age-specific numbers of new cases and cancer deaths by 5 broadage groups(younger than 30 years,30-44 years,45-59 years,60-74 years,and 75 ye
48、ars or older)are also presented for allcancers combined and for the 6 most common cancers for2015.Temporal trends in incidence and mortality rates from 2000to 2011(22 registries)were examined by fitting joinpointmodels16,17to the log-transformed,age-standardized rates(per 100,000 population),standar
49、dized according to the worldstandard population.18To reduce the possibility of reportingspurious changes in trends over the period,all models wererestricted to a maximum of 2 joinpoints(3 line segments).Trends were expressed as an annual percentage change(APC),and the Z test was used to assess wheth
50、er the APC was statis-tically different from zero.In describing trends,the terms“increase”or“decrease”were used when the slope(APC)ofthe trend was statistically significant(P.05).For nonstatisti-cally significant trends,the term“stable”was used.For allthose analyses,we present the results for all ca