In the past half century, the incidence and mortality rate of cancer in Chinese group have been rising, and studies have shown that the proportion of Chinese residents dying from cancer has increased from 10.1% in 1973-1975 to 24.2% in 2015!
In addition to the reasons for the aging of the population, the modern lifestyle caused obesity, decreased exercise, air pollution, etc., may lead to a further increase in the burden of cancer in China.
At the same time, with the advancement of medical technology and the development of tumor prevention and control work, the overall 5-year survival rate of cancer patients in China has been continuously improved, from 30.9% in 2003-2005 to 40.5% in 2012-2015.
Despite this, there is still a certain gap between us and developed countries, taking the United States as an example, the 5-year survival rate of all cancers in the United States is about 70%, which is significantly higher than China's 40.5%. At the same time, there is also a gap in the 5-year survival rate between rural and urban patients in China (33.6% in rural areas vs. 46.7% in urban areas).
Cancer survival is closely related to cancer stage, and those diagnosed early in the cancer are more likely to receive treatment and have a better prognosis.
Increasing the proportion of early cancer screening and early diagnosis in China's residents may improve the 5-year survival rate of patients in China, narrow the gap between urban and rural areas, and catch up with developed countries.
The National Cancer Registry of China, together with a number of units, collected and analyzed the electronic medical records of cancer patients registered in hospitals in 12 provinces and 23 regional hospitals in China from January 2016 to December 2017 and the records of the Cancer Registration Center, and found that the five major cancers in China, including lung cancer, gastric cancer, esophageal cancer, colorectal cancer and female breast cancer, more than half of the patients were already in the advanced stage (stage 3-4) at the time of diagnosis, and further analyzed the factors affecting the diagnosis of advanced cancer, including cancer species, sex, Region, age, etc., the study was published earlier this month in The Lancet Public Health.
Note: Geographical distribution of 23 hospitals
Among the patients who have been diagnosed with cancer stage, 19.9% of patients are in stage I at the time of diagnosis, 27.3% are in stage II, 29.2% are in stage III, and 23.6% are in stage IV, so 52.8% of patients are in advanced stage cancer (stage III-IV) as soon as they are diagnosed.
Compared with the United States, China is still lagging behind in the early diagnosis of cancer, with stage I breast cancer confirmed (51.2% vs. China 27.6%), stage I colorectal cancer confirmed (24.1% vs. China 15.2%), and stage I lung cancer confirmed (25.3% vs. China 17.3%). However, the early diagnosis of esophageal cancer in China is better than that of the United States, and the diagnosis of stage I esophageal cancer (18.7% in China vs. 13.8% in the United States).
Figure Note: Differences in the distribution of cancer stages in China and the United States when diagnosed with various cancer species
Among the five major cancers, breast cancer patients were the least likely to be diagnosed at an advanced stage (21.6%), however, 67.7% of lung cancer patients were already in advanced stages at the time of diagnosis.
In terms of sex differences, men were more likely than women to be diagnosed with advanced cancer (64.1% vs 40.2%, adjusted OR1.3, 95% CI 1.2-1.5), and in lung and esophageal cancer, men were 1.7 times more likely than women to be diagnosed with advanced cancer (aOR 1.7, 1.3-2.1) and 1.4 times (aOR 1.4, 1.0-1.8), respectively. In gastric and colorectal cancer, there is no significant difference between men and women who are diagnosed at an advanced stage.
Figure Note: Differences between men and women in the stage of cancer at the time of diagnosis of each cancer species
Rural residents are more likely than urban residents to be diagnosed with advanced cancer (aOR 1.2, 1.1-1.4), particularly lung cancer (aOR 1.5, 1.1-2.0) and breast cancer (aOR 1.2, 1.0-1.4). The reasons for this situation are the imbalance of urban and rural medical resources, as well as the income gap between residents, health awareness, etc., compared with rural residents, urban residents are more willing to carry out early cancer screening.
Note: Regional differences in cancer stage at the time of diagnosis of each cancer species
In terms of age, people with stomach cancer over the age of 75 are at higher risk of being diagnosed with advanced stages than patients under 55 years of age, but in colorectal cancer, the younger the patient, the greater the probability of being diagnosed with advanced stages.
Compared with non-smokers, patients with smoking habits were 30% more likely to be diagnosed with advanced lung cancer (aOR 1.3, 1.0-1.7), and patients who drank alcohol were 1.3 times more likely to be diagnosed with advanced esophageal cancer than those who did not drink alcohol (aOR 1.3, 1.1-1.5).
Patients with a family history of cancer, there is more than one person in the family with cancer, many people will spontaneously understand the knowledge of cancer, advance cancer screening, reduce their own risk of cancer, such patients diagnosed with advanced cancer risk is lower than other patients (aOR 0.8, 0.7-0.9).
Patients with the new rural cooperative medical insurance are at higher risk of being diagnosed with advanced cancer than those with urban resident insurance (aOR 1.4, 1.1-1.9). The difference in the reimbursement ratio of the two medical treatments may explain part of the reason, if the tumor screening can be included in the scope of medical insurance reimbursement, it will promote the popularization of tumor screening and improve the early tumor diagnosis rate.
This study is the first comprehensive assessment of the differences in the stage of diagnosis of different types of common cancers in different populations in China and the factors associated with the diagnosis of advanced cancer.
The results of the study show that more than half of the patients in China are already in the advanced stage when they are diagnosed, and it is of great significance to improve the survival rate of cancer patients by improving the health awareness of the whole people and promoting the early screening and diagnosis of cancer.
At the national level, attach importance to cancer prevention and control, and gradually incorporate cancer screening into the category of national health examination; at the medical level, hospitals at the upper and lower levels form a medical association to promote the sinking of high-quality medical resources, balance regional disparities, and improve the technical level of early diagnosis and early treatment of cancer screening at the grass-roots level; at the social level, increase the publicity of cancer prevention and control, create a good atmosphere for cancer prevention and anti-cancer in the whole society, and improve the willingness and initiative of the masses to take the initiative to accept cancer screening physical examinations!
To achieve the goal of "Healthy China Action (2019-2030)" in 2030, China's overall cancer five-year survival rate will reach 46.6%, and there is still a long way to go!
bibliography:
[1] Zeng H, Ran X, An L, et al. Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study. Lancet Public Health. 2021;6(12):e877-e887.
[2] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health. 2018;6(5):e555-e567. doi:10.1016/S2214-109X(18)30127-X
PAN Feng. Early screening and early diagnosis are the key to improving the 5-year survival rate of cancer[J].China Medical Herald,2021,18(12):1-3.
PAN Feng. Tumor registration effectively promotes the development of cancer prevention and control in China——Visiting Professor He Jie, Academician of the Chinese Academy of Sciences and President of the Cancer Hospital of the Chinese Academy of Medical Sciences[J].China Medical Herald,2020,17(25):1-3.
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