Heavy! China's latest cancer report was released, these points are worth paying attention to!

Text | pineapple

Recently, the National Cancer Center finally released the latest long-awaited report on China's cancer: Cancer Incidence and Mortality in China in 2016.

Many people's first reaction must be: this is 2022, why did you release the 2016 data?

This is because national cancer statistics are usually delayed by 3 to 5 years. In 2016, the National Cancer Center issued a major cancer report, and now after more than 5 years, we finally see the latest data.

Are these trends and messages worth paying attention to this time? After reading the paper carefully, Pineapple felt that the following points were quite important (they were also repeatedly told to you before).

The number one killer

In 2016, about 4.06 million new cases of cancer occurred in China, which is equivalent to 8 people getting cancer every minute. What is the most common cancer? lung cancer!

Regardless of the number of patients or deaths, lung cancer has long been the number one cancer killer in China. In 2016 alone, more than 800,000 people were diagnosed with lung cancer, and nearly 660,000 patients died, accounting for more than 20% and 27% of all cancers, respectively!

The good news is that there have been many new drugs on the market for lung cancer in the past 10 years, including targeted drugs and immune drugs. Even in advanced patients, there are more and more people who can achieve long-term tumor survival, and some subtypes can even be clinically cured. But it is undeniable that the overall 5-year survival rate of patients with advanced lung cancer is still less than 20%.

So in the face of lung cancer, the best choice is to prevent it! These include primary prevention (risk aversion factors) and secondary prevention (screening).

The most important thing about primary prevention is: tobacco control! Tobacco Control! Tobacco Control!

China has the largest smoking population in the world, with more than 300 million smokers and more than 700 million second-hand smokers.

Nicotine is a very strong addictive substance, it is difficult to quit, so people who have been smoking are prone to "cognitive dissonance": on the one hand, they know that smoking is harmful, and on the other hand, they can't quit. What to do? I had to brainwash myself and use many individual examples to prove that smoking would not cause lung cancer. Their favorites are Deng Xiaoping, Zhang Xueliang, Lao Zhang upstairs, and Lao Wang next door.

But over the past few decades around the world, countless statistics will not lie: quitting smoking can drastically reduce lung cancer mortality!

The vast majority of people who smoke started when they were students, and I've never met anyone who started smoking at the age of 30. Therefore, an important goal of tobacco control is to reduce the smoking rate of adolescents. Recently, the management of e-cigarettes has become more and more stringent, and an important reason is that it is likely to increase the risk of nicotine addiction in adolescents, and eventually lead to more people smoking.

An effective secondary prevention of lung cancer is low-dose spiral CT screening, which is officially recommended for high-risk populations every 1 to 2 years. However, the latest data found that even if you do not do a regular physical examination, but only do a low-dose CT screening, you can significantly improve the early lung cancer detection rate and reduce the risk of death!

So, if you've been smoking for a long time, or are regularly exposed to indoor and outdoor air pollution (including second-hand smoke, kitchen fumes, smog, etc.), at least one screening may save your life.

More and more like the developed countries in Europe and the United States

The types of cancer in China have long been different from those in Europe and the United States. For example, we have a particularly high incidence of gastrointestinal tumors, including esophageal cancer, stomach cancer, liver cancer, etc., while Europe and the United States are prostate cancer, breast cancer, skin cancer, colorectal cancer. This difference is related to many factors, including bacterial viral infections, eating habits, lifestyles, and even racial differences.

In the field of business and economy, people like to say that "today in the United States is China's tomorrow." This sentence seems to be correct when put into the field of cancer.

Comparing the incidence of various cancers in China between 2000 and 2016, we clearly found that with the development of China's economy, the lifestyle is becoming more and more like that of developed countries, so the high incidence of cancers specific to China began to decrease, while in the past, There were fewer cancer types in China, and many cancer types in developed countries in Europe and the United States began to increase.

For example, after the age factor is removed, the incidence of esophageal, gastric and liver cancers in Chinese men is declining, but the incidence of prostate, colorectal, leukemia, pancreatic cancer and bladder cancer is rising.

Esophageal, gastric and liver cancers are also decreasing in Chinese women, but thyroid cancer, colorectal cancer, breast cancer and so on are increasing. In fact, breast cancer is already the number one cancer type in Chinese women, with more than 300,000 per year.

Will esophageal, stomach and liver cancers slowly disappear from China?

I'm not optimistic.

For a long time, China will be a dualistic society, both very developed large cities and still backward rural areas. Therefore, the type of cancer in China will also be a hybrid type for a long time.

On the one hand, gastrointestinal cancer will still be a pain point in Chinese society, requiring interventions in prevention and screening, as well as investment in new drug research. On the other hand, cities such as Beijing and Shanghai will become more and more like developed countries in Europe and the United States, and there will be more colorectal cancer, breast cancer, and prostate cancer. We need to strengthen science popularization and publicity to raise public awareness of these cancers.

Cancer that should go away without disappearing

In this report, there is a data that I am particularly concerned about, that is, there are 120,000 cervical cancer patients in China.

Cervical cancer is a typical type of "poor people's cancer", and overall, the more developed a country's economy is, the lower the incidence of this type of cancer. The world's most developed countries have an average of 9.6 cervical cancers per 100,000 women, compared with 26.7 in the most backward countries. In China and India, two developing countries, the incidence of cervical cancer is not the highest, but due to the large population base, patients account for more than 1/3 of the world.

I pay special attention to cervical cancer not only because there are many patients in China, but also because from 2000 to 2016, the incidence and mortality of cervical cancer increased. This is very abnormal.

Theoretically, cervical cancer is one of the easiest types of cancer to prevent because it has both a good primary prevention approach (HPV vaccine) and an effective screening tool (cytology). If both of these points can be done well, cervical cancer may even disappear basically. (Extended reading: Which common cancer may have disappeared from the face of the earth first?) ）

But the ideal is very full, and the reality is very bone. From what I personally know, china has a very low rate of HPV vaccination and cervical cancer screening. This has led to high rates of cervical cancer incidence and mortality.

China is facing a very real problem, that is, many cervical cancer patients in rural areas, poor economic conditions, lack of health awareness, coupled with the low status of women in many families, resulting in frequent delays in coming to see the doctor for a long time. Even after arriving at the hospital, you may not be able to receive standardized treatment.

The last time I went to a top three hospital in the west, I listened to a story: a rural woman under 60 years old had just been diagnosed with advanced cervical cancer, and her husband did not even ask the doctor how to treat it, how much money was needed, he directly said to the patient: "Let's go, cancer, no cure." "What's even more shocking is that this woman really just followed. The final result is self-evident.

We need to work harder so that women like this are adequately protected, whether through vaccines, screenings, or payment systems.

Overdiagnosed tumors

From 2000 to 2016, after removing the age factor, the overall cancer incidence of Chinese men did not change much (some increased, some declined, and the total number was stable), but women increased by 2.3% per year.

Important reasons, in addition to breast cancer, cervical cancer, ovarian cancer incidence have increased, there is a special tumor in women in the number of soaring.

If you look carefully at the historical curve of the incidence of various cancers in China below, you will find that there is a blue line in women that shows an exponential rise, and in just over 10 years, it has rushed from below to the highest, has surpassed lung cancer, and is very close to breast cancer.

This line represents thyroid cancer.

China, the United States, South Korea, thyroid cancer are increasing significantly, the biggest reason behind it is because the detection equipment has improved significantly! With the advent of high-resolution B ultrasound, we have found many tiny nodules or tumors that were absolutely undetectable before, and the vast majority of them are papillary carcinomas! Today's ultrasound technology can find lumps that are only 1 to 2 mm away.

How dangerous are these tiny tumors?

The first thing to know is that thyroid cancer is not a cancer, but is divided into four types, namely papillary carcinoma, follicular carcinoma, undifferentiated carcinoma and medullary carcinoma. Their incidence and risk vary. Undifferentiated carcinoma and medullary carcinoma are more dangerous and require aggressive treatment, but papillary cancers, especially many tiny papillary cancers found on physical examination, are generally inert, unless there are high-risk indications, the vast majority of them are not fatal.

Cancer screening is a double-edged sword. It is very helpful to use well, but it is harmful to use it badly.

Patients who are overdiagnosed with thyroid cancer receive unnecessary treatment and face a heavy burden of disease and quality of life impairments, such as thyroidectomy and lifelong hormone replacement therapy.

A 2020 study by the International Agency for Research on Cancer (IARC) showed that as many as 60%-90% of thyroid cancers in some developed countries are overdiagnosed.