China's provincial cancer map released: Which cancer is high in your hometown?

Text/Xinna Qiao Jiahui

Editor/Wang Xiao

Photo: Pixabay

China's provincial cancer map released.

Recently, the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences published the 2016 Chinese malignant tumor epidemic data in the Chinese Journal of Oncology, which to a certain extent represents the latest data analysis of cancer incidence and mortality in China.

The report, titled "Analysis of the Prevalence of Malignant Tumors in China in 2016", was collected as of August 31, 2019, and contains data from 31 provinces (autonomous regions and municipalities) in China, covering 380 million people.

Unlike in the past, the report is the first to publish the prevalence of major cancer spectrum in each province. From the statistical point of view, there are certain differences in the main epidemic and high mortality of cancers in different provinces. Taking lung cancer, the highest incidence of cancer in China, as an example, lung cancer does not rank first in Tibet, Gansu and Qinghai. Although nasopharyngeal carcinoma ranks 20th in the incidence of cancer in China, it is a susceptible cancer in Guangdong, Guangxi and Hainan, ranking fifth in incidence.

Zhi Xiuyi, director of the Lung Cancer Diagnosis and Treatment Center of Capital Medical University and chief expert of the Department of Thoracic Surgery of Xuanwu Hospital of Capital Medical University, analyzed that the geographical differences in cancer incidence are related to the industrial structure, culture and lifestyle of various provinces and cities. With the continuous maturity of health construction and data statistics, each region will have a clearer ranking of susceptible cancers, so as to carry out more targeted prevention.

Lung cancer remains the number one killer, and the incidence of young people is increasing

In terms of the number of cases, lung cancer still ranks first in the incidence of malignant tumors in China. In 2016, there were about 828,100 new cases of lung cancer in China, and 657,000 people died of lung cancer.

The researchers collected data from 683 cancer registries in China, eliminated those that did not meet quality control standards, and finally included data from 487 registries, covering a total of 192 million urban and 188 million rural populations.

The incidence of lung cancer ranks first among 28 provinces, autonomous regions and municipalities, but ranks second in Tibet, Gansu and Qinghai. The death rate of lung cancer ranks first among 26 provinces, autonomous regions and municipalities, but ranks second in Gansu, Qinghai, Guangxi, Hainan and Tibet.

In first-tier cities, lung cancer cannot be ignored. In Shanghai, for example, lung cancer ranks first in morbidity and death for both men and women.

Lung cancer was the first malignant tumor in Shanghai in 2016, with more than 14,000 cases, accounting for 19.34% of all malignant tumor cases, and a crude incidence rate of 99.41/100,000. 9170 deaths due to lung cancer, accounting for 24.78% of all deaths from malignant tumors.

According to the analysis of Xiuyi, the low lung cancer prevalence data in some provinces is related to the acceleration of aging and the incomplete detection of lung cancer. The average life expectancy in Beijing, Shanghai and other places has exceeded 80 years, and the level of medical treatment is higher, making it easier to detect related diseases.

The number of lung cancer cases is about 830,000 per year, which may be related to China's high smoking rate. Lancet Global Health has published research showing that 45.2% of cancer deaths among adults aged 20 or over in China are related to modifiable risk factors, such as smoking. 24% and 4.8% of lung cancer deaths in Chinese men and women can be attributed to smoking.

Other modifiable risk factors include secondhand smoke, alcohol consumption, physical inactivity, unhealthy diet, overweight or obesity, diabetes, UV exposure, and PM2.5.

It is worth noting that lung cancer also has a younger trend.

According to statistics, the incidence of young lung cancer in China is 12.1%. By comparison, from the National Cancer Institute's SEER database, the incidence of lung cancer in young U.S. patients is about 4 percent.

When analyzing the "clinical characteristics of young lung cancer patients", the research team of the Department of Medical Oncology of the Affiliated Provincial Hospital of Anhui Medical University found that the vast majority of young patients in China were diagnosed with early lung cancer because lung nodules were found during physical examination, and the possible reason for this phenomenon was that with the popularity of low-dose spiral CT in physical examination, the prevalence of ground-glass nodules continued to increase.

However, the National Comprehensive Cancer Network (NCCN) guidelines for lung cancer screening do not recommend low-dose CT screening for lung cancer in people under 50 years of age or without respiratory symptoms who have smoked for less than 20 years, which may lead to overdiagnosis and overtreatment.

According to Zhi Xiuyi's analysis, some young people have been smoking since their teens and have been smoking for nearly 20 years by their 30s; In addition, young people may also smoke second-hand smoke and third-hand smoke, and long-term exposure to smog environment is easy to cause lung cancer.

Kitakami Hiroshi is not prone to esophageal cancer, but be careful of kidney cancer and nasopharyngeal cancer

This cancer epidemic report is the first to disclose the cancer situation of the population in different provinces, and it can be found that the incidence and mortality of different types of cancer show regional differences.

For example, among China's 31 provinces (autonomous regions and municipalities), thyroid cancer ranks seventh in China, but rises to second place in Tianjin, Zhejiang and Xinjiang.

People in Beijing, Tianjin, Shanghai and Guangdong are less susceptible to esophageal cancer, and although this cancer has the sixth highest incidence in China, it is also around 15th in all these regions. And in Shanghai and Tianjin, the death rate from esophageal cancer has dropped to 10th place.

However, the incidence of kidney cancer in Beijing and Shanghai is significantly higher than the Chinese average, both of which are among the top ten regional cancer incidences, and the incidence of this type of cancer ranks 15th in China overall.

The typical feature of the high-incidence cancer map in Guangdong Province is nasopharyngeal carcinoma, which ranks sixth, but the overall cancer incidence rate in China ranks 20th. Similar to this is the case in Guangxi and Hainan.

Nasopharyngeal carcinoma is even known as "Guangdong cancer".

Meng Ruilin, deputy director of the Institute of Chronic Noncommunicable Diseases Prevention and Control of the Guangdong Provincial Center for Disease Control and Prevention, once mentioned in an interview with the media that according to the World Health Organization, about 80% of the world's nasopharyngeal cancer cases are in China; Chinese experts have found that about 80% of China's nasopharyngeal cancer cases are in six southern provinces, of which Guangdong ranks first.

People in Tianjin, Zhejiang and Xinjiang are more susceptible to thyroid cancer, the seventh most common cancer in China and the second highest in all these regions. People in Heilongjiang, Jilin and Liaoning are more likely to die from bladder cancer, and the mortality rate is in the top 10.

According to the level of regional development, different types of malignant tumors have obvious geographical distribution characteristics. In relatively developed areas, the incidence of lung cancer, colorectal cancer, breast cancer, thyroid cancer and prostate cancer is high. However, in areas with relatively backward social economy, there is still a high incidence of digestive tract tumors, such as gastric cancer, esophageal cancer and liver cancer, accompanied by colorectal cancer and breast cancer.

Pan Zhan, deputy chief physician of the oncology department of Zhongshan Hospital affiliated to Xiamen University, pointed out in an analysis article published that the current characteristics of Chinese cancer are the decline of "poor cancer" and the increase of "rich cancer".

In the past, the so-called "rich cancers" such as colorectal cancer and breast cancer, which were low in China and high in developed countries, showed a continuous upward trend. The onset of these cancers is quite related to the modern "rich" lifestyle, especially obesity, sedentary lack of exercise, mental stress, etc.

The so-called "poor cancers" with high incidence and poor prognosis in China, such as esophageal cancer, gastric cancer, liver cancer, etc., have decreased their mortality rate year by year. However, the decline is not significant, and it is still relatively high.

Women in the western region have a high incidence of lung cancer, and men in Shanghai and Xinjiang are wary of prostate cancer

Gender differences also make differences in cancer mortality and cancer types.

In terms of quantity, in 2016, there were 2,234,300 new cases of cancer and 1,530,700 deaths in men, and 1,829,600 cases of cancer and 882,800 deaths in women. The crude incidence and mortality rate of cancer in men, and the cumulative morbidity and mortality rate from 0 to 74 years are significantly higher than those in women.

Lung cancer is a common new cancer in men, with 549,800 in 2016, and breast cancer is a common new cancer in women, with 306,000 women suffering from breast cancer.

Gender differences are even more pronounced if they overlap geographical influences.

Men in Shanghai and Xinjiang are more likely to die from prostate cancer, ranking in the top 10 in terms of mortality; Women in Shanxi, Henan, Hunan, Guizhou, Gansu and Qinghai have higher rates of cervical cancer mortality and are in the top 10 in all these regions.

In addition, the incidence of lung cancer in women in the western region surpassed breast cancer, becoming the highest incidence of female cancer in the region.

Is cancer becoming a common disease?

Cancer has become one of the major diseases that seriously threaten human health and cause death.

The number of cancer cases in China exceeds 5 million every year. Zhi Xiuyi's analysis of "Finance and Health" shows that if we count the people who are still alive after suffering from cancer, there are tens of millions of cancer patients living around us, and now we should treat cancer as a common disease.

Cancer is also the leading cause of death in people around the world. According to the World Health Organization (WHO), nearly 10 million (or nearly one in six) deaths in 2020 were caused by cancer. Among them, the most common are breast, lung, colon, rectal and prostate cancer.

This is similar to the data disclosed by China. According to the results of the 2016 cancer data survey, the top 10 most common malignant tumors in China are lung cancer, colorectal cancer, gastric cancer, liver cancer, breast cancer, esophageal cancer, thyroid cancer, cervical cancer, brain tumor, and pancreatic cancer. Among them, the incidence of the top 5 accounted for about 57.27% of all malignant tumors.

Cancer arises from a multi-stage process in which normal cells transform into tumor cells, usually progressing from precancerous lesions to malignant tumors. A defining feature is the rapid production of abnormal cells that grow beyond their usual boundaries and can invade adjacent parts of the body and spread to other organs, which is called metastasis. Extensive metastasis is the leading cause of cancer death.

If detected and treated early, cancer mortality can be reduced. Among them, standardized cancer prevention physical examination is an important way to detect cancer and precancerous lesions.

In March, the Office of the Healthy China Action Promotion Committee released the "Healthy China Action 2023 Work Points", which involves "cancer prevention and control actions", and recommends that high-risk groups choose professional physical examination institutions for regular cancer prevention physical examinations, and choose the appropriate physical examination interval according to the individual's age and previous examination results.

At present, most common cancers can be detected early, such as gastrointestinal cancer using gastrointestinal scopy, lung cancer can be found by low-dose spiral CT of the chest, and breast cancer can be found by ultrasound combined with mammogram.

Taking the prevention and treatment of lung cancer as an example, Zhi Xiuyi believes that CT equipment that has been widely used in various places can be used to strengthen and promote the screening of lung cancer. CT devices can detect lung nodules or early lung cancer earlier, and the explosive outbreaks of small nodules in the lungs over the past three years are also related to this. After early detection, effective treatment can be taken to improve the survival rate of patients.