CancerStatisticsinChina,2015
TABLE2.EstimatedNewCancerCasesandDeaths(Thousands)bySex:China,2015*
INCIDENCE
MORTALITY
FEMALE
TOTAL
MALE
FEMALE
SITEICD-10TOTALMALE
Lip,oralcavity,&pharynx(exceptnasopharynx)NasopharynxEsophagusStomachColorectumLiver
GallbladderPancreasLarynxLung
OtherthoracicorgansBone
MelanomaoftheskinBreastCervixUterusOvaryProstateTestisKidneyBladderBrain,CNSThyroidLymphomaLeukemia
AllothersitesandunspecifiedAllsitesC00-C10,C12-C14C11C15C16C18-C21C22C23-C24C25C32C33-C34C37-C38C40-C41C43C50C53C54-C55C56C61C62
C64-C66,C68C67C70-C72C73
C81-C85,C88,C90,C96C91-C95A_OALL48.160.6477.9679.1376.3466.152.890.126.4733.313.228.08.0272.498.963.452.160.34.066.880.5101.690.088.275.3178.14291.631.143.3320.8477.7215.7343.724.552.223.7509.38.216.44.33.8———60.34.043.262.152.322.253.044.495.52512.116.917.3157.2201.4160.6122.328.337.92.6224.05.011.63.7268.698.963.452.1——23.618.449.367.935.230.982.61779.522.134.1375.0498.0191.0422.140.779.414.5610.26.520.73.270.730.521.822.526.61.023.432.961.06.852.153.494.02814.215.324.9253.8339.3111.1310.618.845.612.6432.44.112.41.81.2———26.61.015.225.135.82.532.732.055.01809.96.89.2121.3158.780.0111.521.833.81.9177.82.38.31.569.530.521.822.5——8.27.825.24.319.421.339.01004.4
CNS,centralnervoussystem;ICD-10,InternationalClassificationofDiseases,10threvision.
*Thetotalnumberofcasesprojectedfor2015arebasedontheaverageincidenceratesforthemostrecent3years(2009to2011)ofdatafrom72population-basedcancerregistries.
109.5per100,000)(Table4).Likewise,thehighestcancermortalityrateswerefoundinSouthwestChina,followedbyNorthChinaandNorthwestChina,withCentralChinaexhibitingthelowestrate.
ExpectedCancerSurvivalin2015
Itispredictedthat,forallcancerscombined,36.9%ofcan-cerpatientsinChinawillsurviveatleast5yearsafterdiag-nosisaround2015,withwomenhavingmuchbettersurvivalthanmen(47.3%vs29.3%)(Table6).Thereissubstantialvariationinthe5-yearsurvivalestimateaccord-ingtoresidenceatthetimeofdiagnosis:ruralpatientshavemuchlowersurvivalthantheircitycounterparts(30.3%vs42.8%).Likewise,thelowestsurvivalrateswerefoundinSouthwestChina(24.9%),withCentralChinashowingthehighestrate(41.0%).
Age-SpecificIncidenceandMortalityofSelectedCancersbySexin2015
Beforetheageof60years,livercanceristhemostcom-monlydiagnosedcancerandtheleadingcauseofcancerdeathinmen,followedbylungandstomachcancer,whicharethedominanttypesofcancerforbothcasesanddeathsinthegroupages60to74years(Table5).Lungcanceristhemostcommonlydiagnosedcancerandtheleadingcauseofcancerdeathinmenaged75yearsorolder.Mostnewcancercasesandcancerdeathsinmenoccurintheagerangefrom60to74years.
Amongwomen,thyroidcanceristhemostcommonlydiagnosedcancerbeforetheageof30years,followedbybreastcanceratages30to59years,andlungcancerinwomenaged60yearsorolder(Table5).Breastcanceristheleadingcauseofcancerdeathinwomenyoungerthan45years,followedbylungcancer.Thelargestproportionofnewcancercasesanddeathsamongwomenarediagnosedamongthosebetweenages60and74years.
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TrendsinCancerIncidenceandMortality
Forallcancerscombined,theage-standardizedincidencerateswerestableoverthestudyperiod(2000-2011)formales,whilesigni?cantupwardtrendswereobservedforfemales(P<.05)(Fig.3,Table7).Incontrast,theage-standardizedmortalityratesdecreasedsigni?cantlyforbothmalesandfemales(Fig.3,Table8).Despitethisfavorabletrend,however,thenumberofcancerdeathssubstantiallyincreased(73.8%increase)duringthecorrespondingperiod(from51,090in2000to88,800in2011)becauseoftheagingandgrowthofthepopulation(Fig.4).
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TABLE3.
Age-Standardized(SegiStandardPopulation)IncidenceRatesforAllCancersCombinedandEstimatedNewCases(Thousands)forSelectedCancersinChina,2015,byGeographicLocation
ESTIMATEDNEWCASES(THOUSANDS)
ALLCANCERS
AREASSEXASR*LUNGESOPHAGUSSTOMACHCOLORECTUMLIVERBREASTCERVIXTHYROIDBRAINPANCREAS
AllareasUrbanareasRuralareas
TotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemale
201.1234.9168.7191.5215.9168.9213.6259.6168.5213.2240.3187.0189.2208.4169.8193.7224.1165.8185.5208.3164.7202.4242.1165.2226.7281.4170.9207.9253.9158.5
4291.62512.11779.52305.81302.41003.41985.81209.7776.2528.1298.3229.8359.8199.6160.21280.2735.3544.8666.8374.9291.9427.3254.3173.0744.8469.7275.2284.5179.9104.6
733.3509.3224.0445.0306.0139.0288.3203.385.079.552.327.283.754.229.5218.6150.668.0115.782.932.880.555.425.1117.887.430.437.526.411.1
477.9320.8157.2113.887.426.5364.1233.4130.785.255.330.09.88.61.2122.884.238.670.744.126.610.89.01.8143.293.649.535.426.09.5
679.1477.7201.4235.2164.770.4444.0313.0130.997.771.925.836.126.29.9179.5124.554.991.162.228.924.316.97.3174.7118.256.575.757.817.9
376.3215.7160.6263.2150.8112.4113.264.948.238.822.116.741.524.516.9125.670.555.158.532.725.850.828.822.042.926.516.418.310.67.7
466.1343.7122.3205.2156.848.4260.9187.073.942.430.112.336.427.49.1126.894.132.770.551.519.068.855.813.192.664.628.028.420.38.2
268.6189.579.0
98.953.245.7
90.022.267.972.118.154.017.94.113.99.82.37.510.72.58.240.210.230.014.33.111.29.02.26.93.11.12.02.80.72.1
101.652.349.355.826.829.045.725.520.311.05.45.58.54.04.529.614.615.020.69.611.010.85.25.612.88.84.08.34.63.7
90.152.237.959.534.225.430.518.012.59.25.43.810.36.24.138.121.516.611.46.64.86.03.62.48.54.73.86.64.22.4
NorthChinaNortheastEastChinaCentralChinaSouthChinaSouthwestNorthwest
37.233.283.946.730.923.213.4
16.710.527.617.48.111.37.3
ASR,age-standardizedmortalityrate.
*Age-standardizedincidenceratesforallcancersarebasedontheSegistandardpopulation.
Amongthe10mostcommoncancersconsideredinthetemporaltrendanalysesformen,incidenceratesfrom2000to2011increasedfor6cancertypes(pancreas,colorectum,brainandcentralnervoussystem,prostate,bladder,andleukemia),whereastheratesdecreasedforcancersofthestomach,esophagus,andliver(P<.05).Astabletrendwasobservedforcancerofthelung(Fig.5,Table7).
Forwomen,6ofthe10mostcommoncancershadasigni?-cantupwardtrendinage-standardizedincidencerates(cancersofthecolorectum,lung,breast,cervix,uterinecorpus,andthy-roid;P<.05).Aswithmen,adownwardtrendwasseenforcancersofthestomach,esophagus,andliver(Fig.6,Table7).Anupwardtrendinage-standardizedmortalityrateswasobservedfor4ofthe10mostcommoncancersinmen(color-ectum,pancreas,prostate,andleukemia;P<.05),whereassta-bletrendswereseenforothercancertypes(cancersofthelung,bladder,andbrain)(Fig.7,Table8).Inwomen,anincreasingtrendinmortalitywasobservedfor3ofthe10mostcommoncancers(breast,cervix,andovary),withtrendsstableforcolor-ectum,lung,uterine,andthyroidcancers(Fig.8,Table8).
Similartothetrendsincancerincidencerates,decliningtrendsinage-standardizedmortalityrateswereobservedforcancersofthestomach,esophagus,andliverinbothsexes(Figs.(7and8)).Stabletrendswereobservedinbothmenandwomenforlungcancer,whichwastheleadingcauseofcancermortalityforbothmenandwomen.
Discussion
AlthoughnationalestimatesofcancerforChinahavebeenpreviouslyreported,thesearelimitedtoonlyasnapshotofthepatternsbycancersiteduringasingleyear3,4,12,19orarereportedforspeci?ccancers,20–22makingcomparisonsoftrendsacrosscancertypesdif?cult.ThisstudyprovidedmorecomprehensivenationwidecancerstatisticsinChinausingthelatestandmostrepresentativedataandincludinginformationontemporaltrends.
Cancerpreventionandcontrolrelyonpopulation-basedincidenceandmortalitydataasanincentivebothtoactandtoassesstheeffectivenessofcurrentinterventionsandpolicies.
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TABLE4.
Age-Standardized(SegiStandardPopulation)MortalityRatesforAllCancersCombinedandEstimatedDeaths(Thousands)forSelectedCancersinChina,2015,byGeographicLocation
ESTIMATEDDEATHS(THOUSANDS)
ALLCANCERS
AREASSEXASR*LUNGESOPHAGUSSTOMACHCOLORECTUMLIVERBREASTCERVIXTHYROIDBRAINPANCREAS
AllareasUrbanareasRuralareas
TotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemale
126.9165.988.8109.5142.977.1149.0195.1103.8134.5171.997.5116.4146.985.5115.6152.880.6109.4142.277.9122.4168.777.5170.2219.5119.7133.2171.591.9
2814.21809.91004.41382.3884.4497.91431.9925.5506.4338.6215.7122.9224.0142.981.2815.1517.1298.0409.5260.0149.5270.2180.989.3574.9371.5203.4182.0121.960.1
610.2432.4177.8373.4261.7111.6236.9170.766.164.243.121.171.746.924.8182.9128.954.094.069.125.068.848.320.4100.375.924.528.220.28.0
375.0253.8121.389.169.120.0285.9184.7101.267.545.621.97.96.90.994.364.330.053.433.819.68.87.61.2118.075.842.225.119.75.4
498.0339.3158.7162.9112.550.4335.1226.8108.268.649.618.924.818.06.9130.588.342.265.845.220.618.012.45.6141.088.852.349.337.112.2
191.0111.180.0126.673.752.964.537.427.119.411.38.118.811.37.462.735.127.627.015.112.024.814.310.529.118.810.39.25.14.0
422.1310.6111.5185.1139.745.4237.0170.966.138.427.510.933.625.28.3115.885.130.659.943.616.360.148.611.590.263.226.924.117.36.8
69.543.825.7
30.513.616.9
6.82.54.34.51.62.92.30.91.40.70.20.50.60.20.42.10.71.40.90.30.60.90.40.50.60.30.30.90.30.6
61.035.825.230.616.813.830.419.011.56.33.62.75.02.82.218.610.18.510.76.04.65.32.92.310.77.53.14.52.71.8
79.445.633.853.830.723.225.514.910.68.04.63.510.16.14.033.819.014.89.55.44.15.53.32.37.54.23.34.93.01.9
NorthChinaNortheastEastChinaCentralChinaSouthChinaSouthwestNorthwest
8.16.821.111.97.78.85.2
6.12.46.74.12.36.22.6
ASR,age-standardizedmortalityrate.
*ASRsforallcancersarebasedontheSegistandardpopulation.
Thus,theupdatednationwideestimatesofcancerburdenandtimetrendspresentedherearecriticaltounderstandingtheetiologyofcancerandtheeffectivenessofprevention,earlydetection,andmanagementofcancerinChina.TheseresultswillalsoserveasabaselineforfutureassessmentoftheoveralleffectivenessofthecancercontroleffortinChinaandwillprovideinsightsintotheareasofgreatestneedforprioritization.
BecauseofChina’slargepopulationsize,approximatelyone-?fthoftheworldpopulation,theseChinesedatacon-tributesigni?cantlytotheglobalburdenofcancer:almost22%ofglobalnewcancercasesandcloseto27%ofglobalcancerdeathsoccurinChina.23Moreimportantly,thecan-cerpro?leinChinaismarkedlydifferentfromthoseofdevelopedcountries.The4mostcommoncancersdiag-nosedinChinawerelung,stomach,liver,andesophagealcancer.Thesecancersaccountfor57%ofcancersdiagnosedinChina,comparedwith18%intheUnitedStates.24Also,thesecancersdiagnosedinChinacomprisebetweenone-thirdandone-halfoftheglobalincidenceburdenfrom
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lung,stomach,liver,andesophagealcancers.23,25Incom-parison,themostcommoncancersdiagnosedintheUnitedStatesarecancersofthelung,breast,prostate,andcolorec-tum.26ThemostcommoncancersinChinaarethoseasso-ciatedwithratherpoorsurvival;whereasthoseintheUnitedStates,withtheexceptionoflungcancer,aredomi-natedbycancerswithagoodtoexcellentprognosis,and,forprostateandbreastcancers,theincidencemaybein?atedbydiagnosticactivitieslinkedtoearlydetectionandscreening.24,27Thisdifferenceincancertypedistribu-tioncontributessigni?cantlytothehigheroverallcancermortalityrateinChina.
Ourcancerestimatesfor2015werebasedondatafrom72Chinesepopulation-basedcancerregistriescapturingcancerdiagnosesfrom2009to2011.Theseregistriescoveronlyabout6.5%oftheChinesenationalpopulation,buttheyremainthebest-availablenationwidedataforcancerincidence,representingabasepopulationof85.5millionpeople.Moreover,thedatausedinthisstudyhaveanenlargedpopulationcoveragecomparedwithprevious
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TABLE5.EstimatedNewCancerCasesandDeaths(Thousands)forSelectedCancersbyAgeGroups:China,2015
AGE,y
SITE<3030–4445–5960–74??75ALL
Male(thousands)IncidenceProstateColorectumEsophagusLiverStomachLungAllsitesMortalityPancreasColorectumEsophagusLiverStomachLungAllsites
Female(thousands)IncidenceThyroidCervixColorectumStomachLungBreastAllsitesMortalityBreastColorectumLiver
EsophagusStomachLungAllsites
0.11.10.24.41.91.341.60.10.50.13.51.30.819.86.11.51.11.00.74.338.80.50.30.70.10.60.311.0
0.113.07.441.315.815.8151.61.45.04.232.58.010.079.920.528.210.111.510.955.5202.98.73.45.81.45.25.852.8
3.458.089.0130.4134.1122.0707.510.122.556.0111.974.788.5434.027.845.740.749.253.9128.7566.628.313.726.919.129.232.5219.8
24.290.9161.3116.1232.7231.81061.819.341.6121.3106.4160.6188.7748.711.319.064.289.691.262.3623.218.827.444.856.166.569.7381.0
32.452.762.951.693.2138.4549.514.641.572.156.394.7144.5527.62.14.544.450.067.417.8348.013.235.133.244.557.269.4339.7
60.3215.7320.8343.7477.7509.32512.145.6111.1253.8310.6339.3432.41809.967.998.9160.6201.4224.0268.61779.569.580.0111.5121.3158.7177.81004.4
studies(withcoveragelessthan2%ofthepopulation),2,28includingmoreregistriesinthewesternregionsofChinaandarethusmorerepresentativeofthegeneralpopulationinChina.Inaddition,all12population-basedcancerregis-triesinmainlandChinawithhigh-qualitydatathatful?lledtheCancerIncidenceinFiveContinents(CI5)inclusioncri-teriaforthepresentCI5volumeXwereincludedintheanalysis.29ThesenationalincidenceestimatesforChinaarebroadlycomparabletothosepublishedpreviously.3,4,12The2mostrecentlypublishedannualreportsinChinafoundthattheestimatednumberofnewcancercaseswere3.09millionand3.37millionfor2010and2011,respectively.3,4Anearlierestimatewas2.96millionfor2005,althoughadifferentmethodwasused.12Ourestimateofcancerincidencefor2015(4.29millioncases)inChinaisconsiderablyhigherthanthatreportedbytheGLOBOCAN2012initiativeof3.40million.23,25Rea-sonsforthesediscrepanciesmayincludedifferencesindatatimelines(2009-2011vs2003-2007)andrepresentativenessandgeographiccoverage(72cancerregistriescovering6.5%ofthenationalpopulationvs23cancerregistriescov-ering3.0%ofthepopulation).Inparticular,ruralresidents,
whohaveahigherincidenceratethanurbanresidents(213.6per100,000vs191.5per100,000),accountfor32.7%thepopulationinourestimatescomparedwith21.5%inthe2012GLOBOCANestimates.Themethodsusedtoobtainthenationalincidenceestimatesarealsodif-ferent,becauseGLOBOCAN2012convertsnationalmor-talityestimatesfor2012toincidencebymodelingtheage-speci?c,sex-speci?c,andsite-speci?cM/Iratiosfromthe23Chinesecancerregistries.WhileacknowledgingthatnotallofthesecancerregistriesmettheIARCqualitystandards,15,30thesediscrepanciesinpublishedestimatesunderscoretheneedforfurtherimprovementsinthecover-ageandqualityofregistriesinChinatoprovidemoreaccu-ratestatisticsonthecancerburdeninthecountry.
Incontrasttoincidence,therewasgreaterconsistencyinourmortalityestimatesandthoseinGLOBOCAN.Weestimatedthattherewouldbe2.81millioncancerdeathsin2015,andthecorresponding?gurewas2.46millioninGLOBOCAN2012.23Thismayre?ectthatthemortalitydatausedbybothstudieswereobtainedfromasimilarsource:DSPdata(2004-2010)wereusedforGLOBO-CAN2012,whileweusedmortalitydatacollectedfrom
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TABLE6.
Expected5-YearSurvivalforAllCancers
CombinedbySexandGeographicArea:China,2015
SEX
ASRINCIDENCE*
ASRDEATHS*
1-(M/I)
AREAS
AllareasUrbanareasRuralareas
TotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemale
201.1234.9168.7191.5215.9168.9213.6259.6168.5213.2240.3187.0189.2208.4169.8193.7224.1165.8185.5208.3164.7202.4242.1165.2226.7281.4170.9207.9253.9158.5
126.9165.988.8109.5142.977.1149.0195.1103.8134.5171.997.5116.4146.985.5115.6152.880.6109.4142.277.9122.4168.777.5170.2219.5119.7133.2171.591.9
36.929.347.342.833.854.430.324.838.436.928.547.938.529.549.640.331.851.441.031.752.739.530.353.124.922.029.936.032.542.0
NorthChinaNortheastEastChinaCentralChinaSouthChinaSouthwestNorthwest
1-(M/I),complementtothemortality(M)toincidence(I)ratio;ASR,age-standardizedmortalityrate.
*Age-standardizedratesforallcancersarebasedontheSegistandardpopulation.
72cancerregistryareas(2009-2011)forwhichDSPdatawerepartofthewholesetofdataoncancerdeaths.TheDSPdatawerebasedoncountiesandstrati?edbygeo-graphicregions,withsamplingfurtherstrati?edbyurbanorrurallocationandpercapitagrossdomesticproduct,andtheDSPsystemwasspeci?callydesignedtobenationallyrepresentative.19Forbothincidenceandmortalityesti-mates,datafromHongKongandMacaowerealsousedintheestimatesfromGLOBOCAN2012butwereexcludedfromouranalyses.
Wefoundsigni?cantdifferencesincancerincidenceratesforallcancerscombinedbyplaceofresidence(ruralvsurbanandbetweenregions)inChina.Ruralresidentshavehigherincidencecomparedwiththeirurbancounterparts,andinci-denceratesvariedsubstantiallyacrossthe7administrativeregions.Itislikelythatmanyfactorscontributetothisgeo-graphicdifferential,butthehighersmokingprevalenceinruralpopulationscomparedwiththoseinurbanareas31,32likelyplaysadominatingrole.The12cancersformallyestab-lishedasbeingcausedbysmoking33accountforabout75%ofallcancerscombinedinChina.Consistentwiththis
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hypothesis,theareawiththehighestobservedcancerinci-dencerate,SouthwestChina,wasalsoreportedtohavethecitieswiththehighestsmokingprevalencein2002.34WefoundevengreatergeographicvariationsincancermortalityandthesurvivalproxiesacrossChina.Itislikelythatatleastpartofthesegeographicdisparitiescouldbeexplainedbythemorelimitedmedicalresources,lowerlevelsofcancercare,andalargerproportionofpatientsdiagnosedwithcanceratalatestageinruralandunderdevelopedareasinChina.27Recognizingthatdifferencesinotherfactors,suchascompetingcausesofdeathandcomorbidities,mayalsocontribute,theresultsreportedhere,togetherwiththosereportedpreviously,27,35provideastrongjusti?cationforprovidingmoregovernment-fundedhealthresourcesandservicesforcancercontrolinruralandunderdevelopedareasinChinatoreducetheseapparentinequalities.
Therehasbeenamarkedincreaseinthenumbersofcan-cersdiagnosedinChinabetween2000and2011.Muchofthisisexplainedbytheagingandgrowthofthepopulation.Otherfactorsthatmayhavecontributedtotheincreaseintheburdenofcancerincludeincreasesintheprevalenceofunheal-thybehaviorsorcancer-relatedlifestyleandimprovementsindiseaseawareness,detectionservices,anddatacompleteness.Thelargestincreaseinincidencewasseenforcancersoftheprostate,cervix,andthyroidforwomen.Thefactorsdrivingtheincreaseinprostatecancerarenotentirelyunderstood;however,theymayincludegradualimplementationofprostate-speci?cantigenscreeningandimprovedbiopsytech-niques36ortheimpactofanincreasinglywesternizedlife-style.37,38Westernizedlifestyle,particularlyincreasesintheprevalenceofobesityandphysicalinactivityinrecentdecadesinChina,islikelytohavehadanimpactontheobservedriseincolorectalandbreastcancerincidence.39,40Forbreastcancer,theincreasingtrendmayalsore?ectchangesinrepro-ductivebehaviorinChinainrecentdecadesbecauseoftheone-childpolicyimplementedsincethe1970s.41Incontrasttothedecreasingincidencetrendsindevel-opedcountries,asubstantialincreaseincervicalcancerinci-dencewasseeninChina.Thismayre?ecttheinadequacyofPapanicolaou(Pap)testscreeninginChina,becauseonlyone-?fthofChinesewomenreportedhavingeverhadaPaptestforcervicalcancerscreening.42,43Theincreasingprevalenceofhumanpapillomavirus(HPV)infection,espe-ciallyinyoungerwomen,44,45andthelackofHPVvaccinesinmainlandChinaduetotheabsenceofformaldrugapprovals,39suggestthatthedisparityincervicalcancerincidencetrendsbetweenChinaandinternationalcountriesmaycontinuefortheforeseeablefuture.
Thedramaticriseinthyroidcanceramongwomenisconsistentwiththatobservedinothercountries46–49;and,whileitmayre?ect“overdiagnosis”throughincreaseduseofnewimagingtechnologies(ultrasound,computed