CancerStatisticsinChina,2015
quality-controleffortscontinuetoimprovethecomplete-nessandvalidityofdatawithinspeci?clocalcancerregis-tries,asevidencedbytheincreasingnumberofChinesecancerregistriesbeingincludedintheCI5series(fromjust3registriesfrommainlandChinainvolumeVII[1997],to8involumeVIII[2002],andthen12involumeX[2014],82and23usedtoestimatethenationalincidenceburdeninGLOBOCANfor2012),23thereremainssomevariabilityinthequalityofdata,asevidencedbymanyregistriesnotbeingselectedforinclusioninthelastvolumeoftheIARCCI5series(ci5.iarc.fr;accessedJune10,2015).TheM/Iratiowasrequiredasanapproximationfor5-yearrelativesurvival.TheinterpretationoftheM/Iratiocanbeproblematic,becausethemortalityrateinvolvesadifferentcohortofpeo-plethantheincidencerate.83Thismakesitparticularlysus-ceptibletoanychangesinincidenceovertime,andsoprovidesamoreaccurateestimateofsurvivalforthosecan-cerswithhighcasefatality.However,unpublisheddatafromthe17ChinesecancerregistriesshowedthattheM/Iratioforallcancerscombinedwasonlyabout1.4%higher(inabsolutevalues)thanthecalculated5-yearrelativesurvivalreportedpreviously.27Finally,inacountryof1.4billionpeo-ple,thereremainmanychallengesinensuringthattheinci-denceandmortalitynumeratordatarepresentthesamepopulationatriskastheestimatedresidentpopulationdenominator,particularlywhenconsideringcasestreatedinmajorurbanfacilitiesandmigrantworkersfromruralareas.Geographicinformationofincidentcasesisbasedontheplaceofpermanentresidence,notplaceoftreatment.Inaddition,cancersdiagnosedamongthesizablepopulationofmigrantworkers(9%ofthepopulation39)throughtheUrbanResidentBasicMedicalInsuranceprogramortheNewRuralCooperativeMedicalScheme,whichcoverthemajorityoftheChinesepopulation,77,78bothofwhicharebasedontheirplaceofhouseholdregistration.
Conclusions
Todevelopanappropriatelytargetednationalcancercon-trolplaninChina,itiscriticaltohaveadetailedassessment
ofthecancerburdeninChinabasedonrepresentativeandaccurate,population-baseddata.TheseestimatesandtheongoingcancerregistrationeffortsinChinaareimportantstepssupportingthisaim.Whilethereisstillimprecisionassociatedwiththesenationalestimates,theseestimatesarebasedonthebestavailabledataoncancerincidenceandmortality.Theymayserveasabaselineforfuturecompari-sonsandfurtherassessmentstobetterunderstandtheover-alleffectivenessofcancercontrolinChinaandprovideinsightsintotheareasofgreatestneedfortargetedsupport.Internationally,thereisalonghistoryofgovernmentsandotherhealthprovidershavinggreaterincentivetoactwhenthereisclear,quantitativeevidencedemonstratingtheneed.Inthisregard,theselatestestimatesdemonstratethatChinafaceshugechallengesinmanagingtheverylargeandincreasingburdenofcancernowandinthefuture,requir-ingaconcertedeffortandcommitmentfromalllevelsofgovernmentandnongovernmentorganizations.
Keyareasmayincludetheimprovementofclinicalcancercaredeliveryatthepopulationlevel,throughtargetedpol-icychangesandinvestmentinincreasingaccesstohealthserviceinruralareasandprovidingbasichealthcaretothedisadvantagedpopulations.Primarypreventionprograms,suchasaneffectivetobacco-controlpolicyandinitiativestomitigatethenegativein?uencesofamorewesternizedlife-style,arecrucial,alongwitheffortstoincreasetheeffective-nessandcoverageofthediagnostictechniquesandscreeningprogramsthatarecriticaltoreversingthecancerepidemicinChina.Itremainsaprioritytoensurethattheexistingairandwaterpollution-controllegislationisadequatelyimplementedtoensurethatrealimprovementsoccurinpractice.GiventheimportanceofthecontributionofChinatotheworldwideburdenofcancer,especiallyforthe4majorcancers(cancersofthelung,liver,stomach,andesophagus),strategiesandpoliciestoreducetheseprevent-ablecancers(byreducingtheprevalenceoftobaccosmok-ingandtheprevalenceofinfectionsassociatedwithcancerrisk)willhaveagreatimpactonthefuturecancerburdenbothinChinaandworldwide.?
9.ChenW,ZhengR,ZhangS,etal.Theinci-dencesandmortalitiesofmajorcancersinChina,2009.ChinJCancer.2013;32:106-112.10.InternationalAssociationofCancerRegis-tries.Internationalrulesformultiplepri-marycancers.AsianPacJCancerPrev.2005;6:104-106.11.LiGL,ChenWQ.Representativenessof
population-basedcancerregistrationinChina—comparisonofurbanandruralareas.AsianPacJCancerPrev.2009;10:559-564.12.ChenW,ArmstrongBK,ZhengR,ZhangS,
YuX,ClementsM.CancerburdeninChina:aBayesianapproach[serialonline].BMCCancer.2013;13:458.
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