Abstract:
Background: China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum. A comprehensive analysis of the current cancer profiles in China is still urgently needed to provide references for further formulation and adjustments of cancer prevention strategies.
Methods: We extracted data in five aspects of cancer incidence, mortality, survival, staging distributions, and attribution to risk factors in China, the USA and worldwide from open-source databases, including the Global Cancer Observatory Platform, the Global surveillance of trends in cancer survival 2000–14 (CONCORD-3) program, the Surveillance, Epidemiology, and End Results (SEER) program, and the published reports released by the National Central Cancer Registry of China (NCCR). We conducted a secondary analysis of cancer statistics in China in the above aspects, and compared between China and the USA.
Findings: A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020, accounting for 25.1% and 30.2% of global cases, respectively. Lifestyle-related cancers including lung cancer, colorectal cancer, and breast cancer showed an upward trend and have been the leading cancer types in China. 41.6% of new cancer cases and 49.3% of cancer deaths occurred in digestive-system cancers in China, and the cancers of esophagus, nasopharynx, liver, and stomach in China accounted for over 40% of global cases. Infection-related cancers showed the highest population-attributable fractions among Chinese adults, and most cancers could be attributed to behavioral and metabolic factors. The proportions of stage I for most cancer types were much higher in the USA than in China, except for esophageal cancer (78.2% vs. 41.1%). The 5-year relative survival rates in China have improved substantially during 2000-14, whereas survival for most cancer types in the USA was significantly higher than in China, except for upper gastrointestinal cancers.
Conclusions: Our findings suggest that although substantial progress has been made in cancer control, especially in digestive system cancers in China, there was still a considerable disparity in cancer burden between China and the USA. More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.
Keywords: Cancer Burden; Survival Rate; Neoplasm Staging; Risk Factors; China
Audience Take Away Notes:
• Chinese population accounted for 18% of the world's total population, whereas there were over a quarter of global cancer cases and deaths occur in China, which indicates a disproportionate cancer burden to the population at present
• In both China and the USA, smoking and low fruit intake ranked the top five modifiable risk factors with high PAFs of cancer deaths. The highest PAFs of overall cancer deaths were also for behavioral and metabolic factors in the USA, while for infection-associated factors in China
• The proportion of stage I diagnosis in the USA was higher than in China for cancers of colorectum, lung, breast, liver, and all cancers combined, whilst Chinese patients with esophagus cancer showed a higher proportion of stage I
• Age-standardized 5-year survival in the USA was considerably higher than in China, except for stomach cancer and esophagus cancer
