Time trends in cancer mortality in China: 1987–1999

Abstract

A first analysis of time trends in cancer mortality in China at the national level is presented. Using a joinpoint regression model, based on data from a national mortality routine reporting system in China (CHIS), time trends in mortality for 9 major cancers are analyzed. Between 1987 and 1999, the age-standardized mortality rates for all cancers combined declined slightly in rural areas but have increased since 1996 in urban areas. The mortality rates for cancers in oesophagus, stomach, cervix uteri, leukaemia (except for urban males after 1996) and nasopharynx declined, while lung cancer and female breast cancer showed significant increasing trends in both urban and rural areas and for both sexes. Cancers of the colon-rectum and liver had different trends in mortality in urban and rural populations. The trends in agespecific mortality rates suggest some different trends in the younger population, which may presage future overall trends, for example, increasing mortality from cancer of the cervix. The observed trends primarily reflect the dramatic changes in socioeconomic circumstances and lifestyles in China in the last 2 decades. Tobacco smoking remains a major problem, with increases in mortality from lung cancer. The improvements in socioeconomic status, diet and nutrition may be responsible for the declining risk of some cancers (oesophagus, stomach and nasopharynx), while increasing the risk for others (breast and colon-rectum). Screening programs (especially for cervix cancer), and more available and better facilities for cancer therapy, may have helped to reduce mortality for several cancers. The large increases in the absolute number of deaths that resulted from the increasing and aging population are much more important in determining the future cancer burden than any changes due to change in risk, emphasizing the increasing importance of cancer as a health problem in the 21st century in China.

Estimation and projection of the national profile of cancer mortality in China: 1991–2005

“…The remarkable changes in mortality for most major cancers, and their possible explanations have been the subject of an earlier communication (Yang et al, 2003b). The very large improvements in socioeconomic and sanitary conditions may be responsible for declines in cancers associated with infection and/or nutritional deficiency, such as oesophagus, stomach, cervix uteri and nasopharynx, while changes in diet and a more sedentary lifestyle, associated with an increasing prevalence of obesity, may explain some of the changes in risk for cancers of the breast and large bowel.…”

“…Nevertheless, it is not the values of the mortality rates in CHIS that have been used to make a national prediction, but the trends Cancer mortality in China, 1991-2005 within strata of age, sex and urban -rural residence. These trends have been examined in detail elsewhere (Yang et al, 2003b), where it was noted that although there had been no changes in the areas covered by the sample during 1991 -1999, there had been important social and demographic shifts within them, with rapid economic development and marked urban -rural migration. These will have influenced the trends observed within the urban -rural samples in addition to changes in exposures to risk factors, early detection and treatment.…”

“…In breast cancer, for example, age-specific mortality increases little between ages 45 -54 and 75 þ years, while for cervix cancer, the mortality in 2005 is highest in the age group 45 -54 years (11.3 per 10 5 ), decreases at ages 55 -64 years (to 7.5 per 10 5 ) and then rises again (to 10.9 per 10 5 at ages 75 þ ). These are the consequences of large rates of change in the CHIS data between 1991 and 1999 that differ by age; for breast cancer in urban female subjects, and for cervix cancer, the large increases in younger women presumably represent birth-cohort-specific changes in risk (Yang et al, 2003b).…”

Family history of malignancies and risk of breast cancer: prospective data from the Shanghai women’s health study

“…The incidence rates, are on average, three times lower in less developed countries [20,33]. In China, breast cancer incidence is nearly six times lower than in the United States, but the incidence rate has increased substantially from 1987 to 1999 [40]. Shanghai, the largest industrial city on the east coast of China, demonstrated a 40% increase in breast cancer incidence from 1975 (19.6 per 100,000) to 1997 (27.2 per 100,000) [14,33].…”

Human papillomavirus infection in Shanxi Province, People's Republic of China: a population-based study

“…However, nationwide mortality surveys show a heterogeneous pattern of cervical cancer risk, with particularly high rates in central rural provinces (Yang et al, 2003a). Furthermore, while cervical cancer mortality appears to have declined considerably in urban China between 1987 and 1999, this is less marked in rural areas (Yang et al, 2003b). A recent study in one such high-risk rural area, Shanxi Province, revealed that 23.6% of women aged 35 -50 years were infected with high-risk HPV types (Zhao et al, 2006).…”