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BACKGROUND Evidence of the effects of cancer prevention knowledge on the risk of developing cancer remains scarce. The objective of this study was to prospectively examine the association of cancer prevention awareness levels with cancer risk in a population-based cancer screening cohort in China. METHODS This prospective cohort study included 164,341 participants aged 40 to 69 years with no history of cancer and with available information on cancer prevention core knowledge in the Esophageal, Stomach, and Liver Cancer Screening Program. Participants were recruited from 18 rural regions across 4 provinces in China from 2007 to 2014 and were followed until December 31, 2015. The core knowledge of cancer prevention content included 9 items, with a total score ranging from 0 to 100. Cox proportional hazards regression models and restricted cubic spline analysis were used to estimate hazard ratios and 95% CIs. RESULTS High cancer prevention knowledge scores were inversely associated with the overall risk of cancer (group 4 vs group 1: hazard ratio, 0.669; 95% CI, 0.576-0.776). Subgroup analysis showed that this inverse association could be observed in women, participants with lower educational or income levels, and those without a family history of cancer. Restricted cubic spline analysis exhibited a nonlinear (L-shaped) relation between cancer knowledge scores and cancer risk (overall P

Background Lung cancer is the leading cause of cancer mortality among women in China, and incidence and mortality continue to rise despite the fact that smoking prevalence is very low among Chinese women. Aim This study investigated tobacco smoking and trends in histological subtypes of female lung cancer in a central cancer hospital in China. Methods Demographic, smoking history and histological information on female lung cancer patients diagnosed or treated from 2000 to 2012 was collected from the Cancer Hospital, Chinese Academy of Medical Science (CHCAMS). The classification of histological subtypes and clinical stages were conducted using the ICD-O-3 and Eighth AJCC Cancer Staging Manuals. Time-trends of histological subtypes were analyzed based on annual percentage change (APC). Results Overall, 5870 female cases of lung cancer were included in the analysis. The number of female lung cancer patients increased from 509 (2000-2002) to 1744 (2011-2012). The most common histological type of lung cancer was adenocarcinoma (ADC) (72.93%), followed by small cell lung cancer (SCLC) (11.06%), squamous cell carcinoma (SCC) (8.38%) and other (7.63%). Among smokers, the proportion of SCC decreased from 40.5% to 23.7% (P = 0.005), while ADC increased from 35.7% to 50.7% (P = 0.009). In non-smokers, ADC increased from 63.1% to 80.6% (P = 0.006) and SCC decreased from 13.6% to 4.5% (P = 0.016). Among SCC cases, smokers made up a larger proportion of early stage (I/II: 47.1%) compared with late stages (III, 34.3%; IV, 18.6%). Conclusion The number of female lung cancer patients has increased in CHCAMS. In both smoking and non-smoking cases, the proportion of adenocarcinoma increased. Squamous cell carcinomas were more likely to be diagnosed in early stages among smokers.

Background Esophageal cancer has been a common cancer in China for many years. Using the most recent data collected from the National Central Cancer Registry, we present estimates of the esophageal cancer burden in China in 2011. Methods Age‐specific incidence and mortality rates by gender and area for 18 age groups were calculated based on data from 177 qualified population‐based cancer registries. The number of new cases of esophageal cancer and cancer deaths were computed by multiplying these rates by the 2011 population. Crude incidence and mortality rates of esophageal cancer were estimated. Results The estimated number of new esophageal cancer cases and deaths were 291 238 and 218 957, respectively. The crude incidence and mortality rates for esophageal cancer were 21.62/100 000 and 16.25/100 000, respectively. The age‐standardized incidence and mortality rates by world population were 15.83/100 000 and 11.62/100 000, respectively. Both the incidence and mortality rates of esophageal cancer were higher in rural areas than in urban areas, and in men than in women. The age‐specific esophageal cancer incidence and mortality rates increased with age. In China, squamous cell cancer was the most common pathological type of the disease. Conclusion Esophageal cancer remains a major public health issue in China. Primary and secondary prevention are essential for disease control.

BACKGROUND Lung cancer incidence and mortality rates have increased substantially in China despite improvements in clinical diagnosis and treatment approaches as well as significant advances in the implementation of tobacco-control policies in recent decades. METHODS Age-standardized mortality rates and age-specific rates of lung cancer in China were estimated for the periods 1973 to 1975, 1990 to 1992, and 2004 to 2005 using data from 3 National Death Surveys. Among patients with lung cancer who were identified from a hospital-based information system, the percentages of ever-smokers were analyzed according to histologic and demographic variables. RESULTS Age-standardized mortality from lung cancer in China dramatically increased from 7.30 per 100,000 during 1973 through 1975 to 27.62 per 100,000 during 2004 through 2005. Increases in lung cancer age-standardized mortality were consistent among men and women in urban and rural populations. Among men ages 75 to 79 years, lung cancer mortality increased remarkably to 453.67 per 100,000 in 2004 and 2005 (from 246.78 per 100,000 during 1990-1992 and from 53.65 per 100,000 during 1973-1975). Among 6674 patients with lung cancer who were identified from 2003 to 2007 from a hospital-based database, 82.97% of men were ever-smokers (73.35% of men with adenocarcinoma and 91.8% of men with squamous cell carcinoma), and 11.18% of women were ever-smokers (6% of women with adenosquamous carcinoma and 39.02% of women with squamous cell carcinoma). Differences in the numbers of ever-smokers were observed between age groups but not according to the year of diagnosis. CONCLUSIONS The consistent and rapid increases in lung cancer mortality rates observed in the Chinese population and the high prevalence of exposure to smoking in China prompt a strong call for the implementation of a comprehensive tobacco-control policy and specific public health educational strategies. Cancer 2015;121:3107-12. © 2015 American Cancer Society.

Background We conducted a meta-analysis to evaluate the association between traffic-related air pollution and lung cancer in order to provide evidence for control of traffic-related air pollution. Methods Several databases were searched for relevant studies up to December 2013. The quality of articles obtained was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Statistical analysis, including pooling effective sizes and confidential intervals, was performed. Results A total of 1106 records were obtained through the database and 36 studies were included in our analysis. Among the studies included, 14 evaluated the association between ambient exposure to traffic-related air pollution and lung cancer and 22 studies involved occupational exposure to air pollution among professional drivers. Twenty-two studies were marked A level regarding quality, 13 were B level, and one was C level. Exposure to nitrogen dioxide (meta-odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.99–1.13), nitrogen oxide (meta-OR: 1.04, 95% CI: 1.01–1.07), sulfur dioxide (meta-OR: 1.03, 95% CI: 1.02–1.05), and fine particulate matter (meta-OR: 1.11, 95% CI: 1.00–1.22) were positively associated with a risk of lung cancer. Occupational exposure to air pollution among professional drivers significantly increased the incidence (meta-OR: 1.27, 95% CI: 1.19–1.36) and mortality of lung cancer (meta-OR: 1.14, 95% CI: 1.04–1.26). Conclusion Exposure to traffic-related air pollution significantly increased the risk of lung cancer.

Limited population-based cancer registry data available in China until now has hampered efforts to inform cancer control policy. Following extensive efforts to improve the systematic cancer surveillance in this country, we report on the largest pooled analysis of cancer survival data in China to date. Of 21 population-based cancer registries, data from 17 registries (n = 138,852 cancer records) were included in the final analysis. Cases were diagnosed in 2003-2005 and followed until the end of 2010. Age-standardized relative survival was calculated using region-specific life tables for all cancers combined and 26 individual cancers. Estimates were further stratified by sex and geographical area. The age-standardized 5-year relative survival for all cancers was 30.9% (95% confidence intervals: 30.6%-31.2%). Female breast cancer had high survival (73.0%) followed by cancers of the colorectum (47.2%), stomach (27.4%), esophagus (20.9%), with lung and liver cancer having poor survival (16.1% and 10.1%), respectively. Survival for women was generally higher than for men. Survival for rural patients was about half that of their urban counterparts for all cancers combined (21.8% vs. 39.5%); the pattern was similar for individual major cancers except esophageal cancer. The poor population survival rates in China emphasize the urgent need for government policy changes and investment to improve health services. While the causes for the striking urban-rural disparities observed are not fully understood, increasing access of health service in rural areas and providing basic health-care to the disadvantaged populations will be essential for reducing this disparity in the future.

Background The National Cancer Registration of China provides annual updates on female breast cancer incidence and mortality. Methods Data on female breast cancer incidence and mortality was obtained from the population-based cancer registries around China. Based on the criteria of data quality, 72 registries' data was included for further analysis. Incidence and mortality rates of female breast cancer were calculated and stratified by age, sex, and geographical area. Results Female population coverage over 72 cancer registries was 42 238 968, with 28 503 924 in urban areas and 13 735 044 in rural areas. The crude cancer incidence rate in all areas was 42.55/100 000, and the age-standardize rates by Chinese population and World population were 23.16/100 000 and 28.99/100 000, respectively. The incidence rates in urban areas were much higher than those in rural areas. The crude cancer mortality was 10.24/100 000 in all areas, and age-standardized mortality rates by China and World population were 4.94/100 000 and 6.56/100 000, respectively. Age-adjusted mortality rates in urban areas were also higher than those in rural areas. Age specific incidence rates reached highest at the age group of 50–54, whereas the age specific mortality rates were highest in the age group of 85 and above. Conclusion Breast cancer was the most common cancer found in Chinese women in 2009 and the disease was more prevalent in urban areas than in rural areas. Systematic interventions of cancer prevention and control are needed.

Objective: To analyze lung cancer epidemiological trends and estimate the lung cancer burden in China. Methods: The age-specific mortality/incidence ratios in different geographical areas and for both sexes for lung cancer were obtained from the National Cancer Registration database in 2004 and 2005. Cancer crude mortality rates were retrieved from the database of the third national death survey from 2004–2005. Age-specific incidence rates of lung cancer were calculated using mortality and mortality/incidence ratios. The annual percent change was estimated with a log regression model using joinpoint software analyzing pooled lung cancer incidence data from 10 cancer registries from 1988 to 2005. Results: The total estimated new lung cancer cases and deaths in 2005 were 536 407 and 475 768 respectively, the numbers were higher for men than for women, and show an increase of 1.63% annually from 1988 to 2005. However, the trend showed a slowdown of 0.55% after being adjusted for age. Conclusions: Lung cancer is one of the major health issues in China and the burden is getting serious. Aging is the main cause for the increasing incidence and mortality of lung cancer. Effective cancer prevention and control is imperative. Tobacco control especially should be implemented in nationwide.