Cancer Registry and
Screening in China
National Cancer Center, China
Dr. Wanqing Chen
2013.11.15
110329_Tsinghua_final_02.pptx46
In 2008, global cancer
new cases 12.7 M;
China 2.8 M
In 2020 17M, 34% increase;
3.9M, 38% in China
In 2008, global cancer In 2020, 10.2M, 34%
deaths 7.60M; China 2M increase;
China 2.8M, 41%
Cancer Incidence and Death Projection
In China (unit:10 000)
350
300
250
300
Incidence
280
Death
250
210
190
200
160
150
100
155
130
70
50
0
1970
1991
2003
2010
2020
year
4
Changes of cancer mortality in China
1973-1975
200
1990-1992
% (per 100,000)
2004-2005
150
100
50
0
men
women
Crude rates
men
women
Age-adjusted rates
6
Mortality (urban) 2009
Rank
Cause
Mortality
%
1
Cancer
167.6
27.0
Cardiovascular diseases
128.8
20.8
3
Cerebrovascular diseases
126.3
20.4
4
Chronic respiratory diseases
65.4
10.5
5
Injury & poisoning
34.7
5.6
6
Endocrine, nutritional and metabolic
diseases
20.3
3.3
7
Digestive system diseases
16.6
2.7
Genitourinary system diseases
7.3
1.2
9
Nervous system diseases
6.9
1.1
10
Infectious disease
6.3
1.0
2
8
Top 10
93.5
Resource：Health Statistic Report,2010. Center of Statistic Information, MOH
Mortality (rural) 2009
Rank
Cause
Mortality
%
Cancer
159.2
24.3
Cerebrovascular
152.1
23.2
3
Cardiovascular
112.9
17.2
4
Chronic respiratory diseases
98.2
17.2
5
Injury & poisoning
54.1
8.3
6
Endocrine, nutritional and metabolic
diseases
14.6
2.2
7
Digestive system diseases
11.3
1.7
8
Genitourinary system diseases
7.2
1.1
9
Nervous system diseases
5.1
0.8
10
Infectious disease
7.3
1.1
1
2
Top 10
94.8
Resource：Health Statistic Report,2010. Center of Statistic Information, MOH
Number of Cancer registries
in China
300
224
193 195
149
95
2
11 12
43 45 49
36
30
1960s 1988 1993 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012
2015
9
National Cancer Registries in 2012
TOTAL URBAN
URBAN
RURAL
RURAL
Number
224
84
140
Population
(million)
231
139
92
Cancer Incidence in China,
2009
Area
All
Urban
areas
Rural
areas
No. Cases
Crude rate
(1/105)
ASR
(1/105)
Both sexes
244366
285.91
146.87
191.72
22.08
Male
137462
317.97
165.92
220.33
25.68
Female
106904
253.09
129.49
166.04
18.64
Both sexes
174418
303.39
150.31
195.74
22.23
Male
95705
330.19
165.50
219.84
25.25
Female
78713
276.15
137.09
175.03
19.44
Both sexes
69948
249.98
139.68
182.88
21.76
Male
41757
293.10
166.94
220.94
26.65
Female
28191
205.25
113.07
146.24
16.83
Sex
(Cancer Reg. Annual Report 2012)
ASR World Cum.Rates
(1/105)
0-74（%）
Cancer Mortality in China
2009
Area
All
Sex
No.
Cases
Crude rate
(1/105)
ASR
(1/105)
ASR World
(1/105)
Cum.Rate
s
0-74（%）
Both sexes
154310
180.54
85.06
115.65
12.94
Male
96927
224.20
110.89
151.69
16.94
Female
57383
135.85
60.53
82.18
9.06
Both sexes
104551
181.86
80.86
110.57
12.12
64768
223.45
104.57
143.96
15.71
Female
39783
139.57
58.61
80.00
8.69
Both sexes
49759
177.83
94.40
126.73
14.78
32159
225.73
124.60
168.01
19.62
17600
128.14
64.93
87.08
9.89
Urban areas Male
Rural areas Male
Female
(Cancer Reg. Annual Report 2012)
Cancer Incidence in China
2009
Urban
Rank
1
2
3
4
5
6
7
8
9
10
Site
Lung
Colorectum
Stomach
Liver
breast
Esophagus
Thyroid gland
Lymphoma
Pancreas
Bladder
All Site
Rural
Incidence
1/105
58.81
35.78
30.2
26.63
25.94
14.21
8.25
8.21
8.19
8.11
303.39
(Cancer Reg. Annual Report 2012)
Site
Stomach
Lung
Esophagus
Liver
Colorectum
Breast
Cervix
Brain
Pancreas
Leukemia
All Site
Incidence
1/105
48.57
42.8
38.44
32.98
16.4
11.51
5.96
5.49
5.41
4.25
249.98
Cancer Mortality in China
2009
Urban
Mortality
Rank
Site
1/105
1
Lung
50.32
2
Liver
24.15
3
Stomach
21.15
4
Colorectum
17.09
5
Esophagus
10.59
6
Pancreas
7.42
7
Breast
5.99
8
Leukemia
4.56
9
Lymphoma
4.37
10 Gallbladder
4.18
All Site
181.86
(Cancer Reg. Annual Report 2012)
Rural
Site
Lung
Stomach
Liver
Esophagus
Colorectum
Pancreas
Brian
Leukemia
Breast
Lymphoma
All Site
Mortality
1/105
35.81
35.6
29.91
29.47
8.34
4.94
4.19
3.72
3.36
2.48
177.83
Proportion of Incidence
2009
Male
Lung
Stomach
Liver
Female
22.14%
16.81%
15.60%
14.36%
13.21%
10.44%
Colorectum
10.18%
Esophagus
9.57%
8.89%
Breast
Lung
Colorectum
Stomach
5.97%
Liver
Prostate
3.12%
5.39%
Esophagus
Bladder
3.08%
5.12%
Cervix
Pancreas
2.59%
3.99%
Thyroid
Lymphoma
2.42%
3.46%
Uterus
Kidney
2.22%
3.14%
Ovary
(Cancer Reg. Annual Report 2012)
16
Proportion of Mortality
2009
Male
Lung
Liver
Stomach
Esophagus
Colorectum
Pancreas
Female
27.21%
21.91%
16.93%
12.45%
15.45%
10.39%
7.02%
3.32%
lymphoma
2.23%
Leukemia
2.05%
Prostate
1.87%
Brain
1.87%
(Cancer Reg. Annual Report 2012)
Lung
Stomach
10.19%
Liver
9.34%
Colorectum
7.54%
Breast
7.44%
Esophagus
4.23%
Pancreas
2.79%
Gallbladder
2.61%
Brain
2.61%
Leukemia
17
世标率 （1/10万）
400
中国和
世界部
分国家
的癌症
发病率
比较
(1/105)
300
200
100
0
100
200
300
400
世界
发达国家
欠发达国家
中国
澳大利亚
爱尔兰
新西兰
丹麦
德国
意大利
韩国
日本
哈萨克斯坦
摩尔多瓦
新加坡
牙买加
印度
苏丹
阿联酋
叙利亚
尼日尔
加沙地带
男性
女性
250
150
世标率 （1/10万）
50
50
150
250
世界
发达国家
中国和
世界部
分国家
的癌症
死亡率
比较
(1/105)
发展中国家
匈牙利
中国
摩尔多瓦
丹麦
东亚
韩国
意大利
日本
爱尔兰
澳大利亚
亚洲
牙买加
新加坡
印度
苏丹
男性
尼日尔
女性
叙利亚
阿联酋
加萨地带
Trend of Cancer Incidence
350.00
Male CR
Female CR
300.00
Male ASR
Female ASR
250.00
200.00
150.00
100.00
50.00
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
0.00
Urban areas
350.00
300.00
Male CR
Male ASR
Female CR
Female ASR
250.00
200.00
150.00
100.00
Rural areas
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
50.00
Trend of Cancer ASR
30
Lung
25
Breast
Incidence 1/100 000
20
Stomach
Colorectum
Liver
15
Esophagus
10
Cervix
Pancreas
5
0
1998
1999
2000
2001
2002
2003
YEAR
2004
2005
2006
2007
2008
Changes of the age-adjusted mortality
of ten major cancers in China
25
1973-1975
1990-1992
20
% (per 100,000)
2004-2005
15
10
5
0
Lung
Liver
Stomach Esophagus Colorectal Leukemia Breast
NPC
Cervix
Bladder
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Incidence rate, 1/100 000
Comparison with SEER and
Hongkong (Incidence)
700
600
500
400
300
200
100
0
Male,China
Female,China
Male, China Hongkong
Female,China Hongkong
Male,USA
Female,USA
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Mortality, 1/100 000
Comparison with SEER and
Hongkong,(death)
350
300
250
200
150
100
50
0
male,China
Female,China
Male,China,Hongkong
Female,China,Hongkong
male,USA
Female,USA
350.0 280.0 210.0 140.0 70.0
0.0 0.0
70.0 140.0 210.0 280.0 350.0
Liangzhou District,Wuwei
武威市凉州区
厦门市区
Xiamen
铜陵市区
Tongling
Chuzhou District,Huai'an
淮安市楚州区
Dandong
丹东市
Ziliujing District,Zigong
自贡市自流井区
Guangzhou
广州市
Cancer
incidence
and
mortality
in urban
registries
Lianyungang
连云港市区
大连市
Dalian
本溪市
Benxi
苏州市区
Suzhou
马鞍山市
Maanshan
Xining
西宁市
Qingyang District,Chengdu
成都市青羊区
杭州市
Hangzhou
赤峰市
Chifeng
鞍山市
An'shan
Huaiyin District, Huai'an
淮安市淮阴区
沈阳市
Shenyang
中山市
Zhongshan
保定市
Baoding
武汉市
Wuhan
Shanghai
上海市
嘉兴市
发病 Incidence
Jiaxing
阳泉市
死亡 Mortality
Yangquan
哈尔滨道里区
Daoli District,Harbin
赣州市章贡区
Zhanggong District,Ganzhou
Liuzhou
柳州市
Nangang District,Harbin
哈尔滨南岗区
Beijing
北京市
Jiulongpo District, Chongqing
九龙坡区
男性 Male (1/105)
女性 Female (1/105)
350.0280.0210.0140.0 70.0 0.0 0.0
Cancer
incidence
and
mortality
in rural
registries
磁县
阳城县
盐亭县
涉县
扬中市
肥城市
新源县
建湖县
上虞市
四会市
金湖县
金坛市
景泰县
大丰市
仙居县
射阳县
迁西县
东港市
德惠市
肥西县
林州市
扶绥县
嘉善县
海门市
盱眙县
长乐市
启东市
偃师市
临朐县
灌云县
东海县
衡东县
云梦县
延吉市
海宁市
庄河市
西平县
尚志市
海安县
汶上县
泰兴市
70.0
140.0
210.0
280.0
350.0
Cixian
Yangcheng
Yanting
Shexian
Yangzhong
Feicheng
Xinyuan
Jianhu
Shangyu
Sihui
Jinhu
Jintan
Jingtai
Dafeng
Xianju
Sheyang
Qianxi
Donggang
Dehui
Feixi
Linzhou
Fusui
Jiashan
Haimen
Xuyi
Changle
Qidong
Yanshi
Linqu
Guanyun
发病 Incidence
死亡 Mortality
Donghai
Hengdong
Yunmeng
Yanji
Haining
Zhuanghe
Xiping
Shangzhi
Haian
Wenshang
Taixing
男性 Male (1/105)
女性 Female (1/105)
Geographic Distribution of cancer mortality 1973-1975,
esophageal cancer in male
Geographic Distribution of cancer mortality 1973-1975,
Stomach cancer in male
Urban,male
Urban,female
Rural,male
Rural Female
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Average age
66
65
64
63
62
61
60
59
58
57
56
year
Average of incidence of cancer, 1989-2008
Average age of incident cases of cervical cancer,
1988-2008
Cancer Burden Estimates
Site
Nasophary
nx
Esophagus
Stomach
Colorectal
Liver
Pancreas
Lung
Bone
Breast
Cervix
Ovary
Prostate
Bladder
Brain，
CNS
Lymphoma
All sites
Overall
Urban
Rural
Both
Male
Female
Both
Male
Female
Both
Male
Female
37.1
25.3
11.8
19.5
12.9
6.6
17.4
12.3
5.1
286.8
200.2
86.6
82.6
59.7
22.9
204.2
140.5
63.7
502.4
346.5
155.9
191.3
130.1
61.2
311.1
216.5
94.6
228.9
131.7
97.2
131.9
75.4
56.5
96.8
56.1
40.7
420.8
309.1
111.7
164.6
122.1
42.5
256.2
187.0
69.2
45.2
25.8
19.4
28.8
16.0
12.8
16.3
9.7
6.6
548.3
375.9
172.4
275.7
186.4
89.3
272.7
189.6
83.1
32.9
18.9
14.0
18.0
9.9
8.1
14.7
8.9
5.8
176.2
122.4
53.7
74.0
39.0
34.9
29.3
22.1
7.0
35.3
0.0
11.5
60.0
48.3
11.7
38.4
30.6
7.8
21.2
17.4
3.8
69.5
36.5
33.0
42.8
21.2
21.6
26.4
15.3
11.1
37.3
22.2
15.1
24.2
14.2
10.0
13.1
8.0
5.1
3032.7
1780.8
1251.9
1505.6
832.1
673.5
1527.1
949.0
578.1
Predicted incidence of lung cancer in China
Incidence rate
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
crude rate
52.82
53.99
54.95
55.73
56.25
56.83
57.38
58.24
59.72
61.41
63.25
65.03
66.69
ASR World
48.18
48.17
47.84
47.25
46.5
45.87
45.23
44.88
44.89
44.99
45.13
45.23
45.26
crude rate
27.59
28.45
29.28
30.26
31.27
32.15
32.92
33.81
34.88
36.03
37.1
38.26
39.34
ASR World
22.47
22.72
22.88
22.98
23.08
23.11
23.1
23.17
23.25
23.36
23.43
23.52
23.55
crude rate
50.04
50.23
50.54
51.03
51.33
51.71
52
52.25
53.48
54.55
56.09
57.45
58.95
ASR World
45.58
44.74
44.06
43.4
42.59
41.87
41.14
40.44
40.3
40.05
40.12
40.08
40.12
crude rate
21.87
22.33
22.47
22.71
22.76
22.76
22.75
22.66
22.88
23.2
23.58
24.2
24.61
ASR World
17.85
17.81
17.49
17.2
16.8
16.36
15.94
15.53
15.3
15.14
15.02
15.02
14.91
Urban-Male
Urban-Female
Rural-Male
Rural-Female
Incident cases
Urban-Male
Urban-Female
Rural-Male
Rural-Female
All
2008
2013
2014
2015
2016
2017
2018
2019
2020
165090 173088 180589 187610 193845 200399
206919
214683
224690
235729
247580
259511
271224
95208 100719 105952
110949
116461
122636
129234
135743
142699
149529
189531 188366 187670 187616 186845 186314
185467
184460
186661
188210
191287
193643
196350
76636
75837
74745
74643
74816
75155
76220
76624
512611 524983 536187 548466 558841 569301
579172
590349
608630
627989
649765
672073
693727
80584
77406
2009
85258
78271
2010
89953
77975
2011
78032
2012
77432
Cancer Survival Rate in 2003-2005
60%
urban
rural
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Cancer Survival in urban areas
100%
90%
stomach cancer
liver cancer
esophageal cancer
breast cancer
colorectal cancer
lung cancer
80%
70%
60%
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Cancer Survival in rural areas
90%
80%
70%
lung cancer
stomach cancer
liver cancer
esophageal cancer
breast cancer
colorectal cancer
60%
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Cancer Screening Programs
Screening programs in Rural areas
Women Cancer Screening programs
•Esophageal cancer, Colorectal cancer,
•Breast cancer and cervical cancer
Liver Cancer, Nasopharyngeal Cancer,
•Funded by Central Finance from 2007
Stomach Cancer, Lung Cancer, Cervical
•2009-2011: 12 millions for cervical
Cancer
cancer; 1.2 millions for breast cancer
• Central
Fiscal
Transfer
Payment
Programs
•2006-2011: covered 123 counties in 30
provinces (Districts)
Distribution of cancer screening
in high risk areas (Rural)
黑龙江省
内蒙古自治区
吉林省
新疆维吾尔自治区
7
Cancers
辽宁省
北京市
河北省
甘肃省
Covered
123
counties/
Districts
in 30
provinces
天津市
山西省
宁夏回族自治区
山东省
陕西省
青海省
河南省
江苏省
安徽省
西藏自治区
湖北省
四川省
上海市
重庆市
浙江省
贵州省
Oesophageal cancer：78 c/d
in 27 provinces
县级以上医院
网络报告率（%）
Colorectal cancer: 14 c/d in 11
provinces
90 至 100
80 至
70 至
60 至
湖南省
福建省
云南省
广西壮族自治区
Liver cancer: 6 c/d in 4 provinces
Gastric Cancer: 3 c/d in 3 provinces
Lung cancer: 2 c/d in 2 provinces
台湾
广东省
澳门香港
90
80
70
Nasopharyngeal cancer: 4 c/d in 3 provinces
江西省
海南省
? ? ? ?
Cancer prevention and Control Strategies
----Carrying out the cancer early diagnosis and treatment
Taking oesophageal cancer as the breakthrough
Taking the digestive tract cancers as the main line
Distribution of
Oesophageal
Covered all the high risk areas
覆盖所有食管癌高发区
of oesophageal cancer
cancer
programs
Incidence of oesophageal cancer among early
diagnosis and treatment demonstration bases
160
140
980 000
640 000
400 000
120
Incidence
/100,000
（
）
630 000
100
380 000
300 000
80
960 000
1 290 000
60
40
20
0
林州
磁县
涉县
肥城
扬中
泰兴
盐亭
阳城
• Green dotted line marked the national oesophageal cancer incidence (27.4/100,000)；
Yellow dotted line marked the world oesophageal cancer incidence (11.5/100,000)；
• The numbers in the figure were the population in each site, the total was 5.58 million.
Detection rate of National Cancer Screening
Programs
2.5
2
1.5
1
0.5
0
Esophageal
cancer
Colon/Rectum stomach cancer Cervical cancer
Cancer
liver cancer
nasopharyngeal breast cancer
cancer
Early stage rate of National Cancer Screening
Programs
100
90
80
70
60
50
40
30
20
10
0
Colon/Rectum stomach cancer Uterine Sarcoma
Cancer
liver cancer
Esophagus
Cancer
Nasopharyngeal breast cancer
Cancer
Breast Cancer Screening Sites
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Screening Site
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The project has covered 200 screening sites in 31 provinces, cities and
municipalities
42
Working Flowchart of Breast Cancer Screening
1st round screening
2nd round screening
Women enrolled in 1st screening
round except:
• diagnosed as breast cancer
cases;
• screened by MAM in last
screening round
would be invited to 2nd round.
CBE=Clinical Breast Examination
BUS=Breast Ultrasound
MAM=Mammography
43
Flowchart of Lung cancer Screening
Age 45-74 residents
Nodules
S/PS≥5mm
NS≥8mm
Further
examination
3 months later
No change
Increased
≥15mm
B
No
absorption
Clinical Consultation by
senior clinical expert,
radiologist and pathologist
No
intervention
A
CT scan 1 month later after Antiinflammatory treatment
Partly
absorbed
Completely
absorbed
CT 3 months later
No change or
enlagement
Shink or
disapeppear
intervention
Next year screening
S：Solid nodules； PS：part solid nodules;NS：non solid nodules
Flowchart of nasopharyngeal cancer
Screening
Age 30-59 residents
Signing agreement
Questionaire, physical exam, VCA/IgA test
1:80>VCA/IgA>1:5
Positive symptom/sign/ IgA>1:80
Normal
Follow-up in 5 years
EA/IgA and EA/IgG
nasopharyngoscope
Any positive
Normal
Abnormal
Follow-up in 1 year
Biopsy, pathology
Atypical yperplasia
NPC
Follow-up per 6 months
Treatment
Negative
Re-exam in 1 year
Flowchart of cervical cancer Screening
Age 30-59 women
Signing agreement
Questionaire/physical examination
VIA
Normal
VILI
Abnormal
Abnormal
Normal
colposcope
Normal
Screened next year
Abnormal
Biopsy
Screened next year
Treatment
Flowchart of esophageal/ stomach
cancer Screening
Age 40-69 residents
Signing agreement
Questionaire/physical examination
Endoscopy
Mild/moderate dysplasia
Server dysplasia/
insitu/intra-mucosal Ca
APC for moderate Dys
Follow-up per
3-5 years
Invasive Carcinoma
Treatment
Follow-up per
year
Flowchart of liver cancer Screening
population
Male:35-64 Female:45-64
Informed consent
HBsAg(-)
HBsAg(+)
Questionnaire
AFP & B-ultrasound
AFP(+)
B-ultrasound(-)
Reexamine
≥200ug/L 1/month
<200ug/L 1/2month
Quantitative
Review
AFP(+)
B-ultrasound(+)
AFP(-)
B-ultrasound(+)
AFP(-)
B-ultrasound(+)
Diagnosis of
HCC
Timely
Re-examine
Reexamine
after 6
months
Timely
treatment
Flowchart of colorectal cancer Screening
Cancer Screening Programs
Screening programs in Huaihe River
Region
Cancer Screening Programs in cities
•Upper
•Esophageal cancer, Stomach Cancer,
Liver Cancer
• Central
Fiscal
Cancer,
Colorectal cancer, Liver Cancer, Lung
Cancer, Cervical Cancer
Transfer
Payment
Programs
•2007-2012: covered 22 counties in 4
provinces
gastrointestinal
•Funded by Central Finance from 2012
•Covered 5 cities 50 000 each
Distribution of Cancer Screening in Huaihe
River Region (22)
Organization and Implementation
Administration
Technical Support
Disease Prevention and Control
Bureau, Ministry of Health
Chinese Anti-Cancer Association
Cancer foundation
CICAMS
Provincial Department of Health
Provincial Office for Cancer
Screening Program
Committee of
Experts
•Epidemiologists
•Oncologists
•Radiologists
•Pathologists
•…
CDC / Cancer Hospital / Maternal and Child Care Service Center
52
Cancer prevention and Control Strategies
----Carrying out the cancer early diagnosis and treatment
Technology tends to be mature
Continuously improve the technical
programs
Bases tend to be mature
Continuously expand the
demonstration effect
Cancer prevention and Control Strategies
----Carrying out the cancer early diagnosis and treatment
Training：Improve the capacity
Secure the quality
Participants：more than 4000
people in total
Highlights：Forms innovation
Practical Operation
Expert Question
Field Assessment
Budgets
The central budget on earlier detection and
management for cancer（2005-2010）
