An Obvious Increasing Trend for Cancer Prevalence: A Population based Study in Zhongshan of China, 1970-20132018 | Volume 3 | Article 15311
An Obvious Increasing Trend for Cancer Prevalence: A Population based Study in Zhongshan of China, 1970-2013
OPEN ACCESS
Zhongshan People`s Hospital, China, Tel: 86 760 89990412;
E-mail: weikr@sina.com Received Date: 10 Sep 2018 Accepted Date: 30 Sep 2018 Published Date: 06 Oct 2018
Citation: Wei K, Liang Z, Li Z. An Obvious
Increasing Trend for Cancer Prevalence: A Population based Study
in Zhongshan of China, 1970-2013. Clin Oncol. 2018; 3: 1531.
Copyright © 2018 Kuangrong Wei. This is an open access article
distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly
cited.
Research Article Published: 06 Oct, 2018
Introduction Studies on cancer prevalence were few worldwide comparing with the researches on cancer
incidence, mortality, and survival. Only some countries such as Italy, Ireland, India, America, British, Canada, Japan, France, and China estimated their national cancer prevalence according the data of population based cancer registration [1-10]. Moreover, some researchers analyzed the cancer prevalence in the world, Europe, Northern Europe, Central Europe, aged persons, and multiple primary cancers [11-16] some analyzed the factors affected cancer prevalence [17-18], the approaches for estimating cancer prevalence [19], and the influence of cancer prevalence on the allocation of medical resources [20], some compared its differences in different areas of some countries [21].
Studies on cancer prevalence in China were even fewer. Rongshou Zheng et al. [9] estimated the cancer prevalence in China in 2011. A series of researches estimated the prevalence of cancers of common digestive system, lung, thyroid, prostate, brain and central nervous systems in China in 2008 [22-27]. The annual report of Shanghai cancer registry released the brief data of cancers prevalence in Shanghai since 2004 [28]. Two cross sectional surveys analyzed the cancer prevalence in the sampling areas of China [29-30]. Until now, real especially long term prevalent cancer data had never been analyzed systematically in China. But prevalence is a important indicator for assessing the cancer burden, medical quality, and the allocation of medical resources etc. Hence, for providing more information for cancer control in Zhongshan, this paper analyzed the real data of cancer prevalence in Zhongshan of Canton in 44 years.
Material and Methods Prevalent data
Cancer prevalent data came from Zhongshan Cancer Registry, which began to collect the
Abstract Background: Real long term cancer prevalence data has never been systematically studied in China. Hence, we thoroughly explored the 44 years cancer prevalence data in Zhongshan of China.
Methods: Prevalent data of cancer cases, diagnosed in Zhongshan in 1970-2013, still alive on 31, December 2013, which came from population-based Zhongshan Cancer Registry, were collected and collated. Such indices as the prevalent counts, proportions, and the ratio of prevalence with incidence, stratified by time, age, sex, and sites, were calculated and analyzed.
Results: As of 31 Dec, 2013, there were 10 527 alive cancer patients diagnosed in previous 5 years in Zhongshan, the 5 years prevalent proportion was 689.59/105. Top 5 male prevalent cancers were nasopharynx, colorectum, lung, liver, and prostate cancer, respectively, and breast, uterus, colorectum, lung, and thyroid cancers for female, respectively. Nasopharyngeal cancer was the top 1 and 7 prevalent cancer for male and female, respectively. Generally, the female prevalence in Zhongshan was higher than the male, the prevalence diagnosed in previous 2-3 years were higher than diagnosed in previous 1 and 4-5 years. Cancer prevalence varied by different sites, sex, and age. Moreover, its prevalence in 2000-2013 increased obviously in Zhongshan.
Conclusion: Five years cancer prevalent proportions in Zhongshan on 31 Dec, 2013 were at high- middle level worldwide and nationwide, while the prevalence of nasopharyngeal cancer at high level. Its prevalence in Zhongshan in 2000-2013 increased remarkably. It suggested that the medi care for alive cancer patients should be paid more attention, and medical resources in Zhongshan should be allocated accordingly.
Keywords: Cancer; Prevalence; Zhongshan
Department of Cancer, Zhongshan Cancer Institute, Zhongshan People`s Hospital, China
Kuangrong Wei, et al., Clinics in Oncology - General Oncology
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incident, death, and survival data of all malignant tumors of Zhongshan registered residents since 1970 through the Zhongshan Three Ranks Network of Cancer Prevention and Control, which was lead by Zhongshan Cancer Institute, composed of by the municipal hospitals, township health centers, and community health service stations of Zhongshan, and covered all Zhongshan population. The data was collected strictly according to the criteria of data quality and the requirement of National Central Cancer Registry (NCCR), International Agency for Research on Cancer (IARC), and International Association of Cancer Registries (IACR) [31-33]. The cancer data in Zhongshan had a high quality and credibility [34,35], as its incident data were received by Cancer Incidence in Five Continents (CIF) Volume IX, X, and XI [36-38].
Cancer prevalent data in this study approved by the review board of Zhongshan Cancer Registry, referred to the data of cancer cases that were diagnosed in Jan 01, 1970-Dec. 31, 2013, still alive on Dec. 31, 2013, and coded as C00-96, D32-33, 42-43 according to the International Classification of Disease, 10th version (ICD-10) [39]. 90.60% of them were Microscopically Verified (MV) and 9.40% diagnosed by imaging. The prevalent data of 26 major and all cancers sites were analyzed in this paper (Table 1).
Population data Population data came from the Bureau of Statistics and the Heath
Department of Zhongshan. As of Dec. 31, 2013, there were 1,528,005 registered residents in Zhongshan, 758,068 of them were male, 769,937 female, with the female persons slightly higher than the male.
Statistical indices and methods We chose Dec. 31, 2013 as the statistical time point and used
counting method to calculate the numbers of alive cancer cases in this study [40]. Statistical indices included prevalent counts, proportion and the ratio of prevalence with incidence, stratified by sites, time, age, and gender. The statistical methods used by IARC [41] and SEER (The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute of USA) were applied in this study [42].
Results General status of prevalence
On Dec. 31, 2013, there were 11 716 male, 12 767 female, and 24 483 both gender cancer prevalent cases diagnosed in 1970-2013 in Zhongshan, respectively, the prevalent proportions were 1545.51/105, 1658.19/105, and 1602.29/105 for male, female, and both gender, respectively, with the ratio of male to female prevalent counts 0.92. The prevalent proportions of male, female, and both gender in 1970- 2013 in Zhongshan were 4.67, 6.73, and 5.56 times higher than the incident rates of male, female, and both gender in Zhongshan in 2013, respectively (Table 2).
Sites ICD10 Sites ICD10
Nasopharynx C11 Breast C50
Esophagus C15 Cervix C53
Liver C22 Prostate C61
Larynx C32 Bladder C67
Other thoracic organs C37–C38 Thyroid C73
Bone C40–C41 Lymphoma C81-85,88,90,96
Melanoma of skin C43 Leukemia C91–C95
All sites C00–C96,D32-33,42-43
Table 1: Cancer sites and their corresponding International Classification of Disease codes (ICD, 10th revision).
Gender Counts Proportion *New cases *Incident Rates #P:I ratio
Male 11716 1545.51 2508 330.84 4.67
Female 12767 1658.19 1897 246.38 6.73
Both 24483 1602.29 4t405 288.28 5.56
Table 2: Cancer prevalence in Zhongshan, 1970-2013 (N, 1/105).
*The new cases and incident rate in 2013; # the ratio of prevalent proportion to incident rate
Sex Prevalence
#P/I 1 3 5 10 10+ Rate
Male 1746 3723 5078 7671 4046 669.86 2508 330.84 2.02
Female 1591 3875 5449 8561 4230 709.02 1897 246.38 2.88
Both 3337 7598 10527 16256 8276 689.59 4405 288.28 2.39
Table 3: Cancer Prevalence in different periods in Zhongshan (N, 1/105).
*New cases and incidence in 2013; # 5-year cancer prevalence to 2013 incidence ratio.
Kuangrong Wei, et al., Clinics in Oncology - General Oncology
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Prevalence in different periods As of Dec. 31, 2013, there were 3 337, 7 598, 10 527, 16 256, and 8
276 alive cancer cases diagnosed in previous 1, 3, 5, 10, and 10 years ago in Zhongshan, respectively, with the female counts higher than the male except the counts diagnosed in previous 1 year. The prevalent counts of male, female, and both gender diagnosed in previous 5 years were 5 078, 5 449, and 10 527, respectively, and were 2.02,2.88, and 2.39 times higher than the new cases of male, female, and both gender in Zhongshan in 2013 , respectively. The 5 year cancer prevalent proportions of male, female, and both gender in Zhongshan in 2013 were 669.86 /105, 709.02/ 105, and 689.59/105, respectively (Table 3).
Overall, the prevalent count diagnosed in previous 2-3 years was higher than the counts diagnosed in previous 1 and 4-5 years in Zhongshan, especially for the cancers of nasopharynx, corpus uterus, other skin (non melanoma of skin), and CNS, and the prevalent counts diagnosed in previous 1 years was higher than the counts diagnosed in previous 4-5 years. But the prevalent counts of lip, oral and pharynx, esophagus, stomach, liver, gallbladder, pancreas, and lung cancers diagnosed in previous 1 years was higher than the counts diagnosed in previous 2-3 and 4-5 years, and the prevalent counts of nasophrynx, breast, corpus uteri, other skin, and CNS cancers, and leukemia diagnosed in previous 4-5 years was higher than the counts
diagnosed in previous 1 years (Table 4).
Prevalent trends In 2000-2013, there was an obvious increasing trend for the annual
prevalent counts of cancers diagnosed since 1970 in Zhongshan. In the end of 2000, there were only 4 225 male and 3 816 female alive cancers cases diagnosed since 1970 in Zhongshan, respectively, but in the end of 2013, there were 11 219 male and 12 377 female alive cancers cases, respectively, the prevalent counts had increased 165.54% and 224.35% for the male and female, respectively. Join point regression test also revealed that the Annual Percentage Changes (APC) for the male and female prevalent counts in 2000-2013 in Zhongshan were 7.83 (7.4, 8.3) and 9.43 (9.1, 9.7), respectively, both P<0.000 and with statistical significance (Figure 1 and 2).
Prevalent ranks In the end of 2013, top 5 male prevalent cancers diagnosed in
previous 5 years in Zhongshan were nasopharynx, colorectum, lung, liver, and prostate cancers, respectively, accounting for 61.11% of all male cancers prevalent counts. Bottom 5 male prevalent cancers were melanoma of skin, breast, other thoracic organs, bone, and testis cancers, respectively, accounting for 1.42% of all male cancers prevalent counts. Top 5 female prevalent cancers diagnosed in
Sites Male Female Both
1 3-Feb 5-Apr 1 3-Feb 5-Apr 1 3-Feb 5-Apr
Lip, oral cavity and pharynx 74 59 46 12 24 17 86 83 63
Nasopharynx 193 377 335 65 124 133 258 501 468
Esophagus 111 62 38 6 9 4 117 71 42
Stomach 60 53 40 38 31 22 98 84 62
Colorectum 233 303 214 178 251 187 411 554 401
Liver 200 184 78 44 45 11 244 229 89
Gallbladder 16 15 5 16 9 5 32 24 10
Pancreas 18 4 10 10 9 6 28 13 16
Larynx 41 46 43 1 2 1 42 48 44
Lung 342 252 137 223 202 79 565 454 216
Other thoracic organs 6 3 2 5 8 5 11 11 7
Bone 6 7 5 5 4 3 11 11 8
Melanoma of skin 0 4 0 5 6 3 5 10 3
Other skin cancer 30 58 29 30 55 33 60 113 62
Breast 2 4 0 295 526 350 297 530 350
Cervix 105 137 101 105 137 101
Uterus 158 291 196 158 291 196
Ovary 47 63 49 47 63 49
Prostate 96 106 53 96 106 53
Testis 5 14 15 5 14 15
Kidney 34 49 27 17 34 17 51 83 44
Bladder 53 82 53 18 22 16 71 104 69
Brain 59 80 69 74 157 117 133 237 186
Thyroid 31 39 31 134 147 109 165 186 140
Lymphoma 53 62 47 42 51 39 95 113 86
Leukemia 30 36 24 25 27 32 55 63 56
All site 1746 1977 1355 1591 2283 1575 3337 4260 2930
Table 4: Cancer prevalence by site, time and sex in Zhongshan (N).
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previous 5 years were breast, corpus uteri, colorectum, lung, and thyroid cancers, respectively, accounting for 59.57% of all female cancers prevalent counts. Bottom 5 female prevalent cancers were pharynx, bone, melanoma of skin, esophagus, and pancreas cancers, respectively, accounting for 1.38% of all female cancers prevalent counts. NPC was the top 1 and 8 prevalent cancer for male and female in Zhongshan in 2013, respectively, accounting for 17.82% and 5.91% of all male and female cancers prevalent counts in Zhongshan in 2013, respectively (Table 5).
Age specific prevalence As of Dec. 31, 2013, the prevalent counts of cancers diagnosed
since 1970 in Zhongshan was few before age 39, accounting for 9.69% and 0.56% of all cancer prevalent counts for age less than 40 and 15
years, respectively. The prevalent counts increased quickly from age 40 years, peaked at age 55-59 for female and 60-64 years for male, and down quickly thereafter. The female cancer prevalent counts were higher for age 30-64 and lower after age 65 years than the male counts, but with no obviously difference (Figure 3). The patterns of age specific prevalence diagnosed in previous 1, 3, and 5 years were basically the same (Figure 4). The count s in non old age group (40- 64) was the highest (58.86%), followed by old age group (>65, 31.45%) and young age group (<40, 9.69%).
Different age groups also varied with different most prevalent cancers in Zhongshan in 2013. The prevalent counts of testicle, bone cancer, and leukemia were the highest for young age group (<40), accounting for 54.84%, 50.00%, and 40.34% of their total prevalent
Rank Male Female
1 Nasopharynx 905 119.38 Breast 1171 152.09
2 Colorectum 750 98.94 Uterus 646 83.9
3 Lung 731 96.43 Colorectum 616 80.01
4 Liver 462 60.94 Lung 504 65.46
5 Prostate 255 33.64 Thyroid 390 50.65
6 Esophagus 211 27.83 Brain, CNS 348 45.2
7 Brain, CNS 208 27.44 Cervix uteri 342 44.42
8 Lip, oral cavity and pharynx 207 27.31 Nasopharynx 322 41.82
9 Bladder 188 24.8 Ovary 160 20.78
10 Lymphoma 167 22.03 Lymphoma 139 18.05
Table 5: Cancer prevalent rank in Zhongshan, 2013 (N, 1/105).
Figure 1: Male cancer prevalent trend in Zhongshan, 2000-2013.
Figure 2: Female cancer prevalent trend in Zhongshan, 2000-2013.
Figure 3: Cancer age specific prevalence in Zhongshan, 2013.
Figure 4: Cancer age specific prevalence in Zhongshan in different time.
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counts in Zhongshan in 2013, respectively. The counts of uteri (except cervix), cervix, and breast cancers were the highest for non old age group (40-64), accounting for 84.98%, 81.87%, and 75.45% of their total prevalent counts, respectively. The counts of prostate, other skin (non-melanoma), and gallbladder cancer were the highest for the old age group (65+), accounting for 84.98%, 81.87%, and 75.45% of their total prevalent counts, respectively.
Discussion Compared with the data of Globocan 2012 [43], the 5 years
cancers prevalence in Zhongshan in 2013 were at middle high level worldwide, higher than the adult prevalence of world (625.0/105), Asia (415.6/105), and China (456.0/105), ranked about 63 in 184 countries and regions, close to the adult prevalence of Georgia (687.7/105) and Kazakhstan (668.8/105), obviously higher than the prevalence of underdeveloped regions (376.4/105) and the lowest prevalence countries such as the Gambia (82.8/105) and the United Arab Emirates (131.1/105), but much lower than the highest prevalent countries such as Belgium (2142.6/105), Norway (2020.1/105), and developed areas (1618.8/105), also much lower than the adult prevalence of Japan (1830.7/105) and Korea (1522.7/105) in Asia in 2012. The 5 years cancers prevalence in Zhongshan in 2013 was also higher than the prevalence in China in 2011 (556.0/105) [9]. Prevalence was associated with such factors as incidence, survival, cancer types, population increasing and aging [17-18]. High cancer incidence and a relative high incidence of nasophrynx, colorectum, female breast, corpus uteri, cervix, thyroid, and male prostate cancers
[34-35,44], which had relatively high survival [45-46], maybe the reasons for a middle high prevalence in Zhongshan. It indicated that the heath care and allocation of health resource should be adjusted in Zhongshan accordingly. Cancer prevalent rank in Zhongshan in 2013 differed greatly with the ranks in the world and China. The prevalence of male prostate cancer in the world in 2012, lung cancer in China in 2012 [43], and stomach cancer in China in 2011 were the highest [9], whose prevalent counts accounted for 25.2%, 17.3%, and 15.9% of all their cancer prevalent counts, respectively. While the prevalence of nasopharyngeal carcinoma was the highest in Zhongshan in 2013, whose prevalent counts accounted for 17.8% of all cancer prevalent counts. Although the female 5 years prevalence of breast cancer were the highest in the world and China in 2012, and Zhongshan in 2013, they varied greatly, 239.9/105 and 129.3/105 in the world and China in 2012, 152.09/105 in Zhongshan in 2013, respectively, accounted for 36.3%, 27.4%, and 21.5 % of all their cancer prevalent counts, respectively [43]. Thyroid cancer prevalence was high in the world, stomach cancer prevalence high in China in 2012, but lung and nasopharyngeal cancer prevalence were relatively high in Zhongshan in 2013 [43]. The reasons for the difference of cancer prevalent rank in different countries and areas maybe related with the incident rank, prognosis, and treating results of cancers etc. High incidence, better survival, good treating results, well health care resources, population increasing and aging, and long term screening etc may be the reasons for a high prevalence of NPC in Zhongshan in 2013 [44-49].
Cancer prevalence varied by sex. The male prevalence in the world and underdeveloped areas in 2012 were lower than the female, but higher than the female in developed areas. In China, the male 1 and 3 years prevalence were higher than the female, but the 5 years prevalence lower than the female in 2012 [41,43]. In Chinese urban areas, the male 1 year prevalence in 2011 were higher than the female, 3 and 5 years prevalence lower than the female, but in Chinese rural
areas, the male 1, 3, and 5 year prevalence in 2011 were all higher than the female [9]. The results in this study were consistent with the sex difference of cancer prevalence in Chinese urban areas in 2011. Gender difference of cancer prevalence was associated with the difference of cancer incidence, survival, common cancers, economic and education levels between male and female. Although male cancer incidence was higher than the female in China, male common cancers such as lung, stomach, and liver cancers were with lower survival, female common cancers such as breast, corpus uteri, and cervical cancers were with higher survival, and the male overall 5 years cancers survival was 10% lower than the female [9,46,48]. Those reasons maybe why the male prevalence in China was lower than the female. And the reasons maybe the same for the male prevalence in Zhongshan in 2013 lower than female Overall, cancer prevalent counts in Zhongshan in 2013 diagnosed in previous 2-3 years was the highest, followed by the counts diagnosed in previous 1 and 4-5 years in turn. This was consistent with the results reported by Rongshou Zheng et al. [9]. Otherwise, the prevalent counts of cancers diagnosed in previous 2-3 years with better survival such as the cancers of nasopharyngeal, breast, and corpus uteri were higher, while the counts for the cancers diagnosed in previous 1 year with worse survival such as the cancers of esophagus, liver and stomach was higher relatively. It indicated that the medical resources and focus should be adjusted accordingly. For the cancers with better survival focus should be on the rehabilitation and follow up after treating, and more on the treatment for the cancers with worse prognosis.
In 2000-2013, there were an obvious increasing trend for the cancer prevalence in Zhongshan, this was consistent with the remarkable increasing trend of cancer prevalence globally [50], such as in Australia, France, England, Canada, and Sweden [51-54]. The cancer prevalence in Shanghai of China had also increase from 1.67% in 2009 to 2.28% in 2013 [28,55]. Prevalence increasing was related with early diagnosis, improving of treating and survival of cancers, population increasing and ageing etc [17-18]. The studies in Sweden believed that 40% to 47%, 30%, and 23% to 29% of the cancer prevalent increasing were attributed to dynamic population change, survival improving and risk factors, respectively [17]. The reasons for the cancer prevalence increasing in Zhongshan maybe the same. And this indicated that the medical resource in Zhongshan should be timely adjusted accordingly too.
The prevalent counts varied with age and sites. This study showed that the prevalent counts increased quickly from age 40 years, peaked at age 55-59 for female and 60-64 years for male, and down quickly thereafter, the prevalent cancer counts diagnosed in previous 5 years were highest in 40-64 age groups, followed by the counts in 65+ and less than 40 age groups. This was consistent with the results of Rongshou Zheng et al. [9]. The cancers with the most prevalent counts in different age group were the same with the reports by Rongshou Zheng et al. too [9], but only 13 cancers whose prevalent counts were more than 50% of total counts in 40-64 age groups, less than 17 cancers reported by Rongshou Zheng et al. [9].
Generally speaking, this study showed that the 5 year cancer prevalence in Zhongshan in 2013 was at middle high level worldwide, its prevalence increased significantly in 2000-2013 and was the highest at age group 45-64 years. The prevalent counts of nasopharyngeal, colorectum, lung, liver, prostate, breast, corpus uteri, and thyroid cancers were higher. It suggested that the alive cancer patients should be paid more attention, and the medicare and health service in
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Zhongshan should be allocated properly.
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