Thoracic Cancer ISSN 1759-7706
ORIGINAL ARTICLE
Lung cancer incidence and mortality in China, 2010 Rongshou Zheng1, Hongmei Zeng1, Siwei Zhang1, Yaguang Fan2, Youlin Qiao3, Qinghua Zhou2 & Wanqing Chen1 1 National Cancer Center of China, Beijing, China 2 Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China 3 Department of Cancer Epidemiology, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
Keywords Cancer epidemiology; Chinese data; lung cancer. Correspondence Wanqing Chen, National Cancer Center of China, No. 17 Pan-Jia-Yuan South Lane, Chaoyang District, Beijing 100021, China. Tel: +86 10 8778 7039 Fax: +86 10 6771 8227 Email: [email protected] Qinghua Zhou, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, China. Tel: +86 22 6036 3013 Fax: +86 22 6036 3013 Email: [email protected] Received: 5 February 2014; accepted 9 February 2014. doi: 10.1111/1759-7714.12098
Abstract Background: The National Central Cancer Registry of China (NCCR) is responsible for cancer surveillance. Local cancer registries in each province submit data for annual publication. The incidence and mortality of lung cancer in China in 2010 by age, gender, and area is reported in this article. Methods: In 2013, 145 of 219 population-based cancer registries’ 2010 data were selected after quality evaluation. Classification included Western, Middle, and Eastern areas, and the crude incidence and mortality rates of lung cancer were calculated by age, gender, and urban and rural. Age-standardized rates were determined by China and World standard population data. The 6th National Population Census data of China was used, combined with the registries’ data to estimate the lung cancer burden in China in 2010. Results: Lung cancer had the highest incidence and mortality in China for men and women. It was estimated that 605 946 lung cancer cases were diagnosed in China in 2010, with a crude incidence rate of 46.08/100 000, and 486 555 patients died from lung cancer, with a crude mortality rate of 37.00/100 000. Age-standardized rates for incidence were 35.23/100 000 and 35.04/100 000, respectively. Incidence and mortality rates for lung cancer were higher in men and urban areas than those in women and rural areas, reaching a peak for subjects of 80–84 years old. Conclusion: Lung cancer has the highest incidence and mortality of all cancers in China, especially for males in urban areas. Our findings justify the need to plan and develop effective interventions, such as air pollution control and smoking deterrents, to control and prevent the spread of lung cancer in China.
Introduction Incidence and mortality attributed to lung cancer has risen steadily since the 1930s. Efforts to improve outcomes have not only led to a greater understanding of the etiology of lung cancer, but also the histologic and molecular characteristics of individual lung tumors. Lung cancers, primarily caused by tobacco smoking, are the major public health problem in the United States and many other parts of the world.1–9 In China, lung cancer has been the leading cancer diagnosed and the cause of cancer-related death for many years.8–10 Recent reports also describe an increasing trend of lung cancer in China.11 Lung cancer is particularly prevalent in civil cities and in males. Cigarette smoking and air pollution have been established as risk factors of the disease. 330
Thoracic Cancer 5 (2014) 330–336
Population-based cancer registries play an important role in collecting and providing cancer data. In China, the first population-based cancer registry was established in 1958 in Linzhou, Henan Province.12 But the development of cancer registries was limited in the 20th century. In 2002, the National Central Cancer Registry (NCCR) of China was established, acting as a federal bureau for systematic management of cancer surveillance. The population-based cancer registries located around China routinely collect data on patient demographics, primary tumor site and tumor morphology. In this study, the lung cancer burden, and the incidence and mortality of lung cancer in China were estimated by using 145 population-base cancer registries’ data of 2010. Incidence and mortality by age group, gender, and geographic areas were calculated. The updated results from © 2014 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd
R. Zheng et al.
this study will provide important policy suggestions and practical implications.
Material and methods Data source The NCCR of China is responsible for cancer data collection, evaluation, and publication from each population-based cancer registry located in China. All new cancer cases were reported to the local cancer registries when first diagnosed in any hospitals, community health centers or first discovered in other departments, including the Basic Medical Insurances for Urban Residents and the New-Rural Cooperative Medical System. The Vital Statistical Database was linked with the cancer database for updating vital statistics and also as a data supplement. By 1 June 2013, 219 cancer registries (92 cities and 157 counties) from 31 provinces submitted 2010 data to the NCCR. Data covered about 207 229 403 people, accounting for 15.42% of the 2010 national population. The cancer registries coded data with the International Classification of Diseases for Oncology 3rd edition (ICD-O-3) and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Invasive cases of lung cancer (ICD10: C33-C34) were extracted and analyzed from the overall cancer database. The National Statistics Bureau of China provided the sixth National Population Census data.13
Quality control Based on the Guideline of Chinese Cancer Registration and the standard of data inclusion in Cancer Incidence in Five Continents Volume IX, cancer registration data were evaluated by the quality indicators of proportion of morphological verification (MV%), percentage of death certification only (DCO%) and mortality to incidence ratio (M/I).14–18 The detailed standard for data inclusion has been published previously.19 Generally, data with a DCO% less than 20%, an overall MV% between 50% to 95%, and a M/I between 0.55– 0.95 were considered acceptable.
Lung cancer statistics in China
• According to the GB2260-2009 standard, prefecture-level cities were classified into urban areas, whereas counties and county-level cities were classified into rural areas. • The classification of Eastern, Middle, and Western areas is based on the standards of the National Statistics Bureau. • The Eastern areas: Beijing, Tianjin, Hebei, Liaoning, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong, Guangdong and Hainan province. • The Middle areas: Heilongjiang, Jilin, Shanxi, Anhui, Jiangxi, Henan, Hubei and Hunan. • The Western areas: Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shanxi, Gansu, Qinghai, Ningxia and Xinjiang. Crude incidence and mortality rates of lung cancer were prepared by gender, area, and for 19 age groups (0–, 1–4, 5–84 by 5 years, 85+ years). Age-standardized rates were calculated using the Chinese population (2000) and Segi’s World population. The cumulative risk of developing or dying from cancer before 75 years of age (in the absence of competing causes of death) was calculated and presented as a percentage. Software including MS-Excel, IARCcrgTools2.05 issued by IARC and IACR were used for data checking and evaluation. SAS software was used to calculate the incidence and mortality rates.
Results A total of 145 population-based cancer registries were selected for this study after quality evaluation. The population covered by these registries was 158 403 248, including 80 355 188 men and 78 048 060 women, accounting for 11.86% of the 2010 national population. Among them, 63 registries were from urban areas, covering a total of 92 433 739 of the population. Eighty-two registries were from rural areas, covering a total of 65 969 509 of the population. The MV%, DCO%, and M/I ratio for the national pooled data were 54.20%, 4.37%, and 0.84 respectively. In urban areas, the MV%, DCO%, and M/I ratio were 59.31%, 3.90%, and 0.85 respectively. In rural areas, they were 45.47%, 5.16%, and 0.82, respectively.
Statistical analysis
Incidence
Based on the standards of the National Statistics Bureau, China was classified into Eastern, Middle, and Western areas. We calculated the cancer registration data by strata variables of each area (Eastern/Middle/Western), kind (urban/rural), and gender (men/women). The age-specific incidence and mortality rate in the three different areas, and the 2010 National Census Population data were used to estimate incidence and mortality. The classification criteria were as follows:
In 2010, it was estimated that there were 605 946 new lung cancer diagnoses in China (416 333 men and 189 613 in women), with a crude incidence rate of 46.08 per 100 000 (age-standardized rates by Chinese population [CASIR] of 35.23 per 100 000; age-standardized rates by world population [WASIR] of 35.04 per 100 000), accounting for 19.59% of all new cancer cases. Among the new cases, 348 107 (57.45%) came from urban areas and 257 839 (42.55%) from rural areas. Among the 605 946 new lung cancer diagnoses,
Thoracic Cancer 5 (2014) 330–336
© 2014 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd
331
Lung cancer statistics in China
R. Zheng et al.
Table 1 The quality control index of lung cancer in China in 2010 Areas
Gender
M/I
MV%
DCO%
UB%
ALL
Both Male Female Both Male Female Both Male Female
0.84 0.85 0.83 0.85 0.86 0.84 0.82 0.83 0.81
54.20 54.47 53.65 59.31 59.58 58.76 45.47 46.04 44.23
4.37 4.29 4.53 3.90 3.88 3.95 5.16 4.97 5.58
0.73 0.70 0.77 0.89 0.86 0.94 0.46 0.45 0.47
Urban areas
Rural areas
DCO, death certification only; MI, mortality to incidence; MV, morphological verification; UB, unknown basis of diagnosis.
there were 240 858 (39.75%) cases from Eastern areas, 207 748 (34.28%) cases from Middle areas and 157 340 (25.97%) cases from Western areas in China (Table 1). The crude incidence rate for lung cancer was 46.08/100 000 in 2010, accounting for 19.59% of overall new cancer cases in China. The CASIR and WASIR were 35.23/100 000 and 35.04/ 100 000, respectively. Among the patients aged 0–74, the cumulative incidence rate was 4.28%. Lung cancer occurred more often in men than women. For men, the crude incidence rate was 61.86/100 000, whereas the CASIR and WASIR were 49.27/100 000 and 49.16/100 000, respectively. For women, the crude incidence rate was 29.54/ 100 000, whereas the CASIR and WASIR were 21.66/100 000 and 21.40/100 000, respectively. The crude incidence rate in urban areas was 52.52/100 000, which was remarkably higher than that in rural areas (39.54/100 000). After age
standardization, the incidence rate in urban areas (36.39/ 100 000 for WASIR) was still higher than that in rural areas (33.25/100 000 for WASIR) (Table 2). Age-specific incidence rates of lung cancer for both genders and areas were compared. The lung cancer age-specific incidence rates were relatively low up to 45 years of age in each area then increased dramatically, peaking in age group 80–84 or above 85 years old (378.82/100 000). Generally, lung cancer among men had a higher age-specific incidence rate than that among women, except for those in younger age groups (
ORIGINAL ARTICLE
Lung cancer incidence and mortality in China, 2010 Rongshou Zheng1, Hongmei Zeng1, Siwei Zhang1, Yaguang Fan2, Youlin Qiao3, Qinghua Zhou2 & Wanqing Chen1 1 National Cancer Center of China, Beijing, China 2 Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China 3 Department of Cancer Epidemiology, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
Keywords Cancer epidemiology; Chinese data; lung cancer. Correspondence Wanqing Chen, National Cancer Center of China, No. 17 Pan-Jia-Yuan South Lane, Chaoyang District, Beijing 100021, China. Tel: +86 10 8778 7039 Fax: +86 10 6771 8227 Email: [email protected] Qinghua Zhou, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, China. Tel: +86 22 6036 3013 Fax: +86 22 6036 3013 Email: [email protected] Received: 5 February 2014; accepted 9 February 2014. doi: 10.1111/1759-7714.12098
Abstract Background: The National Central Cancer Registry of China (NCCR) is responsible for cancer surveillance. Local cancer registries in each province submit data for annual publication. The incidence and mortality of lung cancer in China in 2010 by age, gender, and area is reported in this article. Methods: In 2013, 145 of 219 population-based cancer registries’ 2010 data were selected after quality evaluation. Classification included Western, Middle, and Eastern areas, and the crude incidence and mortality rates of lung cancer were calculated by age, gender, and urban and rural. Age-standardized rates were determined by China and World standard population data. The 6th National Population Census data of China was used, combined with the registries’ data to estimate the lung cancer burden in China in 2010. Results: Lung cancer had the highest incidence and mortality in China for men and women. It was estimated that 605 946 lung cancer cases were diagnosed in China in 2010, with a crude incidence rate of 46.08/100 000, and 486 555 patients died from lung cancer, with a crude mortality rate of 37.00/100 000. Age-standardized rates for incidence were 35.23/100 000 and 35.04/100 000, respectively. Incidence and mortality rates for lung cancer were higher in men and urban areas than those in women and rural areas, reaching a peak for subjects of 80–84 years old. Conclusion: Lung cancer has the highest incidence and mortality of all cancers in China, especially for males in urban areas. Our findings justify the need to plan and develop effective interventions, such as air pollution control and smoking deterrents, to control and prevent the spread of lung cancer in China.
Introduction Incidence and mortality attributed to lung cancer has risen steadily since the 1930s. Efforts to improve outcomes have not only led to a greater understanding of the etiology of lung cancer, but also the histologic and molecular characteristics of individual lung tumors. Lung cancers, primarily caused by tobacco smoking, are the major public health problem in the United States and many other parts of the world.1–9 In China, lung cancer has been the leading cancer diagnosed and the cause of cancer-related death for many years.8–10 Recent reports also describe an increasing trend of lung cancer in China.11 Lung cancer is particularly prevalent in civil cities and in males. Cigarette smoking and air pollution have been established as risk factors of the disease. 330
Thoracic Cancer 5 (2014) 330–336
Population-based cancer registries play an important role in collecting and providing cancer data. In China, the first population-based cancer registry was established in 1958 in Linzhou, Henan Province.12 But the development of cancer registries was limited in the 20th century. In 2002, the National Central Cancer Registry (NCCR) of China was established, acting as a federal bureau for systematic management of cancer surveillance. The population-based cancer registries located around China routinely collect data on patient demographics, primary tumor site and tumor morphology. In this study, the lung cancer burden, and the incidence and mortality of lung cancer in China were estimated by using 145 population-base cancer registries’ data of 2010. Incidence and mortality by age group, gender, and geographic areas were calculated. The updated results from © 2014 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd
R. Zheng et al.
this study will provide important policy suggestions and practical implications.
Material and methods Data source The NCCR of China is responsible for cancer data collection, evaluation, and publication from each population-based cancer registry located in China. All new cancer cases were reported to the local cancer registries when first diagnosed in any hospitals, community health centers or first discovered in other departments, including the Basic Medical Insurances for Urban Residents and the New-Rural Cooperative Medical System. The Vital Statistical Database was linked with the cancer database for updating vital statistics and also as a data supplement. By 1 June 2013, 219 cancer registries (92 cities and 157 counties) from 31 provinces submitted 2010 data to the NCCR. Data covered about 207 229 403 people, accounting for 15.42% of the 2010 national population. The cancer registries coded data with the International Classification of Diseases for Oncology 3rd edition (ICD-O-3) and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Invasive cases of lung cancer (ICD10: C33-C34) were extracted and analyzed from the overall cancer database. The National Statistics Bureau of China provided the sixth National Population Census data.13
Quality control Based on the Guideline of Chinese Cancer Registration and the standard of data inclusion in Cancer Incidence in Five Continents Volume IX, cancer registration data were evaluated by the quality indicators of proportion of morphological verification (MV%), percentage of death certification only (DCO%) and mortality to incidence ratio (M/I).14–18 The detailed standard for data inclusion has been published previously.19 Generally, data with a DCO% less than 20%, an overall MV% between 50% to 95%, and a M/I between 0.55– 0.95 were considered acceptable.
Lung cancer statistics in China
• According to the GB2260-2009 standard, prefecture-level cities were classified into urban areas, whereas counties and county-level cities were classified into rural areas. • The classification of Eastern, Middle, and Western areas is based on the standards of the National Statistics Bureau. • The Eastern areas: Beijing, Tianjin, Hebei, Liaoning, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong, Guangdong and Hainan province. • The Middle areas: Heilongjiang, Jilin, Shanxi, Anhui, Jiangxi, Henan, Hubei and Hunan. • The Western areas: Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shanxi, Gansu, Qinghai, Ningxia and Xinjiang. Crude incidence and mortality rates of lung cancer were prepared by gender, area, and for 19 age groups (0–, 1–4, 5–84 by 5 years, 85+ years). Age-standardized rates were calculated using the Chinese population (2000) and Segi’s World population. The cumulative risk of developing or dying from cancer before 75 years of age (in the absence of competing causes of death) was calculated and presented as a percentage. Software including MS-Excel, IARCcrgTools2.05 issued by IARC and IACR were used for data checking and evaluation. SAS software was used to calculate the incidence and mortality rates.
Results A total of 145 population-based cancer registries were selected for this study after quality evaluation. The population covered by these registries was 158 403 248, including 80 355 188 men and 78 048 060 women, accounting for 11.86% of the 2010 national population. Among them, 63 registries were from urban areas, covering a total of 92 433 739 of the population. Eighty-two registries were from rural areas, covering a total of 65 969 509 of the population. The MV%, DCO%, and M/I ratio for the national pooled data were 54.20%, 4.37%, and 0.84 respectively. In urban areas, the MV%, DCO%, and M/I ratio were 59.31%, 3.90%, and 0.85 respectively. In rural areas, they were 45.47%, 5.16%, and 0.82, respectively.
Statistical analysis
Incidence
Based on the standards of the National Statistics Bureau, China was classified into Eastern, Middle, and Western areas. We calculated the cancer registration data by strata variables of each area (Eastern/Middle/Western), kind (urban/rural), and gender (men/women). The age-specific incidence and mortality rate in the three different areas, and the 2010 National Census Population data were used to estimate incidence and mortality. The classification criteria were as follows:
In 2010, it was estimated that there were 605 946 new lung cancer diagnoses in China (416 333 men and 189 613 in women), with a crude incidence rate of 46.08 per 100 000 (age-standardized rates by Chinese population [CASIR] of 35.23 per 100 000; age-standardized rates by world population [WASIR] of 35.04 per 100 000), accounting for 19.59% of all new cancer cases. Among the new cases, 348 107 (57.45%) came from urban areas and 257 839 (42.55%) from rural areas. Among the 605 946 new lung cancer diagnoses,
Thoracic Cancer 5 (2014) 330–336
© 2014 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd
331
Lung cancer statistics in China
R. Zheng et al.
Table 1 The quality control index of lung cancer in China in 2010 Areas
Gender
M/I
MV%
DCO%
UB%
ALL
Both Male Female Both Male Female Both Male Female
0.84 0.85 0.83 0.85 0.86 0.84 0.82 0.83 0.81
54.20 54.47 53.65 59.31 59.58 58.76 45.47 46.04 44.23
4.37 4.29 4.53 3.90 3.88 3.95 5.16 4.97 5.58
0.73 0.70 0.77 0.89 0.86 0.94 0.46 0.45 0.47
Urban areas
Rural areas
DCO, death certification only; MI, mortality to incidence; MV, morphological verification; UB, unknown basis of diagnosis.
there were 240 858 (39.75%) cases from Eastern areas, 207 748 (34.28%) cases from Middle areas and 157 340 (25.97%) cases from Western areas in China (Table 1). The crude incidence rate for lung cancer was 46.08/100 000 in 2010, accounting for 19.59% of overall new cancer cases in China. The CASIR and WASIR were 35.23/100 000 and 35.04/ 100 000, respectively. Among the patients aged 0–74, the cumulative incidence rate was 4.28%. Lung cancer occurred more often in men than women. For men, the crude incidence rate was 61.86/100 000, whereas the CASIR and WASIR were 49.27/100 000 and 49.16/100 000, respectively. For women, the crude incidence rate was 29.54/ 100 000, whereas the CASIR and WASIR were 21.66/100 000 and 21.40/100 000, respectively. The crude incidence rate in urban areas was 52.52/100 000, which was remarkably higher than that in rural areas (39.54/100 000). After age
standardization, the incidence rate in urban areas (36.39/ 100 000 for WASIR) was still higher than that in rural areas (33.25/100 000 for WASIR) (Table 2). Age-specific incidence rates of lung cancer for both genders and areas were compared. The lung cancer age-specific incidence rates were relatively low up to 45 years of age in each area then increased dramatically, peaking in age group 80–84 or above 85 years old (378.82/100 000). Generally, lung cancer among men had a higher age-specific incidence rate than that among women, except for those in younger age groups (
