| BackgroundCancer is a serious threat to human health and a major public health problem in China and even the world.In both more and less economically developed countries,cancer is a leading cause of death.There is a huge population in China,which accounting for almost one fifth of the world’s population.China accounts for about 22 percent of the whole world’s cancer incidence,and ranked the 68th highest incidence of cancer in 184countries and regions.Since 2010,cancer became the leading cause of deaths in China and the number of deaths from cancer accounted for about a quarter of all deaths.Cancer with a high incidence and a poor prognosis,seriously endangers people’health and consumes the medical resources in large quantities,which results in great disease burden to the people and society.The prevention and treatment of cancer is the key and difficult point of public health work in China.Investigating cancer incidence and mortality and distribution in the population is of great importance and value for formulating the cancer prevention plan,exploring the causes of cancer and evaluating the quality and effect of research work on cancer prevention.The present research explored the cancer patterns in Changning District of Shanghai first,and then analysed the long-term trends of cancer incidence and mortality in 1973-2013,which is aimed to provide basis data for future intervention measures.MethodsHigh-quality cancer incidence data of Changning District were derived from the Shanghai Cancer Registry in 1973-2013.Cancer was coded according to the 10threvision of the International Classification of Diseases.The death data was derived from the Shanghai Changning District Center of Disease Control and Prevention for the same times.The population data at the end of each year during 1973-2013 was obtained from the Changning District Bureau of Public Security.The average population per year was presented by mid-year population,which was calculated through averaging the populations at the end of two consecutive years.Based on censuses,information of population by sex-age group in census years was obtained.Data of sex-age group in the rest years between two consecutive censuses was estimated via linear interpolation and extrapolation method.Ages were categorized into eighteen 5-year age groups（0-,5-,10-,15-,20-,25-,30-,35-,40-,45-,50-,55-,60-,65-,70-,75-,80-,85+）.Data stratified by sex were divided into 8 intervals（1975-1979,1980-1984,1985-1989,1990-1994,1995-1999,2000-2004,2005-2009,2010-2013）for the time period 1975-2013.The assessments of quality measures includes the proportion of morphologic verification（MV%）,the percentage of cancer cases identified with death certification only（DCO%）,the mortality（M）to incidence（I）ratio（M/I）,and the percentage of cancer with undefined or unknown primary site（O&U%）.Cancer incidence and mortality in Changning District in 2009-2013 were analyzed as cancer epidemic situation.The statistic included crude rates and age-standardized rates.The age-standardized rate（ASR）was calculated by direct standardization with the Segi’s World Standard Population.The trends of cancer incidence and mortality from 1973 to 2013 were performed by the Joinpoint Regression Program.The statistic is the average annual percent change in our analysis.Age-period-cohort model was further implemented to assess the contributions of age,period and cohort effects to the trends using the statistical web tool of United States National Cancer Institute（NCI）.ResultsIn 2009-2013,7,033 male patients were newly diagnosed with cancer in the Changning District of Shanghai,the crude incidence rate was 456.79/100,000,the age standardized incidence rate was 213.14/100,000,and the top five cancers in incidence were lung cancer,stomach cancer,prostate cancer,colon cancer and liver cancer,respectively.For women,6,743 patients were newly diagnosed with cancer in the Changning District of Shanghai in 2009-2013,the crude incidence rate was 433.16/100,000,the age standardized incidence rate was 213.67/100,000,and the top five cancers in incidence were breast cancer,lung cancer,thyroid cancer,colon cancer and stomach cancer,respectively.During 1973-2013,a decreased trend of cancer incidence was observed in men,with an average annual percent change of-0.41%.Specifically,the annual percent change was-0.7%in 1973-2008,but 3.48%in 2008-2013.A significant increasing trend was observed in women during 1973-2013,with an average annual percent change of 0.87%.Specifically,the annual percent change was-1.08%and 1.93%in 1991-2013.The APC model analysis results suggested that variation of incidence trend was affected by both period and cohort effects.During 2009-2013,4,762 male patients were died of cancer in the Changning District of Shanghai,the crude mortality rate was 309.29/100,000,the age standardized mortality rate was 125.21/100,000,and the top five cancers in death were lung cancer,stomach cancer,liver cancer,colon cancer and prostate cancer,respectively.For women,3,450 patients were died of cancer in the Changning District of Shanghai in 2009-2013,the crude mortality rate was 221.62/100,000,the age standardized mortality rate was80.04/100,000,and the top five cancers in death were lung cancer,breast cancer,colon cancer,stomach cancer and pancreas cancer,respectively.Joinpoint regression analysis revealed decreasing mortality trend in men and women throughout the entire period1973-2013,with an average annual percent change of-1.55%and 1.05%,respectively.The APC model analysis results revealed the decreasing period and cohort effects.ConclusionsCompared with all cancer data of Shanghai,the age-adjusted rates of cancer incidence in the Changning District are slightly higher than the average level of whole city.Except for the increasing age standardized incidence in women,the age standardized incidence rate in men and age standardized mortality rates in both genders decreased in the Changning District.However,the cases of incidence and death of cancer are still growing because of the aging population.Some common cancers with increasing incidence and mortality trends,such as colon cancer,thyroid cancer,prostate cancer and breast cancer（women）should be paid more attention by the public health departments,whole society and residents in the Changning District.In terms of tertiary prevention of cancer,health education and implement of cancer control in general population should be needed and conducted which leads to reduce cancer burden in the district. |
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