Jufang Shi

A substantial proportion of liver cancers is attributable to chronic infection with hepatitis B and C (HBV/HCV). Liver cancer could become the second cancer, after cervical, to be effectively controlled globally, if proven interventions such as vaccination can be implemented on a large scale. In 2018, the global mortality rate for liver cancer was estimated to be 8.5 per 100 000 individuals. Given patterns of HBV infection and immigration across countries, liver cancer control requires combined, global action. Liver cancer trends vary between countries, in some Western countries, the incidence rates were relatively low but have increased in recent decades; conversely, in several Asian countries, the incidence rates have decreased over time. China has in the past contributed more than half of the global burden of liver cancer but more recently a national decline in liver cancer incidence has been observed. Here, we review the liver cancer burden and exposure to risk factors in China, compared to other countries. We also review the implementation status for primary and secondary prevention interventions and major outcomes achieved over the past three decades. Using Bayesian age-period-cohort analysis, we examine recent trends and based on these, predict that by 2050, the incidence of liver cancer in China could fall by half. We additionally survey the literature to identify current research needs, and review relevant national policies on liver cancer control in China. A comprehensive set of interventions is proposed to progress toward the long-term goal of liver cancer elimination based on the natural history and evidence-based interventions.

The burden of cervical cancer in China has not been characterized in detail. We reviewed cervical cancer data from national mortality surveys and registries, and conducted a meta-analysis to estimate the prevalence of high-grade lesions (HSIL) and high-risk human papillomavirus (HR-HPV) infections in rural Shanxi Province. We found that a national survey in the 1970s estimated age-standardized cervical cancer mortality rates as ~15 and ~83/100,000 women nationally and in Xiangyuan, Shanxi; but the latest survey (2004-2005) found much lower rates of ~3 and ~7/100,000, respectively. IARC registries record age-standardized cervical cancer incidence in China as <5/100,000 (1998-2002); but the five registry sites cover <2% of the population, and the gross domestic product per capita at each of the registry sites is higher than China's average (by a factor ranging from 1.3 to 3.9). The pooled estimate of the prevalence of HSIL and HR-HPV in women aged 30-54 years in Shanxi was 3.7%(95%CI:2.7-4.8%) and 17.2%(95%CI:13.1-21.3%), respectively. Based on a feasible range informed by the incidence data for China and other unscreened populations, the predicted indicative annual number of new cervical cancer cases nationally, in the absence of any intervention, ranges from ~27,000 to 130,000 (2010) to 42,000 to 187,000 (2050). In conclusion, recent data suggest comparatively low rates of cervical cancer incidence in China, which may be partly explained by the location of registry sites in higher socioeconomic status areas. However, the evidence is consistent with considerable heterogeneity within China, with a higher disease burden in some rural areas such as Shanxi. Therefore, the lower reported rates of cervical cancer in China should be interpreted cautiously.