Chest
Volume 143, Issue 4, April 2013, Pages 1117-1126
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Special Feature
Global Medicine
Lung Cancer in China: Challenges and Interventions

https://doi.org/10.1378/chest.11-2948Get rights and content

In 2008, lung cancer replaced liver cancer as the number one cause of death among people with malignant tumors in China. The registered lung cancer mortality rate increased by 464.84% in the past 3 decades, which imposes an enormous burden on patients, health-care professionals, and society. We performed a systematic review of the published data on lung cancer in China between 1990 and 2011 to analyze the incidence and mortality rates, economic burden, and risk factors of cancer and the effectiveness of interventions. Lung cancer incidence varies within China. People in eastern China, especially women, likely have a higher risk of developing lung cancer than those in western China. The crude mortality rates from lung cancer in 2008 were 47.51 per 100,000 men and 22.69 per 100,000 women. The crude mortality rate was highest in Shanghai (76.49 per 100,000 men and 35.82 per 100,000 women) and lowest in Tibet (25.14 per 100,000 men) and Ningxia (12.09 per 100,000 women). Smoking and environmental pollution are major risk factors for lung cancer in China. Continuous efforts should be concentrated on education of the general public regarding lung cancer to increase prevention and early detection. Specific interventions need to be implemented to reduce smoking rates and environmental risk factors. Standardized treatment protocols should be adapted in China.

Section snippets

Materials and Methods

Using a Web-based search strategy, we analyzed the published data on lung cancer in China from January 1990 to September 2011, including incidence and mortality rates, economic burden, risk factors, and effectiveness of interventions. We restricted the study time because the pre-1990 literature often did not have relevant and complete data in most Chinese journals; the common practice of contacting the corresponding authors was not effective before 1990 in China; therefore, we relied on the

Incidence

At present, population-based cancer registries are not well established nationwide in China, and epidemiologic data for cancer are limited at the province level. Using data collected between 1988 and 2005 from 10 cancer registries, Chen et al6 investigated lung cancer incidence rates in Beijing; Shanghai; Wuhan, Hubei; Harbin, Helongjiang; Cixian, Hebei; Qidong, Jiangsu; Jiashan, Zhejiang; Futuo, Guangxi; ChangLe, Fujian; and Linzhou, Henan. In 2005, the crude incidence rate was 49.35 per

Smoking and Exposure to Secondhand Smoke

Smoking is a well-established global health issue and a principal risk factor for lung cancer. The mortality rate of lung cancer is about 23 times higher in current male smokers and 13 times higher in current female smokers than in lifelong nonsmokers.16 The number of smokers in the world is expected to increase to at least 1.7 billion (1.2 billion men and 500 million women) by 2025.17 In China, about 30% of the world's cigarettes are manufactured and consumed by an estimated 350 million

Smoking Cessation

Cigarette smoking is highly prevalent and associated with substantially increased morbidity and mortality as well as increased health-care expenditures in China. A large prospective cohort study (n = 169,871) showed a significant dose-response association between pack-years smoked and death from all causes in both men and women.40 The study estimated that across China, a total of 673,000 deaths (538,200 men and 134,800 women) was attributable to smoking in persons aged ≥ 40 years in 2005.40

Conclusions

Lung cancer morbidity and mortality have increased rapidly in China over the past 30 years, especially in women, with tobacco consumption and environmental pollution being the major risk factors. For the general population, continuous efforts should be concentrated on health education to increase awareness, prevention, and early detection of lung cancer. For the Chinese government, specific and timely interventions need to be implemented to reduce smoking rates and air pollution in China. For

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Other contributions: We thank Hao Jiamao, PhD, for his help in the search of related references and for providing photographs.

References (53)

  • GS Ma et al.

    The Nationwide Nutrition and Health Survey in China, 2002: Behavior and Lifestyle

    (2006)
  • The Ministry of Health of the People's Republic of China
  • National Office for Cancer Prevention and Control et al.
  • WQ Chen et al.

    Evaluation on the incidence, mortality and tendency of lung cancer in China

    Thoracic Cancer

    (2010)
  • M Wang et al.

    Status quo and issues of direct impatient cost of lung carcinoma in China. [in Chinese]

    Chin Health Economics

    (2007)
  • A Jema et al.

    Cancer statistics, 2006

    CA Cancer J

    (2006)
  • QS Wang et al.

    Lung cancer epidemiology in mainland China [in Chinese]

    Chin J Clin Oncol

    (2006)
  • YQ Li et al.

    Estimates of lung cancer mortality at the province level in China [in Chinese]

    Zhongguo Fei Ai Za Zhi

    (2011)
  • GH Yang et al.

    Smoking and passive smoking in Chinese, 2002 [in Chinese]

    Zhonghua Liu Xing Bing Xue Za Zhi

    (2005)
  • XL Guo et al.

    Economic burden of malignant neoplasms in Shandong province [in Chinese]

    Chin J Publ Health

    (2010)
  • YK Nie et al.

    Early lung cancer baseline screening: preliminary study with low-dose spiral CT [in Chinese]

    Zhonghua Fang She Xue Za Zhi

    (2002)
  • US Department of Health and Human Services et al.

    The Health Consequences of Smoking: A Report of the Surgeon General

    (2004)
  • O Shafey et al.

    The Tobacco Atlas

    (2009)
  • JX Han et al.

    A cross sectional study of passive smoking of non-smoking women and analysis of influence factors on women passive smoking [in Chinese]

    Wei Sheng Yan Jiu

    (2006)
  • DM Wang et al.

    Risk factors on lung cancer: a meta-analysis [in Chinese]

    Chin J Evid-Based Med

    (2010)
  • Cited by (0)

    Funding/Support: Supported in part by the Shanghai Leading Academic Discipline Project [Project Number B115]; the third program of “973”: “Early detection of lung cancer”; and the third program of “985”: “Research on cancer metastases and the clinical translation.” Dr Yang was supported by the Mayo Foundation for Medical Education and Research.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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