[Controversy on the age of initiation in colorectal cancer screening].

Colorectal cancer is a significant public health issue all over the world. Screening has been shown effective in improving the survival rate and decreasing the deaths of colorectal cancer. Several organizations have released guidelines for colorectal cancer screening. However, detailed recommendations like the age to begin remain controversial. This paper summarizes the recommended different age groups in initiating the colorectal cancer screening program from a few guidelines and analyzes the reasons for the inconsistency, thus facilitating the drafting of colorectal cancer screening guidelines in China.

Can Psychosocial Intervention Suppress Testosterone and Triglycerides Among Women With Polycystic Ovary Syndrome? A Feasibility Trial.

Women with polycystic ovary syndrome (PCOS) suffer significant psychological distress, which may activate the hypothalamus-pituitary-ovary axis and further affect their physiological state. They often experience elevated levels of testosterone and triglycerides. Considering reports of psychological distress among women with PCOS, this study aimed to develop a psychosocial intervention to improve their emotional and physical health, particularly in Chinese society. This pilot study employed the Integrative Body-Mind-Spirit (I-BMS) intervention model for women with PCOS in China. After a 2 h health information session, 18 participants were randomly assigned to the I-BMS group (9) or the control group (9). The intervention group received 6 weekly, 3 h I-BMS sessions. Pre- and post-blood tests and psychosocial questionnaires were collected from all participants. Retention to treatment was high with 79.6% treatment adherence gained and an overall average of five sessions completed. Compared with the control group, depression and anxiety symptoms reduced significantly for those in the intervention group (d = -1.24, p < 0.05 and d = -1.33, p < 0.01), their health-related quality of life improved significantly (d = 1.02, p < 0.01) both at post-intervention and 3 month follow-up, and their testosterone and triglycerides levels reduced significantly (d = -0.97, p < 0.001 and d = -0.41, p < 0.05) after joining the intervention. The I-BMS model is feasible and appears promising in improving psychological health, and reducing testosterone and triglyceride levels, in women with PCOS in China. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR1900027606.

[Analysis of low-dose computed tomography compliance and related factors among high-risk population of lung cancer in three provinces participating in the cancer screening program in urban China].

Objective: To analyze the compliance and related factors of low-dose computed tomography (LDCT) screening among the high-risk population of lung cancer in three provinces participating in the cancer early diagnosis and early treatment program in urban areas of China. Methods: From October 2017 to October 2018, 17 983 people aged between 40 and 74 years old at high risk of lung cancer were recruited from Zhejiang, Anhui and Liaoning provinces. The basic demographic characteristics, living habits, history of the disease and family history of cancer were collected by using a cancer risk assessment questionnaire, and the data of participants examined by LDCT were obtained from the hospitals participating in the program. The screening compliance was quantified by the screening participation rate, and it was calculated as the proportion of participants completing LDCT scan among high-risk population. The related factors of LDCT screening compliance were analyzed by using a multivariate logistic regression model. Results: The age of 17 983 participants was (56.52±8.22) years old. Males accounted for 51.9% (N=9 332), and 69.5% (N=12 495) had ever smoked, including former smokers and current smokers. A total of 6 269 participants were screened by LDCT, and the screening participation rate was 34.86%. The results of multivariate logistic regression analysis showed that the age group of 50 to 69 years old, female, passive smokers, alcohol consumption, family history of lung cancer and history of chronic respiratory diseases were more likely to be screened by LDCT, while the compliance of LDCT screening in current smokers was low. Conclusions: The LDCT screening compliance of the high-risk population of lung cancer in urban areas of China still needs to be improved. Age, sex, smoking, drinking, family history of lung cancer and history of chronic respiratory disease are associated with screening compliance.

[Bladder cancer incidence, mortality and temporal trends in China].

Objective: To describe the epidemiological characteristics of bladder cancer in 2015 and temporal trends in China. Methods: From 501 cancer registries in China, we collected data of cancer new cases, deaths and populations in 2015. After qualified, sex-specific, area-specific, age-specific and overall incidence/mortality rates (including age-standardized rates by Chinese standard population and by world standard population) and estimated cases of bladder cancer were calculated. Annual Percent Change (APC)/Average Annual Percent Change (AAPC) fitted from Log-line model was applied to evaluate the temporal trends of bladder cancer incidence/mortality rates from 1998 to 2015. Results: Bladder cancer is the 13(th) most common cancer in China. The crude, age-standardized by China standard population and by world standard population rates were 5.80/10(5), 3.60/10(5) and 3.57/10(5) for incidence, and 2.37/10(5), 1.31/10(5) and 1.32/10(5) for mortality, respectively. The incidence of bladder cancer ranked 7(th) in male. The incidence and mortality of male were 3.8 and 4.0 times as high as those of female. Bladder cancer incidence in urban area was 1.4 times as high as that in rural area. Incidence in western areas and middle areas of China were similar, which were lower than that in eastern areas. Geographical distribution characteristics of mortality was along with incidence.Both incidence and mortality remained low before 45 and 55 years old, then they increased rapidly and peaked at 80-84 and over 85 years old age group. Temporal trend analysis suggested that bladder cancer incidence in China increased in 1998-2007 (APC=2.58, P<0.001), while decreased from 2007 to 2015 (APC=-3.82, P<0.001). Bladder cancer mortality declined gradually, with APCs for 1998-2003 and 2003-2015 of 3.65% (P=0.002) and 1.42% (P<0.001). Conclusions: Bladder cancer is one of the main cancers in China. Its epidemiological distributions varies among different sex, area and age group. Both incidence and mortality of bladder cancer decline. More efforts on tobacco control should be made, and awareness of early diagnosis and early treatment could be enhanced for the middle-aged and elderly.

[Analysis of liver cancer screening results and influencing factors of urban residents in Zhejiang Province from 2013 to 2018].

Objective: To analyze the results of liver cancer screening for urban residents in Zhejiang Province from 2013 to 2018 and explore the influencing factors of the detection rate. Methods: From September 2013 to August 2019, six urban communities in Hangzhou (Jianggan District and Gongshu District), Ningbo (Haishu District, Yinzhou District and Jiangbei District), and Quzhou (Kecheng District) were selected as study sites. All permanent residents aged 40-74 (with local household registration and living in the local area for more than 3 years) were selected as the research subjects by using cluster sampling method. Patients with confirmed cancers and other serious medical and surgical diseases were excluded. A total of 166 293 research subjects were included. Basic demographic characteristics and risk factors of subjects were obtained through questionnaire surveys. The cancer risk assessment system was used to evaluate the liver cancer risk of subjects. Clinical screening participation and screening results for subjects at high risk of liver cancer were obtained from participating hospitals. The high-risk rate of liver cancer, clinical screening rate, detection rate of positive lesions, and detection rate of suspected liver cancer were analyzed. Poisson regression was used to analyze the influencing factors of detection rate. Results: The age of 166 293 subjects was (56.01±8.40) years, of which 41.36% (68 777) were males. A total of 23 765 high-risk subjects for liver cancer were screened (the high-risk rate was 14.29%). Among them, a total of 12 375 subjects participated in clinical screening for liver cancer, with a screening rate of 52.07% (12 375/23 765). A total of 297 cases of positive lesions were detected and the detection rate was 2.40% (297/12 375). A total of 8 cases of suspected liver cancer were detected, with a detection rate of 0.06% (8/12 375). The results of multivariate Poisson regression model analysis showed that compared with men, people who never smoked, never ate pickled food, had low oil content, and had no history of hepatobiliary disease, female, people who were smoking or had smoked, sometimes ate pickled food, ate higher oil content, and had a history of hepatobiliary disease had a higher detection rate of positive lesions. The incidence rate ratio (IRR) (95%CI) values were 1.98 (1.45-2.70), 2.23 (1.61-3.09)/2.08 (1.31-3.28), 1.82 (1.22-2.70), 1.44 (1.08-1.91), and 1.45 (1.05-2.00), respectively. Compared with those aged from 40 to 49 years old and without HBsAg test, the IRR (95%CI) of suspected liver cancer in people aged 70 to 74 years old and HBsAg positive were 16.30 (1.32-200.74) and 6.43 (1.24-33.22), respectively. Conclusion: The urban cancer early diagnosis and early treatment project in Zhejiang Province has good compliance in clinical screening of liver cancer. Abdominal ultrasound examination and serum alpha-fetoprotein detection are helpful to detect liver cancer and its precancerous lesions in the high-risk population of liver cancer.

[Results and cost-effectiveness of colorectal cancer screening program among urban residents in Zhejiang province, 2013-2018].

Objective: To analyze the results and cost-effectiveness of colorectal cancer (CRC) screening program among Zhejiang urban residents so as to provide evidence for further optimization of CRC screening strategies. Methods: Based on the Cancer Screening Program in Urban China which was conducted in Zhejiang province from 2013-2018, data related to the rates on compliance and detection through the CRC screening program among the 40-74 year-old residents were analyzed. Chi-square tests were used to compare the differences among groups, and multivariate logistic regression models were applied to explore the potential risk factors. Cost-effectiveness ratio (CER) was calculated by using the cost per lesion detected as the indicator. Results: Among all the 166 285 participants who completed the risk assessment questionnaire, 21 975 (13.2%) were recognized as under the high risk of CRC and 4 389 (20.0%) of them received the colonoscopy. The detection rates of CRC, advanced adenoma, and non-advance adenoma were 0.3% (11 cases), 2.7% (119 cases), and 5.2% (229 cases), respectively. Results from the multivariate logistic regression analyses showed that factors as age, gender, education level, smoking, drinking alcohol, previous fecal occult blood test (FOBT), polyp history, and family history of CRC were significantly associated with the compliance rate of colonoscopy while age, smoking and polyp history were significantly associated with the detection rate of advanced neoplasms (CRC and advanced adenoma). The costs were ï¿¥22 355.74 Yuan for every CER advanced neoplasm detection and ï¿¥264 204.18 Yuan per CRC detection, respectively. The CER decreased along with ageing. Sensitivity analysis showed that CERs were expected to decrease when the compliance rate of colonoscopy was increasing. Conclusions: The current screening program seems effective in detecting the precancerous colorectal lesions, but the relatively low compliance rate of colonoscopy restricting both the diagnostic yields and economic benefits. It is necessary to improve the awareness and acceptance of colonoscopy among the high-risk CRC population.

[Population's acceptance and attitude toward a novel fecal immunochemical test for colorectal cancer screening: a multi-center survey in China].

Objective: To investigate the acceptance and attitude toward a novel fecal immunochemical test (FIT) in colorectal cancer screening among populations in China. Methods: From May 2018 to May 2019, 2 474 people aged 50-74 years were recruited from five provinces of China (Zhejiang, Anhui, Jiangsu, Hunan and Yunnan). The general demographic characteristics, acceptance of the new FIT technology and operational difficulties through the whole screening process were obtained through questionnaire survey. Multivariate logistic regression model was used to analyze the factors related to difficulties encountered in sampling stool, reading and uploading results. Results: The subjects were (60.0±6.4) years old, and female, high school of above educated, unemployed/retired/other, married and with medical insurance status of "new rural cooperative medical care (NRCMC)" accounted for 61.7% (1 526), 29.0%(718), 34.3% (849), 92.7% (2 293) and 31.3%(775), respectively. The population's acceptance of the FIT technology was 94.8%. In the process of FIT screening, the percentage of occurred difficulties in sampling stool, reading and uploading results were 33.1% (819), 46.4% (1 147) and 62.9% (1 557), respectively. The main difficulties were the uncertainty about whether the sampling operation was standard (28.0%), the inability to accurately judge the result displayed (32.5%) and the need for help without using a smartphone (44.2%). The results of multivariate logistic regression model analysis showed that people aged 65-74 years old and with medical insurance status of "NRCMC" were more likely to encounter difficulties in sampling, and those who were unemployed/retired/other and living with 3 or more family members were less likely to encounter difficulties in sampling. Those aged 65-74 years old, farmers or migrant workers, and those with "NRCMC" were more likely to encounter difficulties in readingresults, and those with 3 or more family members were less likely to encounter difficulties in reading result. Those with "NRCMC" were more likely to encounter difficulties in uploading results, and those with education level of high school or above, living with more than 3 family members were less likely to encounter difficulties in uploading results. Conclusion: The acceptance of the new FIT technology is relatively high among the subjects. Age, education level, occupation, number of family members living together and medical insurance status might be related to difficulties encountered in sampling stool, reading and uploading results, and it can be further strengthened in terms of the technology and characteristics of sub-populations.

[Application of Joinpoint regression model in cancer epidemiological time trend analysis].

Joinpoint regression is a common method to investigate epidemiological time trend. Here we took cancer incidence trend analysis as an example to demonstrate the theory and practise of model from principles, steps, examples and attentions to give some references for following similar studies.

[Analysis on the age of onset of malignant tumors in cancer registration areas in Zhejiang Province from 2000 to 2015].

Objective: To study the age of onset of malignant tumors in cancer registration areas in Zhejiang province from 2000 to 2015. Methods: Based on the incidence data of cancer from 14 national cancer registration areas in Zhejiang province between 2000 and 2015, the incidence rate, average/standardized average age of onset, and age-specific incidence proportion were calculated, and standardized by Segi's world population. The population was divided into 7 age groups (0-29, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80 years old). The average age of onset and age-specific incidence proportion were analyzed by using a linear regression. The change trend of the proportion; the average annual percent change (AAPC) of the incidence rate was calculated by using the Joinpoint log-linear regression model. The birth cohort was constructed by using the standardized incidence rate and the year of onset of cancer, and the distribution characteristics of the age groups were described. Results: From calendar year 2000 to 2015, the average age of onset of malignant tumors in Zhejiang Province decreased from 59.7 to 57.6, with an average annual percent decrease of 0.09 year (P=0.033). After the merge of age groups, the standardized incidence proportion of 30-49 and ≥60 years old group standardization increased by an average annual change of 0.38% and decreased by an average annual change of 0.39%, respectively (both P values <0.001). The results of the log-linear regression model showed that the standardized incidence rate of the 30-39 and 40-49 years old age groups increased rapidly, with the AAPC (95%CI) about 5.2% (4.4%-6.0%) and 3.4% (2.5%-4.3%), respectively. The incidence rate of female increased rapidly, especially for 30-39 and 40-49 years old age groups with the AAPC about 6.2% (5.1%-7.2%) and 4.9% (4.0%-5.9%), respectively. The results of the birth cohort analysis showed that the population with different birth years in the same age groups saw an increasing trend with the increase of the birth year. Conclusion: The age of onset of malignant tumors in the cancer registration areas in Zhejiang Province is getting younger. The incidence rate and number of people with malignant tumors in 30-49 years old age group is evident. These characteristics are more obvious in female than that in male.

[Analysis of the incidence and mortality of leukemia in the cancer registration area of Zhejiang Province from 2010 to 2014].

The incidence and mortality rate of leukemia in the cancer registration areas of Zhejiang Province from 2010 to 2014 were analyzed to depict their epidemiological characteristics. From 2010 to 2014, 3789 new cases were diagnosed as leukemia in Zhejiang cancer registration areas, with a crude incidence rate of 6.47 per 100 000. The age-standardized incidence rate of males (standardized by China census data 2000) was 1.35 times that of females. The age-standardized incidence rate of urban areas was similar to that in rural areas (1.04∶1). From 2010 to 2014, 2 568 cases died due to leukemia, with a crude mortality rate of 4.38 per 100 000. The age-standardized mortality rate of males was 1.44 times that of females. The age-standardized mortality rate of urban areas was 0.99 times that of rural areas. The age-standardized incidence and mortality rate did not show any significant change from 2010 to 2014. The annual percent change of these two metrics was -2.36% (t=-0.62, P=0.579) and -3.46% (t=-2.41, P=0.095).

[Incidence and mortality of thyroid cancer in cancer registries of Zhejiang Province, 2010-2014].

From 2010 to 2014, a total of 17 150 new cases of thyroid cancer (TC) reported in cancer registration areas of Zhejiang province, the crude incidence rate of TC was 29.28/100 000. Using the Chinese Census in 2000 and the World Segi's population as the standard population, the age-standardized incidence rate by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 24.11/100 000 and 20.65/100 000 respectively. 256 TC death cases reported in all, the crude mortality rate was 0.44/100 000, the age-standardized mortality rate by Chinese standard population (ASMRC) and by World standard population (ASMRW) were 0.23/100 000 and 0.23/100 000 respectively. The ASIRC had a upward trend [annual percent change (APC)=28.62%, 95%CI: 21.00%-36.72%, t=13.10, P=0.001], while the ASMRC trend seemed stable (APC=0.73%, 95%CI: -7.47%-9.66%, t=0.27, P=0.803).

[Potential demand on cancer screening service in urban populations in China: a cross-sectional survey].

Objective: To understand the acceptance and personal demand for cancer screening service among the urban residents who had never been involved in any national level cancer screening programs in China and identify the key factors influencing the sustainability of cancer screening. Methods: A questionnaire survey was conducted among the local people aged 40-69 years selected through convenience sampling in 16 provinces of China to collect the general information about their demands for the screening service and others. Results: A total of 16 394 qualified questionnaires were completed. The average age of the people surveyed was (53.8±8.0) years, and men accounted for 44.6%. Without concerning the cost, 4 831 people (29.5%) had no demands for cancer screening services, the reasons are as follow: they would like to go to see doctors only when they were ill (61.8%); they had already received similar medical examinations (36.8%) and they would like to receive cancer screening directly without pre-health risk assessment (33.0%). Among the people surveyed, 10 795 (65.8%) had demands for cancer screening services, but they had choice on the screening settings, 43.7% wanted to receive the service in a general hospitals, while 36.5% would like to go to cancer-specialized hospitals. As for the level of medical institutes providing cancer screening service, 61.4% of the people surveyed would choose a higher level one, while 36.4% would choose an ordinary one. On screening procedures, 61.5% of the people surveyed would accept the mode of "clinical examination after questionnaire-assessment" . Conclusion: Most people surveyed had demands for cancer screening services and they would like to receive the screening services in higher level medical institutes. It is suggested to spread cancer screening know ledge, and strengthen the capability building of screening in grass root medical institutes to attract more people to receive cancer screening.

[Constituent and workload of service providers engaged in cancer screening: findings and suggestions from a multi-center survey in China].

Objective: To understand the constituent and workload of service providers engaged in cancer screening in China and provide evidence for the assessment of the sustainability of national cancer screening project. Methods: Using either questionnaire or online approach, the survey was conducted in 16 provinces, where Cancer Screening Program in Urban China (CanSPUC) was conducted, from 2014 to 2015. The medical institutes surveyed included hospitals [71.1% were class Ⅲ(A) hospitals], centers for disease control and prevention (CDCs) and community centers where cancer screening was undertaken during 2013-2015. The questionnaire survey was conducted among the staffs responsible for the overall coordination, management and implementation of the screening project to collect the information about the allocation, workload and compensation of the service providers from different specialties. Results: A total of 4 626 staffs were surveyed in this study, their average age was (37.7±9.5) years, and males accounted for 31.0%. Human resources allocated differed with province. The number of senior staff ranged from 6 (Chongqing) to 43 (Beijing) among the 8 comparable provinces. Among the staffs surveyed, 2 192 were from hospitals, 431 were from CDCs and 1 990 were from community centers, and the staffs who complained heavy workload accounted for 19.9%, 24.6% and 34.1% respectively (P<0.001). Among 227 staffs for overall coordination, 376 management staffs and 3 908 staffs for implementation, those who complained heavy workload accounted for 23.6%, 22.3% and 28.2% respectively (P<0.001). A total of 3 244 staffs (73.8%) got compensations for heavy workload. The compensation types were manly labor fee linked with workload (67.5%) and labor fee regardless workload (26.6%). Conclusion: The province specific differences in human resources allocation indicated the differences in screening project's organizing pattern and capability. It is suggested to conduct routine cancer screening (using specialized staffs), reduce the workload of the first line and community staffs and increase the compensation for the service providers for the sustainability of cancer screening project in China.

[Willingness and preferences of actual service suppliers regarding cancer screening programs: a multi-center survey in urban China].

Objective: From the perspective of actual service suppliers regarding cancer screening, this study aimed to assess the long-term sustainability of cancer screening programs in China. Methods: Based on a Cancer Screening Program in Urban China (CanSPUC), our survey focused on all the hospitals, centers for disease control and prevention (CDC) and community service centers across 16 provinces in China which participated in the programs between 2013 and 2015. All the managers (institutional/department level) and professional staff involved in the program were interviewed using either paper-based questionnaire or online approach. Results: A total of 4 626 participants completed the interview. It showed that the main gains from providing screening service emphasized promotion in social value (63.6%), local reputation (35.9%), and professional skills (30.6%), whereas difficulties encountered included inadequate compensation (30.9%) and discordance among information systems (28.3%). When the service remuneration amounts to about 50 Chinese Yuan per screening item, those professional staff self-reported that they would like to work overtime. More than half (63.7%) of the staff expressed willingness to provide routine screening service, the main expectations were to promote their reputation to the local residents (48.7%) and to promote professional skills (43.1%). Those who were not willing to provide screening services were worried about the potential heavy workload (59.8%) or being interfered with their routine work (49.8%). Further detailed results regarding the different organization types and program roles were presented in the following detailed report. Conclusions: Findings of gains and difficulties showed that if cancer screening is expected to become a long-term running, incentive mechanism from the program, external promotion and advocacy as well as capacity building should be strengthened; furthermore, rewards to staff's screening services should be raised according to the local situations. Results regarding the "willingness to provide service" showed that management of the program should also be strengthened, including information system building and inter-agency and inter-department coordination at the government levels.

[Willingness of potential service suppliers to provide cancer screening in urban China].

Objective: Based on the investment for potential suppliers of cancer screening services, we assessed the reasons that affecting their participation motivation related to the long-term sustainability of cancer screening in China. Methods: Hospitals that had never been involved in any national level cancer screening project were selected by using the convenient sampling method within the 16 project cities of Cancer Screening Program in Urban China (CanSPUC) with 1 or 2 hospitals for each city. All the managers from the institutional/department level and professional staff working and providing screening services in these hospitals, were interviewed by paper-based questionnaire. SAS 9.4 was used for logical verification and data analysis. Results: A total of 31 hospitals (18 hospitals at the third level and, 13 hospitals at the second level) and 2 201 staff (508 hospital and clinic unit managers, 1 693 professional staff) completed the interview. All the hospitals guaranteed their potential capacity in service providing. 92.5% hospital managers showed strong willingness in providing cancer screening services, while 68.3% of them declared that the project fund-raising function was the responsibility of the government. For professional staff, their prospect gains from providing screening service would include development on professional skills (72.4%) and material rewards (46.8%). Their main worries would include extra work for CanSPUC might interfere their routine work (42.1%) plus inadequate compensation (41.8%). Medians of the prospect compensation for extra work ran between 20 to 90 Chinese Yuan per screening item respectively. For all the screening items, workers from the third-level hospitals expected their compensation to be twice as much of those working at the second level hospitals. Conclusion: Professional capacity building and feasible material incentive seemed to be the two key factors that influenced the sustainability and development of the programs.

[Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China].

Objective: From an actual cancer screening service demanders' perspective, we tried to understand the preference on screening frequency and willingness-to-pay for the packaging screening program on common cancers and to evaluate its long-term sustainability in urban populations in China. Methods: From 2012 to 2014, a multi-center cross-sectional survey was conducted among the actual screening participants from 13 provinces covered by the Cancer Screening Program in Urban China (CanSPUC). By face-to-face interview, information regarding to preference to screening frequency, willingness-to-pay for packaging screening program, maximum amount on payment and related reasons for unwillingness were investigated. Results: A total of 31 029 participants were included in this survey, with an average age as (55.2±7.5) years and median annual income per family as 25 000 Chinese Yuan. People's preference to screening frequency varied under different assumptions ( " totally free" and "self-paid" ). When the packaging screening was assumed totally free, 93.9% of residents would prefer to take the screening program every 1 to 3 years. However, the corresponding proportion dropped to 67.3% when assuming a self-paid pattern. 76.7% of the participants had the willingness-to-pay for the packaging screening, but only 11.2% of them would like to pay more than 500 Chinese Yuan (the expenditure of the particular packaging screening were about 1 500 Chinese Yuan). The remaining 23.3% of residents showed no willingness-to-pay, and the main reasons were unaffordable expenditure (71.7%) and feeling'no need'(40.4%). Conclusions: People who participated in the CanSPUC program generally tended to choose high-frequency packaging screening program, indicating the high potential acceptance for scale-up packaging screening, while it needs cautious assessments and rational guidance to the public. Although about seven in ten of the residents were willing to pay, the payment amount was limited, revealing the necessity of strengthening individual's awareness of his or her key role in health self-management, and a reasonable payment proportion should be considered when establishing co-compensation mechanism.

[Cancer screening service utilization and willingness-to-pay of urban populations in China: a cross-sectional survey from potential service demander's perspective].

Objective: To explore the sustainability of cancer screening strategy from potential demander's perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China (CanSPUC) or any other national level cancer screening projects. Methods: Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results: A total of 16 394 participants were included in this study. Among them, 12.1% (1 984/16 394) had ever been on a cancer screening program. Populations with following characteristics as: being elderly (60-69 years, OR=1.27, 95% CI: 1.13-1.43), female (male, OR= 0.56, 95%CI: 0.50-0.62), having had higher education (high school/specialized secondary school, OR= 1.51, 95%CI: 1.35-1.70; college or over, OR=2.10, 95%CI: 1.36-3.25), working for public (OR=2.85, 95% CI: 2.26-3.59), enterprises or self-employed agencies (OR=1.32, 95% CI: 1.06-1.64), having higher income (60 000-150 000 Chinese Yuan, OR=1.55, 95%CI: 1.39-1.73; ≥150 000 Chinese Yuan, OR=2.57, 95% CI: 2.09-3.15), under basic medical insurance programs for urban employees/for government servants'(OR=1.15, 95% CI: 1.01-1.32), on basic medical insurance set for urban residents'/on commercial medical insurance programs etc. (OR=1.01, 95%CI: 0.84-1.22), were in favor of the services. When neglecting the fee for charge, 65.8% (10 795/16 394) of the participants said that they could accept the cancer screening program, particularly in those who had already been on the screening program (P<0.05). 61.2% (10 038/16 392) of all the participants showed the willingness-topay for a long-term packaging screening services, particularly in those who were relatively younger (60-69 years, OR=0.80, 95%CI: 0.74-0.87), working for public (OR=1.76, 95%CI: 1.56-1.98) or enterprise sectors or self-employed households (OR=1.32, 95%CI: 1.18-1.47), having higher income (60 000-150 000 Chinese Yuan, OR=1.51, 95%CI: 1.40-1.63; ≥150 000 Chinese Yuan,OR= 1.95, 95% CI: 1.60-2.38), utilized screening services (OR=2.18, 95% CI: 1.94-2.46). Conclusions: The rate of using the cancer screening services should be improved. Factors including age, gender, education, occupation, income and insurance appeared as major factors related to the use of cancer screening services. Willingness-to-pay seemed relatively high, but the amount of payment they could afford was limited. Factors including age, occupation, income and insurance appeared as major factors to the willingness-to-pay.

[Report of colorectal cancer incidence and mortality in China, 2013].

Objective: To estimate the incidence and mortality of colorectal cancer (CRC) in China, providing basic information of treatment and prevention in CRC. Methods: In 2016, National Central Cancer Registry (NCCR) collected registration data in 2013 from local cancer registries and assessed the data according to the auditing methods and evaluation criteria formulated by NCCR. 347 cancer registries submitted data of 2013 to NCCR. Qualified data from 255 registries was pooled, analyzed and stratified by area (urban/rural), gender, and age. CRC incidence and mortality were estimated using national population in 2013. Results: In 2013, the estimate of new cases diagnosed with CRC in China was 347.9 thousands, with 9.45% of new cancer cases. The crude incidence of CRC was 25.57/100, 000 (28.64/100, 000 for male and 22.34/100, 000 for female, 30.92/100, 000 in urban areas and 19.35/100, 000 in rural areas), ranking fourth in all cancer. The age-standardized rates by China population and by world population were 17.45/100, 000 and 17.20/100, 000, respectively. Cumulative incidence of CRC in China was 2.05%. The estimated CRC deaths of China was 164, 900 in 2013, accounting for 7.39% of overall cancer deaths. The crude mortality rate for CRC was 12.11/100, 000 (13.49/100, 000 for male and 10.67/100, 000 for female, 14.41/100, 000 in urban and 9.45/100, 000 in rural), ranking fifth in all cancer. The age-standardized rates by China population and by World population for mortality were 7.87/100, 000 and 7.76/100, 000, respectively. Cumulative mortality rate of CRC in China was 0.82%. For both of incidence and mortality, males had much higher rates than females, while urban areas had much higher rates than rural areas. The incidence and mortality rates of CRC increased greatly with age, especially after 35 or 40 years old, and reached the peak in the age group of 80 or 85+ year old. Conclusion: The disease burden of CRC was still serious in China. Primary prevention and early detection of CRC in China is crucial.

[The accuracy of mammography screening for breast cancer: a Meta-analysis].

Objective: To estimate the accuracy of mammography for population-based breast cancer screening. Methods: Studies of screening mammography performance were systematically reviewed in the Medline, Embase, Cochrane and China National Knowledge Infrastructure (CNKI) literature databases. The retrieval was performed by using related key words, including disease name, screening and intervention indicators and study type. A total of 1 167 records were retrieved by June 4, 2015 and those studies met the inclusion criteria were included for the current analysis. The numbers of true-positive, false-positive, false-negative and true-negative were originally extracted and calculated from each individual study. A QUADAS checklist was used to assess the quality of the studies. A curve of summary receiver operating characteristic (SROC) was applied as a comprehensive assessment of diagnosed accuracy. The pooled effect size of both sensitivity and specificity was quantitatively synthesized in both total population and subgroup with dense breast using the bivariate mixed-effects models. We conducted a sensitivity analysis in the studies with sample size over 100 000. Heterogeneity between studies was measured by the Q test and I2 statistic, and publication bias was evaluated by a funnel plot and the linear regression test. Results: A total of 48 publications with 8 551 873 individuals were identified for the final qualitative synthesis, most of them were from Europe area and American (38 studies), 8 were from Asia area, and 2 were from Oceania area. The studies were conducted during period of 1975-2013, and the age of study women ranged mostly from 40 to 75 years. The area under the SROC curve (AUC) was 0.95 (95%CI: 0.93-0.97). It was estimated that the pooled sensitivity and specificity were 0.81 (95%CI: 0.77-0.84) and 0.96 (95%CI: 0.94-0.96), respectively. The results were indicated stable and robust in sensitivity analysis. In the subgroup with dense breast, the sensitivity and specificity were 0.74 (95% CI: 0.61-0.83) and 0.93 (95% CI: 0.89-0.96), respectively. Funnel plot and test results showed there was no significant publication bias among the included studies. Conclusion: The accuracy of mammography is high for population-based breast cancer screening in women, although the sensitivity is lower in women with dense breast.