Cancer incidence in urban Shanghai, 1973-2010: an updated trend and age-period-cohort effects.

BACKGROUND: To provide a comprehensive overview of temporal trends in cancer incidence during 1973-2010 in urban Shanghai. METHODS: The estimated annual percent changes (EAPCs) for the whole period and for the time segments in age-standardized incidence rates (ASR) were evaluated with Joinpoint analysis. Age-period-cohort (APC) models were modeled to examine the effects of age, period and birth cohort on cancer incidence. RESULTS: The overall ASR decreased slightly and significantly in males (EAPC of -0.41) but increased significantly in females (EAPC of 0.57) during 1973-2010 in urban Shanghai. The incidence trend was not linear and varied by time segments. During the most recent 10 years (2001-2010), the ASR in males decreased by 1.65% per year and stabilized in females. Incidence rates continued to decline during 1973-2010 for esophagus, stomach, and liver cancer in both sexes, as well as male lung cancer and cervix cancer. It should be noted that it was the first time to document a significant decline in lung cancer incidence among males during 1973-2010 with EAPC of -0.58%, and a notable upward for cervix cancer since 1996 with EAPC of 8.94%. Unfavorable trends in incidence were observed for the most common cancer sites in the 38 years period: colorectum, gallbladder & biliary tract, pancreas, kidney, bladder, brain & central nervous system (CNS), thyroid, non-Hodgkin's lymphoma (NHL), prostate, female breast, corpus uteri, and ovary. APC analysis showed age, period and birth cohort yielded different effects by cancer sites. CONCLUSIONS: The observed trends primarily reflect dramatic changes in socioeconomic development and lifestyles in urban Shanghai over the past four decades.

[Recent incidences and trends of childhood malignant solid tumors in Shanghai, 2002-2010].

OBJECTIVE: To examine the recent incidences and trends of childhood malignant solid tumors in Shanghai. METHOD: Data from the population-based Shanghai Cancer Registry and related retrospective survey were used to analyze the patterns of incidence and trends of malignant solid tumors diagnosed between 2002 and 2010 in children aged 0-14 years. The distributions of incidences were described according to gender, age and cancer types which were classified according to International Classification of Childhood Cancer (ICCC). Annual age-standardized rates (ASRs) were adjusted by the world standard population. Approximate confidence intervals for standardized rate ratios (SRR) based Poisson distribution test-based methods were used to assess changes in incidence over the period 2002 - 2006 and 2007 - 2010. RESULT: (1)A total of 868 cases of childhood malignant solid tumors were diagnosed in Shanghai during 2002 - 2010, accounting for 65.8% of all childhood cancers. The ASR of 2002 - 2010 was 80.2 per million for all solid tumors. (2) The ASR was higher in boys (86.3 per million) than in girls (73.8 per million) with SRR 1.2 (95%CI 1.0 - 1.3). Incidence rate was the highest in the first five years of life with 93.4 per million. The age-specific incidence rates in 5 - 9 and 10 - 14 age groups were 65.2 and 79.3 per million, respectively. (3) CNS tumors, lymphomas, germ cell tumors, neuroblastoma, and soft tissue sarcomas were the top 5 most common solid tumors in children, with the incidence rate of 23.8, 11.0, 7.8, 7.7 and 6.8 per million, respectively. The patterns of subgroups varied in different age groups. Blastomas, such as neuroblastoma, retinoblastoma, were more common in the children aged 0 - 4 years, whereas epithelial carcinomas and bone tumors developed more frequently in elder children aged 10 - 14 years. (4) Compared with the ASR in 2002 - 2006, the ASR for both genders in 2007 - 2010 had no substantial changes (78.7 per million in 2002 - 2006 and 82.9 per million in 2007 - 2010). However, among boys, the incidence rate in 2007 - 2010 was significantly higher than that in 2002 - 2006 with SRR 1.2 (95%CI: 1.0 - 1.4). For specific subgroups of cancer, there were no substantial changes. Some cautions should be taken when interpreting results involving a small number of cases per year and those with wide 95% confidence intervals. CONCLUSION: The incidence rate of pediatric malignant solid tumors among males was higher than females during 2002 - 2010, and it differed among different age groups with the highest in the first five years of life. CNS tumor was the most common type of solid tumors in children. This was a unique characteristics comparing with adult reflected in disease spectrum and age of onset. The patterns of incidence and its trends for childhood malignant solid tumors in Shanghai could provide a basis for etiologic research and preventive interventions. The findings also suggest an urgent need for longer population-based surveillance to verify the pattern and changing trends.

Population-based survival for childhood cancer patients diagnosed during 2002-2005 in Shanghai, China.

BACKGROUND: There have been no population-based studies on cancer survival among children aged 0-14 years in China. In this study, we aimed to characterize the cancer survival among children in Shanghai. PROCEDURE: Childhood cancer cases registered by the Shanghai Cancer Registry between 2002 and 2005 and enrolled in the Shanghai Childhood Survival Study were included in this study. We used Kaplan-Meier product-limit method for survival analysis and Cox proportional hazards models for investigating the effects of various prognostic factors. RESULTS: The median follow-up time was 5.4 years (range 0-8.9 years). The 5-year observed survival for all childhood cancers combined was 55.7% (95% CI: 51.7-59.6%). For leukemia, lymphoma, and central nervous system tumors, the three most common types of childhood cancer, 5-year survival rates were 52.2%, 58.8%, and 41.2%, respectively. Higher 5-year survival rates were observed for epithelial cancer (88.9%), malignant renal tumors (86.7%), germ cell and other gonadal tumors (78.4%), and retinoblastoma (75.0%). Cancers with poor prognosis included sympathetic nervous system tumors (57.9%), soft tissue sarcoma (54.1%), bone tumors (52.6%), and liver cancer (33.3%). There were no significant differences between survival rates by gender and age groups. Compared with those reported in the USA and Europe, the survival rates for all cancers combined and the three most common types in Shanghai were lower. CONCLUSIONS: The survival rate for children aged 0-14 diagnosed with cancer in Shanghai during 2002-2005 was at the medium level. There was a substantial survival difference from childhood cancers between Shanghai and specific developed countries.

[Estimates and prediction on incidence, mortality and prevalence of breast cancer in China, 2008].

OBJECTIVE: To estimate the incidence, mortality and 5-year prevalence of breast cancer in China, in 2008. METHODS: Data from 36 cancer registries and the Third National Death Survey in China (2004 - 2005) were used to estimate the incidence, mortality and 5-year prevalence of breast cancer in China in 2008. Mathematical models were used to predict the breast cancer incidence and mortality in the next 20 years. RESULTS: In 2008, the incidence of breast cancer was 169 452 (14.2%) with the incidence rate of 21.6/100 000, ranking the second among all the cancers. Deaths due to breast cancer was 44 908 (6.1%) with mortality as 5.7/100 000, which ranked the sixth among all the cancers. The 5-year prevalence rate of breast cancer in China was 120.8/100 000, taking up the proportion as 26.1%, ranking the first among all the cancers. Breast cancer was seen more frequently among people aged between 40 to 70. Our data on prediction showed that the incidence and mortality of breast cancer in China would gradually increase in the next 20 years. CONCLUSION: Breast cancer was the second cause of incidence rates among all the cancers in China, with both increasing incidence and mortality. Population at most risk for breast cancer were those aged 40 to 70, who deserved special programs for prevention and control.