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Surveillance recommendations for gastric cancer (GC) in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions. We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool, and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance. In the multicenter community-based cohort, 75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021. Cumulative incidence rates (CIRs) of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests. Mixed-effects Cox regression models were used to detect potential factors for progression towards GC. A risk score was calculated as counts of selected factors. An independent cohort, including 26,586 participants was used for external validation. During a median follow-up of 6.25 years, CIRs of GC were 0.302%, 0.436%, and 4.756% for normal group, non-neoplastic (atrophic gastritis/intestinal metaplasia) and neoplastic lesions (low-grade/high-grade dysplasia), respectively (Ptrend<0.001). Four predictors, including male, ⩾60 years, smoking, and limited vegetable consumption, were selected for risk-stratification. High-risk patients (⩾3 risk factors) with non-neoplastic lesions showed higher GC risks (adjusted HR=7.73, 95%CI: 4.29–13.92), and their four-year CIR reached the one-year CIR of neoplastic lesions. Further categorizing non-neoplastic lesions by histological grade, both patients with moderate-to-severe lesions (aHR=3.07, 95%CI: 1.67–5.64) and high-risk patients with mild lesions (aHR=7.29, 95%CI: 3.58–14.86) showed higher risks. Consistent trends were observed in validation cohort. High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening. Our study provides evidence on supplementing current guideline recommendations. [ABSTRACT FROM AUTHOR]

Background The current recommended starting age for gastric cancer screening lacks unified guideline and individualized criteria. We aimed to determine the risk-stratified starting age for gastric cancer screening in China based on individuals' risk profiles and to develop an online calculator for clinical application. Methods In this multicenter, population-based, prospective study, we allocated participants enrolled between 2015 and 2017 (N = 59 771, aged 40-69 years) to screened and unscreened groups and observed them for primary endpoints: gastric cancer occurrence as well as all-cause and gastric cancer–specific death. Median follow-up was 6.07 years. To determine the reference starting age, the effectiveness of gastric cancer screening was assessed by age group after propensity score matching. Further, we categorized the calculated individual risk scores (using well-established risk factors) by quantile. Subsequently, we used age-specific, 10-year cumulative risk curves to estimate the risk-stratified starting age—that is, when the individual's risk level matches the reference starting age risk threshold. Results During follow-up, 475 gastric cancer case patients, 182 gastric cancer–related deaths, and 1860 all-cause deaths occurred. All-cause and gastric cancer–specific mortality decreased among screened individuals 45 years of age and older and 50 to 59 years of age, respectively. Thus, the average population (referent) starting age was set as 50 years. The 10-year cumulative risk of gastric cancer in the average population aged 50 years was 1.147%. We stratified the starting age using 8 risk factors and categorized participants as low-risk, medium-risk, and high-risk individuals whose risk-stratified starting age was 58, 50, and 46 years, respectively. Conclusion Although high-risk individuals warrant starting gastric cancer screening 3 to 5 years earlier than for the average population (aged 50 years), low-risk individuals can tolerate delayed screening. Our online, personalized starting age calculator will help with risk-adapted gastric cancer screening (https://web.consultech.com.cn/gastric/#/). [ABSTRACT FROM AUTHOR]

Deep sea water (DSW) is a globally utilized source of renewable energy and other resources. To understand the characteristics of DSW resources in the South China Sea, in July 2022, the Guangzhou Marine Geological Survey (GMGS) investigated temperature, salinity, pH, dissolved oxygen (DO), inorganic salts (DIN, PO43−-P, and SiO3-Si), heavy metals (Hg, Pb, As, and Cd), trace elements (Cu, Zn, Fe, Mn, Ni, Se, and Mo), and other related indicators. The results of this investigation elucidate the horizontal and vertical changes in the physical and chemical properties of deep sea water in the Xisha Sea. The surface seawater quality in Xisha was found to be excellent and to meet first-class seawater survey standards. However, the concentrations of various nutrient salts in the surface layer were relatively low. As the seawater depth increased, different trace elements and heavy metals exhibited variations, and the concentrations of various nutrients also gradually increased. [ABSTRACT FROM AUTHOR]

In order to achieve the goals of carbon neutrality and reduced carbon emissions, China is increasingly focusing on the development and utilization of renewable energy sources. Among these, ocean thermal energy conversion (OTEC) has the advantages of small periodic fluctuations and large potential reserves, making it an important research field. With the development of the "Maritime Silk Road", the Xisha Islands in the South China Sea will see a growing demand for electricity, providing the potential for OTEC development in this region. Optimal site selection of OTEC power plants is a prerequisite for developing thermal energy provision, affecting both the construction costs and future benefits of the power plants. This study establishes a scientific evaluation model based on the decision-making frameworks of geographic information systems (GISs) and multi-criteria decision-making (MCDM) methods, specifically the analytic hierarchy process (AHP) for assigning weights, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) to reclassify the factors, and weighted linear combination (WLC) to compute the suitability index. In addition to commonly considered factors such as temperature difference and marine usage status, this study innovatively incorporates geological conditions and maximum offshore distances of cold seawater based on cost control. The final evaluation identifies three suitable areas for OTEC development near the Xuande Atoll and the Yongle Atoll in the Xisha Sea Area, providing valuable insights for energy developers and policymakers. [ABSTRACT FROM AUTHOR]

The relationship between Helicobacter pylori (H. pylori) infection and upper gastrointestinal (UGI) cancers is complex. This multicenter, population‐based cohort study conducted in seven areas in China aimed to assess the correlation between current H. pylori infection and the severity of UGI lesions, as well as its association with the risk of gastric cancer (GC) and esophageal cancer (EC). From 2015 to 2017, 27,085 participants (aged 40–69) completed a standardized questionnaire, and underwent a 13C‐urea breath test. Then a subset underwent UGI endoscopy to assess the UGI lesion detection rates. All individuals were followed up until December 2021 to calculate the hazard ratios (HRs) for UGI cancers. H. pylori infection prevalence was 45.9%, and among endoscopy participants, 22.2% had gastric lesions, 19.2% had esophageal lesions. Higher detection rates of gastric lesions were noted in the H. pylori‐positive population across all lesion severity levels. Over a median follow‐up of 6.3 years, 104 EC and 179 GC cases were observed, including 103 non‐cardia gastric cancer (NCGC) cases and 76 cardia gastric cancer (CGC) cases. H. pylori‐infected individuals exhibited a 1.78‐fold increased risk of GC (HR 1.78, 95% confidence interval [CI] 1.32–2.40) but no significant increase in EC risk (HR 1.07, 95% CI 0.73–1.57). Notably, there was a higher risk for both NCGC and CGC in H. pylori‐infected individuals. This population‐based cohort study provides valuable evidence supporting the association between current H. pylori infection and the risk of both NCGC and CGC. These findings contribute to the empirical basis for risk stratification and recommendations for UGI cancer screening. [ABSTRACT FROM AUTHOR]

Cancer is a major public health problem and represents substantial disparities worldwide. This study reported estimates for 36 cancers across 185 countries by incidence, mortality, 5-year prevalence, mortality-to-prevalence ratio (MPR), and mortality-to-incidence ratio (MIR) to examine its association with human development index (HDI) and gross national income (GNI). Data were collected from the GLOBOCAN 2020. MPR and MIR were calculated by sex, age group, country, and cancer type and then summarized into totals. Segi's population and global cancer spectrum were used to calculate age- and type-standardized ratios. Correlation analyses were conducted to assess associations. Results showed that breast cancer was the most diagnosed cancer globally. Low- and middle-income countries had high MPR and MIR. Cancers of esophagus, pancreas, and liver had the highest ratios. Males and the older population had the highest ratios. HDI and GNI were positively correlated with incidence and mortality but negatively correlated with MPR/MIR. Substantial disparities in cancer burden were observed among 36 cancer types across 185 countries. Socioeconomic development may contribute to narrowing these disparities, and tailored strategies are crucial for regional- and country-specific cancer control. [ABSTRACT FROM AUTHOR]

An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries. We aimed to report cancer profiles and trends among young adults in China. Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults (ages 20–49 years) in China in 2017, and an age-period-cohort model was employed to estimate the average annual percent change (AAPC) in incidence and mortality from 2000 to 2017. All 25 cancer types were grouped into obesity- or overweight-associated cancers (12 cancer types) and additional cancers (13 cancer types). In 2017, there were 681,178 new cases and 214,591 cancer deaths among young adults in China. Among young adults, the most common cancers were thyroid, breast, cervical, liver, lung, and colorectal cancer, and the leading causes of cancer deaths were liver, lung, cervical, stomach, breast, and colorectal cancer. From 2000 to 2017, the cancer incidence increased for all cancers combined among young adults, with the highest AAPC (1.46%) for adults aged 20–24 years, while cancer mortality decreased, with the highest AAPC (−1.63%) for those aged 35–39 years. In conclusion, the cancer incidence in China has increased among young adults, while cancer mortality has decreased for nearly all ages. Cancer control measures, such as obesity control and appropriate screening, may contribute to reducing the increasing cancer burden among young adults. [ABSTRACT FROM AUTHOR]

Background: Screening reduces colorectal cancer (CRC) burden by allowing early resection of precancerous and cancerous lesions. An adequate selection of high-risk individuals and a high uptake rate for colonoscopy screening are critical to identifying people more likely to benefit from screening and allocating healthcare resources properly. We evaluated whether combining a questionnaire-based interview for risk factors with fecal immunochemical test (FIT) outcomes for high-risk assessment is more efficient and economical than a questionnaire-based interview-only strategy. Methods and findings: In this multicenter, population-based, prospective cohort study, we enrolled community residents aged 40 to 74 years in 29 provinces across China. From 2016 to 2020, a total of 1,526,824 eligible participants were consecutively enrolled in the Cancer Screening Program in Urban China (CanSPUC) cohort, and 940,605 were enrolled in the Whole Life Cycle of Cancer Screening Program (WHOLE) cohort, with follow-up to December 31, 2022. The mean ages were 56.89 and 58.61 years in CanSPUC and WHOLE, respectively. In the WHOLE cohort, high-risk individuals were identified by combining questionnaire-based interviews to collect data on risk factors (demographics, diet history, family history of CRC, etc.) with FIT outcomes (RF–FIT strategy), whereas in the CanSPUC cohort, high-risk individuals were identified using only interview-based data on risk factors (RF strategy). The primary outcomes were participation rate and yield (detection rate of advanced neoplasm, early-stage detection rate of CRCs [stage I/II], screening yield per 10,000 invitees), which were reported for the entire population and for different gender and age groups. The secondary outcome was the cost per case detected. In total, 71,967 (7.65%) and 281,985 (18.47%) individuals were identified as high-risk and were invited to undergo colonoscopy in the RF–FIT group and RF group, respectively. The colonoscopy participation rate in the RF–FIT group was 26.50% (19,071 of 71,967) and in the RF group was 19.54% (55,106 of 281,985; chi-squared test, p < 0.001). A total of 102 (0.53%) CRCs and 2,074 (10.88%) advanced adenomas were detected by the RF–FIT, versus 90 (0.16%) and 3,593 (6.52%) by the RF strategy (chi-squared test, both p < 0.001). The early-stage detection rate using the RF–FIT strategy was significantly higher than that by the RF strategy (67.05% versus 47.95%, Fisher's exact test, p = 0.016). The cost per CRC detected was $24,849 by the RF–FIT strategy versus $55,846 by the RF strategy. A limitation of the study was lack of balance between groups with regard to family history of CRC (3.5% versus 0.7%). Conclusions: Colonoscopy participation and screening yield were better with the RF–FIT strategy. The association with CRC incidence and mortality reduction should be evaluated after long-term follow-up. Author summary: Why was this study done?: ➢ The burden of colorectal cancer (CRC) in China has been growing in recent years. ➢ More specific selection of individuals to undergo colonoscopy, based on both questionnaire-based risk assessment and fecal immunochemical test (FIT) results, could result in more efficiency allocation of colonoscopy resources. ➢ There is limited evidence on the colonoscopy screening yield when combining FITs and risk assessment through questionnaires. What did the researchers do and find?: ➢ We calculated the baseline screening yield, participation, and cost per case detected in a national CRC screening program with a combined questionnaire-based risk assessment–FIT strategy. ➢ The baseline screening yield and participation rate were improved in the combined risk assessment–FIT group compared with risk factor assessment only group. ➢ The cost per CRC detected was $24,849 by the combined risk factor–FITs strategy, which was much lower than by the risk factor strategy ($55,846). What do these findings mean?: ➢ A combined CRC screening strategy is feasible in China. ➢ The association between the combined RF-FIT strategy with CRC incidence and mortality reduction should be evaluated after long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy is an effective treatment for indolent non-Hodgkin lymphoma (iNHL); however, the optimal radiotherapy dose remains to be determined. We hypothesize that a suitable dose may exist between 4 and 24 Gy. Methods: This prospective multicenter phase II trial intends to recruit 73 sites of iNHL patients, who will receive involved-site radiotherapy of 12 Gy in four fractions. The primary objective is the 6-month clinical complete response rate. Tumor tissue, blood and conjunctival specimens will be collected to identify potential predictive biomarkers. Discussion: The CLCG-iNHL-01 trial will evaluate the efficacy and toxicity of 12 Gy in patients with iNHL and provide information on a novel hypofractionation regimen of low-dose radiotherapy. Clinical Trial Registration: NCT05543070 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum. We extracted data in five aspects of cancer incidence, mortality, survival, staging distributions, and attribution to risk factors in China, the USA and worldwide from open-source databases. We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects, and compared cancer statistics between China and the USA. A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020, accounting for 25.1% and 30.2% of global cases, respectively. Lifestyle-related cancers including lung cancer, colorectal cancer, and breast cancer showed an upward trend and have been the leading cancer types in China. 41.6% of new cancer cases and 49.3% of cancer deaths occurred in digestive-system cancers in China, and the cancers of esophagus, nasopharynx, liver, and stomach in China accounted for over 40% of global cases. Infection-related cancers showed the highest population-attributable fractions among Chinese adults, and most cancers could be attributed to behavioral and metabolic factors. The proportions of stage I for most cancer types were much higher in the USA than in China, except for esophageal cancer (78.2% vs. 41.1%). The 5-year relative survival rates in China have improved substantially during 2000–2014, whereas survival for most cancer types in the USA was significantly higher than in China, except for upper gastrointestinal cancers. Our findings suggest that although substantial progress has been made in cancer control, especially in digestive system cancers in China, there was still a considerable disparity in cancer burden between China and the USA. More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients. [ABSTRACT FROM AUTHOR]

Cancer is a major contributor to global disease burden. Many countries experienced or are experiencing the transition that non‐infection‐related cancers replace infection‐related cancers. We aimed to characterise burden changes for major types of cancers and identify global transition patterns. We focused on 10 most common cancers worldwide and extracted age‐standardised incidence and mortality in 204 countries and territories from 1990 to 2019 through the Global Burden of Disease Study. Two‐stage modelling design was used. First, we applied growth mixture models (GMMs) to identify distinct trajectories for incidence and mortality of each cancer type. Next, we performed latent class analysis to detect cancer transition patterns based on the categorisation results from GMMs. Kruskal‐Wallis H tests were conducted to evaluate associations between transition patterns and socioeconomic indicators. Three distinct patterns were identified as unfavourable, intermediate and favourable stages. Trajectories of lung and breast cancers had the strongest association with transition patterns among men and women. The unfavourable stage was characterised by rapid increases in lung, breast and colorectal cancers alongside stable or decreasing burden of gastric, cervical, oesophageal and liver cancers. In contrast, the favourable stage exhibited rapid declines in most cancers. The unfavourable stage was associated with lower sociodemographic index, health expenditure, gross domestic product per capita and higher maternal mortality ratio (P <.001 for all associations). Our findings suggest that unfavourable, intermediate and favourable transition patterns exist. Countries and territories in the unfavourable stage tend to be socioeconomically disadvantaged, and tailored intervention strategies are needed in these resource‐limited settings. [ABSTRACT FROM AUTHOR]

Background: There were limited studies on the quantification of the modifiable and nonmodifiable lung cancer burden over time in China. Furthermore, the potential effect of risk factor reduction for lung cancer on gains in life expectancy (LE) remains unknown. Methods: This study explored temporal trends in lung cancer deaths and disability‐adjusted life years (DALY) attributable to modifiable risk factors from 1990 to 2019, based on the 2019 Global Burden of Disease Study. The abridged period life table method was used to quantify the effect of risk factors on LE. The authors used the decomposition approach to estimate contributions of aging metrics to change in the lung cancer burden. Results: Nationally, the majority of lung cancer deaths and DALYs were attributable to behavioral and environmental risk clusters. Potential gains in life expectancy (PGLE) at birth would be 0.78 years for males and 0.35 years for females if the exposure to risk factors was mitigated to the theoretical minimum level. Tobacco use had the most robust impact on LE for both sexes (PGLE: 0.71 years for males and 0.19 years for females). From 1990 to 2019, risk‐attributable age‐standardized death and DALY rates of lung cancer showed an increasing trend in both sexes; adult population growth imposed 245.9 thousand deaths and 6.2 million DALYs for lung cancer. Conclusions: The modifiable risk‐attributable lung cancer burden remains high in China. Effective tobacco control is the critical step toward addressing the lung cancer burden. Adult population growth was the foremost driver of transition in the age‐related lung cancer burden. Plain Language Summary: We estimate the lung cancer burden attributable to modifiable and nonmodifiable contributors and the effect of risk factor reduction for lung cancer on the life expectancy in China.The findings suggest that the majority of lung cancer deaths and disability‐adjusted life years were attributable to behavioral risk clusters, and the risk‐attributable lung cancer burden increased nationally from 1990 to 2019.The average gains in life expectancy would be 0.78 years for males and 0.35 years for females if the exposure to risk factors for lung cancer was reduced to the theoretical minimum risk exposure level.Adult population growth was identified as the foremost driver of variation in the aging lung cancer burden. This study emphasizes the crucial role of context‐specific interventions and policies targeted to reducing modifiable risk exposure and tackling population aging to effectively mitigate the lung cancer burden and ultimately improve the life expectancy. [ABSTRACT FROM AUTHOR]

Background: The ability of lung cancer screening to manage pulmonary nodules was limited because of the high false‐positive rate in the current mainstream screening method, low‐dose computed tomography (LDCT). We aimed to reduce overdiagnosis in Chinese population. Methods: Lung cancer risk prediction models were constructed using data from a population‐based cohort in China. Independent clinical data from two programs performed in Beijing and Shandong, respectively, were used as the external validation set. Multivariable logistic regression models were used to estimate the probability of lung cancer incidence in the whole population and in smokers and nonsmokers. Results: In our cohort, 1,016,740 participants were enrolled between 2013 and 2018. Of 79,581 who received LDCT screening, 5165 participants with suspected pulmonary nodules were allocated into the training set, of which, 149 lung cancer cases were diagnosed. In the validation set, 1815 patients were included, and 800 developed lung cancer. The ages of patients and radiologic factors of nodules (calcification, density, mean diameter, edge, and pleural involvement) were included in our model. The area under the curve (AUC) values of the model were 0.868 (95% CI: 0.839–0.894) in the training set and 0.751 (95% CI: 0.727–0.774) in the validation set. The sensitivity and specificity were 70.5% and 70.9%, respectively, which could reduce the 68.8% false‐positive rate in simulated LDCT screening. There was no substantial difference between smokers' and nonsmokers' prediction models. Conclusion: Our models could facilitate the diagnosis of suspected pulmonary nodules, effectively reducing the false‐positive rate of LDCT for lung cancer screening. [ABSTRACT FROM AUTHOR]

While the life expectancy of cancer survivors has substantially improved over time in the United States, the extent to which cancer patients are cured is not known. Population‐level cure patterns are important indicators to quantify cancer survivorships. This population‐based cohort study included 8978,721 cancer patients registered in the Surveillance, Epidemiology and End Results (SEER) databases between 1975 and 2018. The primary outcome was cure fractions. Five‐year cure probability, time to cure and median survival time of uncured cases were also assessed. All four measures were calculated using flexible parametric models, according to 46 cancer sites, three summary stages, individual age and calendar year at diagnosis. In 2018, cure fractions ranged from 2.7% for distant liver cancer to 100.0% for localized/regional prostate cancer. Localized cancer had the highest cure fraction, followed by regional cancer and distant cancer. Except for localized breast cancer, older patients generally had lower cure fractions. There were 38 cancer site and stage combinations (31.2%) that achieved 95% of cure within 5 years. Median survival time of the uncured cases ranged from 0.3 years for distant liver cancer to 10.9 years for localized urinary bladder cancer. A total of 117 cancer site and stage combinations (93.6%) had increased cure fraction over time. A considerable proportion of cancer patients were cured at the population‐level, and the cure patterns varied substantially across cancer site, stage and age at diagnosis. Increases in cure fractions over time likely reflected advances in cancer treatment and early detection. [ABSTRACT FROM AUTHOR]

Background: The participation and results for liver cancer screening are rarely reported. The aim of this study was to determine the participation rates and factors affecting participation rates as well as to report the detection rate for liver cancer in an organized screening program.Methods: The organized screening program for liver cancer was conducted in 12 rural sites. The risk of developing liver cancer was initially evaluated for each participant. High-risk individuals were offered α-fetoprotein measurement and ultrasonography examination. Potential risk factors associated with the participation rate were screened by fitted generalized linear mixed logistic regression models through reporting odds ratios (ORs) with 95% CIs.Results: A total of 358,662 eligible participants completed the basic surveys, and 54,745 were evaluated to be at high risk of liver cancer. Of these high-risk individuals, 40,543 accepted the screening services. Determinants of participation for screening behavior included older age, being female, being positive for hepatitis B surface antigen, having a family history of liver cancer, chronic depression, and low income. The detection rate for liver cancer was estimated to be 0.41% (95% CI, 0.35-0.48).Conclusions: This study reported several significant factors associated with the screening behaviors for liver cancer.Lay Summary: Participation rate and results for liver cancer screening in rural areas are rarely reported. The determinants associated with adherence rates and early detection rate of liver cancer in an organized screening program for liver cancer were assessed. A possible positive correlation between the participation rates and the early detection rate was observed among attendees of screening. These new finds could be beneficial to increasing the participation rate of screening. [ABSTRACT FROM AUTHOR]

Background: Patients with hepatitis B virus (HBV) were invited to receive ultrasound and alpha-protein examination directly in China. However, not all HBV carriers need to be subjected to further tests. This study aimed to develop a feasible primary screening method to narrow down potential high-risk individuals of liver cancer among populations with HBV. Methods: Based on a prospective community-based cohort, potential risk factors were selected as the predictors, including age, sex, smoking, alcohol consumption, diabetes, liver cancer family history, liver diseases in mothers, source of water, body mass index (BMI), and psychological trauma. Cox proportional regression model was applied to predict the 3-year absolute risk of liver cancer and derive risk scores. The area under receiver operating characteristic curve (AUROC) and calibration plot were used to assess the performance of the model. Bootstrap resampling was used for internal validation. Results: Age, sex, BMI, alcohol consumption, liver diseases in mothers, and psychological trauma were independent risks of liver cancer. The 1- to 3-year AUROC of the prediction model was 71.15% (95% CI, 66.88–75.42), 71.16% (95% CI, 67.42–74.90), and 72.95% (95% CI, 64.20–81.70), respectively. The predicted risk was calibrated well with the observed liver cancer risk. Bootstrap resampling showed that C-index was 0.70 (0.67–0.74). A 32-point risk score was also developed and a score over 5 was identified for patients at extremely high risk. Conclusions: A user-friendly primary screening method was created that could estimate the 3-year absolute risk of liver cancer and identify extremely high-risk individuals among the population with HBV. [ABSTRACT FROM AUTHOR]

Background: The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions.Methods: A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty.Results: The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year.Conclusions: By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China. [ABSTRACT FROM AUTHOR]

Background Esophageal cancer (EC) is one of the most common cancers, causing many people to die every year worldwide. Accurate estimations of the spatial distribution of EC are essential for effective cancer prevention. Methods EC mortality surveillance data covering 964 surveyed counties in China in 2014 and three classes of auxiliary data, including physical condition, living habits and living environment data, were collected. Genetic programming (GP), a hierarchical Bayesian model and sandwich estimation were used to estimate the spatial distribution of female EC mortality. Finally, we evaluated the accuracy of the three mapping methods. Results The results show that compared with the root square mean error (RMSE) of the hierarchical Bayesian model at 6.546 and the sandwich estimation at 7.611, the RMSE of GP is the lowest at 5.894. According to the distribution estimated by GP, the mortality of female EC was low in some regions of Northeast China, Northwest China and southern China; in some regions downstream of the Yellow River Basin, north of the Yangtze River in the Yangtze River Basin and in Southwest China, the mortality rate was relatively high. Conclusions This paper provides an accurate map of female EC mortality in China. A series of targeted preventive measures can be proposed based on the spatial disparities displayed on the map. [ABSTRACT FROM AUTHOR]

High-accuracy spatial distribution estimation is crucial for cancer prevention and control. Due to their complicated pathogenic factors, the distributions of many cancers' mortalities appear blocky, and spatial heterogeneity is common. However, most of the commonly used cancer mapping methods are based on spatial autocorrelation theory. Sandwich estimation is a new method based on spatial heterogeneity theory. A modified sandwich estimation method suitable for the estimation of cancer mortality distribution is proposed in this study. The variances of cancer mortality data are used to fuse sandwich estimation results from various auxiliary variables, the feasibility of which in estimating cancer mortality distributions is explained theoretically. The breast cancer (BC) mortality of the Chinese mainland in 2005 was taken as a case, and the accuracy of the modified sandwich estimation method was compared with that of the Hierarchical Bayesian (HB), the Co-Kriging (CK) and the Ordinary Kriging (OK) methods. The accuracy of the modified sandwich estimation method was better than the HB, the CK and the OK methods, and the estimation result from the modified sandwich estimation method was more likely to be acceptable. Therefore, this study represents an attempt to apply the sandwich estimation method to the estimation of cancer mortality distributions with strong spatial heterogeneity, which holds great potential for further application. [ABSTRACT FROM AUTHOR]

Gene-environment interactions may increase gastric cancer (GC) risk. Seven susceptibility loci identified by genome-wide association studies (GWASs) suggest that genetic factors play a role in gastric carcinogenesis. Meanwhile, Helicobacter pylori ( H. pylori) infection, smoking, and alcohol drinking are also important environmental factors for gastric cancer. However, studies to explore the role of gene-environment interactions in gastric carcinogenesis, and particularly the relationship between the seven susceptibility loci and their potential interactions with H. pylori infection, smoking, and alcohol drinking in risk of GC, and severe intestinal metaplasia (IM)/dysplasia, have been inconclusive. A total of 1273 subjects in a Chinese population were recruited, and genotyping was carried out using the competitive allele-specific PCR (KASP) method. Unconditional logistic regression was applied to model the associations between genetic polymorphisms and the disease risk. Effect modifications by H. pylori infection, smoking and alcohol drinking were evaluated. PSCA rs2294008/rs2976392 showed a significant, multiplicative interaction with H. pylori infection in risk of GC. Meanwhile, PRKAA1 rs13361707 had an additive interaction with H. pylori infection. SLC52A3 rs13042395 showed an interaction with alcohol drinking in risk of GC. Moreover, three SNPs, MUC1 rs4072037, ZBTB20 rs9841504 and PRKAA1 rs13361707, were associated with precancerous gastric lesions (severe IM/dysplasia). Our data suggest that genetic predisposition factors identified by GWAS may interact with environmental risk factors, Particularly for H. pylori infection and alcohol consumption, to increase the risk of GC. [ABSTRACT FROM AUTHOR]

Background Esophageal cancer has been a common cancer in China for many years. Using the most recent data collected from the National Central Cancer Registry, we present estimates of the esophageal cancer burden in China in 2011. Methods Age-specific incidence and mortality rates by gender and area for 18 age groups were calculated based on data from 177 qualified population-based cancer registries. The number of new cases of esophageal cancer and cancer deaths were computed by multiplying these rates by the 2011 population. Crude incidence and mortality rates of esophageal cancer were estimated. Results The estimated number of new esophageal cancer cases and deaths were 291 238 and 218 957, respectively. The crude incidence and mortality rates for esophageal cancer were 21.62/100 000 and 16.25/100 000, respectively. The age-standardized incidence and mortality rates by world population were 15.83/100 000 and 11.62/100 000, respectively. Both the incidence and mortality rates of esophageal cancer were higher in rural areas than in urban areas, and in men than in women. The age-specific esophageal cancer incidence and mortality rates increased with age. In China, squamous cell cancer was the most common pathological type of the disease. Conclusion Esophageal cancer remains a major public health issue in China. Primary and secondary prevention are essential for disease control. [ABSTRACT FROM AUTHOR]