Qidong: a crucible for studies on liver cancer etiology and prevention

Jianguo Chen, Jian Zhu, Gaoren Wang, et al.


Qidong (Jiangsu, China) has been of interest to cancer epidemiologists and biologists because, until recently, it was an endemicarea for liver cancer, having amongst the highest incidence rates in the world. The establishment of the Qidong Cancer Registrytogether with the Qidong Liver Cancer Institute in 1972 has charted the patterns of liver cancer incidence and mortality in a stablepopulation throughout a period of enormous economic, social, and environmental changes as well as of improvements in healthcare delivery. Updated incidence trends in Qidong are described. Notably, the China age-standardized incidence rate for livercancer has dropped by over 50% in the past several decades. Molecular epidemiologic and genomic deep sequencing studies haveaffirmed that infection with hepatitis B virus as well as dietary exposure to aflatoxins through contamination of dietary staples suchas corn, and to microcystins – blue-green algal toxins found in ditch and pond water – were likely important etiologic factors thataccount for the high incidence of liver cancer in this region. Public health initiatives to facilitate universal vaccination of newbornsagainst HBV and to improve drinking water sources in this rural area, as well as economic and social mandates serendipitouslyfacilitating dietary diversity, have led to precipitous declines in exposures to these etiologic factors, concomitantly drivingsubstantive declines in the liver cancer incidence seen now in Qidong. In this regard, Qidong serves as a template for the globalimpact that a package of intervention strategies may exert on cancer burden.


Liver cancer incidence; hepatitis B virus; aflatoxin; microcystin; screening; chemoprevention; mutational signature

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