Review
Liver cancer epidemic in China: Past, present and future

https://doi.org/10.1016/j.semcancer.2010.11.002Get rights and content

Abstract

Primary liver cancer is the second most common malignancy, and currently results in 360,000 incident cases, and 350,000 deaths a year in China. For the past four decades, three national surveys on cancer mortality during the periods of 1973–1975, 1990–1992, and 2004–2005 have made it possible to estimate China's past and present liver cancer epidemic. The mortality rates of liver cancer were 17.6 and 7.3 per 100,000 for males and females in 1973–1975, 29.0 and 11.2 per 100,000 in 1990–1992, and 37.55 and 14.45 per 100,000 in 2004–2005, respectively. Recent monitoring from some regional cancer registries, which cover 5.7% of the total population in China, has revealed the distribution, disparities and trends of liver cancer in rural and urban areas. HBV and aflatoxins have been identified as major causal factors, that act individually and synergistically of liver cancer in the etiology. Other agents such as HCV, genetic susceptibility or genetic polymorphisms may also play important roles in the development of liver cancer. Great effort aimed at primary and Secondary prevention of this cancer, such as universal hepatitis B vaccination in children, chemoprevention in selected population, and early detection in at-risk population, has been undertaken. These strategies might be further emphasized in the future for the effective prevention of liver cancer in China.

Introduction

Primary liver cancer (or hepatocellular carcinoma, HCC) is the sixth most common cancer worldwide in terms of numbers of cases of 626,000, and the third most common cause of death from cancer (598,000 deaths annually) [1]. Since over 80% of deaths are in developing countries, liver cancer has been a major public health problem in these parts of the world. China is the area of the world most affected by liver cancer, with an age-standardized incidence rate of 37.9 per 100,000 for men, and of 14.2 per 100,000 [1]. In China nowadays, liver cancer is the second major cause of cancer deaths, with a mortality rate of 26.26 per 100,000 (males: 37.55 and females: 14.45 per 100,000), accounting for 19.33% of all sites of cancers. Accordingly, the estimated annual incident cases and deaths of liver cancer are 360,000 and 350,000, respectively [2]. This article will review the mortality rates, and incidence rates of liver cancer based on the data acquired during the past four decades, and discuss the possible trends and key preventive strategies of this disease in China.

Section snippets

Cancer registration

There was no nationwide cancer registration report system in China a decade before 2000, although a few cancer registries such as Shanghai, Tianjin and Qidong published their cancer registration data in Cancer Incidence in Five Continents (CI5) in the 1990s [3], [4]. Cancer incidence/mortality rates by site from some of China's cancer registries have been published elsewhere [5], [24], [81]. After the year 2002, about 50 cancer registries in China, covering 73 million people (5.7% of the total

Crude mortality rate and age-standardized rate

According to 158 samples available from the survey of death causes for the periods of 2004–2005 in the third survey in China, the crude rate (CR) of liver cancer was 26.26 per 100,000, being 19.33% (37,465/193,841) of all deaths due to cancer. The age-standardized rate by China's population (ASRc) of 1982 was 17.86 per 100,000, and the age-standardized rate by the world population (ASRw) of 1985 was 23.48 per 100,000. The CR, ASRc, and ASRw were 37.55, 26.44, and 34.61 per 100,000, for men, and

The first nationwide retrospective survey for the period of 1973–1975

The mortality rates of liver cancer were 12.5 per 100,000, and 17.6 and 7.3 per 100,000 for males and females in this period. The ASRc and ASRw were 14.52 and 19.96 per 100,000 for men, and 5.61 and 8.07 per 100,000 for women, respectively. In this survey, for the first time, the geographical patterns of liver cancer were investigated and it was found that the mortality rate of liver cancer was higher in the southeast coastal areas than inland, and even higher at the mouth of the Yangtze river

Incidence monitoring throughout cancer registration

Since 2004, the National Central Cancer Registry has set up a mechanism for cancer annual registration. For the first time, it published the China Cancer Registration Annual Report (CCRAR) 2004 [27], and CCRAR 2005 in 2008 [28], covering 45 cancer registries, of which 34 of them were enrolled into the analysis. These data formed the registration-based source of cancer epidemic in China, which provided another estimation of mortality and incidence of liver cancer. These two years’ results are

Conflicts of interest

The authors declare that there are no conflicts of interest.

References (86)

  • L. Yang et al.

    Statistics on cancer in China: cancer registration in 2002

    Eur J Cancer Prev

    (2005)
  • National Office for Cancer Prevention and Control

    Survey of cancer mortality in China 1990–1992

    (2008)
  • The Editorial Committee

    Atlas of cancer mortality in the People's Republic of China

    (1979)
  • Chen Z (Ministry of Public Health of China), editor. The report on the third national retrospective sampling survey of...
  • J.G. Chen et al.

    A thirty-one year prospective follow-up program on the HBsAg carrier state and primary liver cancer in Qidong, China

    Chin J Epidemiol

    (2010)
  • IARC. GLOBOCAN 2002, Tables: By cancer, liver/Tables: By population/Tables: Age-specific. Lyon, IARC [2009-05-30]....
  • A.E. Grulich et al.

    Cancer incidence in Asian migrants to New South Wales, Australia

    Br J Cancer

    (1995)
  • C.J. Chen et al.

    Cancer epidemiology and control in Taiwan: a brief review

    Jpn J Clin Oncol

    (2002)
  • R.S.P. Tu et al.

    A cross-border comparison of hepatitis B testing among Chinese residing in Canada and the United States

    Asian Pac J Cancer Prev

    (2009)
  • P. Mangtani et al.

    Cancer mortality in ethnic South Asian migrants in England and Wales (1993–2003): patterns in the overall population and in first and subsequent generations

    Br J Cancer

    (2010)
  • S.L. Kwong et al.

    Asian subgroups and cancer incidence and mortality rates in California

    Cancer

    (2005)
  • M. McCracken et al.

    Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities

    CA Cancer J Clin

    (2007)
  • B.A. Miller et al.

    Cancer incidence and mortality patterns among specific Asian and Pacific Islander population in the U.S.

    Cancer Causes Control

    (2008)
  • M.P. Curado et al.
    (2007)
  • S.W. Zhang et al.

    Mortality of primary liver cancer in China from 1990 through 1992

    Chin J Oncol

    (1999)
  • Q.J. Wang et al.

    The trend of cancer incidence in urban Beijing from 1982 to 1997

    Bull Chin Cancer

    (2001)
  • F.S. Yeh

    Primary liver cancer in Guangxi

  • J.G. Chen et al.

    Trends in the incidence of cancer in Qidong, China, 1978–2002

    Int J Cancer

    (2006)
  • K.J. Cao et al.

    Cancer incidence and mortality in Guangzhou City from 2000 to 2002

    Chin J Cancer

    (2008)
  • T.M. Lin et al.

    Mortality of hepatoma and cirrhosis of liver in Taiwan

    Br J Cancer

    (1986)
  • National Office for Cancer Prevention and Control & National Central Cancer Registry, Disease Prevention and Control Bureau, Ministry of Health

    Chinese cancer registry annual report: cancer incidence and mortality in Chinese cancer registration areas in 2004

    (2008)
  • National Office for Cancer Prevention and Control, & National Central Cancer Registry, Disease Prevention and Control Bureau, Ministry of Health

    Chinese cancer registry annual report: cancer incidence and mortality in Chinese cancer registration areas in 2005

    (2008)
  • National Office for Cancer Prevention and Control & National Central Cancer Registry, Disease Prevention and Control Bureau, Ministry of Health

    Chinese cancer registry annual report: cancer incidence and mortality in Chinese cancer registration areas in 2006

    (2010)
  • A. Jemal et al.

    Cancer statistics

    CA Cancer J Clin

    (2010)
  • M.J. Hayat et al.

    Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program

    Oncologist

    (2007)
  • A. Jemal et al.

    Global patterns of cancer incidence and mortality rates and trends

    Cancer Epidemiol Biomarkers Prev

    (2010)
  • M.J. Thun et al.

    The global burden of cancer: priorities for prevention

    Carcinogenesis

    (2010)
  • M.C. Robotin et al.

    Preventing primary liver cancer: how well are we faring towards a national hepatitis B strategy?

    Med J Aust

    (2008)
  • A.H. Olsen et al.

    Cancer mortality in the United Kingdom: projections to the year 2025

    Br J Cancer

    (2008)
  • E.T. Chang et al.

    The burden of liver cancer in Asians and Pacific Islanders in the Greater San Francisco Bay Area, 1990 through 2004

    Cancer

    (2007)
  • C.Y. Zhang et al.

    Epidemiological analysis of primary liver cancer in the early 21st century in Guangxi province of China

    Chin J Cancer

    (2010)
  • Z.L. Wei et al.

    An analysis of trend on incidence of liver cancer in Fusui Guangxi 1974–2003

    Chin Cancer

    (2007)
  • H. Lin et al.

    Evaluation of the secular trend of the mortality of liver cancer in urban of Dalian, 1991–2005

    Prev Med Trib

    (2008)
  • Cited by (229)

    • Exposure to neonicotinoid insecticides and their characteristic metabolites: Association with human liver cancer

      2022, Environmental Research
      Citation Excerpt :

      Cancer is a multifactorial disease attributed by radiation, lifestyle, smoking, viruses, and environmental pollutants (i.e., pesticides) (Hazarika and Hazarika, 2013). Liver cancer ranks the sixth of most diagnosed cancer and the second most common malignancy (Chen and Zhang, 2011; Fu and Wang, 2018). Pesticide exposure was regarded as a critical environmental risk factor associated with liver cancer development (de Brito Sa Stoppelli and Crestana, 2005; Jaga and Dharmani, 2005; Parrón et al., 2014).

    View all citing articles on Scopus
    View full text