Hu D, Yu J, Feng J, Liu P, Chen JM, Zhang HL. Comparison and trend analysis of cancer incidence in China and globally in 2022. World J Clin Oncol 2025; 16(6): 107016 [DOI: 10.5306/wjco.v16.i6.107016]
Corresponding Author of This Article
Ji-Ming Chen, Professor, Department of Oral Ophthalmology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China. cqjimi0567@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Evidence Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dan Hu, Jiao Feng, Ji-Ming Chen, Department of Oral Ophthalmology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing 400014, China
Jiang Yu, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Ping Liu, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Hao-Ling Zhang, Department of Biomedical Science, Advanced Medical and Dental Institute, University Sains Malaysia, Penang 13200, Malaysia
Hao-Ling Zhang, School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Co-corresponding authors: Ji-Ming Chen and Hao-Ling Zhang.
Author contributions: Hu D and Yu J conceived the concept, wrote the original draft and should be considered as co-first authors; Feng J and Liu P analyzed the data; Chen JM and Zhang HL contributed to the supervision of this manuscript, Chen JM provided strategic guidance during the design phases, ensuring the overall quality and direction of the research, Zhang HL similarly played a critical role in project management and data interpretation, offering valuable insights and assisting in the review and revision of the manuscript to ensure its academic rigor. The contributions of both authors were invaluable throughout the research process, and should be considered as co-corresponding authors; and all the authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Ming Chen, Professor, Department of Oral Ophthalmology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China. cqjimi0567@163.com
Received: March 13, 2025 Revised: April 8, 2025 Accepted: April 29, 2025 Published online: June 24, 2025 Processing time: 99 Days and 11.1 Hours
Abstract
In April 2024, the International Agency for Research on Cancer (IARC) published the 2022 Global Cancer Statistics Report in CA: A Cancer Journal for Clinicians, focusing on the incidence of 36 kinds of cancers in 185 countries or regions around the world, different gender, geographical area and Human Development Index differences in different economic regions. Previously, China's National Cancer Center (NCC) collaborated with IARC to estimate China's cancer incidence data using actual and up-to-date surveillance data from China. This collaboration aimed to ensure consistency between the cancer burden data published by IARC and NCC. In February of the same year, the NCC released the latest estimated statistics regarding the cancer incidence in China for 2022 in the Journal of the National Cancer Center. This research seeks to gather and evaluate the latest reports on cancer incidence from both a global perspective and within China for the year 2022. By conducting a multi-dimensional analysis of cancer incidence patterns, gender distribution, geographic spread, and trends over time, the study highlights the distinctions in the burden of malignant tumors between China and the global scenario. Additionally, it explores the risk factors associated with high-incidence cancer types and examines the current status of prevention and control measures. The findings aim to serve as a valuable reference for developing effective cancer prevention and control strategies in China.
Core Tip: This study compares the 2022 cancer incidence data from China and globally, analyzing trends in gender, geographic distribution, and economic factors. It highlights significant disparities in cancer burden between China and the world, examining high-incidence cancer types and associated risk factors. The findings emphasize the need for targeted prevention and control strategies, offering valuable insights for enhancing cancer management in China.
Citation: Hu D, Yu J, Feng J, Liu P, Chen JM, Zhang HL. Comparison and trend analysis of cancer incidence in China and globally in 2022. World J Clin Oncol 2025; 16(6): 107016
In April 2024, the International Agency for Research on Cancer (IARC) released an article titled “Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries” in CA: A Cancer Journal for Clinicians[1]. IARC collects and analyzes morbidity, mortality and survival data from population-based cancer registries around the world, calculates and publishes the burden of cancer disease biennially in countries across the globe, and has published three global cancer statistics reports since 2018[1-3]. GLOBOCAN 2022 provided a comprehensive overview of global cancer incidence and mortality in 2022, including subgroup analyses stratified by gender, geographic region, and economic levels based on the Human Development Index (HDI). Additionally, it projected the overall cancer burden, focusing on incidence rates expected for the year 2050.
China's National Cancer Center (NCC) was in charge of reporting statistics on cancer epidemiology in China regularly. In February 2024, the NCC published the article "Cancer incidence and mortality in China, 2022" in the Journal of the National Cancer Center[4]. Prior to this, to ensure that China's actual monitoring data aligned with the figures released by the IARC, the NCC obtained approval from the National Health Commission and the IARC to concurrently publish China's cancer burden data alongside GLOBOCAN 2022. The 2022 global cancer statistical report leveraged data from 700 cancer registries covering the year 2018. It employed an age-period-cohort model to forecast cancer incidence for 2022 and examined trends in cancer incidence from 2000 through 2018.
This research will compile and evaluate the most recent statistical data on the cancer burden in China and worldwide for 2022. It aims to perform a thorough analysis of the disparities in cancer burden between China and global levels, focusing on overall incidence as well as variations by gender and geographic region. Furthermore, it will explore the underlying reasons for these trends in detail. By placing the epidemiological changes in China in a global context, the study aims to reveal the differences in disease spectrum, urban-rural differences, trends, and prevention and control improvement directions, and the results will provide a basis for optimizing screening programs, customizing health education programs, and reforming the medical insurance payment system. Finally, establishing a framework for comparing the cancer burden between China and the West can not only promote domestic precision prevention and control, but also integrate the unique experience of the world's largest developing country into the international cancer prevention and control system.
CANCER DATA SOURCES
Sources of global cancer incidence data
GLOBOCAN 2022 estimates the global cancer burden using the most reliable available data on incidence and mortality of malignant tumors across 185 countries and regions. The locations and types of cancer were uniformly coded by the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), ranging from C00 to C97, and 36 major cancer species were classified. An exception is the occurrence data for non-melanoma skin cancer (NMSC), which excludes basal cell carcinoma of the skin. In addition, some cancer registries also classify bladder carcinoma in situ and undetermined benign and malignant tumors as bladder malignancies. Unlike GLOBOCAN 2018, gallbladder cancers in GLOBOCAN 2022 only include cases with ICD-10 coded as C23, excluding malignancies (C24) in other and unspecified sites of the biliary tract.
The demographic information originates from the 2019 World Population Prospects released by the United Nations Population Division. The concept of HDI is defined according to the Human Development Report 2021-2022, which is published by the United Nations Development Programme. HDI is a comprehensive indicator to measure the development level of a country or region, which is mainly composed of three aspects: Life expectancy, education and income. A higher HDI value indicates a more advanced level of development. The HDI classifies countries or regions into four categories: Low, medium, high and very high. Among them, China is assessed as a high HDI country, a country with a higher level of human development.
More detailed data for GLOBOCAN 2022 can be found in the online database Global Cancer Observatory, which is updated and refined from time to time. The statistics in this article are based on the article published in CA: A Cancer Journal for Clinicians[1].
Sources of cancer incidence data in China
The most recent projections for new cancer cases in China for 2022, published by NCC in February 2024, as well as the GLOBOCAN 2022 data for China provided by IARC, are derived from the findings of the NCC's measurements in China. Data sources include 2018 morbidity and mortality data from 700 cancer registries in 31 Chinese provinces (autonomous regions and municipalities directly under the Central Government) and the Xinjiang Production and Construction Corps, as assessed by the NCC for data validity, completeness and comparability. The registered total population was 523 million, representing 37.22% of China's total population in 2018. Furthermore, the data sources encompass statistics from 106 registries spanning the period from 2010 to 2018. These registries consistently provide high-quality data for the Annual Report of Chinese Tumor Registration. The national population data are supplied by the National Bureau of Statistics. All diagnosed cancer cases were categorized and coded according to the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) and the ICD-10.
The NCC employs Segi's World Standard Population Age Structure to compute the Age-Standardized Incidence Rate (ASIR). ASIR refers to the incidence of disease calculated after standardized treatment in a specific population. Because age is an important factor affecting health status and disease occurrence, differences in age distribution across regions or populations can lead to inaccurate direct comparisons of incidence rates. Segi's World Standard Population is a reference population composition used for standardization, based on age distribution data for multiple countries and regions around the world. The standard provides a uniform way to calculate and compare ASIR across different populations. Using Segi's World standard population to calculate ASIR is an important epidemiological tool that effectively eliminates the effect of differences in age structure on disease incidence comparisons.
To examine the data, NCC utilized a Bayesian age-period-cohort model. This analytical framework organized information from 106 registries, covering the period from 2010 to 2018, into 18 distinct age categories with five-year intervals and nine time periods with one-year intervals. Obtain Annual Percentage Change (APC) by city/country, sex and age group, average APC (AAPC) is presented across three separate time spans: 2000 to 2018, 2009 to 2018, and 2014 to 2018. APC is the percentage change in a variable between a given year and the previous year. It can be used to assess how much an indicator has increased or decreased over the course of a year. APC can help analyze the change trend of a certain indicator in the short term, which is suitable for the comparison of annual data. By looking at changes in the APC, it is possible to quickly identify growth or decline in a given area. AAPC represents the mean of the annual percentage changes computed over an extended time frame. It combines data from multiple years to provide a smoother picture of trends. The AAPC provides a long-term perspective suitable for analysing trends in multi-year data. By calculating AAPC in different time periods, the amplitude of change in different stages can be compared, which provides a basis for policy formulation and resource allocation.
OVERVIEW OF GLOBAL CANCER INCIDENCE
Top 10 cancers in the world
In 2022, it is estimated that there will be 19.96 million new cancer cases globally. When NMSC is excluded, the number of new cancer cases is projected to be 18.73 million. The top 10 types of cancer comprised 63.83% of all cases. Lung cancer topped the list, representing 12.42% of total cases, succeeded by female breast cancer (11.56%), colorectal cancer (9.65%), prostate cancer (7.35%), stomach cancer (4.85%), liver cancer (4.33%), thyroid cancer (4.11%), cervical cancer (3.31%), lymphoma (3.18%) and bladder cancer (3.07%, Table 1). It is worth noting that in 2022, lung cancer surpassed female breast cancer and once again became the first cancer occurrence in the world compared to 2020. The incidence of thyroid cancer has risen sharply, from ninth in 2020 to seventh in 2022. The incidence of esophageal cancer dropped significantly, from 8th to 11th place.
Table 1 Estimated numbers of new cancer cases and cancer incidence rates in China and globally in 2022.
In 2022, the global incidence of new cancer cases was slightly higher among men, with 10.31 million new cases reported in males, representing 51.62% of the total number of cases. Approximately 9.66 million new cancer cases were diagnosed in women, representing 48.38% of the total cases. Among the top 10 cancers in men, lung cancer ranks first, accounting for 15.25%. This was followed by prostate cancer (14.23%), colorectal cancer (10.37%), gastric cancer (6.09%), liver cancer (5.82%), bladder cancer (4.57%), lip, oral and pharyngeal cancer (4.44%), esophageal cancer (3.54%), lymphoma (3.49%) and leukemia (2.70%, Table 2). Among the top 10 cancers in women, breast cancer ranks first, accounting for 23.77%. This was followed by lung cancer (9.41%), colorectal cancer (8.87%), cervical cancer (6.84%), thyroid cancer (6.36%), uterine cancer (4.35%), gastric cancer (3.53%), ovarian cancer (3.36%), lymphoma (2.85%) and liver cancer (2.74%, Table 2). Notably, three types of digestive system cancers—colorectal cancer, liver cancer, and gastric cancer—were among the top 10 most common cancers in both males and females.
Table 2 Cancer incidence by sex in China and globally in 2022.
Geographical distribution of global cancer incidence
There are significant regional differences in the global distribution of cancer. In 2022, it is projected that nearly half (49.2%) of all new cancer cases globally will be concentrated in Asia, a region that is home to 59.2% of the world's population. In addition to the population base factor, the possible reason is that the proportion of lung cancer, breast cancer and digestive tract tumors with high incidence in Asia is relatively high. Africa, which comprises 17.6% of the global population, accounts for 5.9% of new cancer cases worldwide. This discrepancy may be influenced by the region's age structure, as the average life expectancy in Africa is less than 65 years. Europe has less than a tenth of the world's population (9.6%), but accounts for about a fifth of new cancer cases (22.4%). The Americas (13.1% of the global population) accounted for 21.1% of new cases worldwide. The above differences in cancer distribution between different regions of the world are basically the same as in 2020. In summary, variations in cancer incidence across regions primarily reflect differences in exposure to major risk factors for common cancers, the distribution of various malignancy types, and the effectiveness of prevention, early detection, and treatment measures.
The geographic distribution of the most common cancer types varies by sex across 185 countries or regions in 2022. For males, prostate cancer was the leading type in 118 regions, followed by lung cancer in 33 regions, liver cancer in 11 regions, colorectal cancer in 9 regions, and stomach cancer in 8 regions. Among females, breast cancer was the most common in 157 regions, while cervical cancer ranked first in 25 regions. Notably, lung cancer was the most prevalent type among women in China and North Korea.
Global HDI distribution of cancer incidence
From a global perspective, cancer incidence is on the rise as HDI levels increase. Among men, the top 3 cancers with high/very high HDI incidence were lung cancer (40.1/100000), prostate cancer (35.5/100000), and colorectal cancer (27.3/100000). The top 3 world standard incidence rates in middle/Low HDI areas were prostate cancer (12.6/100000), lung cancer (10.5/100000) and oral cancer (10.0/100000). In women, regardless of HDI levels, the incidence of breast cancer far exceeds that of other cancers. In high and very high HDI regions, the second most common cancer among women was lung cancer, with an incidence rate of 20.7 per 100000. In contrast, in low and medium HDI regions, cervical cancer ranked second, with an incidence rate of 19.3 per 100000.
Global cancer burden forecast by 2050
The IARC research team expects the number of new cancer cases worldwide to exceed 35 million in 2050, a 77% increase compared to 20 million in 2022, with population growth and aging being the main drivers of the changing burden of cancer disease. It is projected that the global population will increase from 8 billion to 9.7 billion between 2022 and 2050, with relatively higher absolute increases in new cancer cases in high HDI (including China) and very high HDI (4.8 million and 3.9 million, respectively, with increases of 64% and 42%). The increase was most significant in areas with low HDI (from 800000 to 2 million cases, a 142% increase). In medium HDI regions, including India, the number of new cancer cases is expected to increase from 2.4 million in 2022 to 4.8 million in 2050, representing a 99% rise. This significant growth underscores the ongoing increase in the global burden of cancer.
OVERVIEW OF CANCER INCIDENCE IN CHINA
Top 10 cancers in China
In 2022, the number of new cancer cases in China accounted for 24.17% (4824700/19964800) of the total number of cancer cases in the world[4], and China's population accounted for about 18.3% of the global population. The crude incidence rate for all cancer sites in China in 2022 was 341.75 per 100000 people (351.44 per 100000 in men and 331.64 per 100000 in women). The ASIR was 201.61/100000. Based on the sequence of onset, the top 10 most common types of cancer in China were lung cancer (21.98%), colorectal cancer (10.72%), thyroid cancer (46.61%), liver cancer (36.77%), stomach cancer (35.87%), female breast cancer (35.72%), esophageal cancer (22.40%), cervical cancer (15.07%) and prostate cancer (13.42%), and pancreatic cancer (11.87%, Table 1). It is worth noting that lung cancer, stomach cancer and cervical cancer rank 1st, 5th and 8th respectively in China and the world at the same time. Colorectal cancer, liver cancer and gastric cancer, three kinds of digestive system tumors, rank among the top 10 in the incidence of cancer in China and the world.
Gender distribution of cancer incidence in China
In 2022, China reported 2533900 new cases of male cancer, representing 52.52% of the total, while females accounted for 47.48% with 2290800 new cases. Among the top ten cancers in males, lung cancer was the most prevalent with 658700 new cases, followed by colorectal, liver, stomach, esophageal, prostate, thyroid, bladder, pancreatic cancers, and lymphoma. Notably, more than 40% of global incidences of male lung, liver, esophageal, and thyroid cancers occurred in China. For females, lung cancer also topped the list with 401900 new cases, followed by breast, thyroid, colorectal, cervical, stomach, liver, uterine, ovarian cancers, and esophageal cancer. It is important to highlight that lung cancer was the leading cause of cancer incidence for both genders in China. Additionally, three digestive system tumors—colorectal, liver, and gastric cancers—were among the top ten cancers for both males and females. Detailed statistics are provided in Table 2.
Urban and rural distribution of cancer incidence in China
The estimated number of new cancers in urban areas in China in 2022 is 2903900, including 1469500 in men and 1434400 in women. The age-standardized incidence rates by Chinese standard population (ASIRC) was 212.95/100000, 215.23/100000 for males, and 214.20/100000 for females. Lung cancer ranked first in urban areas (611600), accounting for 21.1% of all cancers in urban areas, followed by thyroid cancer (347400), colorectal cancer (330500), female breast cancer (242800) and liver cancer (205700). The top 5 cancers accounted for 59.5% of all cancers in urban areas. The most common cancers in urban areas were lung cancer (367300), colorectal cancer (191100) and liver cancer (151000) among men, and thyroid cancer (251000), lung cancer (244300) and breast cancer (242800) among women.
In 2022, the number of new cancer cases in rural areas in China was estimated to be 1920800, including 1064400 in males and 856400 in females. The ASIRC was 199.65/100000, 207.52/100000 in males, and 195.85/100000 in females. In terms of incidence of male and female cancers in rural areas, lung cancer ranked first, with 449000 cases, accounting for 23.4% of all cancers in rural areas, followed by colorectal cancer (196600), gastric cancer (170400), liver cancer (161900) and esophageal cancer (119500). The top 5 cancers accounted for 57.1% of all cancers in rural areas. The most common cancers in rural areas were lung cancer (291400), stomach cancer (119800), liver cancer (116900) and colorectal cancer (116600) among men, and lung cancer (157600), breast cancer (114400) and thyroid cancer (90200) among women.
Cancer incidence trends in China
During the period 2000-2018, ASIR for all cancers in China increased significantly by about 1.4% per year. The aggregate ASIR for all cancers remained stable among men from 2000 to 2018. In contrast, the ASIR for women increased significantly by 2.6% annually, primarily driven by rising diagnoses of thyroid cancer (AAPC = 15.7%) and cervical cancer (AAPC = 7.3%). Additionally, the ASIR for uterine cancer (3.4%), lung cancer (3.1%), and breast cancer (3.1%) also showed an upward trend among women, whereas the ASIR for esophageal cancer (6.4%), gastric cancer (2.8%), and liver cancer (2.4%) exhibited a downward trend.
Between 2014 and 2018, the ASIR for thyroid cancer (AAPC = 8.5%) and lung cancer (AAPC = 8.3%) exhibited significant increases among women. The average annual growth rate of cervical cancer ASIR declined from 14.8% prior to 2008 to 1.7% in 2018. For men, the AAPC showed an increase in incidence for thyroid cancer (16.9%), prostate cancer (7.0%), and colorectal cancer (2.7%), while it decreased for esophageal cancer (3.5%), stomach cancer (2.9%), and liver cancer (2.3%). Trends in lung cancer remained stable from 2000 to 2014. During the period from 2014 to 2018, there were notable increases in ASIR for thyroid cancer (9.2%), prostate cancer (5.1%), colorectal cancer (3.5%), and lung cancer (2.7%) among men.
CANCER PREVENTION AND CONTROL STRATEGIES IN CHINA
In 2022, there were about 4.82 million new cancer cases in China, accounting for 24.17% of the total cancer cases in the world, while the Chinese population accounted for only 18.3% of the global population. From 2000 to 2018, the ASIR for all cancers showed a significant annual increase of approximately 1.4%. This indicates that the disease burden of cancer in China is relatively heavy and continues to rise[5-7]. There was significant difference between urban and rural cancer spectrum in China. The top 5 cases in urban areas were lung cancer, thyroid cancer, colorectal cancer, breast cancer and liver cancer. In rural areas, the top 5 cases were lung cancer, colorectal cancer, stomach cancer, liver cancer and esophageal cancer, mainly digestive tract tumors. The disparities in cancer prevention and treatment between urban and rural areas in China are primarily manifested in the incidence of cancer and the allocation of medical resources. In rural regions, the incidence of cancer tends to be higher, particularly for types such as esophageal, gastric, and liver cancers. This trend is strongly associated with lifestyle factors, environmental exposure, and the scarcity of medical resources in rural settings[8]. Regarding cancer prevention and control, rural areas face significant challenges, including insufficient medical resources, a shortage of healthcare professionals, and geographic remoteness. These obstacles result in limited access to cancer screening, diagnosis, and treatment for rural residents, thereby impacting early detection rates and therapeutic outcomes[9]. Moreover, rural residents generally exhibit lower levels of health literacy and awareness regarding cancer prevention, further complicating efforts to manage cancer in these regions[10]. To address these challenges, it is essential to enhance medical infrastructure in rural areas and improve access to cancer screening and diagnostic services. The establishment of regional cancer centers that offer comprehensive cancer treatment options, including diagnosis, chemotherapy, and surgery, could significantly improve cancer care in rural areas[11]. Additionally, strengthening health education initiatives is crucial to raising health awareness and disseminating cancer prevention knowledge among rural populations. Community-based educational programs and outreach activities can effectively promote awareness of cancer screening and early diagnosis[10]. Furthermore, policymakers should consider urban-rural disparities when formulating targeted cancer prevention and control strategies. For instance, implementing tailored screening and prevention programs for prevalent cancer types in rural areas, supported by adequate financial resources and resource reallocation, could help bridge the urban-rural gap[8]. Through these interventions, the overall effectiveness of cancer prevention and control in rural areas can be substantially enhanced, ultimately improving the health status of rural residents. China's vast territory, different levels of economic development, allocation of medical resources and differences between urban and rural areas determine that the cancer spectrum in China has the characteristics of cancer prevalence in both high and low HDI areas, and the prevention and control situation is complicated.
In 2022, lung cancer is projected to be the most prevalent cancer in China, topping the list for both males and females. It stands as the primary driver of the increasing cancer burden in the country. Smoking remains the most significant risk factor for lung cancer, and China houses the world's largest population of smokers. According to the "China Smoking Hazards Report 2020" published by the National Health Commission, the number of smokers in China exceeds 300 million. In 2018, the smoking prevalence among individuals aged 15 and older in China was 26.6%, with the smoking rate for males reaching 50.5%. In addition, the risk of female lung cancer may be related to factors such as outdoor air pollution, indoor coal-fired heating, and kitchen cooking fumes[12]. It is recommended to enhance tobacco control initiatives through increased public awareness campaigns regarding the hazards of smoking, thereby promoting stricter enforcement of smoking prohibition policies in public areas. For high-risk populations, such as individuals aged 45 and older and long-term smokers, low-dose spiral computed tomography screening should be performed in line with the Chinese Medical Association's Lung Cancer Clinical Diagnosis and Treatment Guidelines (2024 edition). This approach aims to facilitate early detection and prompt treatment. Given the multitude of risk factors associated with lung cancer, it is anticipated that a lung cancer incidence risk model will become an essential tool for identifying high-risk groups in the future[13].
In 2022, China reported 517000 new cases of colorectal cancer, making it the second in cancer incidence. Notably, the ASIR among men has approached levels observed in high and very high HDI regions. As HDI increases, the incidence of colorectal cancer continues to rise, imposing a significant economic burden on both society and individuals. Therefore, it is particularly important to propose targeted prevention and control measures based on the three key dimensions of the HDI: Health, education, and living standards. In the health dimension, the prevention of colorectal cancer primarily relies on lifestyle modifications and early screening. Studies have shown that lifestyle factors such as smoking, alcohol consumption, lack of physical activity, and high body mass index significantly affect the incidence of colorectal cancer[14]. Hence, public health officials should promote the prevention and management of these modifiable risk factors through national policies to reduce the incidence of colorectal cancer[15]. Additionally, early screening is particularly crucial for high-risk populations. Optimizing early screening strategies and rigorously implementing diagnostic and treatment guidelines can effectively reduce the burden of colorectal cancer[15]. Secondly, in the education dimension, enhancing public awareness of risk factors and preventive measures for colorectal cancer is key. Educational activities conducted by cooperatives can significantly improve members' understanding of green prevention technologies, thereby promoting the adoption of healthy behaviors[16]. Similarly, health education regarding colorectal cancer should include the promotion of healthy dietary habits and the enhancement of awareness related to early screening among high-risk individuals. Finally, in the living standards dimension, the incidence of colorectal cancer is closely related to the level of socioeconomic development. Research indicates that improving quality of life can facilitate regional economic development and, to some extent, narrow the disparities between regions[17]. Therefore, enhancing residents' living standards, particularly in economically disadvantaged areas, through strengthened policy support and social security, will contribute to the coordinated development of regional economies and help reduce the incidence of colorectal cancer. Given China’s vast territory and the economic and cultural differences between regions, it is essential to formulate corresponding screening policies based on the incidence characteristics of different regions and populations. Special emphasis should be placed on improving screening detection for early-onset and familial/regionally clustered colorectal cancer cases. Early diagnosis and treatment may effectively reduce the disease burden of CRC in China and contribute to the establishment of colorectal cancer prevention and treatment guidelines that are uniquely suited to the Chinese context.
In 2022, the incidence of thyroid cancer in China saw a rapid increase, particularly among women, with a significant rise in ASIR. Notably, over 50% of new thyroid cancer cases globally occurred in China that year. Compared to 2020, when it ranked seventh, thyroid cancer incidence in China surged to third place in 2022. Specifically, the world-standardized incidence rate for women more than doubled, increasing from 17.5 per 100000 in 2020 to 36.5 per 100000 in 2022. This phenomenon can primarily be ascribed to the widespread adoption and application of imaging, ultrasound, and biopsy technologies. These advancements facilitate the detection of previously undiagnosable micro-thyroid cancers, thereby markedly enhancing the thyroid cancer detection rate[18,19]. Concurrently, dynamic environmental changes and shifts in lifestyle patterns also constitute critical factors that warrant attention[20]. In China, the large population base, combined with substantial improvements in economic conditions, has led to heightened awareness of health and increased participation in medical examinations. As a result, the number of newly diagnosed cases of thyroid cancer has risen rapidly, further exacerbating the disease burden associated with thyroid cancer in China. However, overdiagnosis of thyroid cancer has also caused widespread concern. It is recommended that thyroid cancer screening should be carried out cautiously in the general population to avoid overdiagnosis and overtreatment[21]. Additionally, efforts should be intensified to standardize the diagnosis and treatment of thyroid cancer, thereby enhancing the quality of medical care.
China is among the countries with a high incidence of liver cancer, which ranked fourth in cancer incidence within the country in 2022. The disease exhibits particularly high incidence rates in rural and economically underdeveloped regions. The incidence of liver cancer in China is significantly higher than the global average, closely related to multiple factors. Firstly, China is a high-prevalence area for hepatitis B virus (HBV) infection, which is one of the primary causes of liver cancer. Although the rate of HBV infection has decreased in recent years due to vaccination programs, its long-term impact remains significant[22]. Secondly, the incidence of non-alcoholic steatohepatitis is also rising in China, correlated with the rapid economic development of the country, significant changes in lifestyle, shifts in dietary patterns, and accelerated urbanization, leading to an increase in obesity rates[23]. Additionally, a culture of alcohol consumption is prevalent in certain regions, making alcohol intake another important risk factor for liver cancer[24]. Furthermore, in rural areas, the distribution of medical resources and the dissemination of health education remain inadequate, which may also contribute to the high incidence of liver cancer[25]. Currently, the most effective primary prevention measure for liver cancer is the vaccination against hepatitis B, along with antiviral treatments for HBV and hepatitis C virus infections. The focus of secondary prevention of liver cancer is on early detection, early diagnosis, and prompt treatment, aiming for a favorable prognosis after disease remission and preventing recurrence, especially with regard to the monitoring of high-risk populations. For patients diagnosed with liver cancer, implementing effective treatment measures is crucial to reduce disease progression and complications, thereby improving the quality of life of patients. Among these, transarterial chemoembolization with drug-eluting beads has emerged as an important therapeutic strategy in recent years, demonstrating favorable outcomes in improving survival rates and treatment responses[26]. Other treatment modalities include surgical resection, liver transplantation, chemotherapy, radiation therapy, targeted drug therapy, ablation, and immunotherapy. Through the comprehensive implementation of these effective treatment measures, it is possible to significantly improve patient prognosis.
Efforts in cancer prevention and control in China should also target other cancers with high incidence rates, such as gastric, esophageal, breast, and prostate cancers. For gastric cancer and esophageal cancer, we should continue to promote the comprehensive prevention and treatment strategy of digestive system tumors, strengthen health education, improve eating habits, and reduce the intake of pickled and smoked foods. For breast cancer and prostate cancer, standardized screening should be promoted to improve the early diagnosis rate.
According to GLOBOCAN 2022, the global incidence of malignant tumors is projected to increase by 77% in 2050 compared to 2022. This trend underscores the escalating global burden of cancer, reaffirming its status as a critical public health issue that necessitates collaborative efforts from governments and international organizations to mitigate this challenge[27]. Additionally, the demand for radiation therapy is rising worldwide. By 2050, it is estimated that there will be 33.1 million new cancer diagnoses annually, with over 21 million cases requiring radiation therapy[28]. This highlights the imperative for global health systems to adopt a comprehensive approach to cancer control, ensuring equitable access to appropriate treatment for all patients. The burden of malignant tumors remains substantial in China, necessitating the urgent implementation of targeted intervention measures. Despite recent advancements in cancer prevention and control, further improvements are required in health education, professional training, and the establishment of a sustainable anti-cancer network to effectively implement cancer control strategies[29]. China can also draw valuable lessons from successful cancer prevention initiatives in other countries. For instance, the United States has achieved significant reductions in human papillomavirus related cervical cancer incidence through increased adolescent vaccination rates[30]. Finland's "FinnGen" project, which involved whole-genome sequencing of 500000 individuals, identified cancer susceptibility genes and facilitated the development of tailored screening programs for high-risk populations, thereby enhancing precision in cancer prevention and control[31]. In conclusion, the growing cancer burden, both globally and in China, demands immediate and effective interventions to curb this trend. Enhanced international cooperation and resource allocation are essential to addressing this pressing public health challenge.
At present, China's population-based cancer registration work has basically achieved full coverage across the country, but the cancer registration work itself has a time lag, it takes time to collect complete patient-related information, quality control and data processing, from the start of the work to the data through the review can be released generally 3 to 4 years. In addition, due to the epidemic of coronavirus disease 2019 (COVID-19), the work related to diagnosis, treatment and nursing of cancer patients has been challenged[32,33], which also has a continuous impact on patient diagnosis, follow-up and tumor registration data collection. First and foremost, the COVID-19 pandemic has exerted significant pressure on healthcare systems worldwide, resulting in the postponement or cancellation of numerous cancer screening and diagnostic procedures due to constrained medical resources. This may consequently lead to an underestimation of cancer incidence data[34,35]. The observed decline in reported cases may not accurately reflect actual cancer rates but rather stems from delayed diagnoses and reduced screening activities. Furthermore, the outbreak of COVID-19 pandemic has exacerbated mental health challenges among cancer patients, potentially influencing the timeliness of diagnosis and treatment. Studies have demonstrated that cancer patients experienced heightened psychological stress during the pandemic, which could impair their willingness and capacity to seek medical assistance[36,37]. Therefore, the impact of COVID-19 pandemic on cancer diagnosis and reporting is multifaceted, possibly leading to an underestimation of current cancer incidence data and compromising the accuracy of subsequent conclusions. Future research should address this issue to ensure the reliability and precision of cancer-related data. In general, the current cancer spectrum structure in China has the characteristics of both developing and developed countries, and gastrointestinal cancer presents a high incidence and death level, while it also needs to face the gradual increase of colorectal cancer, prostate cancer, thyroid cancer, etc., and the cancer prevention and control situation is complicated. Moreover, the impact of cancer differs among various regions, and there are notable differences between urban and rural settings within the same area. Consequently, approaches to cancer prevention and control should be adapted to suit local circumstances.
CONCLUSION
The cancer burden in China remains substantial, characterized by a unique blend of cancer types observed in both medium-to-low and high-to-very-high HDI regions. There is a rising trend in cancers associated with unhealthy lifestyles, including lung, colorectal, and breast cancers. At the same time, traditionally prevalent gastrointestinal cancers—such as those of the stomach, liver, and esophagus—continue to exhibit high incidence rates in specific areas. In the face of the complex prevention and control situation, comprehensive prevention and control strategies should be adopted, health education should be strengthened, a healthy lifestyle should be advocated, standardized screening and early diagnosis and treatment should be promoted, and medical quality should be improved. Simultaneously, tailored prevention and control measures should be developed based on the distinct characteristics of the cancer burden in various regions, and social and health resources should be rationally allocated. In line with the Global Breast Cancer Initiative, the Global Strategy for Accelerating the Elimination of Cervical Cancer and the Global Hepatitis Strategy launched by the World Health Organization, China will continue to promote vaccination and early diagnosis and treatment of cancer, promote capacity building of grassroots medical institutions, increase investment in and support for research and development of new drugs, and accelerate the recovery of patients. Through a combination of measures, we will effectively reduce the burden of cancer disease in China and help achieve the goals of the Healthy China strategic plan. It is essential to highlight that China's rapid advancement in digital health offers a significant opportunity for a "leapfrog" development in cancer prevention and control. However, the sustained success of these efforts hinges on institutional changes, such as enhancing legislation for chronic disease management and increasing access to anti-cancer medications. Through the effective combination of technological innovations and healthcare system reforms, China can showcase its unique approach to contributing to global cancer prevention and control initiatives.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Oncology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade A
Novelty: Grade B
Creativity or Innovation: Grade B
Scientific Significance: Grade A
P-Reviewer: Lampridis S S-Editor: Liu JH L-Editor: A P-Editor: Zhao YQ
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