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      National trend of gastric cancer mortality in China (2003–2015): a population-based study

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          Abstract

          Background

          Gastric cancer mortality decreased substantially over the last decades in most countries worldwide. This study aimed to assess the most recent national trend of gastric cancer mortality and examine the disparity of gastric cancer mortality between rural and urban areas in China.

          Methods

          The crude mortality data of gastric cancer by sex, age group, and area were obtained from China Health Statistical Yearbooks (2003–2015) covering 10% of Chinese population. The age-standardized rates of mortality (ASRM) of gastric cancer in rural and urban areas were estimated using the 2010 Chinese Census population stratified by age, sex, and area. The trend of mortality of gastric cancer was assessed by using Joinpoint analysis.

          Results

          During the 13-year period, the ASRM was reduced from 31.5/100,000 in 2003 to 20.9/100,000 in 2015 in rural areas and from 18.9/100,000 in 2003 to 14.5/100,000 in 2015 in urban areas. In the male population, the annual percent changes of mortality were − 2.2% in urban areas (95% confidence interval [CI] − 3.8% to − 0.6%; P < 0.001) and − 3.4% in rural areas (95% CI − 5.1% to − 1.8%; P < 0.001). In the female population, the annual percent changes of mortality were − 2.7% in urban areas (95% CI − 4.2% to − 1.2%; P < 0.001) and − 4.6% in rural areas (95% CI − 5.5% to − 3.7%; P < 0.001).

          Conclusions

          The declining trend of mortality of gastric cancer was presented from 2003 to 2015 in both rural and urban areas in China. The decrease in gastric cancer mortality is greater in rural areas than in urban areas in China.

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          Most cited references16

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          Cancer prevention and control: alarming challenges in China.

          China is geographically the third largest country in the world and the most populated low-to-middle-income country. Cancer incidence and mortality rates for some cancers in the USA and European countries have steadily decreased over the last decades, whereas the incidence and mortality of certain cancers in China have been increasing at an alarming speed. Rapid industrialization and urbanization in China have been accompanied by incredible changes in lifestyle and environment combined with an aging population. Mortality caused by lung, colorectal and breast cancers has been steadily increasing, whereas cancer mortality from gastric, esophageal and cervical tumors has tended to decrease. Similar to what has occurred in the United States, unhealthy lifestyles in China, including heavy smoking and poor diet combined with pollution, have contributed to increased cancer risk. China is facing many challenges in cancer treatment and prevention for the general population. The major areas that need to be addressed in the control of cancer in China include cancers associated with environmental pollution, tobacco use, occupational carcinogens, infection, excessive alcohol consumption, dietary deficiencies and obesity. In this perspective, we review the problems in each area and suggest ideas for future directions in cancer research and strategies and actions to reduce the incidence of cancer in China.
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            The survival and the long-term trends of patients with gastric cancer in Shanghai, China

            Background Gastric cancer remains a major health issue and a leading cause of death worldwide. This study presented a long-term survival data of gastric cancer registered in Shanghai of China from 1972–2003, with aims to describe the trends as well as the age, sex, stage and tumor sites specific characteristics. Methods The main source of information on cancer cases was the notification card sending to the registry. The residential status of cancer cases was confirmed by home-visits. The methods of follow-up have been a mixture of both active and passive ones. Results We observed an increased trend of survival probability during the last decades. Patients diagnosed during 1972–1976 had a 5-years relative survival rate at 12% for males and 11% for females, respectively, which had dramatically increased to 30% for male and 32% for female patients respectively during the period of 2002–2003. Among the patients diagnosed in 2002–2003, the overall survival probability declined with patient’s age at the time of diagnosis. The lowest survival rate was observed among the oldest group, with the median survival time of 0.8 years. Patients diagnosed with stage I had a higher relative survival rate. Patients with cardia cancer had the worst prognosis, with the 5-year relative survival rate of 29%. Conclusions The survival probability of patients with gastric cancer in Shanghai has improved significantly during the last decades. Age, stage and site of tumor have an impact on prognosis.
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              Exploring the cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer in China in anticipation of clinical trial results.

              Gastric cancer is the second leading cause of cancer-related deaths worldwide. Treatment for Helicobacter pylori infection, the leading causal risk factor, can reduce disease progression, but the long-term impact on cancer incidence is uncertain. Using the best available data, we estimated the potential health benefits and economic consequences associated with H. pylori screening in a high-risk region of China. An empirically calibrated model of gastric cancer was used to project reduction in lifetime cancer risk, life-expectancy and costs associated with (i) single lifetime screening (age 20, 30 or 40); (ii) single lifetime screening followed by rescreening individuals with negative results and (iii) universal treatment for H. pylori (age 20, 30 or 40). Data were from the published literature and national and international databases. Screening and treatment for H. pylori at age 20 reduced the mean lifetime cancer risk by 14.5% (men) to 26.6% (women) and cost less than $1,500 per year of life saved (YLS) compared to no screening. Rescreening individuals with negative results and targeting older ages was less cost-effective. Universal treatment prevented an additional 1.5% to 2.3% of risk reduction, but incremental cost-effectiveness ratios exceeded $2,500 per YLS. Screening young adults for H. pylori could prevent one in every 4 to 6 cases of gastric cancer in China and would be considered cost-effective using the GDP per capita threshold. These results illustrate the potential promise of a gastric cancer screening program and provide rationale for urgent clinical studies to move the prevention agenda forward.
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                Author and article information

                Contributors
                kgao@xjtu.edu.cn
                +1-864-938-3852 , jwu@presby.edu
                Journal
                Cancer Commun (Lond)
                Cancer Commun (Lond)
                Cancer Communications
                BioMed Central (London )
                2523-3548
                2 May 2019
                2 May 2019
                2019
                : 39
                : 24
                Affiliations
                [1 ]ISNI 0000 0001 0599 1243, GRID grid.43169.39, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, , Xi’an Jiaotong University, ; Xi’an, 710049 Shannxi P. R. China
                [2 ]ISNI 0000 0000 9884 2425, GRID grid.423306.0, Department of Pharmaceutical and Administrative Sciences, , Presbyterian College School of Pharmacy, ; 307 North Broad Street, Clinton, SC 29325 USA
                Author information
                http://orcid.org/0000-0003-4098-3833
                Article
                372
                10.1186/s40880-019-0372-x
                6498569
                31046840
                1223291f-deb4-48bd-a259-ee89a0186f35
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 October 2018
                : 25 April 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 31870983
                Categories
                Original Article
                Custom metadata
                © The Author(s) 2019

                gastric cancer,mortality,age-standardized rate,rural population,urban population,health service

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