Lung Cancer in a Rural Area of China: Rapid Rise in Incidence and Poor Improvement in Survival

Background: Lung cancer has been a major health problem in developed countries for several decades,and has emerged recently as the leading cause of cancer death in many developing countries. The incidence oflung cancer appears to be increasing more rapidly in rural than in urban areas of China. This paper presentsthe trends of lung cancer incidence and survival derived from a 40-year population-based cancer monitoringprogram in a rural area, Qidong, China. Materials and
Methods: The Qidong cancer registration data of 1972-2011 were used to calculate the crude rate, age-standardized rate by Chinese population (CASR) and by worldpopulation (WASR), birth cohort rates, and other descriptive features. Active and passive methods were usedto construct the data set, with a deadline of the latest follow-up of April 30, 2012.
Results: The total numberof lung cancer cases was 15,340, accounting for 16.5% of all sites combined. The crude incidence rate, CASRand WASR of this cancer were 34.1, 15.7 and 25.4 per 100,000, respectively. Males had higher crude rates thanfemales (49.7 vs 19.0). Rapidly increasing trends were found in annual percent change resulting in lung cancerbeing a number one cancer site after year 2010 in Qidong. Birth cohort analysis showed incidence rates haveincreased for all age groups over 24 years old. The 5 year observed survival rates were 3.55% in 1973-1977,3.92 in 1983-1987, 3.69% in 1993-1997, and 6.32% in 2003-2007. Males experienced poorer survival than didfemales.
Conclusions: Lung cancer has become a major cancer-related health problem in this rural area. Therapid increases in incidence likely result from an increased cigarette smoking rate and evolving environmentalrisk factors. Lung cancer survival, while showing some improvement in prognosis, still remains well below thatobserved in the developed areas of the world.