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What are the Major Cancer Types in China? Why is it so?
Interview with Dr Zhao Ping, Chairman, Cancer Foundation of China

About Dr Zhao Ping

Dr Zhao Ping has served as chairman of the Cancer Foundation of China since 2016. Prior to this position, he was president of the Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), until the end of 2011. This institute/hospital is the flagship of cancer research and care in China.

Dr Zhao has played a pioneering role in promoting the development of cancer research at home and abroad, especially among Asian countries. He was elected the secretary-general of the Asian National Cancer Centers Alliance in 2009.

Dr Zhao is the chairman of the cancer prevention and control committee of the Chinese Preventive Medicine Association, chairman of the cancer professional committee of the Geriatric Oncology Society of China, directorial committee member of the Chinese Hospital Association’s Cancer Hospital Branch, and directorial committee member of the Beijing Oncology Society. He is also a standing committee member of the oncology professional committee of the Chinese Medical Association.

Dr Zhao is chief editor of the Chinese Journal of Clinical Oncology and Rehabilitation, China Tumor Clinical Yearbook and Oncology Progress, and associate chief editor of China Hospital CEO. He has published more than 200 academic papers, translated and published more than ten academic books, and participated in editing more than 30 medical monographs.

He received a master’s degree of surgery from PUMC in 1982 and a doctorate degree of medical sciences from the Catholic University of Leuven, Belgium, in 1992. Dr Zhao is a surgeon, professor and doctoral tutor, and head of the surgical department of the Cancer Hospital of CAMS/PUMC.

270 in 100 thousand people have cancer disease in China. At The Economist Events’ War on Cancer Healthcare Forum 2017 in Singapore, Dr Zhao Ping, Chairman, Cancer Foundation of China, was one of the panelists to discuss on the appropriate settings for cancer care and control in universal health coverage plans across different income levels.

APBN interviewed Dr Zhao Ping to better understand cancer prevalence and incidence and the efforts on cancer care and control in China. He shared that the common types of cancer in China is different between its urban and suburban areas.

According to the data from China Cancer Registry Annual Report 2012, the top 6 cancer types in cities in China are lung cancer, colorectal cancer, stomach/gastric cancer, liver cancer, breast cancer and esophageal cancer; whereas in rural areas, the top 6 common cancers are stomach cancer, lung cancer, esophageal cancer, liver cancer, colorectal cancer and breast cancer.

China mainland is a large country with 9.6 million km2. Its Western part and the Eastern part differ in terms of economic development. The people living in urban and rural areas of China differ in terms of their income level and living standard and lifestyle, etc. These variations lead to the difference in cancer incidence in different parts of the country. Lung cancer is the number 1 cancer in China major cities, due to smoking. Moreover, people living in cities such as Shanghai, Guangzhou and Shenzhen have westernized lifestyle. The people in major cities have better financial capability to satisfy their dietary needs and meal preferences. They tend to eat more meat, eggs and dairy products nowadays. WHO reported that red meat consumption could cause cancer, therefore the shift of eating habit towards Western style could be the reason to the increasing incidence rate such as colorectal cancer in large cities.

In suburban, Chinese people are mostly practicing traditional Chinese diet which largely contains staples like rice and bun, vegetables and meat, which Dr Zhao Ping deems as a healthier meal option. However, though there are lesser colorectal cancer cases in suburban or rural areas of China, the incidence of stomach and oesophageal cancer is high in some villages. It is mainly because the transport system is not well developed especially in mountainous areas. The inhabitants do not have access to variety of food and somehow have lower chances to eat fresh vegetables and fruits. During winter, they have no choice but opt for preserved vegetables and meat but the fermented food contains carcinogens. This backward living thus led to many incidents of gastric or oesophageal cancers among the rural residents.

What efforts and programmes have been done in China to battle cancer?

From 1970’s onwards, Chinese government cooperated with USA to fight cancer. They put in much effort and resources to help improve the living environment and transportation of many rural areas in China. The National Central Cancer Registry of China (NCCR) was established in 2002, responsible for the collection, evaluation, and publication of cancer data in China. Over the years, the number of cancer registries increases from only 30 cancer registries in 2002 to 308 now, covering a population of three hundred million. More importantly, NCCR also inspected the cancer incidence and mortality rate in China and published the Cancer Registry Report 2008-2012.

In response to the call upon cancer prevention by WHO, Chinese government implements relevant laws and regulations, for instance, the food regulations to protect their workers. They also make efforts to govern the haze conditions in China to control air pollution. They also educate the public about how to prevent and treat cancers, raising the cancer awareness among the community.

China emphasizes on early diagnosis and detection of cancer in order to have timely medical intervention for the disease. With the funding from government, Cancer Foundation of China has started the “early diagnosis and early treatment” programme in rural areas about ten years ago. More than 1.8 million people receive benefit from the cancer screening programme launched by the government, which focuses on breast, liver, lung, gastric, nasopharyngeal, and oesophageal cancers, depending on the need of the areas. Dr Zhao said, through this cancer screening, more than 1% of the beneficiaries are diagnosed with cancer. Among those, about 80% of the diagnosed cancer patients are detected in their early stages. He added that if the patients are diagnosed at the early stage of cancer, the recovery rate can be as high as 90%; while about 10% cancer patients are still able to recover from the advanced stage. Thus, it is a life-saving intervention actively carried out by the government. Today, the cancer recovery rate without reoccurrence in five-year time is about 30-40% among the cancer patients in China. The cancer recovery rate of people in large cities is slightly better compared to that of rural areas.

In recent years, Chinese government built and re-built a lot of cancer hospitals. As the president of the Cancer Institute and Hospital, Dr Zhao Ping stated that many district hospitals (general hospitals or other types of hospitals) are converted into hospitals specialized in the cancer field. The cancer hospitals focus on treating cancer patients and cancer research.

How does the Chinese government distribute the funding for cancer care and control?

Currently, there are about 30 cancer hospitals in different provinces. Chinese government provides annual funding to these cancer hospitals with different weightages in different provinces. They provide financial support in medical insurance and subsidies to the needy especially those from rural areas for their medical expenses.

Though there are challenges, China is doing better and better in terms of cancer care and control and more positive results can be expected in the coming years.

Written by APBN editor, Carmen J.W. Loh
The content of the article is based on APBN interview with Dr Zhao Ping.

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