Trends in incidence of esophageal and gastric cardia cancer in high-risk areas in China.

Incidence rates have risen for gastric cardia adenocarcinoma, whereas rates have remained stable for esophageal squamous cell carcinoma in many western countries. The aim of this study was to describe and analyze trends in incidence rates for esophageal cancer and gastric cardia cancer in Cixian county, which is one of the high-risk areas for esophageal cancer in China as well as in the world. The data were obtained from the Cixian Cancer Registry, which is a population-based registry. All the data were checked and analyzed using SPSS 11.5. Between the years 1988 and 2003 there were 11,183 cases of esophageal cancer in the county. The age-standardized incidence rate was 168.55 per 100,000. In 1988, the age-standardized incidence rate for male patients was 250.76/100,000; it declined to 160.05/100,000 in 2003, representing a decrease of 36.2%. The age-standardized incidence rate for female patients was 153.86/100,000 in 1988; it declined to 82.55/100,000 in 2003, showing a decrease of 46.3%. A slight decreasing trend was observed during the period, with a yearly decrease of 3.61% in male patients and 3.39% in female patients. For gastric cardia cancer, there were 1654 cases from 1988 to 2003. The age-standardized incidence rate was 25.58 per 100,000. The age-standardized incidence rate for male patients was 13.75/100,000 in 1988; it increased to 28.55/100,000 in 2003, with a yearly increase of 7.65%. The age-standardized incidence rate for female patients was 7.12/100,000 in 1988; it increased to 12.91/100,000, with a yearly increase of 5.44%. A statistically significant increasing trend of gastric cardia cancer was observed during the study period. Cixian county is a geographical region with a very high incidence of esophageal cancer and cardia cancer. The trend in the incidence rates of esophageal cancer had decreased slightly; on the other hand, gastric cardia cancer showed a significantly increased trend in the last 16 years. Detailed epidemiological analyses of demographic trends and risk factors will help to guide future cancer control strategies.

[Study on the esophageal cancer incidence and mortality rate from 1974-2002 in Cixian, China].

OBJECTIVE: To describe the incidence and mortality rates of esophageal cancer from 1974-2002 in Cixian county of Hebei province. Basic information on comparative geographical, epidemiological, and clinical research was collected. METHODS: In early 1970s, cancer registry system in Cixian was established, collecting information on all the esophageal cancer cases in Cixian. Data was checked manually, then computerized, coded and analyzed using the software--SPSS 11.5. RESULTS: From 1974 to 2002, there were 18 471 esophageal cancer cases in Cixian, with 11 068 males and 7403 females, respectively. The age standardized incidence rate (ASR) for males was 208.77 per 100,000, while 120.47 per 100,000 for females. The trend of incidence rate of esophageal cancer had decreased during the 29 years from 1974 to 2002 (trend chi(2) = 19.94, P < 0.001). From 25 years of age onward, the incidence rates of the lower age groups declined with the increase of age. As for geographic distribution, the incidence rate in mountainous areas and hilly areas showed a significant declining trend in mountainous areas, chi(2) = 195.00, P < 0.001; hilly areas, chi(2) = 46.08, P < 0.001. The esophageal cancer incidence in plain areas remained steady, but had a slight increase in recent years. From 1969 to 2002, there were 18,736 cases died of esophageal cancer with 11 598 males and 7138 females. The ASR for male was 127.17 per 100,000 and 101.57 per 100,000 for female. Compared with the year 1969, the mortality rate of esophageal cancer in 2002 had a 37.96% decline. The proportion of esophageal cancer among malignant tumors in different decades decreased significantly. CONCLUSION: The trend of the incidence rate of esophageal cancer had been decreasing for the last 29 years. The incidence rate in mountainous areas and hilly areas showed a declining trend while in the plain areas it remained steady but having slight increase in the recent years. The mortality rate of esophageal cancer had a significant decrease from 1969 to 2002.

Decrease in the esophageal cancer incidence rate in mountainous but not level parts of Cixian County, China, over 29 years.

BACKGROUND: Cixian county has one of the highest incidence rates of esophageal cancer (EC) in China, as well as the world. In 1974, the Cixian population-based cancer registry system was established, so that there is now information on esophageal cancer cases over almost 30 years. METHODS: Data from Cixian Cancer Registry were checked and analyzed using SPSS 11.5. RESULTS: From 1974 to 2002, a total of 18,471 new esophageal cancer cases were registered in Cixian, 11,068 in males and 7,403 in females. The age standardized incidence rate (ASR) for males was 208.77 per 100,000, while for females it was 120.47 per 100,000. There was a clear trend for decrease overall in the incidence rate of esophageal cancer over the 29 years (X(2)=19.94, P<0.001). As to the geographic distribution, the incidence rate in mountainous and hilly areas showed a significant decline (X(2) = 195.00 and X(2) = 46.08, respectively, both P X(2)0.001). Data for esophageal cancer incidence in level land areas in contrast were relatively steadily, with increase in recent years. CONCLUSION: Esophageal cancer has decreased in Cixian county during the last 29 years, but this is due to change in mountainous and hilly areas. Compared to other regions in the world, Cixian county still has a very high incidence of ECs.

Endoscopic survey of esophageal cancer in a high-risk area of China.

AIM: To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China. METHODS: A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol's staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software. RESULTS: Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2,013), 0.1% (3/2,013) and 0.9% (18/2,013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2,013), 1.6% (33/2,013) and 0.2% (2/2,013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2,013), 7.8% (157/2,013) and 2.6% (53/2,013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2,013), 0.2% (4/2,013) and 0.7% (14/2,013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2,013) and 11.5% (232/2,013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2,013) and 0.8% (17/2,013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2,013) and 0.8% (17/2,013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2,013/2,725). CONCLUSION: Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.

An analysis of esophageal cancer incidence in Cixian county from 1974 to 1996.

AIM: To describe the incidence of esophageal cancer (EC) in Cixian, a county of Hebei province during 1974-1996. We analyzed the sex and age characteristics as well as the geographic distribution of EC, in order to determine the impact so that methods of preventing and controlling EC in Cixian can be put in place. METHODS: Since the early 1970s, the cancer registry system has been established, which collects the cancer incidence in Cixian county. The malignant tumors were coded according to International Classification of Disease IX (ICD-9). All the data were checked and analyzed using EPIINFO. RESULTS: The trend of the incidence rate of EC from 1974 to 1996 had declined, (229.9/100 000 vs 178.5/100 000, Odds ratio=1.47, 95 % CI:1.32-1.63, chi(2)=52.89. trend chi(2)=26.54, P<0.001). The incidence rate of males declined significantly (281.81/100 000 vs 157.96/100 000, Odds ratio=1.61, 95 % CI: 1.41-1.84, chi(2)=47.85. Trend chi(2)=44.86, P<0.001), whereas, the females remained steady (157.96/100 000 vs 133.41/100 000, odds ratio=1.28, 95 % CI:1.17-1.49, chi(2)=9.26. trend chi(2)=2.69, P>0.05). Male average annual incidence rate was 142.80/100 000 and the female's was 95.18/100 000. The sex ratio (males to females) was 1.50:1. The incidence rate was increasing along with the age. As to the geographic distribution, the incidence rate in mountainous areas and hilly areas showed a significantly declining trend (mountainous areas, trend chi(2)=149.93, P<0.001; hilly areas, trend chi(2)=42.70, P<0.001). The incidence rate of EC in plain areas had increased (trend chi(2)=22.39, P<0.001). CONCLUSION: The incidence rate of EC in Cixian county shows a trend and has declined after two decades, especially in mountainous area. But compared to other regions in the world, Cixian county still had a high incidence rate of EC.