Thyroid cancer is the most common malignant disease of the endocrine system. Previous studies indicate a rapid increase in the incidence of thyroid cancer in recent decades, and this increase has aroused the great public concern. The aim of this study was to analyze the trends in incidence, mortality and clinical-pathological patterns of thyroid cancer in Zhejiang province. Population-based incidence and mortality rates of thyroid cancer were collected from eight cancer registries in Zhejiang from 2000 to 2012. The incidence and mortality rates were age-standardized to Segi’s world population. A Joinpoint model was used to examine secular trends in age-adjusted thyroid cancer rates with the Joinpoint Regression Program Version 4.0.0. Thyroid cancer patients were recruited from Zhejiang Cancer Hospital from 1972 to 2014. Patient demographics, tumor histology and tumor size were compared among the different periods of 1972–1985, 1986–1999 and 2000–2014. The age-standardized incidence rate of thyroid cancer in Zhejiang cancer registries was 2.75/105 in 2000, and increased to 19.42/105 in 2012. Additionally, we observed significantly increasing incidence rates with the Annual Percent Change (APC) of 22.86% (95%CI, 19.2%–26.7%). The age-standardized mortality of thyroid cancer in Zhejiang cancer registries was 0.23/105 in 2000 and 0.25/105 in 2012. No significant change in mortality rate was found. We observed a rapid increase in the proportions of papillary thyroid carcinoma (PTC) in 12,508 patients with thyroid carcinoma identified in the Zhejiang Cancer Hospital from 1972 to 2014 while the proportions of poorly differentiated thyroid cancer (PDTC), medullary thyroid carcinoma (MTC) and follicular thyroid carcinoma (FTC) decreased over the decades. In the PTC cases, the proportion of patients with maximum tumor diameter (MTD) < 1 cm dramatically and significantly increased from 0 in 1972–1985 to 32.1% in 2000–2014. A rapid increase in incidence and a stable trend in mortality of thyroid cancer were found in the distribution of thyroid cancer. Most of the increased incidence was PTC, especially the papillary thyroid microcarcinoma (PTMC) with MTD < 1 cm. This increase in incidence might be due to increased diagnosis with advanced technology.

Background: Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. Objective: This study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. Methods: A population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. Results: At baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). Conclusions: LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed.

This study aimed to identify preferred lung cancer screening modalities in a Chinese population and predict uptake rates of different modalities. A discrete choice experiment questionnaire was administered to 392 Chinese individuals aged 50–74 years who were at high risk for lung cancer. Each choice set had two lung screening options and an option to opt-out, and respondents were asked to choose the most preferred one. Both mixed logit analysis and stepwise logistic analysis were conducted to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. On mixed logit analysis, attributes that were predictive of choice at 1% level of statistical significance included the screening interval, screening venue, and out-of-pocket costs. The preferred screening modality seemed to be screening by low-dose computed tomography (LDCT) + blood test once a year in a general hospital at a cost of RMB 50; this could increase the uptake rate by 0.40 compared to the baseline setting. On stepwise logistic regression, those with no endowment insurance were more likely to opt out; those who were older and housewives/househusbands, and those with a health check habit and with commercial endowment insurance were less likely to opt out from a screening programme. There was considerable variance between real risk and self-perceived risk of lung cancer among respondents. Lung cancer screening uptake can be increased by offering various screening modalities, so as to help policymakers further design the screening modality.

This is a comprehensive overview of long-term cancer survival in Zhejiang Province, China. Hybrid analysis, a combination of cohort and period analysis, has been proposed to derive up-to-date cancer survival estimates. Using this approach, we aimed to timely and accurately analyze the 5-year relative survival (RS) and net survival (NS) in cancer registries of Zhejiang Province, China. A total of 255,725 new cancer cases diagnosed during 2013–2017 were included in 14 cancer registries in Zhejiang Province, China, with a follow-up on vital status until the end of 2019. The hybrid analysis was used to calculate the 5-year RS and 5-year NS during 2018–2019 for overall and stratifications by sex, cancer type, region, and age at diagnosis. During 2018–2019, the age-standardized 5-year RS and NS for overall cancer in Zhejiang was 47.5% and 48.6%, respectively. The age-standardized 5-year RS for cancers of women (55.4%) was higher than that of men (40.0%), and the rate of urban areas (49.7%) was higher than that of rural areas (43.1%). The 5-year RS declined along with age, from 84.4% for ages 74 years. Our results of the RS and NS showed the similar trend and no significant difference. The top five cancers with top age-standardized 5-year RS were thyroid cancer (96.0%), breast cancer (84.3%), testicular cancer (79.9%), prostate cancer (77.2%), and bladder cancer (70.6%), and the five cancers with the lowest age-standardized 5-year RS were pancreatic cancer (6.0%), liver cancer (15.6%), gallbladder cancer (17.1%), esophageal cancer (22.7%), and leukemia (31.0%). We reported the most up-to-date 5-year cancer RS and NS in Zhejiang Province, China for the first time, and found that the 5-year survival for cancer patients in Zhejiang during 2018–2019 was relatively high. The population-based cancer registries are recognized as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems.

Background: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer–specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. Objective: This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. Methods: A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer–specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. Results: The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer–related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. Conclusions: This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program.

Background: Previous studies have proved the effectiveness of endoscopic screening in rural areas; however, long-term, high-quality evidence regarding the effectiveness of risk-adapted upper gastrointestinal cancer (UGC) sequential screening strategies in resource-rich regions is currently lacking. Objective: The objectives were to validate the effectiveness of risk-adapted sequential screening strategies in UGC prevention and control and assess the potential of sequential screening to lower mortality rates. Methods: Based on the Cancer Screening Program in Urban China, a prospective, large-scale cohort study based on population was conducted to recruit individuals from 4 cities in China from 2013‐2019. Those identified as having a high risk of UGC according to a validated risk-score model were advised to undergo endoscopy tests. Follow-up outcomes were tracked until June 2021. Incidence of UGC, UGC-related mortality, and all-cause mortality were evaluated between the screened and nonscreened cohorts. Results: The study included 153,079 participants at baseline. In total, 113,916 (74.42%) of the participants were designated as low risk of UGC. The remaining 39,163 (25.68%) participants were deemed to be at high risk of UGC and were offered gastroscopy tests. Among the high-risk participants, 9627 (compliance rate 24.6%) adhered to the gastroscopy tests. Over a median follow-up of 6.05 (IQR 3.06‐7.06) years, 622 UGC cases, 180 UGC deaths, and 1958 all-cause death cases were traced. The screened cohort exhibited the highest cumulative incidence of UGC (119.2 per 100,000 person-years), followed by the nonscreened and low-risk cohorts. Obvious reductions in both all-cause mortality and UGC mortality were observed between those who undertook screening (153.7 and 4.7 per 100,000 person-years, respectively) and the nonscreened group (245.3 and 27 per 100,000 person-years, respectively). The screening population showed a significant 36% and 82% reduction in both all-cause mortality (hazard ratio [HR] 0.64, 95% CI 0.49‐0.83, P<.001) and UGC mortality (HR 0.18, 95% CI 0.04‐0.74, P=.02), respectively, compared to the nonscreened group. Reductions of 35% in all-cause mortality (HR 0.65, 95% CI 0.49‐0.86, P=.003) and 81% in UGC mortality (HR 0.19, 95% CI 0.05‐0.80, P=.02) were observed in participants aged older than 55 years in the screened group compared to the nonscreened group. The reductions in all-cause mortality and UGC mortality were statistically significant in males (all-cause mortality: HR 0.64, 95% CI 0.47‐0.88, P=.005; UGC mortality: HR 0.10, 95% CI 0.01‐0.72, P=.02), but significant reductions were not observed in females (all P values were >.05). Conclusions: Our study suggests the significance of one-off risk-adapted UGC screening in reducing both all-cause mortality and UGC mortality, particularly among high-risk individuals, indicating its effectiveness in UGC prevention and management.