As the global population ages, the burden of cancer is increasing. We aimed to assess the impact of population ageing on cancer-related disability-adjusted life years (DALYs). We used the decomposition method to estimate the impact of ageing, population growth, and epidemiological change on cancer-related DALYs from 1990 to 2019, stratified by 204 countries/territories and by their sociodemographic index (SDI). This approach separates the net effect of population ageing from population growth and change in age-specific DALY rates. Cancer-related DALYs among individuals aged ≥65 years increased by 95.14% between 1990 (52.25 million) and 2019 (101.96 million). Population growth was the main contributor to cancer-related DALYs (92.38 million, attributed proportion: 60.91%), followed by population ageing (41.38 million, 27.28%). Cancer-related DALYs attributed to population ageing followed a bell-shaped pattern when stratified by SDI, meaning they peaked in middle-SDI countries. Cancer-related DALYs attributed to ageing increased in 171 and decreased in 33 countries/territories. The top three cancer types with the highest increase in the absolute number of cancer-related DALYs associated with ageing were tracheal, bronchus, and lung (8.72 million); stomach (5.06 million); and colorectal (4.28 million) cancers, while the attributed proportion of DALYs was the highest in prostate (44.75%), pancreatic (40.93%), and non-melanoma skin (38.03%) cancers. Population ageing contributed to global cancer-related DALYs, revealing a bell-shaped pattern when stratified by socioeconomic development, affecting middle-SDI countries the most. To respond to the growing ageing population and reduce cancer-related DALYs, it is necessary to allocate health care resources and prioritize interventions for older adults.

Esophageal cancer (EC) remains a global health challenge due to its poor prognosis. China and the United States of America (USA) represent two distinct epicenters of EC burden. Understanding the EC disparities in these two countries is vital for tailoring prevention strategies, optimizing treatment, and enhancing outcomes in both countries. Yet, there lacks a comprehensive comparison of EC characteristics between the two countries. In this multicenter, retrospective hospital-based study, we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016–2017. Using electronic medical records and cancer registration records, information on demographics, lifestyle, and clinicopathological characteristics (including tumor site, pathology, stage, metastases, differentiation, and treatment) were collected. Additionally, we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016–2017 from the Surveillance, Epidemiology, and End Results (SEER) database in the USA. A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally. 85.5% (n = 5,694) of EC were esophageal squamous cell carcinoma (ESCC) in China, while esophageal adenocarcinoma (EAC) was prominent in the USA (58.9%, n = 5,041). Among EC patients with known staging, the proportion of early stage was higher in China compared to the USA (48.3% vs. 30.5%). Among ESCC patients, early-stage cases were higher in China than in the USA (49.8% vs. 31.8%), while among EAC patients, late-stage cases were higher in China than in the USA (77.3% vs. 68.5%) (all P < 0.001). In China, EC mainly occurred in the middle third (60.2%) of the esophagus, whereas in the USA, it was more common in the lower third (59.9%) of the organ. Compared with EC patients with known metastatic status in the USA, China had fewer cases of lymph node metastases (51.4% vs. 57.7%) and distant metastases (7.9% vs. 33.8%). Regarding treatment, China had more surgical therapy (53.7% vs. 22.6%), less radiotherapy (35.6% vs. 53.3%), and less chemotherapy (46.7% vs. 59.7%) compared to the USA. This study reveals notable disparities in EC between China and the USA, encompassing epidemiological, clinicopathological, and treatment dimensions. These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.

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.

Background: Liver cancer continues to pose a significant burden in China. To enhance the efficiency of screening, it is crucial to implement population stratification for liver cancer surveillance. Objective: This study aimed to develop a simple prediction model and risk score for liver cancer screening in the general population, with the goal of improving early detection and survival. Methods: This population-based cohort study focused on residents aged 40 to 74 years. Participants were enrolled between 2014 and 2019 and were prospectively followed until June 30, 2021. Data were collected through interviews at enrollment. A Cox proportional hazards regression was used to identify predictors and construct the prediction model. A risk score system was developed based on the weighted factors included in the prediction model. Results: A total of 153,082 study participants (67,586 males and 85,496 females) with a mean age of 55.86 years were included. During 781,125 person-years of follow-up (length of follow-up: median 6.07, IQR 3.07‐7.09 years), 290 individuals were diagnosed with liver cancer. Key factors identified for the prediction model and risk score system included age (hazard ratio [HR] 1.06, 95% CI 1.04‐1.08), sex (male: HR 3.41, 95% CI 2.44‐4.78), education level (medium: HR 0.84, 95% CI 0.61‐1.15; high: HR 0.37, 95% CI 0.17‐0.78), cirrhosis (HR 11.93, 95% CI 7.46‐19.09), diabetes (HR 1.59, 95% CI 1.08‐2.34), and hepatitis B surface antigen (HBsAg) status (positive: HR 3.84, 95% CI 2.38‐6.19; unknown: HR 1.04, 95% CI 0.73‐1.49). The model exhibited excellent discrimination in both the development and validation sets, with areas under the curve (AUC) of 0.802, 0.812, and 0.791 for predicting liver cancer at the 1-, 3-, and 5-year periods in the development set and 0.751, 0.763, and 0.712 in the validation set, respectively. Sensitivity analyses applied to the subgroups of participants without cirrhosis and with a negative or unknown HBsAg status yielded similar performances, with AUCs ranging from 0.707 to 0.831. Calibration plots indicated an excellent agreement between the observed and predicted probabilities of developing liver cancer over the 1-, 3-, and 5-year periods. Compared to the low-risk group, participants in the high-risk and moderate-risk groups had 11.88-fold (95% CI 8.67‐16.27) and 3.51-fold (95% CI 2.58‐4.76) higher risks of liver cancer, respectively. Decision curve analysis demonstrated that the risk score provided a higher net benefit compared to the current strategy. To aid in risk stratification for individual participants, a user-friendly web-based scoring system was developed. Conclusions: A straightforward liver cancer prediction model was created by incorporating easily accessible variables. This model enables the identification of asymptomatic individuals who should be prioritized for liver cancer screening.