COMMENTARY

Clear Path to Reducing Cancer Risk in China

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

December 21, 2017

Hello. Ni hao. I am David Kerr, professor of cancer medicine at University of Oxford in England. One of the benefits of being a person, such as me, who is old, over-the-hill, tired, and past it, is that you are invited to join academic groupings around the world.

I am delighted and honored to be a visiting professor at the Second Military University in Shanghai, People's Republic of China, and at the Cancer Center in Xiamen in the southeast of China. In addition, I work very closely with colleagues at the Chinese Academy of Medical Sciences in Beijing. China is a country I visit often. I have enormous respect for the incredibly hardworking oncologists who deliver high-quality cancer care, at least within the major cities of that country.

I have always been interested in new data coming out of China. A recent publication in the Annals of Oncology[1] has looked at the risk factors involved in new incident cases of cancer in China and the factors that contribute to cancer deaths. The burden of cancer in China is immense. There are estimated to be 4.3 million new cancer cases every year and 2.8 million deaths. Cancer is the number-one killer in China.

For this study, a group of distinguished epidemiologists have taken the year 2013 and have pulled out the different epidemiologic factors associated with risk for cancer, and attributed a degree of this risk to tumors in men and tumors in women. By using a relatively simple epidemiologic set looking at smoking, passive smoking, dietary intake of vegetables, hepatitis B virus (HBV) infection leading to hepatocellular carcinoma, and so on, they were able to attribute a proportion of risk to these known factors.

They found that for new cases, they could explain about 50% of the underlying risk for men and about 35% of the underlying risk for women. For men, the top risk factor was smoking, followed by HBV, and third, low intake of fruits and vegetables. For women, the top risk factor was HBV, followed by low intake of fruits and vegetables, and then third was secondhand or passive smoking.

Why is this important? I am honored to have been acquainted with Zhu Chen, the former Chinese health minister. Dr Chen is a great man, a remarkable health minister, and a fantastic hematologist. He and his colleagues who have filled the ministry subsequently have an incredible public health challenge in dealing with cancer in China. Clearly, this study directs exactly where the public health effort needs to go: tobacco control, obviously; dealing with infections and particularly HBV; and doing anything that one can to reduce the price of and improve the accessibility and availability of fruits and vegetables. But tobacco control and dealing with HBV infection are the dominant public health problems of the day. Anything that has an impact on those risk factors would bring enormous savings for the Chinese healthcare system.

This study was a very nice piece of work. An excellent international team came together to deliver this and provide a very strong signpost pointing to how the Chinese Health Ministry can respond to this incredible burden of disease.

As always, thank you for listening and stay safe. I would be delighted to take any questions or comments you may have. For the time being, Medscapers, over and out.

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