Cancer Surveillance in Shanghai

1
Cancer Surveillance in Shanghai

• Ying Zheng, MD, MS
• Shanghai Cancer Registry
• Shanghai Municipal Center for Disease Prevention
  and Control
• NAACCR Annual Meeting
• Denver, Colorado, June, 2008

2
General Information of the Cancer Registries in
Mainland of China

• First Cancer Registry in China was established
  at Linxian county in Henan province in 1959.
• The Linxian County had one of the highest
  incidence rate of esophageal cancer in the
  world.
• Hard of swallowing disease had been an endemic
  disease for generations in the Linxian county.

3
Cancer Registries in China in Recent 20 Years
Data source The National Office for Cancer
Prevention, Control and Research of China (NOCPCR)
4
Mainland China 48 Cancer registries
Covered 20 provinces 75.27Million (5.96)
129,300Km2 (1.38)
27 registries affiliate with hospitals or
Institutes 21 in CDC
Data source NOCPCR
5
New Cases Coding in 2003 in Mainland China
Data source NOCPCR
6
Percentage of Microscopically Verified Cases in
Mainland China, 2003
Data source NOCPCR
7
Cancer Registry Data of Mainland China

• Low population coverage
• Quality of data unbalanced and unstable
• gt Lack of quality control
• - Missing Reports
• - Inaccurate discharge diagnoses
• gt Lack of stable financial support
• gt Lack of technical support
• gt Lack of training
• Data interpretation and further mining

8
Some Facts about Shanghai (2005)

• Area 6340.5 square kilometers
• Administrative divisions 18 districts and 1
  county
• Population 13.60 million
• 50.25 Male, 49.75
  Female
• Age over 60 19.58

Data source Shanghai Municipal Statistics Bureau
9
Three Leading Causes of Death in Shanghai
Cardiovascular Cerebrovascular
Others
24
disease
34
Respiratory
disease
11
Cancer
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10
Cancer Registry in Shanghai - History

• 1960s
• gt Established by Shanghai Municipal Health Bureau
  through the Cancer Registry Amendment Act
• gt Cancer Reporting Procedure in Shanghai was
  issued
• gt Date collection system only covered the 9 urban
  districts
• gt Supported by research funds

11
Cancer Registry in Shanghai - History

• 1980s
• gt Establish network
• gt Budget from the government
• 2001.12
• gt Shanghai Cancer Registry was expanded to cover
  
• all administrative divisions (18 districts
  and 1 county)
• gt Budget 400,000/year

12
Cancer Registry Network
Report
175 Hospitals
19 District CDC
Municipal CDC
Data Input Check Coding Death Certificate check

Administration Technical support Case
consolidation
207 Community Health Service Center
Home care Regular follow-up
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Information System for Cancer Registry and
Patient Follow-up

• Cancer registry database over 360,000 cases
  recorded
• Patient follow-up
• gt All patient are active followed until death
• gt Active follow-up home visit or telephone visit
  at least once a year
• gt The first visit happens within 1-2 months after
  diagnosed normally

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Cancer Registry in Shanghai - Quality Assurance

• Registration guidelines (IACR)
• Registrar training
• - Disease classification (ICD-10, ICD-0-2)
• - Cancer related terminology
• - Cancer diagnosis and treatment
• - Computer and network skill
• - Epidemiology and statistics
• Quality control audit

18
Cancer Registry in Shanghai Data Application

• Annual report and a recent 30 year report
• Reports, educational materials
• CI5
• Urban area, about 6.5 M

19
Cancer Registries of China in CI5
20
Cancer Registry in Shanghai Data Application

• Cancer epidemiology researches
• Case control studies on lung cancer, breast
  cancer, endometrial cancer for the urban Chinese
  women.
• The Shanghai Breast Cancer Study
• gt 1500 pairs of cases and controls
• gt 5000 breast cancer cases cohort since 2002
• Provide cancer information for other studies
• gt The Shanghai Womens Health Study
• gt The Shanghai Mens Health Study

21
2005 Shanghai Cancer Incidence, Male
1 Rate are per 100,000 and adjusted using World
population standard. 2 US rates are for
2000-2004.
22
2005 Shanghai Cancer Incidence, Female
1 Rate are per 100,000 and adjusted using World
population standard. 2 US rates are for
2000-2004.
23
2005 Shanghai Cancer Mortality, Male
1 Rate are per 100,000 and adjusted using World
population standard. 2 US rates are for
2000-2004.
24
2005 Shanghai Cancer Mortality, Female
1 Rate are per 100,000 and adjusted using World
population standard. 2 US rates are for
2000-2004.
25
Age-adjusted (Word Standard) Cancer Incidence
Rates by Gender, Shanghai Urban,1973-2005
26
Age-adjusted (Word Standard) Cancer Incidence
Rates of Selected Cancers, Shanghai
Urban,1973-2005. Male
27
Age-adjusted (Word Standard) Cancer Incidence
Rates of Selected Cancers, Shanghai
Urban,1973-2005. Male
28
Age-adjusted (Word Standard) Cancer Incidence
Rates of Selected Cancers, Shanghai
Urban,1973-2005. Female
29
Age-adjusted (Word Standard) Cancer Incidence
Rates of Selected Cancers, Shanghai
Urban,1973-2005. Female
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Shanghai Cancer Survivors

• Prevalence, 2006-12-31
• Total 178, 813 (1.3)
• Male 79,288 (1.2)
• Female 99,525 (1.5)
• Home or telephone visit, 2006
• Total 153 465 in 209708 (73.2)

32
Anatomic Site Distribution of Cancer Survivors by
Sex, Shanghai, 2006

• All sites 79288 99525
• Site Cases Site Cases
• Stomach 12488 15.75 Breast 29098 29.24
• Lung 9182 11.58 Colon 8521 8.56
• Colon 7842 9.89 Stomach 7352 7.39
• Rectum 6303 7.95 Thyroid gland 6143
  6.17
• Bladder 5564 7.02 Rectum 5748 5.78
• Prostate 4614 5.82 Lung 4642 4.66
• Liver 3847 4.85 Corpus uteri 4597 4.62
• Kidney 2960 3.73 Brain, CNS 4372 4.39
• Brain, CNS 2833 3.57 Ovary 4073 4.09
• Nasopharynx 2570 3.24 Cervix uteri 2861
  2.87

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• Contact me
• Ying Zheng
• yzheng_at_scdc.sh.cn
• 86-21-627587101418
• 86-21-62087109