|Year : 2015 | Volume
| Issue : 6 | Page : 143-148
Laryngeal cancer incidence and mortality in China, 2010
Shuang-Shuang Zhang1, Qing-Min Xia1, Rong-Shou Zheng2, Wan-Qing Chen2
1 Editorial Board of Journal of Chinese Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
2 National Office for Cancer Prevention and Control, National Cancer Center, Beijing, China
|Date of Web Publication||26-Oct-2015|
National Office for Cancer Prevention and Control, National Cancer Center, Beijing
Source of Support: None, Conflict of Interest: None
Purpose: To analyze the incidence and mortality of laryngeal cancer in cancer registration areas of China in 2010.
Materials and Methods: Until June 1, 2013, 219 population-based cancer registries submitted data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 120 cancer registries were selected after quality evaluation for this analysis. Laryngeal cancer cases were selected from the database according to International Classification of Diseases 10th Revision coded as "C32." We calculated the crude incidence and mortality rates of laryngeal cancer by sex, age, and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age-standardized rates.
Results: In 2010, it was estimated that there were 20,272 new cases diagnosed as laryngeal cancer in China, including 17,703 males and 2569 females. The crude incidence rate of laryngeal cancer was 1.54/100,000 in 2010, accounting for 0.66% of overall new cancer cases. The age-standardized by China population (ASRcn) and by world population (ASRwld) were 1.18/100,000 and 1.20/100,000, respectively. Cumulative rate (0–74 years old) and truncated age-standardized rate (35–64 years old) were 0.15% and 1.98/100,000, respectively. Moreover, it was estimated that there were 11 914 cases died in laryngeal cancer in China, including 10,038 males and 1876 females. The crude mortality rate was 0.91/100,000, accounting for 0.61% of overall cancer deaths. The ASRcn and ASRwld were 0.68/100,000 and 0.69/100,000, respectively. Cumulative rate and truncated age-standardized rates were 0.08% and 0.88/100,000, respectively.
Conclusions: Both incidence and mortality of laryngeal cancer in China were still low in 2010.
Keywords: China, incidence, laryngeal cancer, mortality
|How to cite this article:|
Zhang SS, Xia QM, Zheng RS, Chen WQ. Laryngeal cancer incidence and mortality in China, 2010. J Can Res Ther 2015;11, Suppl S2:143-8
| > Introduction|| |
Laryngeal cancer is the most common cancer in the larynx and is the second cancer of the respiratory tumors only after lung cancer. The incidence of laryngeal cancer is generally low, accounting for 1–5% of all cancer sites. Estimated by GLOBOCAN 2008, the incidence and mortality rate (rate standardized by Segi's population) of laryngeal cancer in the world were 2.2/100,000 and 1.2/100,000, respectively. In China, the incidence and mortality rate of laryngeal cancer in 2003–2007 were 1.43/100,000 and 0.71/100,000, respectively. With the rapidity of population aging process, high smoking rate and
environmental pollution are becoming serious due to urbanization and industrialization, and the incidence of laryngeal cancer in China is not optimistic.
Since the National Central Cancer Registry (NCCR) started to publish the cancer registry annual report in 2008, six books have been continuously come off the press, which provided scientific basic data for cancer prevention and control in China. In 2013, the NCCR collected data for the calendar year 2010 from 219 cancer registries. After comprehensive quality evaluation, data from 120 cancer registries were selected as sources of this study, and the incidence and mortality for the registration areas in 2010 were calculated. In this study, we analyzed the incidence and mortality of laryngeal cancer in order to understand the epidemic distribution of laryngeal cancer in 2010 in China.
| > Materials and Methods|| |
NCCR is the bureau for the collection, storage, management and analysis of data on persons with cancer. Traditionally, new cancer cases reporting methods have been classified as active or passive. Active reporting involves registry personnel actually vesting the sources of data. Passive reporting relies on other health care workers to complete notification forms and forward them to the registry or to send copies of abstracts from which the necessary data can be obtained. The mortality material often comes from population-based death database. The population data originate from census data, Departments of Statistics or Public Security.
In 2013, there were 219 cancer registries (92 cities and 127 counties) from 31 provinces submitted cancer data of 2010 to NCCR, covered about 207,229,403 population totally, accounting for 15.56% of the whole national population. The NCCR coded cases by International Classification of Diseases 10th Revision (ICD-10) and ICD-O-3, and laryngeal cancer (ICD-10 code of C32) was selected and analyzed.
The value of cancer registry relies heavily on the underlying quality of data and quality control procedures. Based on "Guideline of Chinese Cancer Registration," each cancer registration data were evaluated by the quality indicators, including the proportion of morphological verification (MV%), percentage of death certificated only (DCO%), and mortality to incidence ratio (M/I). In general, the quality indicators for all cancer sites with DCO% <15%, MV% more between 55% and 90%, and M/I between 0.55 and 0.95 were considered acceptable. Finally, a total of 120 cancer registries with qualified data were included in the final database for further analysis.
Software such as © SAS Institute Inc. SAS9.3 version, Microsoft © MS-FoxPro6.0 version, MS-Excel, and IARC/IACR tools IARC-crg Tools were used for data collection, sorting, check and statistics. In our study, we calculated several variables including crude incidence rate, mortality, China age-standardized rate (national population structure in 2000), world age-standardized rate (world Segi's population), cumulative rate, age-specific rate, truncated rate and so on. Cumulative rate expresses the probability of onset of laryngeal cancer between birth and specific age (74 years old). Truncated rate is the calculation of rates over the truncated age of 35–64 years old, using WHO world standard population.
| > Results|| |
A total of 120 population-based cancer registries were enrolled in this study after evaluation for each submitted data, covered about 124,652,935 populations including 63,076,221 males and 61,576,714 females, accounted for 9.29% of the whole national population. There were 55 cancer registries came from urban areas covering about 79,987,999 (64.17%) populations, and 65 cancer registries came from rural areas covering about 44,664,936 (35.83%) populations. The M/I, MV%, DCO%, and percentage of unknown basis (UB%) for the pooled data were 0.55, 78.61%, 3.11%, and 0.51%, respectively. In urban areas, the M/I, MV%, DCO%, and UB% were 0.52, 81.82%, 2.17%, and 0.38%, respectively while in rural areas, they were 0.63, 70.02%, 5.62%, and 0.85%, respectively. The detailed information for quality control index of laryngeal cancer in 2010 in China was shown in [Table 1].
In 2010, it was estimated that there were 20,272 new cases diagnosed as laryngeal cancer in China, including 17,703 males and 2569 females. Two-thirds of new cases occurred in urban areas and one-third in rural areas. Much more new cases came from Eastern areas and Middle areas while less new cases from Western areas [Table 2].
The crude incidence rate of laryngeal cancer was 1.54/100,000 in 2010, accounting for 0.66% of overall new cancer cases, ranked the 22nd in all cancer sites. The age-standardized by China population (ASRcn) and by world population (ASRwld) were 1.18/100,000 and 1.20/100,000, respectively. Cumulative rate (0–74 years old) and truncated age-standardized rate (35–64 years old) were 0.15% and 1.98/100,000, respectively.
Laryngeal cancer occurred more often among men than women. In male, the crude incidence rate, ASRcn and ASRwld were 2.63/100,000, 2.09/100,000, and 2.12/100,000, respectively, while in female, the crude incidence rate, ASRcn and ASRwld were 0.40/100,000, 0.30/100,000, and 0.30/100,000, respectively. The crude incidence rate, ASRcn and ASRwld were higher in urban areas than those in rural areas. In Middle areas, the crude incidence rate, ASRcn and ASRwld were the highest (1.73/100,000, 1.32/100,000, and 1.34/100,000), followed by Western areas (1.54/100,000, 1.20/100,000, and 1.22/100,000), and lowest in Eastern areas (1.40/100,000, 1.07/100,000, and 1.08/100,000) [Table 2].
The age-specific incidence rate of laryngeal cancer was relatively low before 45 years old and dramatically increased after 45 years old both for all populations and male, reached peak at age group of 80− years old and 85+ years old, respectively. However, in the female the incidence rate was relatively low before 60 years old, reached the peak at the age group of 80− years old. Compared the age-specific incidence of laryngeal cancer for different locations, the incidence rates were generally higher in urban areas than those in rural areas for male; for female, the curves were especially similar [Table 3] and [Figure 1].
|Table 3: Age-specific incidence rate of laryngeal cancer in China in 2010 (1/100,000)|
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In 2010, it was estimated that there were 11,914 cases died in laryngeal cancer in China, including 10,038 males and 1876 females. The number of deaths was much more in urban areas (6491 deaths) than that in rural areas (5423 deaths). Middle areas had 4291 laryngeal cancer deaths, followed by Eastern areas (3889 deaths) and Western areas (3734 deaths) [Table 4].
The crude mortality rate of laryngeal cancer was 0.91/100,000 in 2010, accounting for 0.61% of overall cancer deaths, ranked the 21st in all cancer sites. The ASRcn and ASRwld were 0.68/100,000 and 0.69/100,000, respectively. Cumulative rate (0–74 years old) and truncated age-standardized rate (35–64 years old) were 0.08% and 0.88/100,000, respectively.
The mortality of laryngeal cancer was higher in male than that in female. In male, the crude mortality rate, ASRcn and ASRwld were 1.49/100,000, 1.19/100,000, and 1.19/100,000, respectively, while in female, the crude mortality rate, ASRcn and ASRwld were 0.29/100,000, 0.21/100,000, and 0.21/100,000, respectively. The crude mortality rate was higher in urban areas than that in rural areas but after age-standardized, ASRcn and ASRwld were higher in rural areas than those in urban areas. In Western areas, the crude mortality rate, ASRcn and ASRwld were the highest (1.09/100,000, 0.84/100,000, and 0.85/100,000), followed by Middle areas (1.02/100,000, 0.77/100,000, and 0.77/100,000), and lowest in Eastern areas (0.71/100,000, 0.53/100,000, and 0.52/100,000) [Table 4].
The age-specific mortality rate of laryngeal cancer was relatively low before 40 years old, and dramatically increased after 40 years old both for all populations and male, both reached peak at age group of 85+ years old, respectively. However, in female the incidence rate was relatively low before 50 years old, reached the peak at the age group of 85+ years old. Compared the age-specific mortality of laryngeal cancer for different locations, the mortality rates were generally higher in urban areas than those in rural areas for male, especially in older age group as; for female, the curves were especially similar [Table 5] and [Figure 2].
|Table 5: Age specific mortality of laryngeal cancer in China in 2010 (1/100,000)|
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| > Discussion|| |
The incidence rates of laryngeal cancer had a slightly upward trend in different regions and different sexes in China, 2003–2007. In 2003, the incidence rate of laryngeal cancer was 2.04/100,000 and then increased to 2.11/100,000 in 2007. However, the upward trend of the mortality of laryngeal cancer was not obvious. The mortality rates of laryngeal cancer were 1.12/100,000 and 1.13/100,000, respectively. Compared with other countries and regions, the world standardized rates of incidence and mortality of laryngeal cancer in China were lower than the average of the world. The incidence rate was lower than that in developed countries and developing countries for male or female. The mortality rate for male also was lower than that in developed countries and developing countries. However, for female, the mortality rate was lower than that in developing countries but similar to the level of developed countries.
In 2010, the incidence rate of laryngeal cancer for male was 5.58 times higher than that for female in national registration areas while the incidence rate of laryngeal cancer in urban areas was 0.46 times higher than that in rural areas. The mortality rate of laryngeal cancer for male was 4.14 times higher than that for female in national registration areas while the mortality rate of laryngeal cancer in urban areas was 0.18 times higher than that in rural areas. The incidence and mortality rates of laryngeal cancer were higher in urban areas than those in rural areas. The possible reasons are as the followings. First, the proportion of the rural population in cancer registration system is always low. Second, in rural areas, economic underdevelopment, lack of medical resources, and the lack of ability of tumor diagnosis all will cause the omission report of the tumor. Finally, because of the lack of the regulations of cancer reporting and stable financial support, the cancer reporting is still active reporting form. Therefore, the report rate is low in rural areas than that in urban areas.
In 2010, the incidence and mortality rate of laryngeal cancer for a male was far higher than that for female, which might relate to the risk factors of laryngeal cancer. Tobacco exposure (smoking, snuff, chewing tobacco, chewing betel, and smoking in other ways) and alcohol drinking are important pathogenic factors of laryngeal cancer.
Smoking is considered as the primary risk factor for laryngeal cancer. A Japanese epidemiological investigation showed that 96% of patients with laryngeal cancer had smoking habits, and Mcguirt et al., reported the rate was 96.5%. Furthermore, Feng et al., reported 92.4% of laryngeal cancer patients had smoking habits, and the odds ratio of risk of laryngeal cancer in smokers was 20.66 compared to nonsmokers. The mechanism of smoking may be due to a large amount of carcinogen in tobacco smoke, including polycyclic aromatic hydrocarbons (benzopyrene), an aryl group, heterocyclic amines and nitroso compound. These precursors can be converted into carcinogens in vivo. The latter has a pro electronic structure, which can covalently bind with the pro-nuclear groups in the cells, resulting in the damage of DNA. If DNA repair process is not timely or imperfect, gene expression disorders will occur, and eventually lead to carcinogenesis.
Almost all of the studies abroad showed that alcohol drinking was one of the most important risk factors. Elwood et al., considered that the relationship between alcohol consumption and laryngeal cancer was more closely related compared to smoking. Burch et al., found that beer and liquor could increase the risk of laryngeal cancer. Wynder et al., found that heavy whisky consumption played a major role in the etiology of laryngeal cancer. Zhang et al., reviewed the relationship between alcohol drinking and the risk of laryngeal cancer among Chinese population. It showed that the pooled odds ratio (OR) between drinking and the risk of laryngeal cancer were 2.69 (95% confidence interval [95% CI]: 1.60–4.52). Moreover, the pooled ORs were 2.15 (95% CI: 1.27–3.65) for seldom drinkers and 3.51 (95% CI: 1.36–9.07) for frequent drinkers, respectively. The main factor causing the laryngeal cancer is ethanol. Alcohol is actually reduced by the amount of exposure to ethanol, thereby reducing ethanol on the stimulation of larynx and the damage to body after the transformation into acetaldehyde.,, This is a serious test for our country. In order to avoid the excessive risk of laryngeal cancer caused by alcohol consumption, we should increase the health propaganda of hazard of drinking alcohol.
Besides smoking and alcohol drinking, the risk factors still include air pollution, virus infection, occupational exposure, gender, family history of cancer, and so on.,,,, In 1983, it was suggested that human papillomavirus (HPV) was involved in the formation of head and neck tumor. The pathogenic link between laryngeal cancer and high-risk HPV has been established. Especially, high-risk HPV16 and HPV18 infection are the risk factors of laryngeal cancer. The positive rate of HPV in patients with laryngeal cancer is 8–54%. The possible mechanism is that HPVE6/E7 protein can promote tumor occurrence through the action of p53 and Rb pathway. Other risk factors of laryngeal cancer that have been studied included laryngeal precancerous lesions (laryngeal keratosis, laryngeal papilloma of an adult), throat reflux, gastroesophageal reflux disease, particle ray, and so on.
Due to the poor prognosis of laryngeal cancer, the 5 years survival rate is only 50–60%, about one-third of the patients will relapse. Patients' swallowing function, language function, and facial features have been seriously affected after surgical treatment. Therefore, early diagnosis and prevention can reduce laryngeal cancer-related mortality and disability rate. Giving up smoking and temperance are important measures to prevent laryngeal cancer, and also can reduce the harm of other cancers and chronic diseases. The successful development and listing of HPV vaccine will decrease the incidence of laryngeal cancer caused by HPV infection. The treatment strategy for laryngeal cancer has taken the effect of HPV into consideration. In addition, supplementation of fruits and vegetables has also proven to reduce the risk of laryngeal cancer.
All staff from each local cancer registries that have made a great contribution for providing their cancer registration database are acknowledged.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]