and air pollution.
The mortality and incidence of lung cancer is higher in
urban areas than in rural areas, but the gap between the two
areas has significantly reduced in recently years. The reason
may be due to the process of industrialization and
urbanization in rural areas which leads to similar lifestyles
and environments to urban areas, as well as a higher
prevalence of smoking in rural areas.
Smoking is the predominant cause of lung cancer. As the
world's largest producer and consumer of tobacco, the
current smoking rate was 66% for males and 3.1% for
females (7). Tobacco use in China accounts for 75.04% of
lung cancer deaths in men and 18.35% in women (8). Tobacco
control in China is imperative.
Outdoor and indoor air pollution is another important risk
factor for lung cancer, and lung cancer attributable to air
pollution in China has not yet been well quantified. With
rapid economic development and urbanization, air quality in
China is among the worst in the world, especially in cities,
where it is mainly caused by coal, motor vehicles and
industrial dust (9). The average annual PM2.5 concentration
in Beijing in 2011 has reached 100 µg/m3
, which is nearly 10
times higher than the World Health Organization guidelines
of 10 µg/m
3 (10).
Lung cancer prevention and control in urban China
Tobacco control is the most important measure of primary
prevention of lung cancer. In 2005, China joined the WHO
Framework Convention on Tobacco Control (WHO FCTC).
Since then, many measures have been implemented
including enforcing smoke-free policies in public places and
increasing taxes. In 2012, The China Tobacco Control
Programme (2012-2015) was released. Since 2009, China
has raised the tobacco tax for grade A and B cigarettes and
cigars from 45% to 56%, 30% to 36% and 25% to 36%,
respectively. However, the cigarette retail prices did not
change after the 2009 tax adjustment, which suggests a
further increase of tobacco tax in the future (11). An onlinebased
survey demonstrated that a smoking ban had a
significant effect on Chinese internet users' smoking-related
behaviours (12), but the true effect of this measure needs to
be further assessed. Also, recently the Beijing Government
approved rules to ban smoking in all indoor public places,
workplaces and public transport vehicles, which took effect
in June 2015. However, according to the results of a national
survey, though smoking prevalence has decreased in urban
areas from 1993-2003, heavy smoking has increased
substantially and only 6.9% of current smokers reported
that they intended to quit in urban locations (Fig. 3) (13). In
addition, former smokers with long-term abstinence still
have elevated lung cancer risk. Therefore, the effect of
tobacco control on lung cancer prevention has not been seen
in recent years.
Outdoor air in China is more polluted in cities than in rural
areas. In 2013, the State Council released the Action Plan
for Air Pollution Prevention and Control which would be the
DISEASE-SPECIFIC CANCER CONTROL
90 CANCER CONTROL 2015
Table 1: Baseline screening in some cities in China (supported by a public health special subsidy from central government)
Province (City) Time Partici- Cases Detection No of Early No of Treatment
pants rate (%) early lung detection treatments rate (%)
cancers rate (%)
Tianjin 2010 1000 4 0.40 3 75.00 3 75.00
2010.7-2011.6 1000 9 0.90 4 44.40 8 88.90
2011.7-2012.6
2012.7-2013.6 1082 6 0.57 2 33.30 3 100.00
2013.7-2014.6 245 00 0 0 0 0
Total 3227 19 0.57 9 47.23 17 89.47
Beijing 2012.7-2013.6 682 2 0.29 2 100 2 100
2013.7-2014.6 1254 1 0.08 001 100
Yunnan (Gejiu) 2013.7-2014.6 1018 7 0.69 4 57.14 6 57.14
Sichuan (Nanchong) 2013.7-2014.6 1050 2 0.19 2 100 2 100
(Chengdu) 2013.7-2014.6 1031 500480
Total 8262 36 0.44 17 47.22 32 88.89