Page 0092

In 2003, with the increasing burden of cancer, the Ministry

of Health of China issued a Compendium of Cancer Prevention

and Control in China for year 2004-2010 (21). The

compendium stated clearly that early detection, early

diagnosis and early treatment of cancer should be carried out

according to local conditions. On the basis of the principle of

this Compendium, in 2005, the Ministry of Finance and the

Ministry of Health have included the cancer early detection

and treatment programme into a special fund programme

supported by the public health special subsidy from the

central government, i.e. the central government would assign

special funds to run the programme for early detection and

treatment of cancer. By the end of 2009, six kinds of cancers

(cervical cancer, esophageal cancer, liver cancer, colorectal

cancer, nasopharyngeal cancer and gastric cancer) had been

included into this programme. However, even though

numerous studies have shown the benefit of stage shift and

cancer survival from LDCT since the 1990s, due to the

effectiveness of screening, these had not been confirmed and

lung cancer screening was not included into this programme.

In 2010, in view of the burden of lung cancer in China and

the excellent survival of early lung cancer cases detected by

LDCT, lung cancer screening was included in this programme

though its effectiveness had not been confirmed by the

National Lung Cancer Screening Trial (NLST) at that time

(2,22). For the smooth implementation of the project, the

administration of this programme includes three levels:

Cancer Foundation of China which represents the Disease

Prevention and Control Bureau of the Ministry of Health, the

Provincial Department of Public Health, and county

Department of Public Health. For its implementation, this

project is conducted in local hospitals at county level, and

academic support is provided by national and provincial

experts (22). This pilot project is an ongoing, prospective,

multi-centre observational study of screening with LDCT

initiated in 2010. Up to now, several cities have been involved

in this project, including Beijing, Tianjin, Chengdu in Sichuan

province, Gejiu in Yunnan province, Hangzhou in Zhejiang

province and Shenyang in Liaoning province. Table 1 shows

the preliminary results of baseline screening between 2010

and 2014.

In 2012, another government-backed cancer screening

programme was launched in China. This five-year project is

being jointly undertaken by the Disease Prevention and

Control Bureau under the Ministry of Health, the National

Cancer Centre and the Cancer Institute & Hospital (CIH)

under the Chinese Academy of Medical Sciences. Its focus is

on lung, breast, colorectal, upper digestive tract and liver

cancer early diagnosis and treatment in urban China. The

project will cover 14 provinces and 700,000 high-risk people

will be screened with an estimated budget of 480 million

Yuan. As regards lung cancer, 2000 high-risk people were

scheduled to be screened in each city in nine provinces in

2012, and 3000 high-risk people were scheduled to be

screened each city in 12 provinces in 2013, thus a total of

54,000 high-risk people would receive LDCT lung cancer

screening by the end of 2013, according to the programme

schedule. Through this programme, the National Cancer

Centre expects to establish a long-term cancer prevention

and control system and network including lung cancer in

urban China (23).

Besides LDCT screening, the above two screening

programmes involved several other items including health

promotion to increase screening acceptance, technical

training for local doctors and technical personnel, delivery of

smoking cessation intervention, biomarker discovery and

validation to evaluate whether the early lung cancer

biomarker can be refined for high-risk populations and

augment LDCT accuracy through classifying nodules

detected by LDCT. In addition, to keep a sustainable

development of a national screening programme, the two

programmes have been included in the special programme

for medical insurance system reform in China to explore the

possibility of incorporating lung cancer screening in the

routine health insurance system in China.

Currently, it is not the right time to cover LDCT screening

among high-risk populations nationwide due to the

uncertainties regarding reducing the side-effects due to

LDCT screening, how to translate the NLST result into clinical

practice and the unknown cost-effectiveness of LDCT in

China. For these reasons, the two screening programmes only

cover a small fraction of high-risk pollution with the aim of

exploring the feasibility of LDCT screening in China.

Lung cancer treatment in urban China

Up to now, no nationwide database for the clinical

characteristics of lung cancer has been established. Thus,

information about stage distribution of lung cancer in urban

China is unavailable. However, there was no doubt that most

lung cancer cases were diagnosed at an advanced stage and

accordingly lost the chance of surgery. To standardize the

diagnosis and the treatment of lung cancer, Chinese

guidelines on the diagnosis and treatment of primary lung

cancer were issued in 2011 (24). In these guidelines, an

individualized multidisciplinary treatment model combining

surgery, chemotherapy, radiotherapy and targeted biological

therapy was recommended. There is marked urban-rural

disparity in lung cancer treatment. Compared to rural

DISEASE-SPECIFIC CANCER CONTROL

92 CANCER CONTROL 2015

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