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
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