07-11 16:20 Caijing Magazine

http://www.caijing.com.cn/20080711/74197.shtml

China is paying more attention to cancer prevention and rural spending, but smoking and pollution inflict a heavy toll.

By staff reporter Li Hujun

This has been a year for funerals -- and questions about cancer in China -- for a professional woman in Beijing named Liu.

“I have attended three of my friends' funeral ceremonies this year,” she told Caijing recently. “Two died from stomach cancer, the other from lung cancer.”

Then with a sigh, Liu posed a question that reflects China's rising anxiety over cancer and its frightening health statistics. “Is it true that only old people tend to get cancer?”

Cancer death rates are rising dramatically in China, and not only among the elderly. Results from an exhaustive survey conducted by the Ministry of Health and the Ministry of Science and Technology said the nation's cancer death rate has risen 80 percent in the past 30 years to 136 per 100,000 citizens, from 74 in the mid-1970s and 108 in the early 1990s.

Cancer is now the No. 1 killer in Chinese cities and No. 2 in the countryside. The disease accounts for 25 percent of all urban deaths and 21 percent in rural areas, according to the survey, which was based on data from 160 counties and cities nationwide in 2004 and '05.

Rao Keqin, director of the health ministry's statistics center, warned that cancer soon may surpass cerebrovascular disease to become the biggest killer in rural areas.

The survey, the third since the 1970s, was ordered in response to what health officials see as dramatic lifestyle changes among China's 1.3 billion people.

An aging society had long been seen as a key reason for rising cancer rates. More than 100 million Chinese are past age 65, accounting for 7.6 percent of the population.  However, even after factoring in the elderly population, health officials found the nation's cancer death rate increased 20 percent in the past 30 years.

And statistics on fatalities by cancer type also show that old age cannot shoulder all the blame. For example, the nation's lung cancer death rate rose 465 percent over the past 30 years, while the age-adjusted increase was an astounding 261 percent.

What's more worrying is that the cancer death rate has not peaked. Yang Gonghuan, vice director of the Chinese Center for Disease Control and Prevention, told Caijing that lung cancer cases and death rates will continue to climb as the number of smokers increases.

China is the world's largest tobacco manufacturing and consuming country, boasting 350 million smokers and another 500 million affected by second-hand smoke. A recent health ministry report on tobacco control decried a lack of effective limits on youth smoking, which is why China has 15 million smokers between ages 13 and 18, and almost 40 million teens who've at least tried to smoke.

China appears to be following the same course set by the United States in the 1950s, said Dr. Peter Boyle, director of the International Agency for Research on Cancer. In those days, U.S. men smoked an average 10 cigarettes a day. The trend continued into 1970s. But because cigarettes harm the body gradually, the U.S. cancer rate did not peak until 1990, when deaths linked to smoking rose to 33 percent from 12 percent in the 1950s among men between 35 and 69 years old.

The smoking average for Chinese men rose to 10 cigarettes a day in 1992. Lung cancer is expected to follow. Global epidemiological research shows a close link between smoking and lung cancer. Indeed, 80 percent of lung cancer is blamed on smoking. The World Health Organization (WHO) estimates that lung cancer in China may reach 1 million cases annually by 2025.

Meanwhile, China's tobacco industry is booming. Smoking control seems to have been set aside while China pursues economic growth. Some 42 million cartons of cigarette were produced last year, a 5 percent increase year-on-year. Taxes levied on tobacco reached 38.8 billion yuan in 2007 and have risen 20 percent annually for the past five years.

The anti-smoking movement is getting a boost while Beijing hosts the Olympics. Since May 1, the city has banned smoking in public places. But the tobacco industry's power has not diminished. One reason is that state-owned China National Tobacco Corp. and the industry's watchdog, the State Tobacco Monopoly Administration (STMA), operate under the same roof.

Expert critics such as Yang Gonghuan, director of National Tobacco Control Office, have long urged separating the company and watchdog. Opinions about a proposed split were collected and submitted earlier this year to the nation's leadership by Han Qide, a committee vice chairman for China's top legislative body, the National People's Congress. But so far nothing has happened.

Neither has the government raised tobacco taxes, a move suggested by some as an effective way to reduce smoking. Quite the opposite: STMA has allocated funds to encourage low-price cigarette production for the rural market.

But smoking is not the only cancer factor. Dietary habits, water pollution and environmental problems are some of the other deadly factors in China.

Professor Dong Zhiwei, a former president for the Cancer Institute and Hospital at the Chinese Academy of Medical Sciences (CICAMS), said bad diet is second only to smoking as a cancer cause in China. Obesity is an issue, and some Chinese have adopted western eating habits.

Air pollution and smoking affect health in urban areas. Lung cancer is the No. 1 killer in cities, where more people can afford cigarette habits as well as emissions-producing cars.

In rural areas, water pollution is often blamed for stomach and liver cancer death rates that exceed world averages. The media has described many villages plagued by cancers of the digestion system, which medical experts link to polluted drinking water. Environmentalist Huo Daishan told Caijing that most “cancer villages” are near sources of water ranked high for pollutants. In addition, poor infrastructure means that at least 300 million rural Chinese have no access to safe drinking water.

Liver cancer is the deadliest form of the disease in the countryside. But in addition to water pollution, poverty and hygiene have roles to play. More than 100 million Chinese carry the hepatitis B virus, which may cause liver cancer. Although a hepatitis B vaccine was developed in 1980s, it was not added to China's national vaccination system until much later.

For years, many poor families could not afford to vaccinate their children in rural China. Qiao Youlin, director of the CICAMS epidemiology department, faulted the government for short-changing rural vaccination funds. This led to higher occurrences of cancers of the stomach, esophagus and cervix in rural areas.

Fighting cancer is also beyond the means of many. Some rural Chinese reject treatment due to astronomical costs; they'd rather die than burden their families.

Yet the nation as a whole spends a lot to fight cancer. The nationwide cost of cancer treatment alone is almost 100 billion yuan, accounting for 20 percent of China's medical expenditure. But only 10 percent of patients survive more than five years after diagnosis.

China has concentrated its limited medical resources on treatment instead of prevention. But prevention efforts worked in the past. More than 60 “prevention bases” were established around the country in cancer hot spots, following the government's first national mortality survey in 1973 and first report on tumors in 1979.

But prevention projects lost government funding as the country adopted a market economy. Kong Lizhi, a health ministry deputy director general, said only one-third of the prevention bases are still functioning well.

Moreover, staffing at CICAMS has been strained by an exodus of health professionals who can make more money treating cancer patients at market-oriented hospitals. The brain drain has shrunk CICAMS to only a few dozen experts from a peak of more than 300.

China is starting to look more carefully at ways to fight cancer. A 2003 health ministry guide says China's government should “play a leading role (with) prevention as the leading force and the countryside being the focus” in a war on cancer. It also urges early diagnosis and early treatment.

One possible example to follow is the United States, where a decline in cancer death rates since the early 1990s has been credited to smoking control, early diagnosis and advanced treatment. WHO says up to half of all cancer is preventable, and that prevention costs much less than treatment.

The health ministry first invested in early diagnosis and treatment in 2005, when a portion of its budget was set aside for early diagnosis and early treatment for cancers of the esophagus and cervix. The central government this year allocated 40 million yuan to cover exam fees for more than 500,000 people in 118 counties nationwide.

“The government has to play a major role and include (fighting cancer) in their work agenda,” said CICAMS' Dong.

Indeed, government spending can make a big difference in rural China. Qiao Youlin, who spent a decade studying in rural Shanxi Province, said public funding is critical for cancer prevention in rural areas, where the poor can't even afford medical exams.

Qiao and his research partners discovered that a cancer detection method for women can cost only 35 yuan, and that rural women would pay 25 yuan for a check-up. If the local government would provide just 10 yuan per case, he argued, far more exams could be conducted. In addition, Chinese and Indian researchers have co-developed a low-cost surgery for cervical cancer.

More good news for cancer prevention has come from the State Council, China's cabinet, which has approved a plan for a national cancer center. Provincial governments also may set up cancer centers. Although the budget for the national center is small compared with counterparts in the United States, Japan and Korea, Qiao said “it's a good beginning.”

“A small move by the central government can sometimes stimulate overall development of cancer prevention and treatment,” he said.