Cancer Burden in China

Currently the cancer burden in the Greater China Region is enormous – nearly 2 million people die from cancer annually in China alone. It is believed that as China undergoes continued economic growth, the incidence of and mortality rate of cancers will increase dramatically, echoing the pattern previously observed in Taiwan and Hong Kong. In Hong Kong, cancer is the leading cause of death, accounting for over one-third of all deaths. Since 1982, cancer has overtaken cardiovascular disease as the leading cause of death in Taiwan. In China, stomach, lung and liver cancers are among the most prevalent cancers among both women and men, and the deadliest. Mainland China is the world’s largest producer and consumer of tobacco products, with 350 million smokers. Smoking-related diseases, including cancer, account for nearly 1 million deaths annually. In China, the public health system confronts a variety of challenges, including:

• Competition exists for limited health resources to address both non-communicable diseases, including cancer, as well as the still high burden of infectious disease.

• Efforts at tobacco control are complicated by the fact that the country’s profitable tobacco industry is Government-owned, accounting for about 5 percent of tax revenue.

• China is the largest consumer and producer of cigarettes in the world, but it lacks smoking cessation services and health care providers have limited information on smoking cessation and tobacco control advocacy measures.

• Vast underserved populations remain vulnerable due to geographical gaps in the availability of cancer treatment, early detection and palliative care services.

Despite the state-owned tobacco industry, the Government has taken commendable strides in addressing tobacco control, displaying great initiative in ratifying the Framework Convention on Tobacco Control (FCTC) and embarking on implementation of the treaty. The Government has recently embraced Bloomberg initiatives to provide tobacco control funding, with tobacco control programs operating outside of the Government purview. The Government has also signaled openness to Gates Foundation support for research on Tobacco Control.

Patient Need

In the rural areas of the region, in particular, cancer is stigmatized and viewed as a “death sentence” – much of the population is not aware that cancer is largely treatable through early detection and treatment. A diagnosis of cancer is greeted with fatalism and a culture of silence surrounds the disease. In more urban areas of the region, while there is greater openness about cancer and a greater awareness of the concept of survivorship, there is still residual stigma. Perceptions of cancer vary with educational levels, social indicators and access to early detection and treatment services. For example, in metropolitan areas such as Shanghai, where there is better access to early detection services, the concept of survivorship is more prevalent due to longer life expectancies stemming from earlier stage diagnosis. Support groups, particularly for breast cancer, have emerged and become more vocal as advocates as greater numbers of patients conceptualize themselves as “survivors.” In Taiwan and especially, Hong Kong, greater freedom of the press has led to increased media attention to cancer control and patient support groups, contributing to a more open and supportive environment for survivorship (although myths and misconceptions related to cancer are still prevalent in rural areas of Taiwan).

American Cancer Society Involvement

ACS has maintained close ties with cancer control institutions in Taiwan for over 10 years. Since 2002, ACS has deepened relationships with governmental organizations, health care leaders and NGOs in mainland China. In the region, ACS has worked on reducing tobacco use and creating tobacco control initiatives; enhancing the quality of cancer early detection and screening through clinical training and medical education; increasing cancer awareness; promoting cancer prevention, early detection and access to information; and improving the quality of life for cancer patients and survivors. ACS employs two full-time staff-consultants in the ACS/Beijing office, established in 2005.

History of ACS Collaboration:

• ACS sponsored the first American Cancer Society University (ACSU) event with participants from the region in 2003 in Oakland. Since that time there have been 6 ACSU events in the region and over $250,000 disseminated in seed grants for participants to implement cancer control interventions in their own communities.

• ACS has trained over 80 health care workers in smoking cessation counseling and established over 9 smoking cessation clinics in the region.

• In 2007, ACS sponsored the First Cross Strait Tobacco Control Conference in Taiwan and, since 2006, ACS has sponsored smoking cessation train-the-trainer programs in Wuhan, Guangzhou, Kumming, Hong Kong and Taipei.

• In 2008, ACS partnered with the China Tobacco Control Network to develop a cessation clinic operational manual for the China CDC and to conduct train-the-trainer programs for public health professionals in Chengdu.

• In collaboration with the China CDC and other NGOs, ACS developed a toolkit on smoke-free workplaces for companies in China. ACS launched a smoke-free worksite campaign in Beijing in 2008, garnering the signatures of nearly 80 companies to the China Smoke-free Declaration – this initiative will protect over 200,000 employees from secondhand smoke in the workplace.

• ACS conducted focus groups on introducing elements of the ACS Employer Initiative program with multi-national corporations in Beijing; the participants have expressed interest in conducting pilot projects on health and wellness to fight cancer in the workplace.

• ACS will host a regional Chinese-speaking cancer support focus group discussion in 2009 to study the feasibility of establishing an Internet-based Global Chinese Cancer Survivors e-Network.

• Since 2004, ACS has collaborated with cancer control colleagues in Taiwan to launch International Relay for Life events (the most recent by the Hope Society of Taiwan in Taipei in 2008).

• Ongoing collaboration with CACA to educate health care professionals about the importance of breast cancer early detection and to provide clinical training in screening techniques and treatment skills has resulted in continuous medical education for over 600 physicians and technicians across China.

To learn more about the American Cancer Society’s cancer-fighting efforts in China or to become a Founding Supporter of the American Cancer Society China Initiative, please contact June Chan, Manager of East Asia Programs and Project Director for California International Programs, at Jchan@cancer.org, or by phone at 510-893-7900.