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Shanghai cancer registry

The Shanghai cancer registry, established in 1963, is the oldest one in mainland China. It is based at the Shanghai Cancer Institute, Shanghai. The registry has been contributing data to the quinquennial IARC publication Cancer Incidence in Five Continents since Vol IV^[1]. Cancer notification is by a regulation issued by the Shanghai Municipal Bureau of Public Health. Hence, cancer registration is entirely done by passive methods. The principal source of information on cancer cases is the notification card consisting of basic required information for cancer registration that is sent to the registry. The residential status of cancer cases is confirmed by house visit. The registry covers an area of 290 km2 and caters to a population of about 6.4 million, with a sex ratio of 982 females to 1000 males in 1995. The average annual age-standardized incidence rate is 190 per 100 000 among males and 155 per 100 000 among females with a lifetime cumulative risk of one in 5 of developing cancer in the period 1993–1997. The common cancers among males are lung, stomach and liver. The rank order among females is breast, lung and stomach^[1].

Map: Map showing location of Shanghai, People's Republic of China Click here to open map (PDF format)

The registry contributed data on survival from 38 cancer sites or types registered during 1988–1991 to the first volume of IARC publication on Cancer Survival in Developing Countries^[2]. In the present volume, data on survival from 52 cancers registered during 1992–1995 are reported.

Data quality indices

The proportion of cases with histologically verified cancer diagnosis in the series is 56%, varying from 14% (liver cancer) to 95% (corpus uteri cancer). The proportion of cases registered as death certificates only (DCOs) is the highest in lip cancer (2%), and cases without any follow-up are negligible. Thus, 98–100% of the total cases registered are included in the estimation of the survival probability.

Table 1. Data quality indices - Proportion (%) of histologically verified and death certificate only cases, number and proportion of included and excluded cases by site, Shanghai, China, 1992-1995 cases followed-up until 2000 Click here to open table (PDF format) Click here to open comparative statistics by registry

Outcome of follow-up

The methods of follow-up have been a mixture of both active and passive ones. These included obtaining cancer mortality information from the death certificates in vital statistics section of Shanghai Hygiene and Anti-epidemic Centre. The mortality data are periodically matched with the incident cancer database. The vital status of the unmatched incident cases is then collected by house visits or postal/telephone enquiries.

The closing date of follow-up was 31^st December 2000. The median follow-up ranged from 3 months for cancers of the pancreas and liver to 81 months for cancer of the adrenal gland. The completeness of follow-up at 5 years from the incidence date is available in 95-100%.

Table 2. Number and proportion of cases with complete / incomplete follow-up and median follow-up (in months) by site, Shanghai, China, 1992-1995 cases followed-up until 2000 Click here to open table (PDF format) Click here to open comparative statistics by registry

Survival statistics

All ages and both sexes together

The top ranking cancers on 5-year relative survival are thyroid (90%), other male genital organ (89%), non-melanoma skin (86%), corpus uteri (86%) and penis (83%). The least survival is encountered with pancreatic cancer (8%), preceded by liver (9%), unspecified leukaemia (12%), lung and gallbladder (15%). Lip and salivary gland (73%) among other head and neck cancers and colon, rectum and anus (48-51%) among gastrointestinal cancers have higher survival than others. Survival from cancers of the urinary system is 65% for urinary bladder and 62% for renal pelvis. Hodgkin lymphoma had a better survival (66%) than non-Hodgkin lymphoma (39%). The survival figures for leukaemias are lymphoid (30%) and myeloid (27%).

The 5-year age-standardized relative survival (ASRS) probability for all ages together is generally less than or similar to the corresponding unadjusted one for a majority of cancers. Also, the 5-year ASRS (0–74 years of age) is generally higher than or similar to the corresponding ASRS (all ages) for a majority of cancers.

	Table 3. Comparison of 1-, 3- and 5-year absolute and relative survival and 5-year age-standardized relative survival (ASRS) by site, Shanghai, China, 1992–1995 cases followed-up until 2000 Click here to open table (PDF format) Click here to open comparative statistics by registry
	Figure 1a. Top ten cancers (ranked by survival), Shanghai, China, 1992–1995 Click here to open figure (PDF format) Click here to open graph for all the cancer sites

Sex

Table 4a. Site-wise number of cases, 5-year absolute and relative survival by sex, Shanghai, China, 1992-1995 cases followed-up until 2000 Click here to open table (PDF format) Click here to open comparative statistics by registry

Male

The 5-year relative survival probabilities for lip, breast, renal pelvis, bladder, other urinary organ cancers and lymphoid leukaemia are noticeably higher among males than females.

Figure 1b. Top five cancers (ranked by survival), Male, Shanghai, China, 1992–1995 Click here to open figure (PDF format) Click here to open graph for all the cancer sites

Female

The 5-year relative survival is distinctly higher among females than males in cancers of the oral cavity, oropharynx, nasopharynx, nose/sinuses, ureter, brain and adrenal gland.

Figure 1c. Top five cancers (ranked by survival), Female, Shanghai, China, 1992–1995 Click here to open figure (PDF format) Click here to open graph for all the cancer sites

Age group

The 5-year relative survival by age group reveals an inverse relationship: a decreasing survival with increasing age at diagnosis for many cancers: tongue, salivary gland, nasopharynx, oesophagus, stomach, liver, pancreas, other thoracic organs, bone, uterus unspecified, ovary, bladder, thyroid and other endocrine glands. In the rest, it is observed to fluctuate.

Table 4b. Site-wise number of cases and 5-year relative survival by age group, Shanghai, China, 1992–1995 cases followed-up until 2000 Click here to open table (PDF format) Click here to open comparative statistics by registry

Trend

The data on survival trend is available for 38 cancers sites or types spanning eight years in the two time periods 1988–1991^[2] and 1992–1995. An increasing trend in the 5-year absolute and relative survival probabilities is observed for most cancers registered in 1992–1995 compared to 1988–1991.

Table 5. Comparison of 5-year absolute and relative survival of cases diagnosed between 1988–1991 and 1992–1995, Shanghai, China Click here to open table (PDF format) Click here to open comparative statistics by registry

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References

1. Parkin DM, Whelan SL, Ferlay J and Storm H. Cancer Incidence in Five Continents, Vol I to VIII: IARC Cancerbase No. 7. IARCPress, Lyon, 2005.
   (link to CI5)


2. Jin F, Xiang YB and Gao YT. Cancer survival in Shanghai, People’s Republic of China. In: Cancer Survival in Developing Countries (eds) R Sankaranarayanan, RJ Black and DM Parkin. IARC Scientific Publications No. 145. IARCPress, Lyon, 1998, pp 37-50.
   (link to Cancer Survival, volume 1)