Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug;34(8):1800-5.
doi: 10.1093/carcin/bgt007. Epub 2013 Jan 14.

Dramatic reduction of liver cancer incidence in young adults: 28 year follow-up of etiological interventions in an endemic area of China

Zongtang Sun  1 , Taoyang Chen, Snorri S Thorgeirsson, Qimin Zhan, Jianguo Chen, Ju-Hyun Park, Peixin Lu, Chu Chieh Hsia, Nengjin Wang, Libin Xu, Lingling Lu, Fei Huang, Yuanrong Zhu, Jianhua Lu, Zhengping Ni, Qinan Zhang, Yuying Wu, Guoting Liu, Zhiyuan Wu, Chunfeng Qu, Mitchell H Gail
Affiliations

Dramatic reduction of liver cancer incidence in young adults: 28 year follow-up of etiological interventions in an endemic area of China

Zongtang Sun et al. Carcinogenesis. 2013 Aug.

Abstract

Qidong City, China, has had high liver cancer incidence from endemic hepatitis B virus (HBV) infection and dietary exposure to aflatoxin. Based on etiologic studies, we began interventions in 1980 to reduce dietary aflatoxin and initiate neonatal HBV vaccination. We studied trends in liver cancer incidence rates in the 1.1 million inhabitants of Qidong and examined trends in aflatoxin exposure, staple food consumption, HBV infection markers and annual income. Aflatoxin exposure declined greatly in association with economic reform, increased earnings and educational programs to shift staple food consumption in the total population from moldy corn to fresh rice. A controlled neonatal HBV vaccination trial began in 1983 and ended in November, 1990, when vaccination was expanded to all newborns. Liver cancer incidence fell dramatically in young adults. Compared with 1980-83, the age-specific liver cancer incidence rates in 2005-08 significantly decreased 14-fold at ages 20-24, 9-fold at ages 25-29, 4-fold at ages 30-34, 1.5-fold at ages 35-39, 1.2-fold at ages 40-44 and 1.4-fold at ages 45-49, but increased at older ages. The 14-fold reduction at ages 20-24 might reflect the combined effects of reduced aflatoxin exposure and partial neonatal HBV vaccination. Decrease incidence in age groups >25 years could mainly be attributable to rapid aflatoxin reduction. Compared with 1980-83, liver cancer incidence in 1990-93 significantly decreased 3.4-fold at ages 20-24, and 1.9-fold at ages 25-29 when the first vaccinees were <11 years old.

PubMed Disclaimer

Figures

Fig. 2.
Fig. 2.
Per capita annual consumption of corn in Qidong from 1973 to 1981 and per capita annual consumption of corn, rice and wheat in Qidong from 1988 to 2010. Corn was the main staple food during 1973–81, when consumption varied from 65 to 124kg/person/year. By 1988, rice was the main staple food, and rice consumption varied from 225 to 235kg/person/year from 1988 to 2010.
Fig. 3.
Fig. 3.
Age-specific incidence rates of liver cancer in Qidong on semi-logarithmic scale. The bold solid curve describes aggregated data from 2005 to 2008, the bold dashed curve aggregated data from 1990 to 1993, and the grey hatched curve aggregated data from 1980 to 1983. Age-specific relative risks with confidence intervals are shown. CIs from the Poisson distribution are based on the assumption that the logarithm of the relative risk is normally distributed with variance estimated by the sum of the reciprocals of the age-specific numbers of incident cases in the two time periods.
Fig. 1.
Fig. 1.
Urinary AFM1 concentrations in a cohort of 145 men with CHB. These men were recruited in 1987–88 and followed to 2000. (A) In 1988, 78 (54%) of the 145 men had urinary AFM1 levels >4ng/l (‘detectable’ levels); these detectable levels ranged from 5.7 to 243ng/l with mean 48ng/l (left panel). (B) In 2000, of the 78 men with detectable AFM1 in 1988, there were 34 accessible survivors, of whom 21 provided 2 urine samples spaced 4 days apart. During the periods of urine collection, they all ate rice as their usual main staple food. Twenty of these men had non-detectable AFM1 levels, and one had a level of 9ng/l (right panel).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Jemal A., et al. (2011). Global cancer statistics. CA. Cancer J. Clin., 61, 69–90 - PubMed
    1. Chen J.G., et al. (2006). Trends in the incidence of cancer in Qidong, China, 1978–2002. Int. J. Cancer., 119, 1447–1454 - PubMed
    1. Xia Q.J., aka Hsia C.C., et al. (1984). Liver cell cancer in the young and adolescent and its relation to hepatitis B virus (HBV). Chin. J. Oncol., 6, 413–416 - PubMed
    1. Lu J., et al. (1983). Matched prospective study of primary hepatocellular carcinoma in chronic carriers of HBsAg. Chin. J. Oncol., 5, 406–408 - PubMed
    1. Sun T., et al. (1984). Carcinogenesis and prevention strategy of liver cancer in areas of prevalence. In Mak T.W. et al. (eds) Cellular and Molecular Biology of Neoplasia., Alan R. Liss Inc. New York, USA: pp. 39–44 - PubMed

Publication types

MeSH terms