Objective: To investigate the current awareness of core knowledge about cancer prevention and its influencing factors among residents in Zhejiang Province, in order to provide a reference for formulating provincial health education strategies of cancer prevention. Methods : From November 2019 to October 2020, the permanent residents aged 18-74 years in Zhejiang Province were selected using multi-stage stratified sampling method. A questionnaire was designed according to Core Information and Knowledge on Cancer Prevention to collect general information, health status, and awareness of core knowledge about cancer prevention. The multivariate logistic regression model was used to analyze the influencing factors. Results: Among 6 974 valid respondents, 3 139 ( 45.01% ) were males and 3 835 ( 54.99% ) were females. The overall awareness rate of core knowledge about cancer prevention was 74.66%; the awareness rates of basic knowledge, risk factors and primary prevention, screening and early diagnosis as well as treatment and rehabilitation were 79.08%, 80.83%, 76.08% and 82.99%, respectively. The multivariate logistic regression analysis showed that the residents who were in rural areas ( OR=0.659, 95%CI: 0.585-0.743 ), ≥45 years old ( OR: 0.794-0.801, 95%CI: 0.655-0.981 ) and with obesity (OR=0.531, 95%CI: 0.436-0.647) had lower awareness rates, while the residents who were with an educational level of junior high school/technical school/senior high school or above ( OR: 1.390-4.361, 95%CI: 1.208-5.600 ), married (OR=1.414, 95%CI: 1.142-1.752), administrative/technical personnel ( OR=2.602, 95%CI: 2.005-3.377 ), service staff/private business owners ( OR=1.368, 95%CI: 1.111-1.684), retired ( OR=1.345, 95%CI: 1.105-1.639 ) and others ( OR=1.542, 95%CI: 1.295-1.838 ), and with experience of cancer screening or examination ( OR=1.267, 95%CI: 1.123-1.428 ) had higher awareness rates. Conclusions The awareness rate of core knowledge about cancer prevention in Zhejiang Province is 74.66%. Health education for the residents aged ≥45 years, living in rural areas, having low educational levels, and having obesity should be

Objective To investigate the epidemic characteristics and trends of incidence and mortality of prostate cancer in cancer registration areas in Zhejiang province from 2000 to 2009.Methods Clinical data incidence and mortality of prostate cancer were collected from 6 cancer registration areas in Zhejiang province,including Hangzhou,Jiaxing,Jiashan,Haining,Shangyu and Xianju.Crude rates,standardized rate and change trend,age-specific rates and annual percent change (APC,95％ CI) of prostate cancer were checked,sorted and analyzed in Zhejiang Cancer Center.Results The prostate cancer incidence rate from 2000 to 2009 was 9.79/100 000,age-standardized incidence rates by world standard population (ASIRW) was 6.39/100 000,and the incidence cumulative risk of males aged 0-74 was 0.72％ ; while the mortality rate was 2.73/100 000,age-standardized mortality rates by world standard population was 1.74/100 000,and the mortality cumulative risk of males aged 0-74 was 0.14％.Age-specific incidence of prostate cancer remained low before 50,years old and peaked at over 85-year-old group (130.30/100 000).Age-specific mortality of prostate cancer increased after 55,and also peaked at over 85-year-old group (81.19/100 000).The annual prostate cancer incidence rate generally grew from 1.39/100 000 (2000) to 13.89/100 000 (2009),and the APC was 14.18％ (95％ CI,9.68％-18.98％).Meanwhile,the prostate cancer mortality rate also increased from 1.52/100 000 (2000) to 3.58/100 000 (2009),and the APC was 11.83％ (95％ CI,5.69％-18.33％).Conclusion Prostate cancer incidence and mortality in Zhejiang cancer registration areas increased sharply,and the prevention and treatment of prostate cancer should be strengthened.

Objective:To investigate cancer mortality in Zhejiang cancer registration areas from 2010 to 2014. Methods:Cancer regis-tration data were collected from 14 cancer registries of Zhejiang province. The number of cases, crude rates, proportions, age stan-dardized rates, cumulative rates, cut rates, age-specific rates, top 10 mortality ranks, and annual percentage change (APC) of cancer mortality were calculated. Results:A total of 108,514 cancer deaths in Zhejiang cancer registration areas from 2010 to 2014, including 70,578 males and 37,936 females, were recorded. The crude mortality rate was 186.06/105. The standardized mortality rates in Chi-nese (ASMRC) and world populations were 103.02/105 and 101.73/105, respectively. The cumulative mortality rate (0-74 years old) was 11.46%. The ratio of ASMRC in male and female was 1.95, and that in urban and rural areas was 0.93. Age-specific cancer mortality in-creased significantly after 40 years old and peaked at the 85+age group. The crude cancer mortality increased from 2010 (182.85/105) to 2014 (191.00/105) by 4.46%. After age standardization, the mortality rate standardized by Chinese population was reduced from 107.85/105 to 100.60/105. The APC of ASMRC was-1.96%(P=0.017). The top three mortality cancers were lung cancer, liver cancer and gastric cancer. The top 10 cancers accounted for 89.51%of all cancer deaths. The mortality rates in different age groups were inconsis-tent. Leukemia was the main cancer type among 0~14-year-old population. Liver cancer was the most common cancer type in 15~44-year-old population. Lung cancer was the main cancer in population above 45 years old. The ASMRCs of liver cancer, gastric cancer and esophageal cancer decreased, whereas those of pancreatic cancer, prostate cancer and ovarian cancer increased. Conclusion:Can-cer mortality in Zhejiang cancer registration areas increased, which revealed that the number of cancer deaths will continue to in-crease. However, the ASMRC decreased, which indicated that cancer prevention in Zhejiang province had achieved certain effects. Fur-ther measurements, such as health education, cancer screening, and early detection and treatment, should be improved to reduce the danger of cancer.

Objective: To investigate the healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups (DRGs), so as to provide the evidence for controlling medical costs and relieving burdens of patients with lung cancer. Methods: The basic data and healthcare expenditures of lung cancer patients that were definitively diagnosed from 2015 to 2019 and covered by medical insurance were captured from the cancer registration database of Wenling Center for Disease Control and Prevention and the database of chronic and specific diseases in Wenling Bureau of Medical Insurance. The changes of outpatient expenditures, inpatient expenditures and self-payments were compared before (2015-2016) and after implementation of DRGs (2018-2019) among lung cancer patients. Results: Totally 4 947 lung cancer patients covered by medical insurance were enrolled in this study, including 3 052 males (61.69%) and 1 895 females (38.31%), with a mean age of (64.88±11.64) years. The annual mean healthcare expenditure was 56 675.85 Yuan per capita during the period between 2015 and 2016, in which 14.48% were outpatient expenditures and 85.52% were inpatient expenditures, and the annual mean healthcare expenditure was 38 702.94 Yuan per capita during the period between 2018 and 2019 (a 31.71% reduction as compared to that in 2015 and 2016), in which 24.49% were outpatient expenditures and 75.51% were inpatient expenditures. The proportions of outpatient expenditures, inpatient expenditures and total self-payments consisted of 25.38%, 32.49% and 29.67% of total healthcare expenditures in 2018 and 2019, which were significantly lower than those (50.84%, 50.96% and 50.95%, respectively) in 2015 and 2016 (χ2=13.741, P<0.001; χ2=7.015, P=0.008; χ2=9.340, P=0.002). Conclusions The annual mean healthcare expenditures per capita and the proportion of self-payment reduce among lung cancer patients covered by medical insurance following implementation of DRGs.

Objective To compare the detection rate of esophageal and cardiac mucosal lesions be?tween screening endoscopy and conventional routine endoscopy. Methods Using iodine staining,a total of 8 918 patients aged 40?69 were screened for esophageal and cardiac early cancer in Xianju and Tiantai county of Zhejiang Province from January 2010 to July 2013.Matched with age, data of 43 834(the conven?tional group) patients who underwent routine endoscopy during the same time period were also retrieved. The detection rates of esophageal and cardia mucosa lesions in both groups were compared and analyzed. Results The detection rate of esophageal mucosal lesions in screening group was significantly higher than that in the conventional group[7?? 48%(667/ 8 918)VS 2?? 17%(953/ 43 834),P<0?? 001].The total detection rate was the lowest in 2010 among 4 years, while that in 2011?2013 were higher and similiar. The detection rate of cardiac mucosal lesions in screening group was higher than that in the conventional group [ 0?? 78%(70/ 8 918)VS 0?? 70%(309/ 43 834)] without significant difference(P>0?? 05). The detection rates of low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and mucosa cancer and total detection rates between 2 groups were similar(P>0?? 05). Conclusion Through training, endoscopists can grasp the skills of finding esophageal mucosal lesions. Iodine staining should be used as addition to conventional endos?copy in areas with high incidence of esophageal cancer. Conventional white light endoscopy plays a limited role in detection of cardia mucosal lesion, depending on joint inspection of other related methods.

Objective: To compare the effectiveness of qualitative and quantitative fecal immunochemical tests (FIT) in identifying colorectal cancer, so as to provide insights into perfecting screening strategies for colorectal cancer. Methods: Participants in the Colorectal Cancer Screening Program for Key Populations in Zhejiang Province from May 2020 to December 2021 were recruited, and their demographic information, lifestyle and disease history were collected through a questionnaire survey. Qualitative or quantitative FIT along with a questionnaire-based risk assessment were employed as the initial screening tests. Individuals who were positive in any FIT or had high-risk assessment results were required to attend a subsequent colonoscopy examination. The positive rate, detection rate of colorectal cancer, positive predictive value and number of colonoscopies required were compared between qualitative and quantitative FITs, and stratified analyses by gender and age were conducted. Results: Totally 4 099 769 participants were included. The qualitative FIT group included 3 574 917 individuals, yielding a positive rate of 11.35%, a detection rate of 1.19%, a positive predictive value of 0.48% and 83.84 colonoscopies required to detect one cancer case. The quantitative FIT group involved 524 852 individuals, yielding a positive rate of 6.70%, a detection rate of 2.31%, a positive predictive value of 1.01% and 43.23 colonoscopies required to detect one cancer case. The quantitative FIT group showed significantly higher detection rate of colorectal cancer, higher positive predictive value and less number of colonoscopies required compared to the qualitative FIT group (all P<0.05). The same results were obtained after stratification by gender and age. Conclusion Compared to qualitative FIT, quantitative FIT improves the detection of colorectal cancer and reduces the workload of colonoscopy examinations, making it more suitable for colorectal cancer screening in large-scale populations.

Objective: To understand the incidence and mortality of colorectal cancer in tumor registration areas of Zhejiang Province,and to provide reference for prevention and control strategies for colorectal cancer. Methods: The colorectal cancer data was retrieved from fourteen tumor registries in Zhejiang Province were collected,the incidence rate and mortality rate were calculated and standardized according to the Chinese standard population in 2010 and Segi's world population in 2000. The incidence and mortality of colorectal cancer in different sex,age group and region were analyzed. Results: The crude incidence rate of colorectal cancer from 2010 to 2014 was 35.82/100 000（20 983 cases）. The standardized incidence rate by Chinese and world standard population were 20.80/100 000 and 23.01/100 000. The crude mortality rate of colorectal cancer was 15.25/100 000 （8 934 cases）. The standardized mortality rate by Chinese and world standard population were 8.01/100 000 and 9.39/100 000. The ratio of mortality to incidence was 0.43:1. From 2010 to 2014,the incidence and mortality rates of colorectal cancer were stable（P>0.05）. The incidence rates of colorectal cancer in urban and rural residents were 37.69/100 000 and 31.14/100 000,and the mortality rates were 15.73/100 000 and 14.05/100 000. The incidence rates of colorectal cancer in males and females were 41.53/100 000 and 30.11/100 000,and the mortality rates were 17.74/100 000 and 12.76/100 000. The incidence and mortality rates of colorectal cancer both increased with age. The incidence rate increased significantly in people after 40 years old,and peaked with 187.35/100 000 in people aged 80-84 years. The morbidity rate peaked with 171.27/100 000 in people aged 85 years or over. Conclusion The incidence and mortality of colorectal cancer in Zhejiang Province were stable,but the incidence was higher than the national average level. The incidence of colorectal cancer in people aged over 40 years increased significantly.

Objectives: To analyze lung cancer data of patients who are registered in Zhejiang province from 2010 to 2014 and describe the prevalence and mortality of lung cancer in residents of Zhejiang province, so as to provide a reference basis for the government and health administrative departments to formulate a strategy of cancer prevention and treatment. Methods: According to the report of 14 tumor registries of Zhejiang province from 2010 to 2014 in urban and rural areas, lung cancer incidence and mortality were calculated by gender, age, and urban or rural areas, respectively. The population structure from the 2000 national census and Segi's standard population was used to calculate the standardized rates and indicators such as the 0-74-year-old accumulation rates and 35-64-year-old truncation rates. Results: In 2010-2014, there were 37,227 new cases of malignant tumors of the trachea, bronchi, and lungs in Zhejiang cancer registration areas (which are referred to as lung cancer in this article; ICD10 was coded as c33-c34), with the crude incidence rates of 63.55 per 100,000, 35.73 per 100,000 for ASR China, and 35.54 per 100,000 for ASR world, accounting for 18.85% of all cancer cases. The cu-mulative rate of incidence in those aged 0-74 years was 4.44%. Of the new cases, 25,608 were men and 11,619 were women. The ASR China in male was as 2.26 times high as that in female. The ASR China in rural areas was as 1.12 times high as that in urban areas. There were 31,772 deaths in 2010-2014, with the crude mortality rates of 54.24 per 100,000, 29.39 per 100,000 for ASR China, and 29.05 per 100,000 for ASR world, accounting for 29.22% of all cancer deaths. Of the deaths, 22,796 were men and 8,976 were women. The ASR China in male was as 2.70 times high as that in female. The ASR China in rural areas was as 1.05 times high as that in urban areas. The age-specific incidence and mortality rates were relatively low before 40 years old, and increased dramatically after 40 years old, then reached peak at the age of 80 years old. Rates in male were generally higher than those in female. The age-specific incidence and mortality rates varied in urban and rural areas with similar curves. Conclusions: Lung cancer was the most common malignancy in Zhejiang province, and its incidence and mortality are both in the first place of all cancers . With the relatively high burden of disease, lung cancer should be regarded as one of the key malignant tumors while developing strategies for cancer prevention and treatment.

Objective To investigate the incidence and mortality of brain tumor in Zhejiang cancer registration areas from 2000 to 2009.Methods Data from 6 Cancer registration areas of Zhejiang province were collected.Number of cases,crude rates,proportions,age standardized rates,cumulate rates,cut rates,age-specific rates and annual percentage change (APC,95％ CI) of brain tumor incidence and mortality were analyzed.Results There were 5 123 new diagnosed brain tumor cases in Zhejiang cancer registration areas,accounting for 3.14％ of all the new cancer cases.The incidence rate of brain tumor was 8.53/100 000,and the standardized incidence rate by Chinese population was 5.72/100 000,ranking the 7th in cancer incidence spectrum of anatomic sites.Agespecific incidence of brain tumor increased along with age,and peaked among 70-74 age groups (24.09/100 000).The annual incidence rate of brain tumor increased from 2000 (6.87/100 000) to 2009 (8.35/ 100 000),with APC as 1.58％ (95 ％ CI:-2.17％-5.47％,no statistical significance).A total of 2 357 deaths caused by brain tunor were reported from 2000-2009,accounting for 2.47％ of all the cancer death cases.Mortality rate on brain tumor appeared to be 3.92/100 000,with the standardized mortality rate by Chinese population as 2.45/100 000,ranking the 7th in cancer mortality spectrum of anatomic sites.The age-specific mortality of brain tumor remained low among 0-39 year-olds,and reached the peak at 80-84 age groups (17.64/100 000).The annual mortality rate of brain tumor decreased from 2000 (4.30/100 000) to 2009 (3.83/100 000) with minor fluctuation,and the APC was-0.65％ (95％CI:-3.35％-2.12％,no statistical significance).Conclusion Brain tumors incidence and mortality in Zhejiang cancer registration areas were at a relatively high level.People who were at middle-age,especially above 70 years old should be the key targets for protection on this disease.Brain tumor incidence rates increased annually in Zhejiang,which should be called for attention.

Objective: To study the age of onset of malignant tumors in cancer registration areas in Zhejiang province from 2000 to 2015. Methods: Based on the incidence data of cancer from 14 national cancer registration areas in Zhejiang province between 2000 and 2015, the incidence rate, average/standardized average age of onset, and age-specific incidence proportion were calculated, and standardized by Segi′s world population. The population was divided into 7 age groups (0-29, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80 years old). The average age of onset and age-specific incidence proportion were analyzed by using a linear regression. The change trend of the proportion; the average annual percent change (AAPC) of the incidence rate was calculated by using the Joinpoint log-linear regression model. The birth cohort was constructed by using the standardized incidence rate and the year of onset of cancer, and the distribution characteristics of the age groups were described. Results: From calendar year 2000 to 2015, the average age of onset of malignant tumors in Zhejiang Province decreased from 59.7 to 57.6, with an average annual percent decrease of 0.09 year (P=0.033). After the merge of age groups, the standardized incidence proportion of 30-49 and ≥60 years old group standardization increased by an average annual change of 0.38% and decreased by an average annual change of 0.39%, respectively (both P values <0.001). The results of the log-linear regression model showed that the standardized incidence rate of the 30-39 and 40-49 years old age groups increased rapidly, with the AAPC (95%CI) about 5.2% (4.4%-6.0%) and 3.4% (2.5%-4.3%), respectively. The incidence rate of female increased rapidly, especially for 30-39 and 40-49 years old age groups with the AAPC about 6.2% (5.1%-7.2%) and 4.9% (4.0%-5.9%), respectively. The results of the birth cohort analysis showed that the population with different birth years in the same age groups saw an increasing trend with the increase of the birth year. Conclusion The age of onset of malignant tumors in the cancer registration areas in Zhejiang Province is getting younger. The incidence rate and number of people with malignant tumors in 30-49 years old age group is evident. These characteristics are more obvious in female than that in male.