- Open Access
At-home cancer screening: a solution for China and other developing countries with a large population and limited number of healthcare practitioners
© The Author(s) 2017
- Received: 13 August 2017
- Accepted: 17 August 2017
- Published: 21 August 2017
Five-year survival rate for patients with all cancers combined, in China, is only 30.9%, which is much lower than those in developed countries. The three main reasons for the low cancer curative rates in China include differences in the spectrum of cancer types, in early detection rates, and in the percentage of cancer patients receiving standardized treatment between China and developed countries. The most important mechanism for improving the curative rate is to improve early detection rates of major cancers in China using novel and affordable technologies that can be operated at home by the patients themselves. This attempt could be helpful in setting up a practical example for other developing countries with limited medical resources and a limited number of healthcare practitioners.
- The spectrum of cancer types
- At-home cancer screening
- Early detection rate
- Standardized treatment
- Lung cancer
- Cervical cancer
- Gastric cancer
- Colorectal cancer
- Breast cancer
- Stool DNA
In China, the age-standardized 5-year survival rate for patients with all cancers combined is only 30.9% , which is much lower than that in the United States (68%)  and that in the United Kingdom (54.3%) . There are three main reasons for the huge discrepancies of cancer treatment outcomes between China and developed countries: (1) differences in the spectrum of cancer types; (2) differences in early detection rates; and (3) differences in the percentage of cancer patients receiving standardized treatment.
In the US and other western countries, gastric, liver, and esophageal cancers are less common, whereas in China, these malignancies are consistently among the top 10 most common cancer types [4–6]. Patients with these three types of cancer usually have shorter survival in contrast to patients with prostate and breast cancers, the latter two being more common in the US and other western countries . The differences in the spectrum of cancer types can hardly be changed within a decade. However, along with gradual changes in the Chinese lifestyle, as well as the application of vaccinations against hepatitis B and C virus infections, the incidence of gastric, esophageal, and liver cancers are expected to decline in the next two decades.
Patient survival for many malignancies is mainly dependent on the stage of the disease. The most important reason underlying the discrepancies of the curative rates between China and developed countries is that early cancer detection rates are pretty low for most of the cancer types in China. For operable gastric cancers in China, stage I diseases only account for 18%, and approximately 59% are stage III–IV diseases . Contrastingly, in Japan, early detection rates are very high, with over 60% of stage I diseases and 24% of stage III–IV diseases . For breast cancer, stage I diseases account for only 13.5% of all cases in China, in contrast, it is 50.5% in the US . For colorectal cancer, early detection rates in large city hospitals in China is 30% , whereas the average in the US is 38.5% . Clearly, more endeavors need to be made to significantly increase the early detection rates of major cancers in China.
The application of cancer screening for major cancers in healthy populations using current medical technologies is impeded by two main difficulties. The first difficulty is the expensive cost of current technologies. Due to limited financial resources, the state-owned medical insurance agencies for most Chinese people cannot cover the annual workup for major cancers using traditional technologies, e.g., chest X-ray for lung cancer, let alone using more accurate yet expensive technologies, e.g., low-dose computed tomography scanning for lung cancer. Another difficulty is the limited number of healthcare practitioners in China to complete population-based screening for major cancers using traditional technologies, which are highly dependent on professionals for operation .
Some novel and inexpensive technologies need to be invented to simultaneously overcome these two difficulties in China and other developing countries facing similar challenges. Encouragingly, several promising techniques for at-home cancer screening have been approved for clinical practice in the US. By detecting tumor specific KRAS mutations, abnormal NDRG4, and bone morphogenetic protein 3 (BMP3) methylation, plus hemoglobin immunoassays of stool samples, a company named Exact Sciences has developed an at-home screening kit for detecting colorectal cancer, as well as advanced precancerous lesions, with satisfying sensitivity and specificity . For cervical cancer screening, technologies based on self-collected vaginal samples for human papillomavirus infection (HPV) testing are available and currently under clinical validation [14, 15]. More promisingly, highly sensitive nanoarray sensors for exhaled volatile organic compounds have recently been developed for early detection of lung cancer using breath samples, which can even detect epidermal growth factor receptor (EGFR) mutation for differential diagnosis [16, 17].
Before widespread use of at-home screening technologies in China, validation trials need to be conducted to optimize the techniques and to customize the analytical criteria for the Chinese population. These endeavors could be made by establishing several institutions in different parts of the country responsible for conducting clinical trials, optimizing screening systems, and routinely testing and storing the samples.
It is estimated that over 60% of cancer patients in China are not treated in specialized cancer hospitals or cancer centers but treated in general hospitals. Radiotherapy in some general hospitals is limited and/or inaccessible, therefore, a significant portion of cancer patients do not receive standard treatment following international guidelines. Another challenge is the shortage of oncological specialists in China. China has launched nationwide residency training programs in 2014, including a radiation oncologist residency training program. However, the long time-discussed specialist training programs for medical oncologists and surgical oncologists have not yet been launched. It is expected that by improving the education and training systems for oncological specialists in China, more and more patients will be treated in accordance with international guidelines.
In conclusion, many efforts need to be made to improve the survival rates of cancer patients in China. The most important one is to improve early detection rates of major cancers in China using novel and affordable technologies allowing at-home sample collection by the patients themselves. All of these efforts could be helpful in setting up a successful example for other developing countries with limited medical resources and a limited number of healthcare practitioners.
This work was supported by grants from the National Natural Science Foundation of China (No. 81472386, No. 81672872), the National High Technology Research and Development Program of China (863 Program) (No. 2012AA02A501), the Science and Technology Planning Project of Guangdong Province, China (No. 2014B020212017, No. 2014B050504004 and No. 2015B050501005), and the Provincial Natural Science Foundation of Guangdong, China (No. 2016A030311011).
The author declares that he has no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Zeng H, Zheng R, Guo Y, Zhang S, Zou X, Wang N, et al. Cancer survival in China, 2003–2005: a population-based study. Int J Cancer. 2015;136:1921–30. doi:10.1002/ijc.29227.View ArticlePubMedGoogle Scholar
- National Institutes of Health. Yesterday, Today, Tomorrow: NIH research timelines. 2013. https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=75&key=C#C.
- Cancer Research UK. Cancer survival statistics for all cancers combined. 2014. http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/all-cancers-combined#heading-Zero.
- Chen W, Zheng R, Zeng H, Zhang S. The updated incidences and mortalities of major cancers in China, 2011. Chin J Cancer. 2015;34:502–7. doi:10.1186/s40880-015-0042-6.PubMedGoogle Scholar
- Chen W, Zheng R, Zeng H, Zhang S. The incidence and mortality of major cancers in China, 2012. Chin J Cancer. 2016;35:73. doi:10.1186/s40880-016-0137-8.View ArticlePubMedPubMed CentralGoogle Scholar
- Zheng R, Zeng H, Zhang S, Chen W. Estimates of cancer incidence and mortality in China, 2013. Chin J Cancer. 2017;36:66. doi:10.1186/s40880-017-0234-3.
- Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385:977–1010. doi:10.1016/S0140-6736(14)62038-9.View ArticlePubMedGoogle Scholar
- Wang Y, Wei S, Li Y, Deng S, Luo Q, Li Y. Challenges and a response strategy for the development of nursing in China: a descriptive and quantitative analysis. J Evid Based Med. 2013;6:21–33. doi:10.1111/jebm.12016.View ArticlePubMedGoogle Scholar
- Fujiwara Y, Fukuda S, Tsujie M, Ishikawa H, Kitani K, Inoue K, et al. Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy. World J Gastrointest Oncol. 2017;9:257–62. doi:10.4251/wjgo.v9.i6.257.View ArticlePubMedPubMed CentralGoogle Scholar
- Chen C, Sun S, Yuan JP, Wang YH, Cao TZ, Zheng HM, et al. Characteristics of breast cancer in Central China, literature review and comparison with USA. Breast. 2016;30:208–13. doi:10.1016/j.breast.2016.01.004.View ArticlePubMedGoogle Scholar
- Fang YJ, Wu XJ, Zhao Q, Li LR, Lu ZH, Ding PR, et al. Hospital-based colorectal cancer survival trend of different tumor locations from 1960s to 2000s. PLoS ONE. 2013;8:e73528. doi:10.1371/journal.pone.0073528.View ArticlePubMedPubMed CentralGoogle Scholar
- May FP, Glenn BA, Crespi CM, Ponce N, Spiegel BMR, Bastani R. Decreasing black-white disparities in colorectal cancer incidence and stage at presentation in the United States. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2017;26:762–8. doi:10.1158/1055-9965.EPI-16-0834.View ArticleGoogle Scholar
- Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370:1287–97. doi:10.1056/NEJMoa1311194.View ArticlePubMedGoogle Scholar
- Chen K, Ouyang Y, Hillemanns P, Jentschke M. Excellent analytical and clinical performance of a dry self-sampling device for human papillomavirus detection in an urban Chinese referral population. J Obstet Gynaecol Res. 2016;42:1839–45. doi:10.1111/jog.13132.View ArticlePubMedGoogle Scholar
- Zhao FH, Lewkowitz AK, Chen F, Lin MJ, Hu SY, Zhang X, et al. Pooled analysis of a self-sampling HPV DNA Test as a cervical cancer primary screening method. J Natl Cancer Inst. 2012;104:178–88. doi:10.1093/jnci/djr532.View ArticlePubMedPubMed CentralGoogle Scholar
- Lopez-Sanchez LM, Jurado-Gamez B, Feu-Collado N, Valverde A, Canas A, Fernandez-Rueda JL, et al. Exhaled breath condensate biomarkers for the early diagnosis of lung cancer using proteomics. Am J Physiol Lung Cell Mol Physiol. 2017;. doi:10.1152/ajplung.00119.2017.PubMedGoogle Scholar
- Shlomi D, Abud M, Liran O, Bar J, Gai-Mor N, Ilouze M, et al. Detection of lung cancer and EGFR mutation by electronic nose system. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. 2017;. doi:10.1016/j.jtho.2017.06.073.Google Scholar