In the 1970s, esophageal cancer was the leading cause of cancer-related death in
Hebei Province, China, with one in five people dying from this disease in some high-
risk counties. In the late-stage disease, patients cannot eat or drink, and often die
within 6 months without proper treatment. The 5-year survival rate is under 10%, with
deaths causing considerable economic and emotional hardship.
Oncologists at the Fourth Hospital of Hebei Medical University tackled this
problem using a three-pronged approach. First, they set up a provincial cancer
registry that tracked the cancer epidemiology and burden, laying a foundation
for comprehensive cancer prevention and control. Second, they focused on
determining the etiology of esophageal cancers in Hebei. Researchers determined
that contributing factors included contamination of the local water supply with
toxic nitrogen–containing compounds, mold contamination of food resulting
from long-term storage, trace-element deficiencies in the soil, and poor nutrition
among the local residents. The genetics of the local population was also a factor,
as the cancer appeared repeatedly within certain families. And third, an etiology
prevention strategy was put in place that included improvements to the quality of
the drinking water, bet ter administration of storage for agricultural produce, and an
educational campaign with recommendations for a healthy lifestyle.
But these measures proved insufficient. Oncologists at the Fourth Hospital
therefore set out to determine if early detection and treatment of esophageal
cancer was possible.
A simple, inexpensive test was developed based on the detection of glycogen.
Iodine, when sprayed on esophageal mucosal cells, changes their color if the cells
are normal. No color change indicates potentially cancerous cells. Researchers at
the hospital also participated in a multicenter clinical research program to develop
additional screening technologies for esophageal cancer. They achieved good
success in early detec tion, according to Baoen Shan, direc tor of the Four th Hospital
and the Provincial Institute of Oncology. Furthermore, the hospital was the first in
China to develop a technique for endoscopic resection of esophageal cancer as a
treatment modality. Over 1 million people in 18 provinces have now been trained inthe procedure. Over 230,000 esophageal cancer screenings have been performed
in Hebei in the past 15 years and 4,000 early-stage cases have been detected, with
a 5-year survival rate of 92.7%. 11,429 cases of precancerous esophageal cancer
lesions have been identified.
S t u d i e s h a v e b e e n p e r f o r m e d t o f in d t r e a t m e n t s t h a t m i gh t b l o c k t h e f o r m a t i o n o f
precancerous lesions to prevent or treat early-stage esophageal cancer, including
the extraction and purification of compounds from traditional Chinese medicines,
such as p-hydroxylcinnamaldehyde isolated from the Cochinchina momordica
seed and lupeal acetate from Cortex Periplocae root. Traditional Chinese medicine
prescriptions were also tested in an attempt to prevent or impede precancerous
lesions in the esophagus, mitigating the need for surgery, radiotherapy, or
chemotherapy.
Thanks to 45 years of comprehensive prevention and control, the esophageal
cancer mortality rate in Hebei decreased 82.4% from the 1970s to 2018, a markedly
faster decline than the average across China of 56.6% during the same period. The
5-year survival rate increased from ~8.0% in the 1990s to 34.4% in 2013, higher
than both the Chinese average (30.3%) and that found in the United States (21.1%).
This reduction in mortality and morbidity saves patients in Hebei an estimated
RMB 532 million (USD 83.4 million) in direct medical expenses and RMB 2.1 billion
(USD 329.3 million) in indirect expenses annually. The work being done in Hebei has
considerably reduced patient medical ex penses, saved national medical resources,
and significantly advanced the prevention and control of upper gastrointestinal
cancers in China.
“The money aside, what we are doing is life-saving,” Shan says, “and lives
are priceless.”Advertorial
Esophageal cancer prevention through early diagnosis and
treatment: Lessons from Hebei Province, China
IMAGES PROVIDED BY THE BEIJING HEALTH PROMOTION ASSOCIATIONSponsored byProduced by the Science
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