Cancer statistics in China: Epidemiology, risk factors, and prevention

Abstract

Cancer is a leading cause of death in China, and its epidemiological profile has shifted markedly in recent years. This review summarizes contemporary trends in cancer incidence and mortality, delineates the major modifiable risk factors, and highlights recent national efforts to ease the burden of cancer. In 2022, China recorded 4.8 million new cancer cases (crude rate: 341.7 per 100,000) and 2.5 million cancer deaths (182.3 per 100,000). Lung, colorectal, thyroid, liver, stomach, and female breast cancers accounted for 65% of all diagnoses, while lung, liver, stomach, colorectal, and esophageal cancers constituted 67.5% of cancer deaths. Notable shifts in sex-specific rankings underscored the rising mortality burden of prostate, female breast, and cervical cancers. China has made measurable progress in cancer control. Between 2000 and 2018, the age-standardized mortality rate for all cancers declined by approximately 1.3% annually, and the age-standardized 5-year relative survival improved from 30.9% in 2003−2005 to 43.7% in 2019−2021. According to Global Burden of Disease (GBD) 2023, nearly half of cancer deaths and disability-adjusted life years (DALYs) were attributable to modifiable risk factors such as tobacco, air pollution, high alcohol use, dietary risks, and unsafe sex. In response, the government has implemented a suite of prevention-oriented policies, including expansion of human papillomavirus (HPV) vaccination, strengthened tobacco control, sustained air pollution reduction, enhanced health education, and broadened cancer screening coverage. Collectively, these initiatives demonstrate a sustained national commitment to reducing the cancer burden.

Introduction

Against the backdrop of China’s ongoing economic transformation and profound demographic and societal shifts, notable changes have occurred in lifestyle patterns, environmental exposures, and population aging. These transitions have further accentuated the public health burden posed by cancer (1). Cancer has become one of the leading causes of death in China, and the cancer profile has undergone significant changes in recent years (2,3). The increasing burden of cancer imposes substantial health and economic pressures on families and society, contributing to high medical expenditures and constraining improvements in life expectancy.

By systematically examining cancer incidence, mortality, and associated risk factors, cancer epidemiology data provide convincing evidence for monitoring temporal trends and evaluating the effectiveness of prevention and control strategies (4). Timely review and comparison of epidemiological data are fundamental for generating robust evidence that can support governmental policy-making and inform the design of cancer control programs.

This review aims to describe contemporary cancer trends and changes in the patterns of cancer epidemiology in China, summarize major cancer-related risk factors, and highlight recent national efforts undertaken to ease the burden of cancer. We retrieved relevant data from peer-reviewed publications indexed in major electronic databases, as well as from books and authoritative official sources, including the Government of the People’s Republic of China, the National Health Commission, and the World Health Organization (WHO).

Cancer epidemiology

Cancer incidence in China, 2022

According to cancer burden estimates jointly released by the National Cancer Center (NCC) of China and the International Agency for Research on Cancer (IARC) in GLOBOCAN 2022 (5,6), approximately 4.82 million new cancer cases (2.53 million in males and 2.29 million in females) were diagnosed in China in 2022. The crude incidence rate for all cancer sites combined was 341.75 per 100,000 in 2022 (351.44 per 100,000 for males and 331.64 per 100,000 for females). The most commonly diagnosed cancers were lung, colorectal, thyroid, liver, stomach, and female breast, accounting for 22.00%, 10.73%, 9.67%, 7.63%, 7.44%, and 7.41% of all cases, respectively, and together representing 65% of the national cancer burden (Table 1).

Table 1. Estimates of cancer incidence in China by sex, 2022.

Cancer sites	All					Male					Female
	Cases (×104)	Percentage (%)	Crude rate (1/105)			Cases (×104)	Percentage (%)	Crude rate (1/105)			Cases (×104)	Percentage (%)	Crude rate (1/105)
*, Non-melanoma skin cancer (C44) was included. CNS, central nervous system.
Lung	106.06	22.00	75.13			65.87	26.00	91.36			40.19	17.54	58.18
Colon-rectum	51.71	10.73	36.63			30.77	12.14	42.67			20.94	9.14	30.32
Thyroid	46.61	9.67	33.02			12.49	4.93	17.32			34.12	14.89	49.40
Liver	36.77	7.63	26.24			26.79	10.57	37.16			9.98	4.36	14.44
Stomach	35.87	7.44	25.41			24.66	9.73	34.20			11.21	4.89	16.23
Female breast	35.72	7.41	51.71			−	−	−			35.72	15.59	51.71
Esophagus	22.40	4.65	15.87			16.75	6.61	23.23			5.65	2.47	8.19
Cervix	15.07	3.13	21.81			−	−	−			15.07	6.58	21.81
Prostate	13.42	2.78	18.61			13.42	5.30	18.61			−	−	−
Pancreas	11.87	2.46	8.41			6.71	2.65	9.31			5.15	2.25	7.46
Bladder	9.29	1.93	6.58			7.32	2.89	10.15			1.97	0.86	2.85
Brain, CNS	8.75	1.82	6.20			4.24	1.67	5.88			4.51	1.97	6.53
Lymphoma	8.52	1.77	6.03			4.81	1.90	6.68			3.71	1.62	5.36
Leukemia	8.19	1.70	5.80			4.70	1.85	6.52			3.50	1.53	5.06
Uterus	7.77	1.61	11.25			−	−	−			7.77	3.39	11.25
Kidney	7.37	1.53	5.22			4.73	1.87	6.56			2.64	1.15	3.81
Lip, oral cavity & pharynx	6.51	1.35	4.61			4.56	1.80	6.33			1.95	0.85	2.82
Ovary	6.11	1.27	8.84			−	−	−			6.11	2.67	8.84
Nasopharynx	5.10	1.06	3.61			3.67	1.45	5.08			1.44	0.63	2.08
Gallbladder	3.11	0.65	2.21			1.27	0.50	1.76			1.85	0.81	2.67
Larynx	2.95	0.61	2.09			2.72	1.07	3.77			0.23	0.10	0.33
Melanoma of skin	0.88	0.18	0.62			0.44	0.17	0.61			0.44	0.19	0.64
Testis	0.35	0.07	0.48			0.35	0.14	0.48			−	−	−
All sites*	482.47	100	341.75			253.39	100	351.44			229.08	100	331.64

Among males, lung cancer was the predominant cancer type (658,700 cases; 26.00%), followed by colorectal cancer (307,700 cases; 12.14%), liver cancer (267,900 cases; 10.57%), stomach cancer (246,600 cases; 9.73%), and esophageal cancer (167,500 cases; 6.61%). In contrast, the top 5 cancers in females were lung cancer (401,900 cases; 17.54%), breast cancer (357,200 cases; 15.59%), thyroid cancer (341,200 cases; 14.89%), colorectal cancer (209,400 cases; 9.14%) and cervical cancer (150,700 cases; 6.58%), accounting for 63.74% of total new cancer cases in females. The crude incidence rates of lung, liver, stomach, and esophageal cancers in males were 91.36, 37.16, 34.20, and 23.23 per 100,000, respectively-substantially exceeding the corresponding rates of 58.18, 14.44, 16.23, and 8.19 per 100,000 observed in females. In contrast, thyroid cancer displayed an opposite pattern, with a markedly higher incidence in females (49.40 per 100,000) compared with males (17.32 per 100,000).

Cancer mortality in China, 2022

According to GLOBOCAN 2022 (6), approximately 2.57 million cancer deaths occurred in China in 2022, with a crude mortality rate of 182.34 per 100,000. Gender-specific data showed 1.63 million deaths in males (crude rate: 225.97 per 100,000) and 0.94 million deaths in females (136.79 per 100,000). The most common causes of cancer death were lung, liver, stomach, colorectal, and esophageal cancers, accounting for 28.49%, 12.30%, 10.12%, 9.32%, and 7.28% of all cancer deaths, respectively, and together representing 67.51% of the total cancer mortality burden (Table 2).

Table 2. Estimates of cancer mortality in China by sex, 2022.

Cancer sites	All				Male				Female
	Deaths (×104)	Percentage (%)	Crude rate (1/105)		Deaths (×104)	Percentage (%)	Crude rate (1/105)		Deaths (×104)	Percentage (%)	Crude rate (1/105)
*, Non-melanoma skin cancer (C44) was included. CNS, central nervous system.
Lung	73.33	28.49	51.94		51.59	31.66	71.55		21.74	23.01	31.47
Liver	31.65	12.30	22.42		22.98	14.10	31.87		8.68	9.19	12.56
Stomach	26.04	10.12	18.44		18.16	11.15	25.18		7.88	8.34	11.41
Colon-rectum	24.00	9.32	17.00		14.26	8.75	19.78		9.74	10.31	14.10
Esophagus	18.75	7.28	13.28		14.04	8.62	19.47		4.71	4.98	6.82
Pancreas	10.63	4.13	7.53		6.11	3.75	8.47		4.52	4.78	6.55
Female breast	7.50	2.91	10.86		−	−	−		7.50	7.94	10.86
Brain, CNS	5.66	2.20	4.01		3.16	1.94	4.38		2.51	2.66	3.63
Cervix	5.57	2.16	8.06		−	−	−		5.57	5.89	8.06
Leukemia	5.01	1.95	3.55		2.92	1.79	4.04		2.09	2.21	3.03
Prostate	4.75	1.85	6.59		4.75	2.92	6.59		−	−	−
Lymphoma	4.16	1.62	2.95		2.51	1.54	3.48		1.65	1.75	2.39
Bladder	4.14	1.61	2.93		3.25	1.99	4.51		0.88	0.93	1.28
Lip, oral cavity & pharynx	3.52	1.37	2.49		2.58	1.58	3.58		0.94	0.99	1.35
Ovary	3.26	1.27	4.73		−	−	−		3.26	3.45	4.73
Nasopharynx	2.84	1.10	2.01		2.13	1.31	2.95		0.71	0.75	1.03
Gallbladder	2.45	0.95	1.74		0.98	0.60	1.36		1.47	1.56	2.13
Kidney	2.40	0.93	1.70		1.64	1.01	2.27		0.76	0.80	1.10
Larynx	1.69	0.66	1.19		1.50	0.92	2.08		0.18	0.19	0.26
Uterus	1.35	0.52	1.96		−	−	−		1.35	1.43	1.96
Thyroid	1.16	0.45	0.82		0.43	0.26	0.60		0.72	0.76	1.05
Melanoma of skin	0.54	0.21	0.38		0.29	0.18	0.40		0.25	0.26	0.36
Testis	0.08	0.03	0.11		0.08	0.05	0.11		−	−	−
All sites*	257.42	100	182.34		162.93	100	225.97		94.49	100	136.79

Lung cancer remained the leading cause of cancer death in both genders, with a more pronounced impact in males: it contributed 31.66% of male cancer deaths (515,900 cases) compared to 23.01% of female deaths (217,400 cases). Among males, the leading causes of cancer-related mortality mirrored those observed in the overall population, with liver (229,800 cases; 14.10%), stomach (181,600 cases; 11.15%), colorectal (142,600 cases; 8.75%), esophageal (140,400 cases; 8.62%), and pancreatic (61,100 cases; 3.75%) cancers ranking highest. Together, the top six cancer types accounted for approximately 78.03% of all cancer deaths in males. In females, lung cancer was followed by colorectal (97,400 cases; 10.31%), liver (86,800 cases; 9.19%), stomach (78,800 cases; 8.34%), breast (75,000 cases; 7.94%), and cervical (55,700 cases; 5.89%) cancers as the major causes of cancer mortality. These six cancers collectively contributed to about 64.68% of total cancer deaths among females.

The crude mortality rates of digestive system malignancies, including liver, stomach, and esophageal cancers, were 31.87, 25.18, and 19.47 per 100,000 in males, respectively-substantially exceeding the corresponding rates of 12.56, 11.41, and 6.82 per 100,000 observed in females. Prostate cancer, a sex-specific malignancy, accounted for 2.92% of male cancer deaths, with a crude mortality rate of 6.59 per 100,000. Among females, sex-specific cancers constituted a sizeable proportion of cancer mortality, including breast cancer (10.86 per 100,000), cervical cancer (8.06 per 100,000), and ovarian cancer (4.73 per 100,000). These patterns underscore distinct sex-specific profiles in cancer mortality across major cancer sites.

Rank changes and trends in cancer incidence and mortality for leading cancer types

Rank changes

Data from GLOBOCAN 2022 and national cancer statistics based on 487 registries in 2016 were used to assess changes in cancer burden from 2016 to 2022 (Figure 1) (6,7). Lung and colorectal cancers remained the two most common cancer types, both showing increases in age-standardized incidence rate (ASIR). Thyroid cancer rose to third place, with its ASIR doubling and the number of cases increasing by 263,500. Prostate cancer climbed to 9th place, with a 1.5-fold rise in ASIR and 55,900 additional cases. In contrast, stomach, esophageal, and brain cancers declined in rank, accompanied by marked decreases in both case counts and ASIR.

Figure 1.

Rank and estimate changes in the most common cancers (A) and leading cancer deaths (B) in China between 2016 and 2022. Blue represents no rank change, red represents rank decrease, and green represents rank increase. ASIR, age-standardized incidence rate; CNS, central nervous system; ASMR, age-standardized mortality rate.

Regarding cancer mortality in China, lung, liver, stomach, colorectal, esophageal, and pancreatic cancers remained the leading causes of cancer deaths. Marked shifts were observed in the ranking of sex-specific cancers. Females breast cancer rose from 11th in 2016 to 7th in 2022, with an age-standardized mortality rate (ASMR) remaining 6.1 per 100,000, yet the number of deaths increased by 37,900. Cervical cancer similarly climbed to 9th place, with 38,500 more deaths in 2022 compared with 2016. Prostate cancer advanced from 13th to 11th place over the same period, accompanied by an increase of 13,900 deaths. These trends highlight the growing mortality burden associated with sex-specific cancers in China.

Trends

According to estimates from the NCC, temporal patterns in ASIR and ASMR from 2000 to 2018 were examined using data from 22 cancer registries with continuous reporting (6). Over this 19-year period, the ASIR for all cancers increased significantly, with an average annual rise of approximately 1.4%. Among males, the ASIR remained relatively stable, whereas among females it increased markedly-by 2.6% per year-driven primarily by rising diagnoses of thyroid and cervical cancers.

During the same period, the ASMR for all cancers combined declined significantly by about 1.3% annually. Among males, all-cancer ASMR decreased at an average percentage of 1.2% per year, although the ASMRs from prostate, colorectal, and pancreatic cancers showed upward trends. Among females, overall cancer ASMR declined by 1.3% per year; however, increasing ASMRs were observed for cervical and ovarian cancers.

Survival trends

The overall age-standardized 5-year relative survival rate among patients diagnosed with cancer in China increased from 30.9% in 2003−2005 to 43.7% in 2019−2021 (8,9). During 2003−2021, significant improvements were observed in survival for 19 cancer types, with absolute average change ranging from 1.4% to 5.0%. Notable increases occurred for lung, prostate, bone, uterine, breast, cervical, stomach, colorectal, and thyroid cancers, with prostate cancer showing the most substantial improvement.

Data from 281 cancer registries indicate that in 2019−2021 (8), males had substantially lower 5-year relative survival than females (36.4% vs. 51.6%). For all cancers combined and for most cancer types, 5-year relative survival declined progressively with advancing age. Marked variation was observed across cancer types, ranging from 8.5% for pancreatic cancer to 92.9% for thyroid cancer. Eight cancers—thyroid, breast, testicular, bladder, prostate, kidney, uterine, and cervical cancers—had 5-year survival rates exceeding 60%. In contrast, pancreatic, liver, gallbladder, esophageal, and lung cancers had the lowest 5-year relative survival rates, all below 30% (Table 3).

Table 3. Estimate changes in age-standardized 5-year relative survival by cancer types between 2003 and 2021.

Cancer sites	Age-standardized 5-year relative survival [% (95% CI)]		Average change per calendar period [% (95% CI)]c	P for trendc
	2003−2005a	2019−2021b
a, Data extracted from Table 3 in Reference (9); b, Data extracted from Table 2 in Reference (8); c, Data extracted from Supplementary Table 5 in Reference (8). 95% CI, 95% confidence interval.
Lip, oral cavity & pharynx	42.2 (38.9, 45.5)	47.0 (46.3, 47.7)	0.8 (−0.8, 2.4)	0.235
Nasopharynx	43.8 (39.6, 48.0)	56.2 (55.6, 56.9)	0.9 (−0.5, 2.4)	0.153
Esophagus	20.9 (20.1, 21.6)	27.9 (27.5, 28.2)	1.8 (0.5, 3.2)	0.019
Stomach	27.4 (26.7, 28.1)	35.2 (35.0, 35.4)	2.0 (1.4, 2.5)	<0.001
Colon-rectum	47.2 (46.1, 48.3)	55.7 (55.4, 55.9)	2.3 (1.5, 3.1)	0.001
Liver	10.1 (9.5, 10.7)	14.4 (14.2, 14.5)	1.4 (0.6, 2.2)	0.009
Gallbladder	20.1 (18.1, 22.1)	17.8 (17.4, 18.3)	−0.1 (−1.1, 1.0)	0.855
Pancreas	11.7 (10.5, 12.9)	8.5 (8.2, 8.7)	−0.7 (−1.3, −0.1)	0.026
Larynx	51.7 (47.3, 56.1)	52.9 (51.8, 53.9)	1.5 (0.8, 2.1)	0.004
Lung	16.1 (15.6, 16.6)	28.7 (28.6, 28.9)	3.7 (1.4, 5.9)	0.010
Other thoracic organs	30.5 (25.0, 36.0)	40.1 (38.9, 41.4)	1.7 (0.5, 2.9)	0.019
Bone	17.1 (13.8, 20.5)	39.5 (38.6, 40.4)	3.9 (2.4, 5.4)	0.002
Melanoma of skin	38.8 (30.8, 46.7)	50.3 (48.6, 52.1)	4.2 (1.8, 6.6)	0.008
Breast	73.1 (71.2, 75.0)	80.9 (80.5, 81.3)	2.1 (1.4, 2.8)	0.001
Cervix	45.4 (40.7, 50.2)	66.9 (66.5, 67.4)	1.7 (−0.4, 3.8)	0.091
Uterus	55.1 (51.6, 58.5)	68.1 (67.2, 68.9)	3.5 (1.7, 5.3)	0.006
Ovary	38.9 (35.4, 42.3)	39.6 (38.9, 40.3)	0.3 (−0.2, 0.8)	0.132
Prostate	53.8 (49.5, 58.2)	71.1 (70.2, 71.9)	5.0 (3.4, 6.7)	0.001
Testis	48.0 (31.8, 64.2)	80.7 (78.7, 82.6)	2.7 (0.8, 4.7)	0.017
Kidney	62.0 (59.6, 64.4)	65.2 (64.6, 65.7)	1.9 (1.0, 2.7)	0.004
Bladder	67.3 (65.3, 69.4)	71.5 (71.0, 72.0)	1.6 (1.3, 1.9)	<0.001
Brain	18.2 (16.0, 20.4)	37.7 (37.3, 38.2)	1.9 (0.3, 3.4)	0.029
Thyroid	67.5 (63.3, 71.8)	92.9 (92.4, 93.3)	2.8 (1.7, 3.9)	0.002
Lymphoma	32.6 (30.6, 34.6)	40.8 (40.4, 41.3)	1.9 (1.3, 2.4)	0.001
Leukemia	19.6 (17.6, 21.7)	30.6 (30.2, 31.1)	2.0 (0.7, 3.4)	0.014
All others	44.9 (43.2, 46.7)	52.2 (51.8, 52.6)	1.4 (0.2, 2.6)	0.035
All	30.9 (30.6, 31.2)	43.7 (43.6, 43.7)	3.4 (2.8, 4.0)	<0.001

Burden of cancer attributable to risk factors in China

The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 (GBD 2023) provides a standardized framework for evaluating cancer burden across regions and over time, encompassing incidence, mortality, and disability-adjusted life years (DALYs). Importantly, GBD 2023 quantifies the proportion of cancer burden attributable to modifiable risk factors. Using data from GBD 2023, this study assessed the cancer burden attributable to risk factors in China in 2023 (10).

In 2023, an estimated 1.28 [95% uncertainty interval (95% UI): 1.09−1.48] million cancer deaths in China were attributable to modifiable risk factors, accounting for 49.86% (95% UI: 44.95%−55.12%) of all cancer deaths. Among males, 0.95 (95% UI: 0.79−1.13) million deaths—57.09% (95% UI: 51.51%−63.32%) of all male cancer deaths—were associated with risk factors, compared with 0.33 (95% UI: 0.27−0.41) million deaths in females, representing 36.57% (95% UI: 32.03%−41.52%) of female cancer deaths. Cancer DALYs attributable to modifiable risk factors totaled 30.76 (95% UI: 26.25−35.58) million, representing 48.55% (95% UI: 43.76%−53.58%) of all cancer DALYs. Males accounted for 22.88 (95% UI: 19.32−27.45) million DALYs (55.19% of total male cancer DALYs), whereas females contributed 7.88 (95% UI: 6.59−9.54) million DALYs attributable to risk factors (35.98% of total female cancer DALYs).

Tobacco use was the leading level 2 risk factor for cancer mortality in males in 2023, accounting for 44.95% (95% UI: 39.73%−51.11%) of all cancer deaths in males, followed by air pollution, dietary risks, and high alcohol use, which contributed 7.44% (95% UI: 4.80%−10.60%), 6.19% (95% UI: 2.03%−12.36%), and 5.92% (95% UI: 1.42%−11.67%), respectively. Among females, tobacco likewise constituted the predominant risk factor, responsible for 12.30% (95% UI: 10.16%−14.67%) of cancer deaths, with dietary risks [7.38% (95% UI: 2.34%−13.08%)], air pollution [6.41% (95% UI: 4.39%−8.74%)], and unsafe sex [5.30% (95% UI: 3.39%−6.87%)] following.

A similar pattern was observed for cancer DALYs. In males, tobacco accounted for 42.61% (95% UI: 37.32%−48.75%) of all cancer DALYs, with air pollution [6.87% (95% UI: 4.38%−9.77%)], high alcohol use [6.62% (95% UI: 1.64%−12.61%)], and dietary risks [6.14% (95% UI: 1.99%−12.11%)] as additional major contributors. Among females, tobacco remained the leading level 2 contributor to cancer DALYs [11.14% (95% UI: 9.36%−13.12%)], followed by dietary risks [7.16% (95% UI: 2.14%−12.52%)], unsafe sex [6.55% (95% UI: 4.13%−8.42%)], and air pollution [5.68% (95% UI: 3.90%−7.76%)] (Figure 2).

Figure 2.

Cancer deaths (A) and DALYs (B) in China attributable to eleven level 2 risk factors in 2023. DALY, disability-adjusted life year; M, male; F, female.

Cancer prevention and control of China

Governmental policies

National health strategies

Over the past decade, China has continuously strengthened its national strategies and action plans for cancer control, fostering the establishment of a more institutionalized, long-term, and coordinated framework for cancer prevention and treatment. In 2016, the State Council released the “Outline of the Healthy China 2030 Plan” (11), elevating population health to a national strategic priority for the first time. The plan highlighted disease prevention as the overarching principle and identified the control of chronic and major diseases, including cancer, as a core objective. It also articulated phased targets and resource allocation priorities at the strategic level, marking the first national blueprint to formally embed health goals into China’s medium- and long-term development agenda. This document provided high-level design and political impetus for subsequent cancer control interventions, such as population-based screening programs and vaccination initiatives.

In 2017, the State Council issued the “Medium- and Long-term Plan for the Prevention and Treatment of Chronic Diseases (2017−2025)” (12), incorporating chronic disease control, including cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases, into national strategic planning. The plan underscored the integration of the Healthy China agenda with comprehensive chronic disease prevention and control. It proposed quantitative targets, such as significantly reducing premature mortality from major chronic diseases among individuals aged 30−70 years, and emphasized society-wide participation, prevention-first principles, and life-course management. Structurally, it signaled a shift from a treatment-centered model to one centered on population health.

In 2019, the central government introduced the “Healthy China Initiative (2019−2030)” (13), which served as a detailed implementation roadmap for the Healthy China strategy. Cancer prevention and control was designated as one of the 15 flagship initiatives. The document laid out measurable targets for 2022 and 2030 and specified actionable measures covering risk-factor reduction, early detection and treatment, standardized clinical care, and research and technological innovation.

Cancer-specific policies

In 2019, the National Health Commission and ten ministries jointly issued the “Implementation Plan for Cancer Prevention and Control (2019−2022)” (14). As a refinement of the Healthy China Initiative, the plan established concrete objectives for 2022, including substantial improvements in cancer screening, early diagnosis and treatment, and standardized clinical management, as well as curbing the rising trends in cancer incidence and mortality. By translating strategic goals into operational tasks, this plan accelerated the systematic rollout of cancer control interventions nationwide. Over its implementation period, China made notable progress in strengthening cancer prevention systems, expanding cancer registry coverage, improving early detection programs, and enhancing public health education (15). Building on these achievements, in 2023 the National Health Commission, together with 12 ministries, released the “Implementation Plan for the Cancer Prevention and Control Action (2023−2030)” (16). The new plan aligns with the major targets of the Healthy China Initiative, for example, increasing the national 5-year overall cancer survival rate to 46.6% by 2030 and effectively reducing the disease burden among patients. In response to current challenges in cancer prevention and control, the plan focuses on seven priority areas, including strengthened risk-factor control, and further refines task allocation to promote high-quality development of cancer control efforts.

Taken together, these national policies and targeted action plans mark a significant evolution in China’s cancer control efforts. They illustrate a shift from isolated, small-scale initiatives toward a more institutionalized and integrated governance model; from narrowly focused prevention measures to comprehensive, system-wide interventions; and from short-term, campaign-style activities to enduring, long-term mechanisms. Overall, these developments represent a substantial advancement in establishing a coordinated, sustainable, and evidence-informed framework for cancer prevention and control in China.

Policies on comprehensive cancer prevention and control

In recent years, China has advanced a series of national, cross-sectoral policy initiatives aimed at strengthening its integrated system for chronic disease and cancer prevention and control. These initiatives have collectively shaped a multi-tiered policy framework encompassing risk-factor reduction, promotion of healthy lifestyles, and region-based demonstration programs. Among them, the “China Healthy Lifestyle for All” (17), led by the Ministry of Health and launched in 2007, has continuously promoted key behavioral goals, including reduced intake of salt, oil, and sugar; improved oral health; and maintenance of healthy weight and bone health. This initiative has created the largest population-based health promotion system in the country, laying a broad societal foundation for primary cancer prevention. Notably, it was the first nationwide, government-led program dedicated to chronic disease prevention and the promotion of healthy lifestyles across the entire population.

In 2010, the Ministry of Health launched the “National Demonstration Areas for Integrated Prevention and Control of Chronic Diseases” (18), which sought to build regional mechanisms for chronic disease prevention through government leadership, multisectoral collaboration, and community engagement. These demonstration areas strengthened risk-factor surveillance, health-promoting behaviors, and systems for early detection and early treatment. Their spillover effects contributed substantially to advancing chronic disease prevention nationwide. By 2020, 488 national demonstration areas had been established, providing scalable and replicable models for chronic disease and cancer control (19).

In 2025, the government formally incorporated the “Healthy Weight Management Action” as a new component of the “Healthy China Initiative” and launched a national campaign “Year of Weight Management” (20,21). This action recognizes overweight and obesity as major public health risks requiring systematic intervention. It sets targets to curb the increasing prevalence of overweight and obesity and to raise national health literacy levels by 2030. The initiative aims to promote coordinated actions across healthcare institutions, communities, and families, thereby building a nationwide weight-management service system. By targeting the rising prevalence of obesity and its associated metabolic abnormalities and obesity-related cancers such as breast, colorectal, and liver cancers, this initiative represents a key measure to strengthen risk-factor management within primary cancer prevention.

Collectively, these policies demonstrate a transition from disease-specific interventions to integrated, population-based strategies emphasizing shared risk-factor management and regional governance. These efforts have laid a robust policy foundation for China’s comprehensive cancer control system and hold long-term public health significance in reducing the incidence and mortality burden of cancer and other major chronic diseases.

Primary prevention

Primary prevention remains the most cost-effective component of cancer control, focusing on reducing exposure to risk factors and enhancing population health literacy to prevent cancer onset. Evidence indicates that approximately 40% of cancer cases and deaths could be prevented by eliminating or managing modifiable risk factors (22,23). Through a combination of interventions, such as vaccination (e.g., HPV vaccine), tobacco control, weight management, and health education, primary prevention can ease the burden of cancer on the healthcare system (4,24). At the same time, these measures lower shared risk factors for multiple chronic diseases, thereby producing broad public health co-benefits.

Vaccination

Preventing HPV infection is the cornerstone of primary prevention for cervical cancer. As the first vaccine developed specifically to target a cancer-causing agent, the HPV vaccine has demonstrated clear effectiveness and safety in preventing cervical cancer and its precancerous lesions (25). Earlier vaccination and higher population coverage yield greater preventive benefits. Optimal protection is achieved when adolescents complete the full vaccination series before the onset of sexual activity. In 2020, the WHO launched the “Global Strategy to Accelerate the Elimination of Cervical Cancer”, under which 194 countries committed to working toward the “90−70−90” targets by 2030 (26). In China, Ordos City in Inner Mongolia became the first locality to provide free HPV vaccination, offering vaccination to nearly 10,000 female students aged 13−18 years (27). Since 2021, several provinces, including Guangdong, Hainan, and Jiangsu, have incorporated free HPV vaccination for schoolgirls aged 13−14 years into local public welfare initiatives, providing domestically produced bivalent HPV vaccines. Estimates based on China’s immunization information system indicate that between 2017 and 2022, the cumulative first-dose coverage of HPV vaccines among females aged 9−45 years was approximately 10%, while about 6% completed the recommended full vaccination schedule (28). In 2022, the first-dose HPV vaccination rate among girls aged 9−14 years was only 4% (29). Although national coverage has shown an upward trend, it remains far below the WHO target of “90% full vaccination coverage” for girls. In 2023, the National Health Commission issued the Action Plan to Accelerate the Elimination of Cervical Cancer (2023−2030) (30), calling for strengthened public education on cervical cancer prevention and sustained efforts to expand HPV vaccination among eligible girls. Beginning in 2025, China introduces free HPV vaccination for adolescent girls within the National Immunization Program — the first new vaccine added to the program in 17 years (31). This major policy advancement provides a solid foundation for China’s contribution to achieving the WHO’s global cervical cancer elimination goals.

Tobacco control

Tobacco use remains the leading preventable cause of cancer worldwide, with smoking implicated in the development of at least 15 cancer types, most notably lung, laryngeal, esophageal, and bladder cancers (32). The WHO Framework Convention on Tobacco Control (FCTC), endorsed by China in 2003 and implemented in 2006, provides a structured framework for global tobacco control through the MPOWER package (33). China introduced a series of regulatory measures, such as bans on tobacco advertising, increases in tobacco taxation, and standardized health warning labels, although early progress was hindered by the economic importance of the tobacco industry and uneven local enforcement. The “Healthy China Initiative” set a clear target of reducing adult smoking rate to below 20% by 2030 (13). In support of this goal, the government has strengthened the enforcement of smoke-free policies in public spaces and expanded the creation of smoke-free environments. To date, more than 20 provincial-level administrative regions and major cities, including Beijing, Shanghai, Henan, Shenzhen, and Xi’an (34), have adopted comprehensive smoke-free legislation. Large-scale surveys indicate a substantial decline in smoking prevalence between 2007 and 2018, for example, a 13% relative reduction among adults aged 18−69 years (35). The China Adult Tobacco Use Survey reported the smoking prevalence among Chinese residents aged ≥15 years was 23.2% in 2024, with pronounced disparities by sex (43.9% in males vs. 1.8% in females) and residence (24.9% in rural vs. 20.9% in urban areas); secondhand smoke exposure among non-smokers declined to 46.5%, a 5.9% decrease from 2022 (36). However, as of November 2025, smoke-free laws covered only 16.2% of the population, approximately 229 million people (34), highlighting that the reach of existing regulatory frameworks remains limited. Tobacco control in China is expected to move toward a multidimensional governance model that integrates legislative enforcement, fiscal policies, and cultural interventions.

Air pollution

Fine particulate matter (PM2.5) is the predominant air pollutant in many regions of China and imposes a substantial disease burden (37). In 2019, PM2.5 exposure contributed to an estimated 1.9 million deaths, and China ranked among the highest globally in PM2.5-attributable lung cancer mortality and DALYs (38,39). PM2.5 is a complex mixture of more than 50 components, with its carcinogenicity largely determined by adsorbed substances onto its surface such as high-molecular-weight polycyclic aromatic hydrocarbons (PAHs) and heavy metals (e.g., arsenic, cadmium, lead) (40-44). The chemical composition of PM2.5 provides insights into both health risks and pollution sources (45), for instance, arsenic and selenium indicate coal combustion (46,47), while vehicular and industrial activities emit substantial metal elements (48); PAHs are commonly linked to biomass burning, coal use, and motor vehicle exhaust (49). In response to severe air pollution, China implemented the 2013−2017 Air Pollution Prevention and Control Action Plan, achieving notable health benefits (50). The capital city Beijing has served as a pilot region, introducing major policies such as the 2013−2017 “Air Pollution Action Plan” (“Ten Measures for Air”) and the 2018−2020 “Blue Sky Defense” initiative. Previous studies indicate that Beijing’s annual mean PM2.5 concentration declined to its lowest level on record in 2022; however, toxicological analyses of PM2.5 components show that substantial carcinogenic risks persist (51). Moving forward, continued long-term monitoring and component-specific analysis of PM2.5 on health risks will remain critical for guiding tailored control strategies, assessing policy effectiveness, and identifying evolving pollution sources over time.

Health education

Health literacy represents an important and modifiable determinant to reduce health disparities (52). Cancer literacy encompasses the essential knowledge required by the general public to understand information and recommendations provided by health systems concerning cancer prevention, diagnosis, and treatment (53). The “Healthy China Initiative” established targets to increase cancer-related knowledge awareness to 70% by 2022 and 80% by 2030 (13). A national assessment conducted by the NCC indicated that the national cancer literacy rate has reached 70.05%, with substantial disparities observed across populations differing in demographic and socioeconomic characteristics (54). Higher levels of cancer literacy are closely linked to favorable health behaviors and outcomes throughout the continuum of cancer prevention (55-57). Specifically, adequate literacy supports the identification of risk factors and adoption of healthy lifestyles (primary prevention), recognition of early symptoms and participation in cancer screening and early intervention (secondary prevention), as well as effective emotional management and adherence to treatment and rehabilitation (tertiary prevention). Enhancing public awareness of cancer prevention and routinely monitoring literacy levels, while addressing intergroup and regional gaps, will be essential to advancing the three-tier cancer prevention strategy and mitigating the national cancer burden.

Secondary prevention

As a central component of secondary prevention, cancer screening plays a critical role in reducing the growing cancer burden by enabling earlier detection and intervention, which in turn substantially lowers disease-specific mortality and improves survival. Screening programs generally operate under two models: organized population-based screening and opportunistic screening. Organized screening involves systematic, protocol-driven efforts in which individuals in a predefined target population are regularly invited to undergo evidence-based tests with standardized procedures for quality assurance, monitoring, and follow-up. By contrast, opportunistic screening occurs during routine clinical encounters, where health-care providers recommend appropriate early detection tests. Although less structured, this model offers greater flexibility and supports individualized, shared clinical decision-making.

Organized cancer screening

In China, the commitment to organized screening is demonstrated through the establishment of several large-scale, government-funded programs since 2005. These initiatives represent a strategic public health effort to combat cancer in high-risk regions and among vulnerable populations. Major programs include the “Early Detection and Early Treatment of Cancer in Rural Areas” (2005), the “Early Detection and Early Treatment of Cancer in Huaihe Areas” (2007), the “Cervical and Breast Cancer Screening Program for Rural Women” (2009, commonly known as the “Two Cancers Screening”), and the “Cancer Screening Program in Urban China” (2012) (58). Collectively, these programs provide free screening services targeting the eight most common cancers in China— lung, stomach, liver, colorectal, esophageal, cervical, breast, and nasopharyngeal cancers. These organized efforts constitute a foundational element of the national cancer control framework, facilitating the population-wide implementation of secondary prevention across both rural and urban settings.

Beyond nationally coordinated screening programs, a significant proliferation of locally funded cancer screening projects has emerged across multiple provinces and municipalities in China (58). These sub-national efforts exemplify a decentralized yet strategically aligned approach to broadening screening coverage and tailoring interventions to regional cancer profiles. Representative examples include Tianjin’s municipality-wide colorectal cancer screening (2012) and its multi-cancer project spanning seven districts (2017); Liaoning’s eight-city colorectal screening (2021); Shanghai’s district-level screening (2012); and Jiangsu’s province-wide multi-cancer (2019) and targeted colorectal screening programs (2020). Zhejiang has implemented extensive colorectal screening (2020) along with lung and gastrointestinal cancer projects in specific counties. Other provinces, including Shandong, Hubei, Hunan, Guangdong, and Guangxi, have similarly launched screening projects targeting major cancers such as colorectal, gastric, lung, liver, and nasopharyngeal cancers. These initiatives incorporate regional needs and resource structures and signify an important evolution in China’s cancer control strategy: the deployment of fiscally independent, population-specific screening interventions to more effectively address local cancer burdens.

Research progress

Current cancer screening initiatives in China have yielded measurable health benefits. Evidence from high-risk regions confirms that a single endoscopic screening can reduce the incidence of upper gastrointestinal cancers by 23% [relative risk (RR) = 0.77, 95% CI, 0.74−0.81)] and mortality by 57% (RR=0.43, 95% CI, 0.40−0.47) (59). One-time low-dose computed tomography screening has similarly been shown to decrease lung cancer-specific mortality by 31% and all-cause mortality by 32% and risk-stratified approach for never- and ever-smokers may further increase the screening efficiency (60,61). For colorectal cancer, the risk-adapted approach is a feasible and cost-effective strategy for population-based screening (62). In liver cancer screening, annual alpha-fetoprotein testing combined with ultrasound for HBsAg-positive individuals improves survival by 35% (63), whereas biannual screening of hepatitis B virus carriers and patients with chronic hepatitis reduces hepatocellular carcinoma mortality by 37% (64). Ultrasound outperforms mammography for breast cancer detection among high-risk Chinese females (65). For cervical cancer, high-risk HPV testing has been validated as an effective primary screening modality in primary health care settings (66).

Building on these demonstrated achievements, the NCC led the development of seven cancer-specific screening and early detection guidelines between 2020 and 2022，covering lung, breast, colorectal, esophageal, gastric, liver, and prostate cancers (67-73). This technical foundation was subsequently elevated to national policy by the National Health Commission. In January 2022, the Commission issued the Implementation Plan for Cervical and Breast Cancer Screening (74), followed in 2024 by dedicated plans for esophageal, gastric, lung, and colorectal cancer screening (75,76). These guidelines and implementation plans establish a unified, evidence-based framework that explicitly defines eligible populations, specifies core screening technologies, outlines quality control metrics, and standardizes follow-up procedures for screen-positive individuals. By promoting procedural homogenization and quality assurance, these policies mitigate heterogeneity in service delivery and ensure more equitable access to high-quality screening across regions from metropolitan areas to rural counties. This national standardization markedly enhances the consistency, equity, and overall effectiveness of organized cancer screening in China.

Cancer opportunistic screening

The Cancer Prevention and Control Implementation Plan (2023−2030) explicitly advocates for the expansion of opportunistic cancer screening as a priority strategy to improve early detection and population coverage. China initiated an opportunistic screening pilot for upper gastrointestinal cancers in 2019 across 300 high-risk rural areas and demonstrated its feasibility in real-world settings. Building on this foundation, a larger program was rolled out in 2025 through the Cancer Screening Program in Urban China, involving 16 leading hospitals across the country and supported by an initial fiscal allocation of roughly 20 million RMB. In parallel, health checkups have become an increasingly important platform for opportunistic screening. To standardize cancer-related examinations within these settings, the NCC released the Guidelines for Medical Examination for Cancer in Health Examination Agency (2025 Edition) (77), which delineate evidence-based recommendations regarding the target populations, screening protocols, diagnostic methods, result interpretation, follow-up, and quality control. By establishing a unified practice standard, these efforts aim to enhance the consistency and effectiveness of opportunistic cancer detection nationwide.

Conclusions

In the past decade, China has achieved notable progress in cancer prevention and control. The national cancer control system has been steadily strengthened, with near-complete coverage of population-based cancer registries and continuous expansion of cancer screening and early detection. The overall 5-year cancer survival has reached 43.3%, the interim target in 2022 set by the Healthy China Initiative. However, the overall landscape remains challenging. Population aging, rapid industrialization, and the increasing prevalence of unhealthy lifestyles continue to drive the cancer burden, and substantial regional disparities persist in cancer control capacity and outcomes. Moving forward, sustained investment in scientific innovation and translational research will be essential, alongside the development of a health-centered, multisectoral, and interdisciplinary framework for comprehensive cancer control.

Funding Statement

This study was supported by the National Natural Science Foundation of China (No. 82404342 and No. 82273721) and Chronic Disease Management Research Project of National Health Commission Capacity Building and Continuing Education Center (No. GWJJMB202510022137).

Author contributions

WQ Chen, W Cao, and K Qin conceptualized the study and designed the analytical framework; W Cao and K Qin extracted and analyzed the data and drafted the manuscript; BY Liu conducted the literature search and organized references; All authors critically reviewed and approved the final manuscript.