Summary of Key Points
China has become one of the countries with the highest cancer burden in the world, with 5.15 million new cancer cases in 2024, and this is expected to exceed 7.3 million by 2050. More importantly, the composition of cancers is shifting from "poor cancers" (such as esophageal, gastric, and liver cancers) to "rich cancers" (such as lung, colorectal, breast, and prostate cancers), driven by factors including economic development, lifestyle changes, population aging, and medical advancements. Innovative pharmaceutical companies need to adapt to this trend by focusing on both locally prevalent cancer types and conducting sophisticated research and development for globally significant cancers.
I. Increasing Cancer Burden and Changing Cancer Spectrum: The Top Ten Cancers Are Evolving
In the past decade or so, the number of new cancer cases in China has soared from 3.09 million to 5.15 million, and this is expected to continue to rise. However, the change in the ranking of cancers is even more noteworthy:
- Declining "old cancers": The incidence and mortality rates of esophageal, gastric, and liver cancers, which were once characteristic of China, have decreased by more than 50% in the past 20 years. For example, liver cancer has seen a significant reduction in new infections due to the widespread use of hepatitis B vaccines, cutting off the source of the disease.
- Rising "new cancers": Lung, colorectal, breast, prostate, and thyroid cancers have become the main drivers of growth. Colorectal cancer has seen the fastest increase, with the incidence rate doubling in men over 20 years; thyroid cancer has increased by 15 times in the same period (though some of this may be due to more widespread screening leading to overdiagnosis).
China's cancer spectrum is now increasingly similar to that of the United States, where the top five cancers are lung, breast, colorectal, prostate, and breast cancers. This indicates that China is undergoing the same "cancer spectrum transformation" as developed countries.
II. The Dual-Edged Sword of Economic Development: The Decline of "Poor Cancers" and the Rise of "Rich Cancers"
The change in the cancer spectrum is not random but is directly related to improving living standards:
- Why are "poor cancers" declining? In the past, people's diets were less fresh (with more pickled foods) and hygiene conditions were poor, leading to high incidences of gastric and liver cancers. Now, with more access to fresh vegetables and fruits and free hepatitis B vaccinations, these cancers have decreased.
- Why are "rich cancers" rising? Although living standards have improved, new unhealthy habits have emerged:
- Diet-related cancers: High-fat, high-sugar diets and excessive consumption of processed meats, along with low fiber intake, increase the risk of colorectal cancer (the more developed a country is, the higher the incidence of colorectal cancer).
- Lifestyle-related cancers: Sedentary lifestyles and increasing obesity lead to metabolic disorders and chronic inflammation, which can also cause cancer.
- Tobacco-related cancers: Smoking is the leading cause of lung cancer, and exposure to secondhand smoke among women has contributed to rising rates of lung cancer in females.
- Age-related cancers: The proportion of people over 60 years old is high (23%), which means more cell mutations and decreased immunity, leading to higher cancer rates.
- The "illusion" of medical progress: Some increases in cancer incidence may be due to improved screening. For example, breast cancer screening has led to the detection of more early-stage asymptomatic cases, making the incidence rate appear higher, but the prognosis is better because early treatment has a higher survival rate.
III. Gender Differences: Early Onset of Breast Cancer in Women and High Metastasis Rates in Men
There are clear gender differences in the cancer spectrum:
- Women: The incidence of breast cancer has doubled in women over 20 years, with a median age of diagnosis 10 years earlier than in Europe and the United States (50-54 years old in China compared to 60-64 years old). Incidences are also rising among younger women under 35.
- Men: The incidence of prostate cancer has quadrupled in men over 20 years, but due to a lack of nationwide screening, 54% of patients are already metastasized by the time they are diagnosed, resulting in poorer treatment outcomes.
IV. How Should Innovative Pharmaceutical Companies Respond?
The changing cancer spectrum presents new challenges for pharmaceutical companies:
- Seize local opportunities: Companies can focus on locally prevalent cancers with unique targets (such as Claudin18.2 and HER2) and use China's extensive clinical data to develop new drugs quickly, addressing both domestic patient needs and gaining a competitive edge internationally.
- Target specific cancer types: For common cancers like lung cancer, although there are many targeted and immunotherapy drugs available, many patients remain untreated or do not benefit from them. Companies are now focusing on subgroups with rare mutations (such as RET and MET) or developing post-surgery adjuvant therapies using new technologies like ADCs and second-generation immunotherapies.
- Prepare for declining cancers: Cancers like liver cancer may become less common in the future due to hepatitis B vaccinations, and companies need to adjust their strategies accordingly.
In summary, the changing cancer spectrum in China is a result of social development. Pharmaceutical companies that can adapt to these changes will be better able to serve domestic patients and establish themselves in the global market.
Conclusion
While the increase in cancer burden is a reality, the transformation of the cancer spectrum also presents new opportunities. For individuals, making lifestyle changes (such as reducing processed meat consumption, exercising more, and quitting smoking) can reduce the risk of "rich cancers." For companies, focusing on both local needs and global trends will help develop more effective drugs. In the next decade, it is hoped that Chinese innovative pharmaceuticals will benefit patients around the world.