Tributes paid to Sun Yan, the 'founder' of medical oncology in China

Tributes have been paid to Professor Sun Yan, a pioneer of clinical oncology in China, who died on January 24, 2026 at the age of 97.

Sun Yan was the director of Internal Medicine at the Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing for many years and served as the director of the Clinical Research Center for New Drugs.

According to the Chinese Academy of Engineering, Sun Yan became one of the founders of medical oncology treatment in China when he was appointed to work with surgeons and radiation therapy specialists at Beijing’s Ritan Hospital in the 1960s.

The Academy said Professor Sun took the lead in advocating the concept of comprehensive cancer treatment, took the lead in the research and development and clinical trials of novel oncology drugs in China, and actively explored the path of integrated Chinese and Western medicine for prevention and treatment. During his time as head of the oncology department he led nearly 80 clinical trials, and trained more than a thousand oncology internal medicine specialists.

He participated in the development of more than 30 new drugs including N-formyl-lysosarcoma, ectinib, lanxanthene injection and recombinant human endostatin. Among these, the tyrosine kinase inhibitors ectinib was China’s first small molecule targeted anti-cancer drug with nationally independent intellectual property rights. Sun Yan also developed the Traditional Chinese Medicine product Zhenqi Righting to boost bone marrow and immune function as adjuvant treatment of cancer patients after radiotherapy and chemotherapy. The success of the products boosted the local pharmaceutical industry in rural Gansu and lifted the Dingxi, area out of poverty.

A tribute article for Sun Yan was published by the Chinese Collaborative Professional Committee for Clinical Oncology (CSCO), for which Sun Yan was founder and Honorary Chairman. It noted that Sun Yan personally initiated the establishment of CSCO with the goal of promoting unity, pragmatism and collaboration in clinical oncology in China. Following his guidance, the Society now conducts in-depth exchanges and cooperation with international authoritative organisations such as ASCO and ESMO, assists in promoting the integration of international multicentre clinical research and promotes the continuous development of China’s anti-tumour drug research and development,

The Society has cultivated a large number of leading clinicians and created a backbone workforce active at the forefront of the Chinese oncology community.

Sun Yan was born in 1929 and graduated from Beijing Union Medical College in 1956. He joined Beijing Union Hospital in the same year. In 1959, he entered the Cancer Hospital of the Chinese Academy of Medical Sciences.

At this time, when the field of solid tumour research in China was very limited, Sun Yan began to work with Zhou Jichang and other pioneers to create China’s first tumour chemotherapy group. Starting with five hospital beds, he built the first foundations of medical oncology in China.

In 1979 Professor Sun went to the MD Anderson Cancer Center in the United States to study, and was later appointed as a visiting professor. He continued international collaborations, fostering strong links with professional groups such as ASCO, whose annual meetings he attended on a regular basis to provide updates on oncology in China.

In the 1980s, Professor Sun tackled the lack of standardised standards in the field of clinical trials of new anti-cancer drugs in China. As the director of the National Clinical Research Center for New Drugs (Antitumour Drugs), he led the formation of a professional review team, drafting the first edition of the “Clinical Research Specifications for New Antitumour Drugs”, and delineated the regulations for clinical trials of new drugs, with a priority on ensuring patient safety.

In the 1990s he continued to develop a workforce of new oncology drug R&D personnel and clinicians, and to promote an anti-tumor drug clinical trial quality management specification (GCP) training course. At the same time he was at the international forefront of clinical trials of new anticancer drugs.

Professor Sun also led the collaborative efforts of a number of top hospitals across China to optimise combined chemotherapy regimens, with a focus on improving treatment and outcomes for patients with advanced non-small cell lung cancer.

“Your life was the most perfect interpretation of benevolence and benevolence and the sincerity of the great doctor,” said Dr Li Zhiming, director of the Department of Oncology at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, a in a tribute article.

Professor Li highlighted Sun Yan’s leadership in the organisation of the national investigation of cancer causes of death, and his development of the first “Atlas of Malignant Tumours”, as well promoting the construction of a disciplinary system.

The Cancer Hospital of the Chinese Academy of Medical Sciences wrote in an article in memory of Sun Yan noting that he carefully nurtured younger colleagues and made outstanding scientific research achievements.

“Comrade Sun Yan’s life is a life of dedicated service to the cause of oncology medicine in our country,” it said.

Drug sale reforms; Autistic children abused; Tibetan monks don't get hypertension; Guangzhou's first private clinic; Doctors stabbed in Fuzhou; Tax breaks for private health insurance

by MICHAEL WOODHEAD
The move to stop county-level hospitals from deriving their income from 15% markups on pharmaceuticals will severely dent their revenue stream and threaten services, health economists have warned. China has already trialled  drug commission bans in 300 county hospitals and now plans to extend the system to 1000 hospitals nationally, Caixin reports. However, the plan could leave hospitals short of funds and thus reduce the level of services and hurt the morale of medical workers,  academics and doctors say. The State Council has said local governments should help hospitals to make up for the lost income from drug sales. However,Wang Zhen, a research fellow at the Chinese Academy of Social Sciences, said local governments were already strained financially and they don't have extra money for hospitals.Wang said that without government subsidies and other measures in place, scrapping the markup practice might wind up creating other problems because hospitals will find alternative ways to make money.

Children with autism in China face experience high rates of physical abuse from their parents and family members, a study from Henan shows. In a survey of 180 children with autism, Zhengzhou researchers found that 36% had recently experienced severe physical maltreatment such as slapping on the face, being beaten with objects or kicked. Less severe physical maltreatment such as being slapped, or shaken was experienced by 86% of autistic children.

Tibetan monks have low rates of hypertension, according to a study carried out in Gansu. The survey of 984 monks found that 19% had hypertension, compared to 34% of the local population. However, despite having low rates of high blood pressure, there were also low rates of awareness, treatment and control of hypertension among monks, the researchers found.

Encouraged by new government policy a surgical oncologist has opened Guangzhou's first major private clinic. The clinic set up by Dr Lin Feng will offer speedy diagnosis and high quality treatment by a well known surgeon previously practicing at the renowned 3rd Hospital of Guangzhou. The clinic charges about 2-3000 yuan fees, and offers high quality diagnosis and surgery without the long waits and rushed consultations of public hospitals, its operators say.

Two doctors at a Fuzhou hospital were stabbed in an attack by a 66-year old male patient, local media report. One male and one female doctor were seriously injured by the man armed with a 40cm knife who had been attending the Fuzhou hospital to have his haemorrhoids treated. A hospital spokesman said the man was unhappy with the treatment he received for his haemorrhoids and stabbed a female doctor in the hip. The male doctor who tried to restrain him was also stabbed in the arm.

Tax breaks are to be introduced for Chinese consumers who take out private health insurance, the government has announced. People who spend more than 2,400 yuan on commercial health insurance policies per year will now only pay individual taxes on income above 3,700 yuan per month, instead of 3,500 yuan, CCTV has reported. The move is part of a government campaign to encourage Chinese people to  purchase private health policies in addition to their standard government benefits.

Personal experience of the Chinese health system

An overseas Chinese friend of mine has just come back from China, where she returned to care for her dying father. Her experience of the Chinese health system was mostly positive, but her story reveals some of the reality behind the rhetoric of recent government pronouncements on reforms.
Her father was seriously ill with lung cancer and had only a few weeks to live. After the diagnosis, at an army-affiliated hospital, the doctors did not try to offer futile chemotherapy with expensive drugs, but just offered a poor but honest prognosis. There was no access to what we in the west would call palliative care. Instead, doctors recommended that he return home, to be cared for by family members. In some pain and discomfort, the father was provided with some analgesics, but no opioids.

After about a week, the father was in considerable pain and returned to the hospital for treatment. He lived for another 18 days, being given a mixture of analgesics and other drugs to ease his bowel problems. The cost of treatment was 18,000 yuan. As he had been a member of his employer's urban health insurance plan, the father (or rather his family) was able to claim back about 70% of the medical expenses. However, the hospital treatment did not include 'extras' such as meals, dressings and bed linen! The nurses provided most of the basic medical care but none of the ancillary care such as washing, feeding and chaging bed linen that nurses in western hospitals would do. Instead this was left to the family. As the family were not able to be on 24/7 carer duty they hired a 'kanghu' carer at a cost of 800 yuan per day, to do basic chores such as feeding and cleaning the patient.

The family were satisfied with the overall level of medical care provided by the hospital, though they found it somewhat basic until they used their guanxi to find a better team of doctors and nurses. This was done because they knew someone who knew one of the senior doctors at the hospital.No money changed hands, but the father benefited form having more attention paid to his care by the more senior medical practitioner in the hospitals. After the father passed away, the family presented hongbao containing about 200 yuan to each of the 20 medical team who cared for him. This was done to maintain face and  confirm the good guangxi that was used to obtain better care for the father.
Funeral arrangements were made for the father via the hospital contacts, who no doubt gained some financial advantage from their referral.

The family believed their father received good care that was personal and respectful - but no doubt because they were able to use their connections in what was essentially a small city where everybody knew everybody.

Research fraud and inappropriate treatment: my blog about medical news from China for Sunday 15 February.

Last week I blogged about how so many medical journal articles in China are simply "vanity publications", written by ghostwriters to satisfy the doctor's need to achieve a quota of published articles. However, this week we see that there are also major problems with 'serious' research clinical trials carried out in China. An article in JAMA this week by Charles Seife reveals that the FDA found serious problems with the Chinese clinical trials of apixaban, a novel anticoagulant.
 At one site the FDA concluded that patient records had been altered. When they investigated further the FDA inspectors declared that data from 23 other Chinese clinical trial sites was suspect and should be excluded from their evaluation of apixaban (Eliquis). We often hear that western pharma companies are shifting their R&D from the US and Europe to China. It may be cheaper but with reports like this you have to wonder if it is worth it in the long run.

China is also trying to make a name for itself in high tech areas such as stem cell transplantation. An announcement in the Shanghai media said the city was to build the world's largest hospital for 'blood diseases'. This seems to be a reference to  hematopoietic stem cell transplant procedures for patients with blood diseases such as leukaemia. This is a highly specialised and expensive form of treatment for a small niche of patients (and often of limited benefit), so it is odd that a city that can't even meet demand in its emergency departments  is pushing ahead with a hospital for rare diseases. perhaps the explanation is that the project is being run by the China Stem Cell Group Co Ltd. This may be more about making profits than providing needed health facilities.

China's love of high tech for its own sake is  also manifest in the move by a Guangdong hospital to set up 1000 telehealth stations in pharmacies to provide online consults. The move by the Second People's Hospital of Guangdong to set up the Guangdong Online Hospital will reportedly include 200 doctors providing services via videolink. All sounds very modern, but how exactly does a doctor do a physical exam, order tests and imaging and provide 'hands on' care over a video link? It might be of limited value in follow up counselling consultations and for repeat prescriptions, but it sounds like a gimmick to me.

Online hospitals are supposed to help address the problem of overcrowded hospitals. I'm not sure how they will help the cancer patients who need a bed but can't get one. In places such as Changsha in Hunan the hospital bed shortages are so acute that patients have to make do with 'cancer hotels' instead. Patients with cancer who require treatment but who are on the waiting list pay 1100 yuan a month to stay in hotels adjacent to the cancer hospitals so they can go into outpatients for treatment. Locals say that about half the hotels near the hospital are occupied by patients, who face 1-2 month waits for a bed.

Breast cancer is an increasing concern in China, but rates are still not as high as in the west, perhaps due to dietary and lifestyle factors. Screening for breast cancer is also not part of the Chinese health system, although there has been some use of mammography. However ultrasound has been favoured by some Chinese clinicians, reportedly because it is more suitable to the smaller and more dense breast tissue of Chinese women. Now a study has confirmed that ultrasound is a more effective screening method for breast cancer in Chinese women. A study of more than 12,500 women who underwent either or both found that of the 30 cancers detected, five were in the mammography group and 11 in the ultrasound group, and 14  in the combined group. Ultrasound was more sensitive had the same specificity and positive predictive value as mammography. It was also considerably cheaper, costing $7876 to detect one cancer compared to $45 253 for mammography.

In other clinical news, metabolic syndrome (a highly dangerous combination of abnormal cholesterol, high blood pressure and pre-diabetes) was found to occur in 27% of Chinese people. A study of 15,477people in NE China found that 28% of men and 26% of women had metabolic syndrome. The condition was more common in Chinese on high incomes, those who ate more rice and those who did less physical activity - in other words, 'to get rich is glorious' but it also comes at a price of this disease of affluence. 

However, Chinese people might be forgiven for thinking twice about going for a jog, given the terrible air pollution in many cities. This has now been confirmed by Dr Liu Yu of the Key Laboratory of Exercise and Health Sciences at Shanghai University of Sport. This week he published an article in the BMJ which warned that the harms of ambient air pollution on the cardiovascular and respiratory systems might outweigh the benefits of exercise. He estimated that air pollution probably caused more than a thousand deaths a year in the city.

It's not all bad news from China, though. A paper published by the WHO this week shows that Chinese healthcare workers have had great success in reducing deaths from HIV using a simple 50c antibiotic, co-trimoxazole. Their study showed that giving the antibiotic at the same time as antiretroviral reduced HIV deaths by 37% - a staggering achievement. If routinely use in China for HIV patients  this could save thousands of lives among HIV positive people, the researchers sai.d Unfortunately, however, antibiotic use if often missed in this patient group.

Leukaemia donations missing | Asthma rates soar | Syphilis rates as high as 44% in sex workers

Leukaemia boy misses out on donations

One of the top stories in the Xinhua news this weekend is the story of a boy from Leshan in Sichuan with leukaemia who has missed out on most of the funds donated by wellwishers for his treatment. The family of the 8-year-oldcalled Lin Zhouzheng appealed for help in paying several hundred thousand yuan in medical bills after they ran out of money and even sold their house to pay for chemotherapy for their son. They were approached by a local man called Xu Ping who mounted a major publicity drive to raise money, and this netted more than 100,000 yuan. However, to date the boy's family have only received 7,000 in money from all the fundraising despite taking part in many media interviews, publicity appearances and having an army of volunteers working under Xu Ping. However, Xu Ping told reporters that the 110,000 yuan raised had only been pledges rather than actual donations - and he was still working to get companies and individuals to make good on their pledges.

Asthma rates soar in Shanghai

Asthma rates in Shanghai have increased four-fold over the last 15 years, with pollution being given much of the blame. A study of more than 27,000 residents of Pudong found that the prevalence of asthma was 1.4%, markedly higher than the 0.4% rate seen in the last major study carried out in 1997. Researchers from the Department of Respiratory Medicine at the Shanghai Putuo District People's Hospital carried out further pulmonary tests on 428 people with asthma and found that 53% had an FEV below 80% of normal and the severity of impaired lung function increased with age. The main triggers for asthma were dust exposure, cold air and respiratory tract infections.


STDs rates high in Jiangxi sex workers

More than 40% of female sex workers in Jiangxi have syphilis, a study has found. Researchers from the Department of Dermatology and STDs at the Affiliated Hospital of Nanchang University tested 361 street-based female sex workers and found that 44% had syphilis infection. About half of the sex workers had little education, a high proportion had been sex workers for several years and many failed to use condoms consistently. "Comprehensive interventions targeting this high-risk group, especially scaling up screening and ensuring consistent use of condoms during sex are needed," the researchers suggested.

Robot surgery for Chengdu | Aussies help with primary care | Weibo cancer medical fee man dies

Robotic surgery is now being used by hospitals in China, with the da Vinci surgery robot system completing its first operation at the Provincial People's Hospital in Chengdu. The 30 million yuan ($5 million) system can perform accurate and less invasive surgery in cases such as prostate cancer and gallbladder procedures but has been criticised by some clinicians as being an expensive system with a steep learning curve that does not offer any real improvements in outcomes compared to conventional surgery.

China is turning to Australia for advice and training in how to expand its primary health system. The National health and Family Planing Commission has asked Melbourne-based Professor Shane Thomas of Monash University to help guide the pilot programs of primary care taking place in Shenzhen. Monash is also hosting 24 Chinese health managers who are attending a leadership-training program at the School of Primary Health Care.

A Chinese man with cancer who became famous for using Weibo to solicit donations for his medical bills has died. Noodle shop owner Li Gang of Zhengzhou raised $16,000 to pay for medical treatment which he could not afford in 2012. His message went viral and he had many visitors to his noodle shop, but some commentators said it highlighted the lack of affordable medical care for most Chinese people with cancer.

The two H's that cause the most common cancers in China

Pre-cancerous cirrhotic liver

by Michael Woodhead
In western countries we are quite rightly focused on the high profile cancers and how to prevent them. Lung cancer is now in decline due to the very successful campaigns to stop smoking. Likewise in sunny Australia we are starting to see declines in skin cancer thanks to the campaigns that encourage people to cover-up and avoid carcinogenic UV rays. Other common cancers that are the focus of public attention are of course breast cancer, prostate cancer and to a lesser extent cervical and bowel cancer. All of these are the focus of major screening activities - some with official blessing, others (hello prostate cancer) despite a lack of evidence that they reduce cancer deaths.
In China it's a very different story. As you'd expect given the high rates of smoking, lung cancer is the most common malignancy seen in the country, but the other common cancers are those of the liver and digestive tract - hepatic cancer, gastric cancer and oesophageal cancer, in that order. A new review finds that the incidence of these cancers has increased dramatically since the 1980s. Perhaps because Chinese people now live longer or have better access to diagnostic services, but the gastric and liver cancers are now more common than ever. And the causes? It's the "H''s  - hepatitis and H. pylori. The high rates of hepatitis B in China are the reason for the country's huge rates of liver cancer. China has some of the highest rates of hepatitis B in the world (almost one in ten people have been infected) and new infections are still a major problem. The good news is that most children are now being immunised against hepatitis B, and the government believes that there will be far fewer hepatitis cases by 2050, when the current generation of immunised kids are adults.
Gastric cancer is the third most common cancer in China, and much of this may attributable to diet and chronic infection with the carcinogenic H. pylori pathogen. It has been estimated that the number of people in China infected with H. pylori infection rate is still above 50%, and as high as 80% in rural areas. Some hospitals are now implementing a 'test and treat' H. pylori screening approach and providing antibiotic-based eradication therapy to those found to be positive. There have also been some attempts to screen patients with endcoscopy - but is going to be a resource-intensive and logistically impossible approach to adopt nationally. Oesophageal cancer is another common cancer in China. To try prevent more cases, the government is focusing on diet in rural areas, and urging pubic health services to improve nutritional campaigns and avoid agents such as nitrosamines and harmful water contamination.
For the time being, however, China will continue to have high rates of liver and gastric cancers. Eradicating hepatitis and H. pylori will help in the long run, but Chinese people should be aware of the cancers that currently pose the greatest risk to themselves and their families.
[Based on an article by Dr Wang Rui and colleagaes at the Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, published in Clinics and Research in Hepatology and Gastroenterology)

One Country, Two Health Systems: or how Hong Kong has a socialist health system while China has a capitalist one

by Michael Woodhead
It is seldom remarked, but capitalist Hong Kong has a socialist health system while 'communist' China has a capitalist one. 
Hong Kong has a British NHS-inspired publicly-funded health service that remains efficient, good value for money and corruption free. China, on the other hand, has ditched its Soviet-era state-run 'health for the masses' system and replaced it with a state-owned user-pays system that is run on private lines. Don't take my word for it - there is an excellent article illustrating this in the obscure medical journal the International Journal of Radiation Oncology. It makes an interesting comparison of the Hong Kong and Chinese health systems through the eyes of oncologists who work in a cross-border co-operation clinic in Shenzhen.

Health systems
The oncologists note that Hong Kong's health system is based on heavily-subsidised public hospitals that provide treatment at no cost or only minor cost to all Hong Kong residents. It is an efficient system that accounts for only a modest 5.2% of GDP (compared to around 9% for many western  countries and 17% for the US). The Hong Kong public health system is perhaps a little too successful for some interest groups, as it means there is a very low uptake (27%) of private health insurance.
In contrast, China has a capitalist health system (where “money follows the patient') that is struggling to meet the needs of many citizens. Although China has a high rate of health insurance (often funded by employers), this does not cover expensive drugs or medical treatments. There is no safety net system provided by the state, and medical bills are a major burden, especially for low-income families. Initial consultation charges are a modest $2-3, but all Chinese hospitals have to be financial sustainable and thus doctors are encouraged to prescribe expensive drugs, order tests and even promote nutritional products, none of which may be justified by the patient's condition. As the oncologists say with some understatement: "there are serious concerns about the cost effectiveness and quality of services." 

Disease trends
In terms of cancer, Hong Kong and China are also poles apart. Due to preventive health and better treatment programs, cancer rates have decreased by 22% in Hong Kong in the last 25 years and cancer death rates have decreased by 29%. In China, however, rates of cancer have increased dramatically in the last decade as Chinese people have become wealthier and adopted unhealthy lifestyles and persist in smoking. In Shenzhen, cancer rates increased  from 37 per 100,000 people to 100 per 100,000 in the last 10 years. Many of the common cancers could have been prevented through screening and early detection- such as cervical cancer in women, rates of which have been decreasing in Hong Kong. Hepatitis B vaccination is another intervention that should reduce liver cancer rates. 

Doctor training
For oncologist training, Hong Kong follows the UK system of requiring several years postgraduate training regulated by peer group 'colleges' during which clinicians must demonstrate practical expertise in medical oncology, radiation oncology and palliative care, rather than being single branch specialists. Thus patients are treated by a team of oncologists in a 'one stop shop' model. In China there is no formal training program for oncologists, most specialise in one branch of oncology by doing written exams and there is no palliative care training. In China the work of oncologists is governed by 'standard operating procedures' in which the emphasis is on compliance rather than quality or outcomes. 

Access to treatment
When it comes to treatment, cancer patients in Hong Kong have access via public hospitals to the latest technology such as linear accelerators, at modest cost (US10 per attendance). Access is based on clinical need, not financial status or connections. Thus a full course of radiotherapy would be about $400 for a public patient, whereas it would cost $36,000 for a private patient. Across the border in Shenzhen, access to the latest radiotherapy equipment is - in the words of the authors - "appalling". There are only a handful of poor-quality liner accelerators and they are scattered across various hospitals - most patients and doctors do not know how to access them, and even those who do are often reluctant to use them because of fears about toxicity, not to mention the high cost. Shenzhen needs at least 16 such machines (Hong Kong has 37) but hospitals find it extremely difficult to buy such major items because of red tape from the Ministry of Health and the inflated costs of middlemen and the 'commissions' needed to import high-tech equipment into China. 

Drugs - if you can afford them
Access to chemotherapy drugs also differs markedly between Hong Kong and China. In Hong Kong, drugs are approved for use if they can be shown to be cost effective. Regulators model their the drug approval processes on those of western countries.
Patients pay US $13 per oncologist consultation and US $1.30 per drug prescribed. Some high cost drugs are not publicly funded but some costs may be covered by the public safety net or by charities.
In China, many chemotherapy drugs are not available or are long delayed in gaining approval from the China FDA. Drugs that are approved are available on a user-pays basis and can be very expensive. Pemetrexed, for example, costs US $1155 for the genuine drug in Shenzhen although a Chinese generic version is available for US $353. However, the quality of generic drugs is often poor. There are no programs for low income patients. 

Opium wars left their mark?
For palliative care, Hong Kong has developed an integrated  multidisciplinary system based in public hospitals and with hospices. In China, palliative care services are limited or non-existent. There are no palliative care specialists, and so treatment is provided - if at all - by anaesthetists. Pain relief is hampered by draconian regulations over the use of opioids. Most doctors are not allowed to prescribe them, and those who are authorised can only provide a week's supply. Many terminally-ill cancer patients are too weak to return to the hospital every week. This means that cancer pain is under-treated in China.

Looking to the future, on the positive side, health services in China are now evolving rapidly and there is a huge demand for good-quality clinical services. The authors say their Hong Kong-Shenzhen hospital has been operating for only a year but is already providing valuable lessons and experience. It has established a strict 'no-bribery' rule and has also become the first hospital in China to gain international certification for quality of management.

[Editor's note: This story is based on an article by Drs Anne Lee, Henry Sze, Lam Ka-On and Chen Xian of the Clinical Oncology Center, University of Hong Kong – Shenzhen Hospital.]

Breast cancer with Chinese characteristics

by Michael Woodhead
Breast cancer rates in Chinese women are only one sixth those of their American counterparts, but China is catching up quickly, a new report says.
A review of breast cancer in China published in the Lancet Oncology this week shows that breast cancer has traditionally been an uncommon disease in China but rates are increasingly rapidly as the country adopts more affluent lifestyles.
The report by researchers at the National Office for Cancer Prevention and Control, Chinese Academy of Medical Sciences, Beijing shows that more than 1·6 million Chinese people are diagnosed with breast cancer and 1·2 million die of the disease each year. Breast cancer is now the most common cancer in Chinese women, accounting for cases 12% of all newly diagnosed breast cancers. Annual incidence rates are about 22 per 100,000, compared to rates of around 120 per 100,000 in the US.
The reviewers say breast cancer occurs at a younger age in Chinese women compared to their western counterparts, and for this reason screening programs such as mammography would probably not be appropriate. Rates have increased in recent years due to reproductive factors such as the single child policy and later age of first birth increasing exposure to sex hormones.
For these reasons, and because of the low awareness and delays in diagnosis, Chinese women with breast cancer tend to have more advanced stages of disease when diagnosed.
Another major disparity with breast cancer in China is the lack of adequate treatment. Most women cannot afford the more expensive advanced drugs for breast cancer now recommended in international guidelines. Paradoxically, treatment of breast cancer by Chinese doctors tends to be over-aggressive, with excessive surgery and chemotherapy. Many women have unnecessary mastectomy and axillary lymph node dissection and also chemotherapy. Under-treatment is also common, with some women receiving inadequate therapy for treatable cancers. The reviewers say palliative-care programs probably represent the best way forward to manage quality of life for patients with advanced disease and their families.
They conclude by saying there is a need for more public  awareness of breast cancer and promotion of early detection.
"Because the disparity of access to treatment for breast cancer will remain for some time, great effort is needed to expand insurance benefits and cancer-care infrastructure to underserved women in China," they conclude.

The top 8 medical news stories from China for Thursday 1 May

1. A person's blood group may influence their survival from cancer according to oncologists in Guangzhou. In a study of patients with oesophageal cancer they found five year survival rates were 50 % for patients with blood type A, 45% for type B, 51% for type O, and 61% for type AB.

2. The incidence rate of type 1 diabetes is increasing at a rate of 14.2 % per year in Shanghai and if present trends continue, the number of new type 1 diabetes cases will double from 2016 to 2020, researchers say.

3. Chinese neurologists say people with atrial fibrillation may be able to avoid the need to take lifelong anticoagulant drugs to prevent stroke by using a minimally invasive surgery procedure called left atrial appendage closure (using a system created by Boston Scientific Corp - could be an advertorial).

4. The introduction of the New Cooperative Medical Scheme (NCMS) has increased access to healthcare for elderly people, but not had any effect on their overall health, a study from Nanjing University shows. The study found that the health cover did not affect overall health status and did not reduce the out-of-pocket spending of elderly people.

5. An outbreak of hand, foot, and mouth disease that hospitalised 1844 children in Central China from 2011 to 2012 was caused by a mixture of co-circulating coxsackievirus A16 (CVA16). and enterovirus I71 (EV71). This may have contributed to the genomic recombination between the pathogens say researchers from Wuhan University.

6. The whistleblower 'Corridor Doctor' doctor of Mianyang who worked in a corridor after being suspended from her job for two years, has now been sacked. Authorities said Dr Lan Yuefeng had been absent for almost two years and had been disruptive and uncooperative. Her colleagues rejected charges of overservicing at the hospital and went on strike claiming she had made false allegations and damaged their reputation.

7. Health authorities in Beijing are urging adults to have measles vaccination after a surge in cases in thecity. They say there has been a spike in cases in the past two months, and more than half of the infected are in adults, probably because protection from childhood vaccination has waned.

8. Radiologists in Sichuan claim that resting-state functional MRI could be useful in providing early and accurate diagnosis of ADHD. In a study published in Radiology, Dr Qiyong Gong of the West China Hospital of Sichuan University, showed that the boys with ADHD had altered structure and function in certain areas of the brain, such as the orbitofrontal cortex and the globus pallidus. that play in executive inhibitory control - the ability to control inappropriate behaviors or responses.

Clinical Friday - news briefs from the medical journals

An outbreak of Hand, Foot, and Mouth Disease in Changchun in 2013 affected more than 1125 children and was caused by Coxsackievirus A6 researchers report. They say the finding of a different causative strain means that vaccination against enterovirus EV71 will not solve the millions of cases of the disease in China every year.

More than 80% of elderly people in Beijing are infected with the stomach bug Helicobacter pylori that predisposes to ulcers and gastric cancer, a study has found. The infection rate with the more pathogenic type 1 H. pylori strain was 56%, researchers found.

Patients with H7N9 influenza living in rural areas were more likely to be female and caught the infection from backyard poultry breeding, a study from Zhejiang has shown.

Heart failure has a poor prognosis in China with 40% patients dying within four years if they have chronic heart failure with reduced ejection fraction, a study from the National Center for Cardiovascular Diseases and Peking Union Medical College shows.

More than one in ten patients attending China's overcrowded hospitals leave without being seen, a study has found. Patients who left without waiting for treatment tended to have less serious illness and have arrived on foot, according to researchers from the Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu.

Uric acid may have a role in hypertension, according to researchers from Xinjiang. In a study of 3778 children and adolescents they found that increasing levels of serum uric acid were associated with high blood pressure.

The most common forms of cancer in China are lung cancer (20.5%), stomach (11%), colorectal (10%) and liver cancer (10%) according to new figures from the National Central Cancer Registry.

Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

China's medical experts warn about marketing of regular CT scan check-ups

by Michael Woodhead
Medical experts have warned Chinese consumers to reject the marketing hype for the latest craze of having six monthly health check-ups using PET-CT scanners.
Many medical clinics are "jumping on the bandwagon" and using advertising to promote the inappropriate and dangerous use of high end scanners, say radiotherapy specialists at leading hospitals.
Adverts urge consumers to have six monthly CT scans, claiming the advanced technology will detect fast-growing tumours that would escape detection by other health checks or from symptoms alone, accordingto a report in the People's Daily.
However, Dr Lin Hongwei, a cancer specialist at Beijing's Qinhua University Changgeng Hospital said the promotion of PET-CT scan was inappropriate and potentially harmful. He said PET-CT scans delivered a high dose of radiation and should only be used in monitoring existing tumours and for detetion of certain difficult tumours. There was no role for CT scanning in screening of the general population, and anyusch ue was in contravention of current guidelines, he warned.
"The use of expensive PET-CT scans for regular check ups is inappropriate, it is a waste of resources and also can do harm to the patient," he said.

HPV linked to oesophageal squamous cell carcinoma in China

Medical researchers have uncovered an alarming link between HPV virus and the quadrupling of a string of deadly cancers in China.
The deadly Human Papilloma Virus increases the risk of oesophageal squamous cell carcinoma (OSCC) in China by almost four- fold, according to research led by University of New South Wales (UNSW) academics.
In addition to causing cervical, anal and genital cancers, HPV has more recently been found to cause head and neck cancers. OSCC is a cancer where a possible link with HPV has been postulated in the past, but not resolved.
"The problem with OSCC is that there is no way to screen for it, so it is usually diagnosed quite late and has a very high mortality," said the first author of the paper, Surabhi Liyanage, a PhD candidate with UNSW Medicine.

'Cancer street' set up by Hunan outpatients having treatment

Half a kilometer in length, the narrow Jiatong Street that cuts through the Hunan Provincial Tumor Hospital and Hunan Normal University Medical College has been dubbed "Cancer Street," as it is populated by hundreds of cancer patients seeking treatment at the hospital. 
It began with some patients who rented apartments in the street for long-term medical treatment, and after some time it naturally developed into a neighborhood accommodating hundreds of patients, most of whom live here for a couple of months at a time.
The street has fully adapted to its population. Small hotels full of tenants occupy this area, with groceries, eateries and pharmacies serving their needs. It looks like a common, rundown yet lively backstreet seen in most cities, but look closer and the vegetable shops here also sell stoves and woks to tenants, clothing shops offer wigs to those losing hair from radioactive treatment, and pharmacies and clinics are also a source of psychological support for patients fighting the fear of cancer.
On a fine day, tenants spread white bedding under the sun, like those in the hospital. Coming from all over the province, the tenants usually share their experiences in combating the diseases and try to encourage each other.
Some patients who have recovered and left Jiatong Street call it the "old place" that they will visit again, but not everyone will be fortunate enough to reminisce about this place.
Source: Global Times

Guangzhou oncologists develop better staging method for colon cancer

Guangzhou oncologists have developed an improved staging method for colon cancer that accurately predicts the risk of disease recurrence and benefit of adjuvant chemotherapy for patients who have had surgery for stage II colon cancer.
Researchers from the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, used expression patterns of multiple microRNAs (miRNAs) combined into a single model to improve postoperative risk stratification and prediction of chemotherapy benefit for these patients.
Using this tool, they were able to classify patients as at high risk or low risk of disease progression. Five year disease-free survival was was 85% for the low-risk group, and 57% for the high-risk group. The six-miRNA-based classifier was an independent prognostic factor for, and had better prognostic value than, clinicopathological risk factors and mismatch repair status.
Patients in the high-risk group were found to have a favourable response to adjuvant chemotherapy The clinicians developed two nomograms which combined the smiRNA-based classifiers and clinicopathological risk factors to predict which patients might benefit from adjuvant chemotherapy after surgery for stage II colon cancer.
“Our six-miRNA-based classifier is a reliable prognostic and predictive tool for disease recurrence in patients with stage II colon cancer, and might be able to predict which patients benefit from adjuvant chemotherapy. It might facilitate patient counselling and individualise management of patients with this disease,” they concluded.
Full study: Lancet Oncology

What hope for preventing cervical cancer in China with no access to Pap tests or HPV vaccine?

An inflatable uterus in a Shanghai park aims to raise awareness of women's health

by Xuyang Jingjing
As World Cancer Day is celebrated on February 4, it is a sad reality that potentially life-saving cervical cancer vaccines are being kept from the Chinese mainland due to tight import restrictions and testing requirements. 


HPV types 16 and 18 are responsible for about 70 percent of cervical cancer cases. 

HPV vaccines have been available in Hong Kong, Macao and Taiwan since late 2006. But for vaccines, or any new imported drugs, to be sold in the mainland, new clinical trials have to be performed on mainland residents. Then the drugs are re-evaluated and reviewed by the State Food and Drug Administration before they can be imported, according to regulations.

 Some women who are aware of the vaccines and have the means to do so choose to get inoculated in Hong Kong. There are also many agencies that help mainland women book appointments in Hong Kong hospitals. Such procedures usually come in at around HK$3,000.

 Both Gardasil and Cervarix are given in a series of three shots over the span of six months, which means women have to travel back and forth. They could also take the other two shots back home and get injected at a local clinic, but strictly speaking this is illegal since the vaccines are not yet approved for the mainland. 


Zhou Zijun, professor with the School of Public Health of Peking University, said the purpose of such barriers is to protect the Chinese people while noting that every country has its own set of standards and procedures when approving imported drugs. This also serves to protect domestic pharmaceutical companies. 

But many doctors argue that these regulations are too stringent and may be keeping some good medicines out. The tests done in Hong Kong and Taiwan should have been sufficient, said Gong Xiaoming, a gynecologist at Beijing Union Medical College Hospital.

 He gave another example of an overseas pharmaceutical company that estimated it would cost around 100 million yuan ($16 million) to do all the clinical trials and evaluations to introduce a drug for ovarian cancer to the mainland, ultimately deciding it wasn't worth it and shelving the launch. 


"We should have standards when importing new drugs, but right now it seems the threshold is too high and is preventing us from using some good drugs," said Gong.

 The two vaccines started clinical trials in China around 2007. The first two stages of clinical trials have been concluded and have proven the safety of the vaccine. The third stage has been going since 2009, aiming to test the efficacy of the vaccines. But it could still take years, experts say.

 In the meantime, Chinese pharmaceutical companies have also started clinical trials for domestically-produced HPV vaccines. But it is unclear when any of these will start to be sold on the mainland.
Statistics from the Ministry of Health in 2011 showed over 130,000 new cases of cervical cancer in China each year, accounting for about one-fifth of all new cases worldwide. This translates to about 30,000 women in China dying of cervical cancer each year.

 n China, cervical cancer usually occurs among women over 35 years old, especially between the ages of 45 and 49, according to research carried out by Qiao Youlin, a leading oncologist and a professor at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences.

 Worryingly, recent years have seen reports indicating that the disease is becoming increasingly prevalent among women in their 20s.

 Most cervical cancer cases occur in central and western areas such as Shanxi, Shaanxi and Hunan, and more so in rural areas than in cities, according to a report released by the Center for Cancer Registry in January.


Besides vaccination, regular screenings are crucial for the early detection and treatment of cervical cancer. However, the biggest problem at the moment is that the general public, especially those in rural or poverty-stricken areas, lack awareness about the disease and the importance of getting regularly tested, said Gong. 


Chinese authorities have also been trying to raise awareness of breast and cervical cancer and have launched programs to promote screening. 

Between 2009 and 2011, China invested over 350 million yuan to screen for breast cancer and cervical cancer among women aged between 35 and 59 in rural areas. Over 11 million rural women were tested for cervical cancer and the country aimed to screen another 10 million in 2012. Whether this program was successful remains unknown.

 Despite the government's effort to promote screening, not enough is being done to ensure that the hundreds of millions of women who need the test are all able to receive it.

 The commonly used screening technique, the pap smear test, detects pre-cancerous and cancerous processes in the cervical canal. It requires skilled doctors to analyse cells for cancerous changes and is therefore more suited to developed countries where medical staff have decades of experience. 

It takes over 10 years to train a doctor qualified to diagnose the disease from the test, but China lacks both the training system and qualified doctors, according to Qiao. 

In 2008, Qiao and scientists from other countries announced in a paper published in The Lancet Oncology that they had developed a new test, named careHPV, to detect 14 high-risk types of HPV in about 2.5 hours.

 It took the team five years to develop the new test, which is considerably cheaper and faster than the currently used pap smear or HPV DNA tests. It is also much easier for medical workers to master. The new test, based on the Hybrid Capture 2 technology, is designed for low-resource areas and works in environments that lack water, electricity or modern equipment.

Qiao said that the new test has just been approved by the State Food and Drug Administration last year and will enter mass production soon. 

In 2011, the Cancer Foundation of China launched a research program that aims to prevent cervical cancer in ethnic minority areas. An ethnic minority county would be chosen respectively from Inner Mongolia, Yunnan and Sichuan where about 6,000 girls between 13 and 15 years of age would be inoculated with HPV vaccines.

 Qiao is hoping that the medical community in China could push for the vaccines to get approved as early as possible. "We are already seven years late. Who knows how many people have been affected during that time?" said Qiao.
Source: Global Times

One in five Chinese will develop cancer by the age of 75: report

About one in five Chinese people might develop cancer if they live to be 74, according to a new report.
There is one death from cancer every five minutes on the Chinese mainland, which translates into 2.7 million cancer deaths annually, according to the 2012 Cancer Registry Annual Report, which is recognized by the government.
The figures are based on data collected from 72 cancer surveillance sites in 24 provinces, covering 85 million people.
"Worldwide, China continued to have relatively low cancer incidence, but the death rate was relatively high," Chen Wanqing, deputy director of the National Central Cancer Registry, under the Ministry of Health, told China Daily on Wednesday.
The report said the cancer rate stands at 285.91 per 100,000 people in China, bringing 3.12 million new cases a year.
This is lower than most developed economies, like the United States, European nations and Australia, but far higher than in underdeveloped economies, Chen said.
"The cancer incidence rate goes up as people age," he said, peaking when they reach 80.
Given its rapidly aging population, "China's cancer burden will increase as well," Chen said.
The report said lung, stomach, colorectal and liver cancers are the main types among the Chinese population, with lung, liver and stomach cancers being the top killers.
Breast, lung, thyroid and colorectal cancers are rising sharply, Chen said.
Liu Yuewu, a leading cancer specialist at Peking Union Medical College Hospital, said thyroid cancer must be the fastest growing cancer in recent years, citing clinical experience.
In 1986, the hospital performed surgery eight times for patients with thyroid cancer, according to Liu. The figure increased to 1,125 in 2012.
A survey released last month by the Beijing Institute for Cancer Research showed the incidence of thyroid cancer more than doubled in the Chinese capital during the past decade.
"The trend has also been seen in other countries, like the US and South Korea," Liu said, adding that ever-increasing radiation exposure from widespread use of mobile phones is mainly to blame.
He suggests that integrating thyroid B scans with regular body examinations can help with early detection and treatment.
Chen agrees and is urging decision-makers to greatly increase public awareness and access to cancer screening services. But he also said cost is a concern.
A majority of newly diagnosed cancer cases are already in a late stage, resulting in unsatisfactory treatment results and a higher death rate, he said.
An average of 7,300 people die from cancer on the mainland each day, the report said. Patients older than 60 account for more than 63 percent of the deaths.
Chen said breast, lung and colorectal cancers tend to affect younger people, and suggested people go for cancer screenings after they turn 40.
Source: In Kunming

End of life care discussion in China

Discussions about dignified dying are no longer a taboo in China

by Zhao Xu
It's been nearly six weeks since her 82-year-old mother died, but Huang Yuan still cringes when she remembers the glimpses she caught of the elderly woman behind the thick glass wall of the intensive care unit. It's a wall that separates, often once and for all, the realm of the living and the immediate, dark corridor leading to the world of death.
"My mother had lost the ability to expectorate. So to prevent her from choking on the phlegm building up in her throat, the doctors decided to place her face down," said Huang, taking long, hard pauses between words as she tried to simultaneously recall but also blunt the painful memories.
"Mom remained there, her head hanging over the edge of the bed and her forehead supported by a cushioned chair. The combined effects of the illness and gravity had given her a swollen face. It was so bad she could barely open her eyes. Moreover, her lips had been constantly acted on by the same forces, to the point that even when she was temporarily restored to her normal, lying position on the bed, they were fixed in a terrible expression, parted, elongated."
The intense suffering was witnessed by the dying woman's seven heartbroken daughters. It sparked a long, often furious, yet ultimately inconclusive, debate among them as to whether their mother was paying too high a price for a chance of recovery so slim that it almost didn't exist.
"What did she want - life or relief from the pain? We are still haunted by that question and will be forever," said Huang.
"Maybe they didn't have to decide and suffer perennial torment over whatever decision they made," said retired cardiologist Luo Diandian. Luo is now a writer whose own experience of her mother-in-law's death, allied to her exposure to Western medical ideas and practices regarding terminal illnesses, combined to make her a strong advocate of so-called Living Wills.
"As the names suggests, a living will is a clear expression of what a person wants and, just as importantly, doesn't want, when it comes to the handling of his or her illness in its very final stage. The core centers on the medical treatment," she said. "For example, a person can specify whether or not he or she will opt for all, or just a certain part of the life-support measures, ranging from being fed by tube and mechanical ventilation, to dialysis and defibrilation."
Two things are emphasized when a person is considering making a will of this kind. First, a living will can be changed whenever the testator wishes, with the final version being the last one made while he or she was still capable of doing so, either in written or oral form. Second, for a living will to be officially valid, the testator must be diagnosed with a terminal illness and a clinically estimated life span of less than six months. In addition, the person must not have expressed any wishes to the contrary.
In some parts of the United States and Canada, the concept of the living will has become so entrenched that it's now considered a basic human right and is legally protected, according to Luo. Although making a will is not compulsory, people are likely to be advised to seriously consider writing one, once they enter adulthood.
So why don't more people embrace this concept and assert control over their exit from the world? The answer is complicated and can be rendered impenetrable by the welter of implications relating to death.
'Bound by sensitivity'
Weng Li, an attending physician at Peking Union Medical College Hospital in Beijing, where Wang's mother spent her last days, wrestles with complexities such as this every day.
"Unlike their Western counterparts, who are legally obliged to tell the full truth directly to their patients, Chinese doctors seem to be 'bound by sensitivity' to conceal the painful reality from their patients, but instead will tell the family members something closer to the truth," conceded Weng. "It's a cultural issue, but when it comes to writing a living will, the underlying contradiction is: How can you ask someone to seriously consider the option, while making every effort to convince him or her that they are not going to die?"
He said that neither the doctors nor the relatives should be blamed. "For the majority of Chinese people, death is still too frightening a thought to face honestly. You might be doing the patient a disservice by plunging them into an ocean of fear where they will simply drown," he said.
Huang, whose father died of gastric cardia cancer in 2008, is a believer in "not telling".
"When the cancer was first diagnosed, we were told to be prepared for his death within six months, but dad lasted another three and half years," she said. "Throughout that time, we never mentioned it and he never really asked. I had the feeling that he had started to sense the deadline approaching, but that wasn't until the very end of his life. Keep him in the dark, or under the sun? It could be both."
In other words, the significance of "the will" notwithstanding, a dying person's often implicitly expressed desire to talk only about survival should be fully respected. And in this case, to be an accomplice in the denial of a hard and imminent truth may be the ultimate demonstration of love, even though it often exacts a tremendous emotional price on those closest to the dying and may deprive both parties of the chance of saying a proper goodbye.
In 2006, Luo set up a website, www.xzyzy.com, and started recruiting volunteers to spread her message. But, despite her continuing efforts, she has only managed to have brochures displayed in one private hospital in Beijing. Refusal is often based on the grounds that such a graphic representation of death, often unsparing in its evaluation of each and every treatment and the potential revival measures required, is potentially offensive and may be at variance with a doctor's mission to save lives.
"When the odds are overwhelmingly stacked against the patient, and death becomes destiny, a doctor's first priority automatically changes from enabling life to easing its end. It's also the time when the doctor should stop being 'aggressive', take a conscious step back and let the patient decide what's the best for him or her," said Liu Duanqi, a former director of the oncology department at Beijing's General Army Hospital, who spent his working life treating terminal cancer patients. "Sadly, in reality, the majority of patients are dragged by their 'ever-dutiful' doctors all the way through their last, physically and emotionally ravaging journey."
There's a tendency to blame the profit motive, because hospitals are often attacked for being driven by financial self-interest, and there's also a fear that some doctors may "persuade" dying patients to undergo harsh, experimental treatment for research purposes, he said.
However, according to Liu, the lack of education about death provided to Chinese medical students is at the heart of the problem.
"Ask a patient whether he wants to live or not and that person will most definitely say yes. But, if you change the question to whether he is willing to endure this or that in order to live just one more week, you might get a different answer. With all their professional knowledge, empathy and skills, doctors can take a guiding role, even from behind the scenes," said Liu.
The reluctance, or possibly inability, of many Chinese doctors to engage patients and their families in sensitive and meaningful discussion about the range of possible choices and potential results often leads to unfounded hope, sudden disillusionment and ultimately anger and despair, according to Liu.
"Despite their general feeling of being wronged, these doctors have, in effect, robbed their dying patients of their last opportunity to make sensible, well-informed decisions," he said.
"And for people with high-level medical insurance, to prolong the process of death at the taxpayers' expense constitutes, for me, a form of social injustice."
The depth of understanding and the courage shown by a person in the face of impending death is the best and most generous parting gift those left behind will ever receive.
Chen Zuobing, director of the emergency department at the First Hospital of Zhejiang University in Hangzhou, East China, knows all about that. His father was diagnosed with terminal-stage peritoneal cancer in July, 2011. After a short, yet intense period of wavering that proved all-consuming, Chen helped his 77-year-old father face the stark reality.
After deciding against chemotherapy, the elderly man left the hospital where his son worked and returned to his home in the countryside. He planted pumpkins and played with the neighborhood children until his deteriorating health prevented him from doing so. Nine months later, in April, he died quietly at home.
"I gave my father the choice and he proved himself a hero," said Chen.
While stressing that she puts quality of life above quantity, Luo insisted that there's absolutely nothing wrong if a person decides "not to become reconciled to the idea of mortality, and to fight to the very bitter end".
"The idea of a graceful death has always been controversial. To me, the commitment to continued existence, no matter how much pain it entails, requires just as much courage," she said. "The purpose of a living will is to fulfill one's last wishes. Any decision that is truly heartfelt is heroic and fully dignified."
Read more: China Daily

China sets up national cancer registries

Registry will allow Chinese doctors to understand trends in cancer

China is setting up a national cancer registry to fully understand the extent of the disease in the country and to help improve cancer prevention policies.
Chen Wanqing, deputy director of the national cancer registry center, under the Ministry of Health, said so far the government-funded project has set up more than 220 surveillance sites across the mainland, covering some 200 million people.
The sites include health institutions, specialized cancer hospitals, research institutions, and public health institutions, he said.
"Accurate cancer registration and monitoring is crucial for effective cancer prevention and control. This new system will involve the gathering of all kinds of cancer-related information," he told China Daily.
He called the new registry a long-term and systematic collection of data about cancer and tumor diseases, which will gather information on diagnostic findings, patient history, treatment progress and the status of cancer patients nationwide.
Qiao Youlin, vice-chairman of the expert board for early detection and treatment of cancers at the Ministry of Health, said the system will be able to gauge cancer trends and patterns from which it will be possible to better allocate resources, improve research and evaluate and improve cancer control programs.
But he added that the project will need the full support of all community-level medical service providers to work.
"Data collected at the grassroots levels represents the most accurate picture of the extent of the disease in China," Qiao noted.
Those currently on the registry are mainly those who hold a hukou (residence permit), but information on the large migrant population is missing, Chen added.
"It's hard to ensure the quality of the data, particularly in rural and run-down areas," he said.
Due to the sheer size of the population, Chen said, it would be hard for the registry to ensure coverage of every area.
"But we can still make a reasonably accurate calculation of the extent of the disease across the country, through quality coverage of regional data," he added.
Various European countries already have national cancer registries, which have managed to gather reliable findings on total cancer numbers.
In the United States, national cancer information is practically guaranteed through the Cancer Registries Amendment Act, which requires all institutions to register the information.
Chen urged medical institutions across China to support the new initiative by reporting cancer cases and any related data to the registry.
According to the Ministry of Health, there are 2.8 million new cancer cases on the Chinese mainland each year and the number is expected to reach 3.8 million within the next decade.
"Cancer has been on the rise, both in terms of incidence and death rate, over the past 20 years," said Chen.
He said that there are also changing patterns in those numbers.
Previously, Chinese were more susceptible to those so-called "poor cancers", such as liver, stomach, and esophagus cancers, according to data so far from the registry.
But as the country's wealth has continued to grow, there are increasing cases of what people call "rich cancers", like lung, breast, and colorectal cancers, he added.
Read more: China Daily