title: Dramatic reduction of liver cancer incidence in young adults: 28 year follow-up of etiological interventions in an endemic area of China.
abstract: Qidong City, China, has had high liver cancer incidence from endemic hepatitis B virus (HBV) infection and dietary exposure to aflatoxin. Based on etiologic studies, we began interventions in 1980 to reduce dietary aflatoxin and initiate neonatal HBV vaccination. We studied trends in liver cancer incidence rates in the 1.1 million inhabitants of Qidong and examined trends in aflatoxin exposure, staple food consumption, HBV infection markers and annual income. Aflatoxin exposure declined greatly in association with economic reform, increased earnings and educational programs to shift staple food consumption in the total population from moldy corn to fresh rice. A controlled neonatal HBV vaccination trial began in 1983 and ended in November, 1990, when vaccination was expanded to all newborns. Liver cancer incidence fell dramatically in young adults. Compared with 1980-83, the age-specific liver cancer incidence rates in 2005-08 significantly decreased 14-fold at ages 20-24, 9-fold at ages 25-29, 4-fold at ages 30-34, 1.5-fold at ages 35-39, 1.2-fold at ages 40-44 and 1.4-fold at ages 45-49, but increased at older ages. The 14-fold reduction at ages 20-24 might reflect the combined effects of reduced aflatoxin exposure and partial neonatal HBV vaccination. Decrease incidence in age groups >25 years could mainly be attributable to rapid aflatoxin reduction. Compared with 1980-83, liver cancer incidence in 1990-93 significantly decreased 3.4-fold at ages 20-24, and 1.9-fold at ages 25-29 when the first vaccinees were <11 years old.
authors: State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, 17 Nangli, Panjiayuan, Beijing, China. ztsun8602@yahoo.com.cn
authors: Zongtang
authors: Z
authors: Sun
authors: Taoyang
authors: T
authors: Chen
authors: Snorri S
authors: SS
authors: Thorgeirsson
authors: Qimin
authors: Q
authors: Zhan
authors: Jianguo
authors: J
authors: Chen
authors: Ju-Hyun
authors: JH
authors: Park
authors: Peixin
authors: P
authors: Lu
authors: Chu Chieh
authors: CC
authors: Hsia
authors: Nengjin
authors: N
authors: Wang
authors: Libin
authors: L
authors: Xu
authors: Lingling
authors: L
authors: Lu
authors: Fei
authors: F
authors: Huang
authors: Yuanrong
authors: Y
authors: Zhu
authors: Jianhua
authors: J
authors: Lu
authors: Zhengping
authors: Z
authors: Ni
authors: Qinan
authors: Q
authors: Zhang
authors: Yuying
authors: Y
authors: Wu
authors: Guoting
authors: G
authors: Liu
authors: Zhiyuan
authors: Z
authors: Wu
authors: Chunfeng
authors: C
authors: Qu
authors: Mitchell H
authors: MH
authors: Gail
mesh_terms: D000328:Adult; D016604:Aflatoxin B1 / Q000506:poisoning; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000821:virology; D002681:China / Q000453:epidemiology; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000379:methods; D055815:Young Adult
chemical_list: D017325:Hepatitis B Vaccines; D016604:Aflatoxin B1