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Chen et al. Hepatoma Res 2019;5:12 I http://dx.doi.org/10.20517/2394-5079.2019.03 Page 7 of 17

Table 1. Status of national screening for liver cancer in rural areas (2011-2018)
No. of screened No. of cases Detection No. of early Early detection* No. of Treatment
(areas) detected rate (%) cases rate (%) treated rate (%)
2011.7-2012.6 7,732 (6) 65 0.84 44 67.69 58 89.23
2012.7-2013.6 14,972 (11) 119 0.79 64 53.78 110 92.44
2013.7-2014.6 19,441 (13) 100 0.51 59 59.00 96 96.00
2014.7-2015.6 21,603 (13) 123 0.57 75 60.98 115 93.50
2015.7-2016.6 22,460 (13) 119 0.53 78 65.55 108 90.76
2016.7-2017.6 21,024 (13) 115 0.55 66 57.39 113 98.26
2017.7-2018.6 20,194 (13) 127 0.63 92 72.44 122 96.06
Total 127,426 768 0.60 478 62.24 722 94.01
Data from Ref. [98] . *The diameter of the tumor is less than 5 cm [96]

In the Qidong screening program, the lead time for screened patients with liver cancer was estimated to be
[94]
12 months . In an Italian study, after 10-year follow-up, they found that the median lead-time calculated
for all surveilled patients was 6.5 months (7.2 for semiannual and 4.1 for annual surveillance). Lead time bias
[39]
accounted for most of the surveillance benefit until the third year of follow-up after HCC diagnosis .
Implementation of the national project on cancer early diagnosis and treatment
In 2004, the China Cancer Foundation launched a project for early diagnosis and treatment of cancer,
[95]
subsidized by central financial transfer payment program , and in 2006, the demonstration project of early
detection and early treatment of liver cancer was officially launched in Qidong, Jiangsu Province and in
Fusui, Guangxi Zhuang Autonomous Region where screening was carried out in high risk populations, i.e.,
male residents aged 35-64 and female residents aged 45-64 with positive HBsAg, who should be followed up
every 6 months by using repeat monitoring examinations of combined AFP and US. This project has been
described in the “Chinese Technical Scheme for Early Diagnosis and Early Treatment of Cancer” [96,97] .

CURReNT sTATUs AND PROgRess IN CHINA
Extensions of the screening program
After 2010, in order to meet the requirements for expanding the scale of liver cancer screening, two areas of
Haimen, Jiangsu Province, and Tong’an, Fujian Province were included into the National screening project.
Later on, Gong’an, Yidu, Yingshan, Dangyang, Honghu, Huangzhou, Jiayu of Hubei Province, Zherong of
Fujian Province, Chongzuo, Guigang, Cenxi, Wuming of Guangxi Zhuang Autonomous Region, Zhongshan
of Guangdong Province, and Huanchi, Shangdan of Gansu Province, were included into the program as
well. At that time there were 19 areas included in the program, but some of them withdrew after one or more
years, with 13 counties (cities) remaining nowadays. From 2007 to 2018, individuals with positive HBsAg
have been repeatedly screened 146,637 times; 965 liver cancer patients were found/detected. The annual
detection rate was 0.66%, the early detection rate was 62.38%, and the treatment rate was 91.09%. Among
them, 127,426 high-risk individual-times were screened during the period of 2011-2018, and 768 liver cancer
patients were found/detected. The detection rate was 0.60%, the early detection rate was 62.24%, and the
[98]
treatment rate was 94.01% [Table 1] .
Cancer Screening Project in Huaihe River Region
A cancer screening program (include liver cancer) was issued by the Bureau of Disease Control of the
National Health Commission of the PR China in 2008 which has included Sheyang of Jiangsu Province,
Fuyang, Suzhou of Anhui Province, Wenshang of Shandong Province, and Xiping, ShenQiu of Henan
[99]
Province . Now this program has been increased to 32 counties (cities) in four Provinces, and has screened
more than 53,400 person-times. The results on the screening of liver cancer have not been reported.

Cancer Screening Program in Urban China
In 2012, the National Cancer Center of China proposed a Cancer Screening Program in Urban China
(CanSPUC), which is also a National Major Medical Reform Project that includes screening for cancers of