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Open Access Original Article Issue
Psychological health mediates the association between diet and upper gastrointestinal cancer: a cross-sectional analysis from a large-scale population-based screening project
Cancer Biology & Medicine 2026, 23(7): 974-988
Published: 23 February 2026
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Objective

Upper gastrointestinal (UGI) cancer, including esophageal and gastric cancers, poses a significant health burden. While unhealthy dietary patterns are a recognized risk factor for UGI cancer, the complex interplay with psychological health that influences UGI cancer risk remains underexplored. The current study aimed to determine the association between dietary quality and UGI cancer, and the link with depression and anxiety symptoms.

Methods

Cross-sectional data were drawn from the baseline survey of the National Cohort of Esophageal Cancer study that was conducted between 2017 and 2019 in five high-risk regions of China. Dietary quality was evaluated using the Diet Balance Index (DBI)-16. Psychological symptoms were measured with the Generalized Anxiety Disorder 7-item Scale (GAD-7) and the Patient Health Questionnaire (PHQ)-9. Eligible participants underwent endoscopy screening and suspicious cases were confirmed via pathologic biopsies.

Results

A total of 434 UGI cancer cases were confirmed among 29,068 participants. Logistic regression models indicated that poor diet quality, reflected by an inadequate intake [low bound score (LBS)] and unbalanced diet [dietary quality distance (DQD)], was associated with psychological distress (e.g., LBS and anxiety: OR = 1.36, 95% CI: 1.19–1.56). UGI cancer participants had more severe psychological symptoms (e.g., anxiety and UGI cancer: OR = 1.20, 95% CI: 1.14–1.26). Path analysis further revealed that psychological symptoms significantly mediate the relationship between poor dietary quality and UGI cancer risk; specifically, anxiety symptoms mediated 27.78% of the LBS-UGI cancer link.

Conclusions

The current study revealed a significant association between dietary quality and UGI cancer risk, suggesting that psychological symptoms may have a mediating role. Incorporating dietary and psychological health management into public health strategies is crucial for comprehensive cancer prevention.

Open Access Original Article Issue
Cervical cancer burden and trends in China, 2000–2020: Asia-Pacific international comparisons and insights for elimination goals
Cancer Biology & Medicine 2025, 22(9): 1017-1035
Published: 01 September 2025
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Objective

Cervical cancer is a growing concern in China, especially among women who reside in rural areas and older women. Understanding age- and region-specific trends in cervical cancer is vital for informing policy and assessing progress toward WHO elimination targets.

Methods

The 2000–2020 data from 22 long-standing registries contributing to the China national cancer registry was analyzed to estimate age-standardized incidence and mortality rates (ASIR and ASMR, respectively). Joinpoint regression yielded an average annual percentage change (AAPC) stratified by age group (<35, 35–64, 65–74, and ≥75 y) and by urban-rural area. The comparative analysis included GLOBOCAN Overtime data from selected Asia-Pacific countries.

Results

The ASIR tripled in China between 2000 and 2020 before stabilizing (AAPC = 6.5%), while the ASMR rose steadily (AAPC = 3.9%). The urban incidence declined after 2009 among women <35 y, while rural trends were broadly stable. The ASIR and ASMR increased in urban areas among women 35–64 y of age, while rural areas had a rising ASIR and a stable ASMR, suggesting potential screening effects. In contrast, women ≥65 y of age had a steadily increasing incidence and mortality in rural and urban areas. Australia and Republic of Korea had consistent declines in the ASIRs and ASMRs compared to other Asia-Pacific countries, whereas Japan exhibited rising trends. The Philippines experienced a surge in mortality rates, despite incidence rates remaining stable or declining.

Conclusions

The cervical cancer burden in China has begun to plateau but large disparities persist by age and geography. To achieve elimination of cervical cancer, it is imperative to implement tailored strategies that prioritize the urgent expansion of HPV vaccination programs, the deployment of high-efficacy screening methods, and the universal access to treatment throughout the nation.

Open Access Original Article Issue
Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030
Cancer Biology & Medicine 2021, 18(3): 900-909
Published: 01 August 2021
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Objective

Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.

Methods

The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.

Results

Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000–2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively.

Conclusions

The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.

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