The Impact of Cancer on China

Cancer is the leading cause of death in China. An estimated 4.3 million new cancer cases and 2.9 million new cancer deaths occurred in China in 2018. Compared to the USA and UK, China has lower cancer incidence but a 30% and 40% higher cancer mortality than the UK and USA, among which 36.4% of the cancer-related deaths were from the digestive tract cancers (stomach, liver, and esophagus cancer) and have relatively poorer prognoses. An estimated 40% of the risk factors can be attributed to environmental and lifestyle factors either in China or other developed countries. Tobacco smoking is the single most important carcinogenic risk factor in China, contributing to ~ 24.5% of cancers in males.Chronic infection is another important preventable cancer contributor which is responsible for ~ 17% of cancers. 

China is the most populous country in the world with an estimated population of nearly 1.42 billion, and by year 2020 to have around 4.51 million cancer cases and 3.04 million cancer deaths [1]. It is observed that 50% cases of digestive cancers, including stomach, liver, and esophagus cancer, occurred in China in 2018, and their 5-year overall survival rates were quite low, < 35% in 2013–2015 [2]. The most commonly diagnosed cancers in Chinese male, in 2018, were dominated by lung (21.9% of total cases), stomach (13.5%), colorectum (12.8%), liver (12.4%) and esophageal (9.0%) cancer, and for Chinese female they were breast (19.2% of total cases), lung (13.3%), colorectum (11.3%), thyroid (7.7%) and stomach (7.1%) cancer. For both sexes combined, China had comparable number of commonly diagnosed cancer cases, with lung, colorectum and female breast cancer (38.9% of total cases) as the UK (34.8%) and USA (29.0%), but had greater proportion of infection-attributable cancers (17.8% of liver and stomach cancer) (Table 1). Digestive tract cancers, arising mainly from the stomach (13.6%), liver (12.9%) and esophagus (9.9%), were responsible for 36.4% of cancer-related deaths in China.

The largest preventable cancer-contributor in China is chronic infection, which is responsible for about 17% of all cancers in China [3] and is predominantly comprised of H. pylori (stomach cancer), HBV (liver cancer), human papillomavirus (HPV; cervical cancer), and EBV (NPC). 

Although cancer incidence in China is generally low compared to that of UK and USA, the cancer burden is still expected to rise in the following years because of the aging and growing population and the rise in westernized lifestyle. 

Through proper education cancer can be prevented, life expectancy can be increased, and quality of life both during and after treatment can be improved exponentially. The Cancer Exercise Training Institute (CETI), a United States-based organization, has trained over 10,000 health and fitness professionals to become Cancer Exercise Specialists since 2004. The language barrier has been an obstacle until now. CETI and it’s regional affiliates are bringing the Cancer Exercise Specialist Advanced Qualification training to China, Taiwan, Hong Kong, and Malaysia in November 2019. This live training will be conducted by Andrea Leonard, 35-year cancer survivor, PFP 2019 Personal Trainer of the Year, and President/Founder of the Cancer Exercise Training Institute. 

Through the comprehensive training health and fitness professionals seeking to attain a higher level of mastery and work with cancer patients during and after cancer surgery and treatment and into survivorship. Participants will expand their skills as a CES and gain a complete understanding of the entire cancer process from diagnosis and treatment to reconstruction and survivorship. The unique and individualized programming will help to improve the patient’s ability to cope with the mental and physical stress following cancer diagnosis and treatment. The comprehensive programming covers 26 types of cancer, as well as pediatrics, with special emphasis on breast cancer and breast reconstruction. 

“The Cancer Exercise Specialist is to CANCER what Cardiac Rehab. is to the HEART PATIENT.” – Andrea Leonard

After the two-day workshop, students will continue their studies through written manuals, video, and power point presentations followed by a 125-question final examination. Regular continuing education is required to maintain the high-standard of expertise required to work with this population.

The benefits of exercise during treatment include:

  1. Increased energy
  2. Improved treatment tolerance
  3. Decrease in pain
  4. Decrease in depression
  5. Better sleep
  6. Improved self-esteem/self-confidence
  7. Prevent weight gain and obesity
  8. Prevent.manage lymphedema
  9. Prevent cancer cachexia 
  10. Maintain independence
  11. Improved balance and strength
  12. Makes treatment more effective at destroying cancer cells

The benefits of exercise during recovery include:

  1. Increased range of motion
  2. Correct muscle imbalances that lead to pain and degeneration
  3. Increased energy
  4. Increased stamina
  5. Increases in strength and cardiovascular endurance
  6. Prevent osteoporosis, diabetes, lymphedema, future cancer, and damage to the heart and lungs 
  7. Decrease body fat and increase lean muscle mass
  8. Improve balance and fall prevention
  9. Improved self-esteem/self-confidence

Based on the tremendous amount of evidence to support the aforementioned lists, it is mind-boggling that so few cancer patients are told to exercise. For those who are given the green light to exercise, the big problem is not knowing where to start, how to safely progress, and how to prevent many of the complications associated with cancer treatment.

By training more allied health professionals worldwide, CETI is creating a global resource for medical professionals to be able to confidently refer their patients. 

“Cancer strips you of everything. Your hair, your body parts, your dignity, your self-confidence, your strength and stamina, your finances, sometimes even your job or spouse. A Cancer Exercise Specialist can help the cancer patient regain control of their life and their body at a time that the patient feels they have no control.” – Andrea Leonard

If you are interested in learning more about our upcoming workshops in China, Hong Kong, Taiwan, and Malaysia, or would like to learn about bringing CETI’s training to your country, please contact

  1. Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2018. Accessed: 20 Feb 2019.
  2. Zeng H, Chen W, Zheng R, Zhang S, Ji JS, Zou X, et al. Changing cancer survival in China during 2003–2015: a pooled analysis of 17 population-based cancer registries. Lancet Global Health. 2018;6(5):e555.
  3. Islami F, Chen W, Yu XQ, Lortet-Tieulent J, Zheng R, Flanders WD, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol. 2017;28(10):2567–74.