In 2018, the incidence rate of cancer in Gansu Province was 252.98/105 (278.58/105 in males, 226.09/105 in females), and the mortality rate was 140.86/105(174.04/105 in males and 106.00/105 in females), the incidence rate of males is 1.23 times that of females, and the mortality rate is 1.64 times. The incidence of tumors in urban areas was 266.71/105, and the mortality rate was 143.48/105; in rural areas, the incidence rate was 242.89/105, and the mortality rate was 138.93/105, the urban morbidity rate is 1.10 times that of rural areas, and the mortality rate is 1.03 times that of rural areas. In 2020, there were 19.29 million new cancer cases worldwide , the incidence rate was 247.5/105, the ASIRW was 201.0/105, the number of deaths was 9.96 million, the mortality rate was 127.8/105, and the ASMRW was 100.7/105; There were 4.57 million new cancer cases in China, the incidence rate was 315.6/105, the ASIRW was 204.8/105, accounting for 23.7% of the global new cancer cases, the number of deaths was 3 million, and the mortality rate was 207.5/105, ASMRW was 129.4/105, accounting for 30.2% of global cancer deaths.In 2018, Gansu ASIRW (205.89/105) was higher than the world and the whole country, ASMRW (116.83/105) was higher than the world, lower than Nationally, it suggests that the cancer burden in Gansu Province is relatively heavy. The incidence, mortality, ASIRC and ASMRC of cancer in Gansu Province in 2018 were lower than those in 2017  (the incidence rate was 295.63/105, the mortality rate was 154.62/105, the ASIRC was 208.71/105, and the ASMRC was 106.75/105). In 2018, the incidence of cancer in Gansu Province for males and females reached the peak in the age groups of 80–84 years and 75–79 years old respectively, and the most new cancer cases were in the age groups of 65–69 years old and 50–54 years old; The 80-84-year-old age group reached a peak, and the 65-69-year-old and 70-74-year-old age groups had the most cancer deaths, suggesting that the middle-aged and elderly people are high-risk groups for cancer in Gansu Province.
In 2018, the top five cancer in Gansu Province were stomach cancer, breast cancer, lung cancer, liver cancer, and colorectum cancer, accounting for 59.65% of all cancer incidences. The top five deaths were stomach cancer, lung cancer, liver cancer, esophagus cancer and colorectum cancer, accounting for 73.30% of all cancer deaths, and Gansu Province has always been a province with a high incidence of upper gastrointestinal cancer. In 2018, the incidence and mortality of cancer in Gansu Province ranked first in stomach cancer. The incidence of stomach cancer accounted for 23.05% of all new cases of cancer, and the deaths from stomach cancer accounted for 26.37% of all deaths from cancer. Compared with the rate level  the incidence of stomach cancer in Gansu Province in 2018 (58.31/105) was 2.03 times the national average (28.68/105), and the mortality rate (37.15/105) was the national average (20.87/105) 1.78 times higher than the national average. Studies have shown that the risk factors for stomach cancer include Helicobacter pylori infection, smoking, high intake of pickled food and low intake of fresh vegetables and fruits . Eradication of Helicobacter pylori infection can significantly reduce the incidence of stomach cancer, especially non-cardia stomach cancer occurrence and risk of death [12, 13]. Upper gastrointestinal endoscopy is the gold standard for the diagnosis of stomach cancer, and the use of gastroscopic screening can significantly reduce the risk of morbidity and mortality of invasive stomach cancer[14, 15]. Esophagus cancer ranks third in incidence and fourth in death, and colon-rectum cancer ranks fourth in incidence and fifth in death. The national survival data from 2012 to 2015 show  that colon-rectum cancer has a better prognosis, while esophagus cancer is relatively the 5-year standardized relative survival rates were 56.9% and 30.3%, respectively, and the former survival rate was nearly twice that of the latter. In 2017, both the incidence and death of lung cancer in the cancer registration areas of Gansu Province ranked second, indicating a high disease burden and a serious threat to the health of residents. Smoking is a major risk factor for the occurrence of lung cancer. At the same time, the occurrence of lung cancer is a complex process involving the interaction of environment and genes, and is closely related to air pollutants [17, 18]. According to data , about 14% of lung cancer deaths in the world are related to high levels of PM2.5, while the proportion in China is much higher, with about 20.5% of lung cancer deaths related to it, suggesting that it should be actively control the risk factors of lung cancer and reduce the incidence and death of lung cancer. Since 2009, Gansu Province has started to use the central financial transfer to pay for the rural cancer early diagnosis and early treatment project to conduct free screening for high-risk groups aged 40 to 69 to reduce their morbidity and mortality. Although significant results have been achieved, the disease burden is still heavy. Still need further control.
Breast cancer ranks first in the incidence of female cancer in the cancer registration area of Gansu Province, accounting for 14.13% of all cancer in women. The incidence rate of female breast cancer in urban areas (23.61/105) is lower than that in rural areas (26.39/105). Cervical cancer ranks fourth in the incidence of female cancer in Gansu Province, accounting for 9.13% of all female cancer. The key to cancer prevention and treatment lies in early detection, early diagnosis and early treatment. Early detection and treatment can significantly improve the five-year survival rate and quality of life of patients. Relevant data show [20–22], the 5-year survival rate of female breast cancer in my country from 2013 to 2015 was 82.0%, which was significantly higher than that of 73.0% from 2003 to 2005, but there is a gap with developed countries such as the United States (93.8%). HPV infection is a necessary cause of cervical cancer. Previous studies have shown [23, 24] that the combination of human papilloma virus (HPV) vaccination and screening can effectively prevent cervical cancer, and it is speculated that China can achieve this in the early 2070s, the goal of eliminating cervical cancer. This study further found that the incidence of leukemia was the highest in both male and female age groups of 0–14, followed by cancer of the central nervous system, which was consistent with the results of domestic and foreign studies , suggesting that leukemia and cancer of the central nervous system should be combined. As a key cancer prevention and control for children in our province, targeted preventive measures have been taken. From the perspective of regional distribution, Gannan Tibetan Autonomous Prefecture (Lintan County) has higher morbidity and mortality, followed by Hexi region (Gaotai County, Ganzhou District of Zhangye City, Liangzhou District of Wuwei City, Gulang County, Tianzhu County, Minqin County, Guohuang City), Hedong Region (Pingchuan District, Qingcheng County, Huining County, Jingtai County, Jingning County, Jingyuan County, and Baiyin District of Baiyin City), are relatively low, it presents certain regional characteristics, suggesting that effective local prevention and control measures should be formulated based on the environmental characteristics of different regions.
This study further analyzed the temporal trends of the ASIRC and ASMRC in Gansu Province from 2010 to 2018. The results of the Joinpoint regression model analysis showed that the standardized incidence and mortality of cancer in Gansu Province decreased from 2010 to 2018, the AAPC were − 1.7% and − 3.9%, respectively, and the difference was not statistically significant (P > 0.05). This may be related to the fact that Gansu Province has successively launched rural cancer early diagnosis and treatment projects and urban cancer early diagnosis and treatment projects in the high-incidence areas of the province. According to urban and rural statistics, ASIRC in urban areas showed a downward trend, AAPC was − 2.7%, and the difference was statistically significant (P < 0.05); ASIRC in rural areas showed an upward trend, AAPC was 0.6%, and the difference was not statistically significant (P > 0.05). The ASMRC in both urban and rural areas showed a downward trend, and the decline in urban areas was greater than that in rural areas, with AAPC of -4.8% and − 2.3%, respectively, with no significant difference (P > 0.05), this may be related to the limited economic level in rural areas, the relative lack of medical resources, and the weak public health awareness.