Highlight
- Over 95% of the working population surveyed reported two or more unhealthy dietary habits, representing a near-universal modifiable risk.
- Significant gender disparities were observed in tobacco and alcohol consumption, with males over 40 times more likely to smoke than their female counterparts.
- Critical gaps in preventive care were identified, with over half of the participants never having been screened for Helicobacter pylori, a primary risk factor for gastric cancer.
- Regional heterogeneity was pronounced, particularly regarding betel quid chewing, which was almost exclusive to participants in Southern China (Xiangtan).
Background: The Escalating Cancer Burden in the Chinese Workforce
China continues to face a significant public health challenge as cancer incidence and mortality rates remain high. While much research has focused on clinical treatments, primary prevention remains the most cost-effective strategy for long-term disease control. The working population, which constitutes a large and relatively stable segment of society, represents a critical demographic for intervention. However, workplace-based health data in China has historically been fragmented. The Comprehensive Workplace Intervention for Cancer Prevention in China (WECAN) project was established to address this gap, aiming to provide a robust evidence base for tailored workplace interventions. Understanding the baseline prevalence of risk factors is the first step toward achieving the goals of the Healthy China 2030 initiative.
Study Design and Methodology
This cross-sectional analysis utilized baseline data from the WECAN project, a stepped-wedge cluster randomized controlled trial. The study focused on 15 workplaces across three geographically and economically diverse cities: Wuhai in Northern China, Nanchong in Western China, and Xiangtan in Southern China. A total of 841 participants were recruited via stratified sampling based on sex and work type to ensure a representative mix of blue-collar and white-collar employees. The primary outcome measures included a comprehensive array of self-reported cancer risk factors, ranging from behavioral habits like smoking and alcohol consumption to clinical indicators such as obesity, vaccination status, and pathogen screening history.
Key Findings: A Landscape of Modifiable Risks
The results of the analysis paint a concerning picture of the health status of China’s workforce. The study population had a mean age of 40.5 years, with 61.4% being male and 57.4% working in blue-collar roles. Notably, 36.4% of participants reported a family history of cancer, emphasizing a baseline genetic or shared-environment risk that necessitates even more rigorous lifestyle management.
Behavioral and Lifestyle Factors
Tobacco and alcohol consumption remain dominant threats. The overall smoking prevalence was 36.9%, but the gender divide was stark: males had an odds ratio (OR) of 40.4 (95% CI 21.6 to 75.7) compared to females. Alcohol consumption followed a similar trend, with 63.6% of the total population consuming alcohol and males being 4.3 times more likely to do so than females. Perhaps the most striking behavioral finding was the regional prevalence of betel quid chewing. While the overall prevalence was 18.8%, a staggering 97.5% of those cases were concentrated in Xiangtan, highlighting how localized cultural habits can drive specific cancer risks—in this case, oral and esophageal cancers.
Dietary and Metabolic Risk
Dietary habits were found to be the most widespread area for improvement. An overwhelming 95.8% of participants reported two or more unhealthy dietary habits out of six assessed metrics (such as low fruit/vegetable intake or high salt consumption). Physical inactivity was reported by 49.1% of the cohort, contributing to a central obesity prevalence of 36.7%. Males were significantly more likely to exhibit central obesity (OR 3.2, 95% CI 2.3 to 4.5), which is a known driver for various malignancies, including colorectal and postmenopausal breast cancer.
Occupational and Environmental Exposure
Despite modern workplace safety standards, 6.1% of participants reported unprotected occupational exposure to harmful substances. This risk was significantly higher among blue-collar workers (OR 2.1) and males (OR 2.8). Additionally, 7.0% of participants reported exposure to household air pollution, a risk factor that correlated strongly with lower educational attainment, suggesting that socioeconomic status continues to influence environmental health risks.
The Prevention Gap: Screening and Vaccination
Clinical preventive measures showed significant room for growth. Nearly half (46.4%) of the participants had never been screened for Hepatitis B surface antigen (HBsAg), and 54.9% had never been screened for Helicobacter pylori. Given that China accounts for a massive portion of the world’s liver and gastric cancer cases, these screening gaps represent missed opportunities for early intervention. Vaccination rates were also suboptimal: 28.1% were unvaccinated against Hepatitis B, and 63.5% of eligible females (aged ≤45 years) had not received the Human Papillomavirus (HPV) vaccine.
Expert Commentary: Precision Prevention in the Workplace
The WECAN project baseline data underscores the necessity of moving away from “one-size-fits-all” public health messaging toward “precision prevention.” The workplace is an ideal environment for such interventions because it allows for longitudinal tracking and peer-group support. However, the data suggests that these interventions must be tailored to specific regional and demographic profiles. For instance, a tobacco cessation program in a northern industrial city might look very different from a betel quid reduction program in a southern commercial hub.
One limitation of the study is its reliance on self-reported data, which may be subject to recall or social desirability bias, particularly regarding alcohol and smoking. Furthermore, as a cross-sectional analysis, it identifies associations rather than causation. Nevertheless, the large, stratified sample across multiple regions provides a high degree of generalizability for the Chinese industrial and service-sector workforce.
Conclusion
The working population in China is currently exposed to a high burden of modifiable cancer risk factors. The near-universal presence of poor dietary habits and the significant gaps in pathogen screening and vaccination are particularly concerning. These findings provide a clear roadmap for the WECAN project’s subsequent intervention phases. By leveraging the workplace as a platform for health education, screening, and vaccination, China has the potential to significantly bend the curve of its national cancer trajectory.
Funding and Registration
The WECAN project is supported by various research funds dedicated to public health and cancer prevention in China. The trial is registered with the Chinese Clinical Trial Registry under the number ChiCTR2200058680.
References
Sun K, Wang B, He FJ, et al. Risk factors for cancer among the working population in China: a cross-sectional analysis of baseline data from the WECAN project. BMJ Open. 2025;15(12):e107063. doi:10.1136/bmjopen-2025-107063. PMID: 41429438.
