Little was known about the cancer burden for the last 40 years in middle-income province in China. This study aimed to assess the overall, cause-specific mortality cancer trend and disability-adjusted life years (DALYs) between 1973-1975 and 2011-2013 in North China (Hebei Province). The collected data were stratified by 5-year age groups, gender and different types of cancer. We found that mortality from cancer showed an upward trend in the 1973-2013. The mortality rate of 0-79 year-old in 2011-2013 was lower than that in other periods. It was about two times higher for the 80+ age group than it was in 1973-1975. The cancer pattern in 4 periods presented differently. Esophagus cancer ranked the first in 1973-1975, whereas in 2011-2013, the most common cancer was lung cancer. DALYs also showed an increasing cancer burden in Hebei Province. This study is the first to analyzecancerburden for the last 40 years in a middle-income province. It could provide a baseline for assessment of effectiveness of cancer prevention and control. Esophagus cancer had a significant declining trend because of endoscopy screening program. Enhancing screening programs in those aged 40-69 year-old is necessary for reducing the cancer burden.