Lifestyle-related cancers, such as lung, colorectal and skin cancers, have increased globally over the past decade, according to the most comprehensive analysis of cancer-related health outcomes and patterns ever conducted. In the paper, ‘Global Burden of Disease (GDB) Cancer Collaboration, Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016’, published in JAMA Oncology, researchers reviewed 29 cancer groups, including lung, breast, prostate, skin, colorectal, pancreatic, stomach, and liver cancers, as well as leukaemia and other cancer groups. The study provides findings by age and sex for 195 countries and territories.
While lifestyle-related cancers saw a universal increase from 2006 to 2016 - several cancers from infectious causes including cervical and stomach cancers - decreased over the same time period.
"While the increase in lung, colorectal, and skin cancers over the past decade is concerning, the prevention potential is substantial," said Dr Christina Fitzmaurice, Assistant Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, whose organization coordinated the study. "Vital prevention efforts such as tobacco control, dietary interventions, and broader health promotion campaigns need to be scaled up in response to this rise in lifestyle-related cancers."
Study estimates were analysed using a Socio-demographic Index (SDI) based on rates of education, fertility, and income. SDI is more comprehensive than the historical ‘developed’ versus ‘developing’ nations framework. Countries with high SDI have high levels of income and education and low fertility, whereas low-SDI countries have low levels of income and education and high fertility.
Large disparities in cancer incidence and death persist between high- and low-SDI countries. Researchers found rates of cancer incidence and death remained higher in high-SDI countries in 2016. For example, the odds of developing breast cancer over the course of one's lifetime were the highest at one in ten women in high-SDI countries, but only one in 50 for women in low-SDI countries.
Conversely, the largest and fastest increase in new cancer cases between 2006 and 2016 occurred in middle-SDI countries. And women in low-SDI countries are nearly four times more likely to develop cervical cancer than women in high-SDI countries, and in 2016, cervical cancer was the most common cause of cancer incidence and death in low-SDI countries.
Colon and rectum cancer
In 2016, there were 1.7 million incident cases of colon and rectum cancer and 830,000 deaths. Colon and rectum cancer caused 17.2 million Disability-Adjusted Life-Years (DALYs) in 2016, of which 97% came from Years of Life Lost (YLLs) and 3% from Years Lived With Disability (YLDs). The odds of developing colon and rectum cancer globally was higher for men than for women (one in 26 men, one in 41 women). The highest odds were in the high SDI quintile (one in 15 men, one in 24 women), and the lowest in the low SDI quintile (one in 112 men, one in 116 women).
Between 2006 and 2016, incidence increased by 34% from 1.3 million to 1.7 million cases. Most of this increase can be explained by an aging and growing population (19% and 12%, respectively); however, even with the same population size and age structure, colorectal cancer cases would have increased by 2% between 2006 and 2016 due to changing age-specific incidence rates. ASIRs between 1990 and 2016 were similar for men and women for all levels of SDI except for the high-middle SDI quintile, where trends levelled off in women but increased in men. Between 2006 and 2016, for both sexes combined, the average annual age-standardized incidence rates (ASIR) and average annual age-standardized death rates (ASDR) decreased in the high SDI quintile. In the high-middle, and middle SDI quintile, the ASDR decreased but the ASIR increased, and for low-middle, and low SDI countries, both ASIR and ASDR increased.
In 2016, there were 1.2 million incident cases of stomach cancer and 834,000 deaths worldwide. Stomach cancer caused 18.3 million (DALYs in 2016, with 98% coming from YLLs and 2% coming from YLDs. One in 32 men and one in 80 women developed stomach cancer over a lifetime. The highest odds for men were in middle SDI countries (one in 24), and the lowest in low SDI countries (one in 90).
For women, the highest odds were in high-middle SDI countries (one in 69) and the lowest in low SDI countries (one in 140). Between 2006 and 2016, stomach cancer moved from the second leading cause of crude cancer YLLs to the third place with a 4% decrease (−4% change; 95% UI, −6.5% to −1.5%) in absolute YLLs. Overall, incidence between 2006 and 2016 increased by 15%, of which a change in the population age structure contributed 18%; population growth, 12%; and falling age-specific rates, −15%. ASIRs have dropped substantially since 1990 globally and for all SDI quintiles.
"Ensuring universal access to health care is a vital prerequisite for early detection and cancer treatment," said Fitzmaurice. "And improving access to advanced diagnostic technologies not commonly available in low-SDI countries is a critical step toward achieving health equity globally."
Additional key findings include:
- In 2016, there were 17.2 million cancer cases worldwide, an increase of 28% over the past decade. There were 8.9 million cancer deaths the same year.
- While cancer death rates decreased in a majority of countries from 2006 to 2016, incidence rates conversely increased.
- Breast cancer was the leading cause of cancer death in women.
- Lung cancer was the leading cause of cancer death in men; it was also the leading cause of cancer mortality globally, accounting for nearly 20 percent of all cancer deaths in 2016.
- Prostate cancer is one of the most common causes of cancer incidence and death in men, in both high- and low-SDI countries, but especially in sub-Saharan Africa.
New cases per 100,000 people (age-adjusted), 2016 (‘worst’ and ‘best’ countries and global)
- Tracheal, bronchus, and lung cancer: North Korea (56.9), Kenya (4.2), global (30.2)
- Colon and rectum cancer: Netherlands (57.5), The Gambia (4.3), global (25.9)
- Breast cancer: Luxembourg (61.8), Niger (5.8), global (24.1)
- Non-melanoma skin cancer: Australia (300.4), Bangladesh (0.7), global (23.2)
- Prostate cancer: Dominica (113.1), North Korea (2.4), global (22.1)
- Stomach cancer: South Korea (44.5), Namibia (2.7), global (17.3)
- Liver cancer: Mongolia (108.4), Morocco (1.9), global (14.6)
- Other neoplasms: Malawi (39.6), Syria (2.6), global (10.9)
- Cervical cancer: Somalia (34.0), Qatar (1.1), global (7.0)
- Leukemia: New Zealand (20.3), Zambia (2.0), global (6.8)
- Non-Hodgkin lymphoma: Canada (21.2), Kyrgyzstan (1.5), global (6.7)
- Bladder cancer: Lebanon (31.1), Nigeria (1.2), global (6.7)
- Esophageal cancer: Malawi (25.2), Syria (0.7), global (6.6)
- Pancreatic cancer: Czech Republic (12.5), India (2.6), global (6.4)
- Uterine cancer: Latvia (23.1), Bangladesh (0.8), global (6.0)
- Lip and oral cavity cancer: Pakistan (22.1), Sao Tome and Principe (1.0), global (5.5)
- Kidney cancer: Latvia (20.5), Nepal (1.0), global (5.0)
- Brain and nervous system cancer: Iceland (20.8), Namibia (1.4), global (4.6)
- Malignant skin melanoma: Australia (55.6), Nepal (0.2), global (4.1)
- Ovarian cancer: Estonia (9.3), Niger (1.2), global (3.6)
- Thyroid cancer: Iceland (18.7), Ghana (0.2), global (3.3)
- Gallbladder and biliary tract cancer: Chile (11.5), Uzbekistan (0.6), global (2.8)
- Larynx cancer: Cuba (8.8), The Gambia (0.6), global (2.7)
- Other pharynx cancer: Hungary (7.3), Palestine (0.2), global (2.4)
- Multiple myeloma: Barbados (6.3), Tajikistan (0.4), global (2.1)
- Nasopharynx cancer: Malaysia (5.1), Mali (0.1), global (1.3)
- Hodgkin lymphoma: Greece (5.3), Syria (0.1), global (1.0)
- Testicular cancer: Chile (6.4), Mozambique (0.04), global (0.9)
- Mesothelioma: United Kingdom (2.9), Palestine (0.1), global (0.5)
Deaths per 100,000 people (age-adjusted) in 2016 (‘worst’ and ‘best’ countries and global)
- Tracheal, bronchus, and lung cancer: North Korea (61.7), Egypt (4.8), global (25.8)
- Colon and rectum cancer: Hungary (31.3), Sri Lanka (5.0), global (12.8)
- Stomach cancer: Mongolia (44.0), Maldives (3.2), global (12.6)
- Liver cancer: Mongolia (114.7), Morocco (2.0), global (12.1)
- Breast cancer: Tonga (24.7), Oman (4.0), global (7.9)
- Other neoplasms: Malawi (37.6), Syria (2.6), global (6.4)
- Esophageal cancer: Malawi (32.4), Syria (0.8), global (6.2)
- Pancreatic cancer: Uruguay (12.8), Bangladesh (2.5), global (6.2)
- Prostate cancer: Dominica (54.9), North Korea (1.9), global (6.1)
- Leukemia: Syria (15.3), Bangladesh (1.9), global (4.6)
- Non-Hodgkin lymphoma: Grenada (11.0), Kyrgyzstan (1.4), global (3.6)
- Cervical cancer: Zimbabwe (28.7), Syria (0.6), global (3.5)
- Brain and nervous system cancer: Palestine (8.3), Japan (1.2), global (3.2)
- Bladder cancer: Malawi (11.8), Albania (0.9), global (2.9)
- Lip oral cavity cancer: Kiribati (14.6), Syria (0.6), global (2.6)
- Gallbladder and biliary tract cancer: Chile (11.3), Uzbekistan (0.6), global (2.5)
- Ovarian cancer: Lithuania (5.9), United Arab Emirates (0.9), global (2.4)
- Kidney cancer: Czech Republic (7.1), Bangladesh (0.5), global (2.0)
- Other pharynx cancer: India (6.1), Syria (0.2), global (1.7)
- Larynx cancer: Cuba (5.3), Japan (0.4), global (1.6)
- Multiple myeloma: Dominica (5.9), Tajikistan (0.4), global (1.5)
- Uterine cancer: Grenada (5.4), Maldives (0.5), global (1.3)
- Malignant skin melanoma: New Zealand (6.6), Bangladesh (0.2), global (0.9)
- Nasopharynx cancer: Malaysia (3.7), Chile (0.1), global (0.9)
- Non-melanoma skin cancer: Zimbabwe (4.5), Bangladesh (0.2) global (0.8)
- Thyroid cancer: Zimbabwe (2.3), Syria (0.2), global (0.6)
- Mesothelioma: United Kingdom (2.6), Palestine (0.1), global (0.5)
- Hodgkin lymphoma: Afghanistan (2.2), Japan (0.1), global (0.4)
- Testicular cancer: Kiribati (1.0), Maldives (0.02), global (0.1)
New cancer cases per 100,000 people (age-adjusted) in 2016
- Australia (743.8)
- New Zealand (542.8)
- United States (532.9)
- Netherlands (477.3)
- Luxembourg (455.4)
- Iceland (455.0)
- Norway (446.1)
- United Kingdom (438.6)
- Ireland (429.7)
- Denmark (421.7)
- Syria (85.0)
- Bhutan (86.0)
- Algeria (86.7)
- Nepal (90.7)
- Oman (94.9)
- Maldives (101.3)
- Sri Lanka (101.6)
- Niger (102.3)
- Timor-Leste (105.9)
- India (106.6)
Cancer deaths per 100,000 people (age-adjusted) in 2016
- Mongolia (272.1)
- Zimbabwe (245.8)
- Dominica (203.1)
- Hungary (202.7)
- Grenada (201.0)
- Uruguay (190.6)
- Tonga (189.7)
- North Korea (188.7)
- Saint Vincent and the Grenadines (183.1)
- Croatia (180.2)
- Syria (67.4)
- Algeria (67.5)
- Oman (69.2)
- Maldives (72.0)
- Sri Lanka (74.7)
- Bhutan (78.6)
- Uzbekistan (80.6)
- Nicaragua (80.9)
- Morocco (81.0)
- Qatar (81.6)
“With the annual updates of the GBD cancer estimates, our goal is to provide relevant and current information on the global, regional, and national burden of cancer. The GBD 2016 study offers new insights into the magnitude of cancer disparities,” the authors conclude. “With population aging and the epidemiological transition, cancer incidence will increase in the future, further widening the cancer divide if current trends continue. The data showing the disparities and knowledge on the root causes exist, as do the tools to reduce them. However, strategic investments in cancer control and implementation of effective programs to ensure universal access to cancer care are required to achieve the Sustainable Development Goals as well as targets set in the WHO Global Action Plan on NCDs.”
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