This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions There will be an estimated 181 million new cancer cases (170 million excluding nonmelanoma skin cancer) and 96 million cancer deaths (95 million excluding nonmelanoma skin cancer) in 2018 In both sexes combined, lung cancer is the most commonly diagnosed cancer (116% of the total cases) and the leading cause of cancer death (184% of the total cancer deaths), closely followed by female breast cancer (116%), prostate cancer (71%), and colorectal cancer (61%) for incidence and colorectal cancer (92%), stomach cancer (82%), and liver cancer (82%) for mortality Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality) Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts CA: A Cancer Journal for Clinicians 2018;0:1-31 © 2018 American Cancer Society

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21492

Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

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Global cancer statistics

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21660

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

/pdf/global-cancer-statistics-2012-18pecqxl5v.pdf

Global cancer statistics, 2012

Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.25516

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.

&lt;div&gt;AbstractBackground:&lt;p&gt;Most prior studies have reported cancer mortality trends across countries for specific cancer types. Herein, we examine recent patterns and trends in cancer mortality rates for the eight common forms of cancer in 47 countries across five continents (except Africa) based on the World Health Organization mortality database.&lt;/p&gt;Methods:&lt;p&gt;Rates were age-standardized to the 1966 Segi-Doll world population, and trends in the age-standardized rates for the most recent 10 years of data were examined using Joinpoint regression.&lt;/p&gt;Results:&lt;p&gt;Cancer-specific mortality rates vary substantially across countries, with rates of infection-related (cervix and stomach) and tobacco-related cancers (lung and esophagus) varying by 10-fold. Recent mortality rates for all major cancers decreased in most of the studied countries except lung cancer in females and liver cancer in males, where increasing rates were observed in most countries. Rates decreased or stabilized in all countries for lung cancer in men and stomach cancer in both sexes.&lt;/p&gt;Conclusions:&lt;p&gt;The findings reinforce the importance of implementing and strengthening resource-stratified and targeted cancer prevention and control programs in all parts of the world to further reduce or halt the rising cancer burden.&lt;/p&gt;Impact:&lt;p&gt;The results may inform cancer prevention and treatment strategies and in so doing, reduce the marked global cancer disparities observed today.&lt;/p&gt;&lt;/div&gt; 

Data from Recent Mortality Patterns and Time Trends for the Major Cancers in 47 Countries Worldwide

The United States (U.S.) witnessed considerable reduction in cigarette smoking prevalence in the recent past. While the correlates of smoking prevalence and related disparities among U.S. adults are well documented, there is limited information on how this success was shared among different population sub-groups. Based on data from the National Health Interview Surveys, 2008 and 2018, representative of non-institutionalized U.S. adults (18 years and above), we applied the threefold Kitawaga-Oaxaca-Blinder linear decomposition analysis. We decomposed the trends in cigarette smoking prevalence, smoking initiation, and successful cessation into changes in population characteristics holding smoking propensities constant (compositional change), changes in smoking propensities by population characteristics holding population composition constant (structural change), and the unmeasured macro-level changes affecting smoking behavior in different population sub-groups at differential rates (residual change) to quantify the shares of population sub-groups by sex, age, race/ethnicity, education, marital status, employment status, health insurance coverage, family income, and region of residence in the overall change in smoking rates. The analysis shows that decreases in smoking propensities regardless of the changes in population composition accounted for 66.4% of the reduction in smoking prevalence and 88.7% of the reduction in smoking initiation. The major reductions in smoking propensity were among Medicaid recipients and young adults (ages 18-24 years). The 25-44-year-olds experienced moderate increase in successful smoking cessation, while the overall successful smoking cessation rate remained steady. Taken together, consistent reduction in smoking among U.S. adults by all major population characteristics, accompanied by disproportionately larger reduction in smoking propensities among the population sub-groups with initially higher smoking propensity compared to the national average, characterized the decline in overall cigarette smoking. Strengthening proven tobacco control measures with targeted interventions to reduce smoking propensities among underserved populations is key to continued success in reducing smoking overall and remedying inequities in smoking and population health. 

Declining trend in cigarette smoking among U.S. adults over 2008-2018: A decomposition analysis.

Letter to the Editor Regarding "Gender Identity Disparities in Cancer Screening Behaviors".

Between 2009 and 2011, the US Food and Drug Administration (FDA) approved multiple new immunotherapy and targeted agents for the treatment of advanced adenocarcinoma of the lung, melanoma, breast cancer, prostate cancer, and renal cell carcinoma based on data from randomized controlled trials. However, little is known about the uptake of these new treatment options, treatment adherence, toxicity, and the impact on survival in patients treated in the real world. Understanding the generalizability of clinical trial findings to community practice is critical for improving health care delivery, especially when treatments are expensive, frequently with annual list prices in excess of $100,000, and can result in significant patient out-of-pocket cost. Patients with cancer in clinical trials differ substantially from those treated in community settings on characteristics associated with survival outcomes, including age, comorbidity burden, socioeconomic status, treatment adherence, and health insurance coverage. Providers and facilities participating in clinical trials may differ from those in community practice as well. In this issue of Cancer, Pulte and colleagues use data from the Surveillance, Epidemiology, and End Results (SEER) cancer registries to conduct a timely study comparing the survival of patients who were diagnosed before and after new treatment options were approved for selected advanced cancers. The study reports a modest improvement in survival for patients newly diagnosed with advanced adenocarcinoma of the lung, melanoma, breast cancer, prostate cancer, and renal cell carcinoma. Overall, point estimates of 2-year survival increased by approximately 3 percentage points for patients diagnosed in 2011 and 2012, compared with patients diagnosed in 2007 and 2008. The authors acknowledged several limitations of the study, principal among them the absence of relevant treatment information in SEER. Comprehensive patient data about tumor markers required for treatment eligibility, receipt of systemic treatment, specific agent(s) received, duration of treatment, and treatment response were unavailable. Instead, the authors used the year of diagnosis as a proxy for receipt of newly approved cancer treatments. Use of the date of diagnosis as a proxy for receipt of cancer treatment is especially problematic for immunotherapy, for which only small percentages of patients are eligible. In an attempt to address this limitation, the authors restricted the analysis to only patients with recorded chemotherapy in SEER (ranging from 54% of patients with non–small cell lung cancer to 5% of those with prostate cancer). However, as explained by the authors, SEER contains only limited information regarding chemotherapy, and immunotherapy is especially subject to misclassification. The unexpected finding of a decrease in survival between 2007 to 2008 and 2011 to 2012 for advanced melanoma and prostate cancer when analyses were restricted to only patients receiving chemotherapy reinforces concerns about this approach. Ultimately, without patient-level treatment information, changes in population-level estimates of survival cannot be attributed to newly introduced treatment options because they may simply reflect increased dissemination of other forms of treatments introduced in prior years. Another limitation of this study, not mentioned by the authors, is the choice of 2-year overall survival as the outcome. First, the authors do not provide background evidence for hypothesizing that the new treatments might increase the number of patients experiencing prolonged survival. The median improvement in overall survival reported in trials for these new treatment options is approximately 2 months. A small benefit observed in a trial may vanish entirely in community practice because of differences in the patients, providers, and facilities. Second, there is growing concern about the initially underestimated toxicity of these treatments. Evaluations of pivotal and postmarketing clinical trials suggest that the likelihood of harm from these new therapies can be substantial.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.32157

Ahmedin Jemal

Papers

Data from Recent Mortality Patterns and Time Trends for the Major Cancers in 47 Countries Worldwide

Declining trend in cigarette smoking among U.S. adults over 2008-2018: A decomposition analysis.

Letter to the Editor Regarding "Gender Identity Disparities in Cancer Screening Behaviors".

Data challenges for evaluating new treatments

Introduction to Part 1