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.

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Global cancer statistics, 2012

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21551

Cancer statistics, 2019.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21590

Cancer statistics, 2020.

INTRODUCTION Population-based cancer survival data provide insight into the effectiveness of health care delivery. Comparing survival for all cancer sites combined is challenging, because the primary cancer site and age distribution of patients may differ among areas or change over time. Cancer survival indices (CSIs) are summary measures of survival for cancers of all sites combined and are used in England and Europe to monitor temporal trends and examine geographic differences in survival. We describe the construction of the North American Cancer Survival Index and demonstrate how it can be used to compare survival by geographic area and by race. METHODS We used data from 36 US cancer registries to estimate relative survival ratios for people diagnosed with cancer from 2006 through 2012 to create the CSI: the weighted sum of age-standardized, site-specific, relative survival ratios, with weights derived from the distribution of incident cases by sex and primary site from 2006 through 2008. The CSI was calculated for 32 registries for all races, 31 registries for whites, and 12 registries for blacks. RESULTS The survival estimates standardized by age only versus age-, sex-, and site-standardized (CSI) were 64.1% (95% confidence interval [CI], 64.1%-64.2%) and 63.9% (95% CI, 63.8%-63.9%), respectively, for the United States for all races combined. The inter-registry ranges in unstandardized and CSI estimates decreased from 12.3% to 5.0% for whites, and from 5.4% to 3.9% for blacks. We found less inter-registry variation in CSI estimates than in unstandardized all-sites survival estimates, but disparities by race persisted. CONCLUSIONS CSIs calculated for different jurisdictions or periods are directly comparable, because they are standardized by age, sex, and primary site. A national CSI could be used to measure temporal progress in meeting public health objectives, such as Healthy People 2030.

Construction of a North American Cancer Survival Index to Measure Progress of Cancer Control Efforts.

Cancer may soon become the leading cause of death in the United States. The Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control is a national leader in cancer surveillance and cancer control, and is well positioned to monitor the growing cancer burden and to respond from both a population and public health perspective. The National Program of Cancer Registries helps support a nationwide network of cancer registries and the National Comprehensive Cancer Control Program helps to support state-based programs that focus on prevention, detection, treatment, survivorship, and health disparities. CONCORD is a program for the global surveillance of cancer survival. In 2015, the second cycle of the program (CONCORD-2) established the long-term surveillance of cancer survival worldwide. In this supplement to Cancer, net survival by race, stage at diagnosis, and state of residence at the time of diagnosis are presented for 10 commonly diagnosed cancers. This is the largest analysis of population-based survival in the United States to date, covering approximately 80% of the US population. The quality of the CONCORD-2 data, the rigorous statistical methods used, and the large population coverage ensure that the results presented in this supplement provide a broad and comprehensive overview of trends in geographic and racial disparities in survival among patients diagnosed with cancer from 2001 through 2009. These articles also demonstrate the ability of cancer registry data to tell a compelling story regarding the disproportionate burden of lower cancer survival experienced by vulnerable populations. Data are graphically represented to illustrate the large and consistent inequities in cancer survival observed between black and white Americans for many cancers. These inequities represent a large and growing number of potentially avoidable premature deaths. The information contained in this supplement provides a unique perspective concerning cancer survival at the state, regional, and national levels, which can be used by cancer control planners and policy makers to help target and evaluate state-based cancer control strategies. These data also benchmark the status of cancer survival in the United States at the beginning of the new millennium, just prior to the passage of the Patient Protection and Affordable Care Act in 2010. As shown in the CONCORD-2 study, overall survival in the United States is among the highest in the world. However, large racial disparities persist and health equity has eluded us. Further improvements in survival may be observed in the era of personalized cancer care and targeted therapies, and as federal and state initiatives seek to improve patient access to timely, effective care. If the goal of these strategies and initiatives is to ensure that all patients with cancer, regardless of race, ethnicity, and socioeconomic position, benefit equally from gains made in improving access to high-quality screening, diagnostic, and treatment services for everyone, the data contained herein can help to measure progress in their achievement.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.30898

The essential role of population-based cancer survival in cancer control in the United States.

Testicular cancer is a disease which occurs largely among young adult, white males. The incidence rate in Ontario in 1988 was 4 per 100,000 men per year. Among men aged 15–29 the rate was 7 and among men aged 30–44 the rate was 8 per 100,000. Testicular cancer has attracted recent attention because the incidence has been increasing in high incidence populations in Europe, North America, and Australia, yet the etiology remains largely unknown. Nearly all of these cancers arise in the germ cells. Germ cell tumours of the testis can be subdivided into distinct histologic subgroups. About half of the tumours are seminomas while the other half are often grouped together as nonseminomas and includes teratomas and choriocarcinomas (a small proportion of tumours have mixed seminoma and nonseminoma histology). These two groups have distinct age distributions with nonseminomas occurring more commonly at younger ages than seminomas which peak during the 30’s. This suggests that they may have different etiologies or, if they have the same etiology, that the type of tumour depends on the age at which it develops.

Occupations of Fathers before Conception and the Risk of Testicular Cancer in their Sons

Incidence of Selected Cancers in Non-Hispanic American Indian and Alaska Native Adolescent and Young Adult Populations, 1999-2019.

Objectives. We describe rates and trends in kidney cancer incidence and mortality and identify disparities between American Indian/Alaska Native (AI/AN) and White populations. Methods. To improve identification of AI/AN race, incidence and mortality data were linked with Indian Health Service (IHS) patient records. Analysis focused on residents of IHS Contract Health Service Delivery Area counties; Hispanics were excluded. We calculated age-adjusted kidney cancer incidence (2001‐2009) and death rates (1990‐2009) by sex, age, and IHS region. Results. AI/AN persons have a 1.6 times higher kidney cancer incidence and a 1.9 times higher kidney cancer death rate than Whites. Despite a significant decline in kidney cancer death rates for Whites (annual percentage change [APC] = ‐0.3; 95% confidence interval [CI] = ‐0.5, 0.0), death rates for AI/AN persons remained stable (APC= 0.4; 95% CI = ‐0.7, 1.5). Kidney cancer incidence rates rose more rapidly for AI/AN persons (APC = 3.5; 95% CI = 1.2, 5.8) than for Whites (APC = 2.1; 95% CI= 1.4, 2.8).

https://www.nec.navajo-nsn.gov/Portals/0/NN%20Research/AJPH/Research%20and%20Practice/KidneyCancerIncidenceAndMortality.pdf

Hannah K. Weir

Papers

Construction of a North American Cancer Survival Index to Measure Progress of Cancer Control Efforts.

The essential role of population-based cancer survival in cancer control in the United States.

Occupations of Fathers before Conception and the Risk of Testicular Cancer in their Sons

Incidence of Selected Cancers in Non-Hispanic American Indian and Alaska Native Adolescent and Young Adult Populations, 1999-2019.

KidneyCancerIncidenceandMortalityAmongAmerican IndiansandAlaskaNativesintheUnitedStates, 1990-2009