Freddie Bray

Abstract 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 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) 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

Abstract 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.

Statistics are given for global patterns of cancer incidence and mortality for males and females in 23 regions of the world.

Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large "areas" of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths).

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.

Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large “areas” of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.

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.

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.

Estimates of the worldwide incidence and mortality from 36 cancers and for all cancers combined for the year 2018 are now available in the GLOBOCAN 2018 database, compiled and disseminated by the International Agency for Research on Cancer (IARC). This paper reviews the sources and methods used in compiling the cancer statistics in 185 countries. The validity of the national estimates depends upon the representativeness of the source information, and to take into account possible sources of bias, uncertainty intervals are now provided for the estimated sex- and site-specific all-ages number of new cancer cases and cancer deaths. We briefly describe the key results globally and by world region. There were an estimated 18.1 million (95% UI: 17.5-18.7 million) new cases of cancer (17 million excluding non-melanoma skin cancer) and 9.6 million (95% UI: 9.3-9.8 million) deaths from cancer (9.5 million excluding non-melanoma skin cancer) worldwide in 2018.

IntroductionCancer incidence and mortality estimates for 25 cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for the European Union (EU-27) for 2012.MethodsWe used statistical models to estimate national incidence and mortality rates in 2012 from recently-published data, predicting incidence and mortality rates for the year 2012 from recent trends, wherever possible. The estimated rates in 2012 were applied to the corresponding population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2012.ResultsThere were an estimated 3.45 million new cases of cancer (excluding non-melanoma skin cancer) and 1.75 million deaths from cancer in Europe in 2012. The most common cancer sites were cancers of the female breast (464,000 cases), followed by colorectal (447,000), prostate (417,000) and lung (410,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (353,000 deaths), colorectal (215,000), breast (131,000) and stomach (107,000). In the European Union, the estimated numbers of new cases of cancer were approximately 1.4 million in males and 1.2 million in females, and around 707,000 men and 555,000 women died from cancer in the same year.ConclusionThese up-to-date estimates of the cancer burden in Europe alongside the description of the varying distribution of common cancers at both the regional and country level provide a basis for establishing priorities to cancer control actions in Europe. The important role of cancer registries in disease surveillance and in planning and evaluating national cancer plans is becoming increasingly recognised, but needs to be further advocated. The estimates and software tools for further analysis (EUCAN 2012) are available online as part of the European Cancer Observatory (ECO) (http://eco.iarc.fr).

<h3>Objective</h3> The global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. In this study, we aim to describe the recent CRC incidence and mortality patterns and trends linking the findings to the prospects of reducing the burden through cancer prevention and care. <h3>Design</h3> Estimates of sex-specific CRC incidence and mortality rates in 2012 were extracted from the GLOBOCAN database. Temporal patterns were assessed for 37 countries using data from <i>Cancer Incidence in Five Continents</i> (CI5) volumes I–X and the WHO mortality database. Trends were assessed via the annual percentage change using joinpoint regression and discussed in relation to human development levels. <h3>Results</h3> CRC incidence and mortality rates vary up to 10-fold worldwide, with distinct gradients across human development levels, pointing towards widening disparities and an increasing burden in countries in transition. Generally, CRC incidence and mortality rates are still rising rapidly in many low-income and middle-income countries; stabilising or decreasing trends tend to be seen in highly developed countries where rates remain among the highest in the world. <h3>Conclusions</h3> Patterns and trends in CRC incidence and mortality correlate with present human development levels and their incremental changes might reflect the adoption of more western lifestyles. Targeted resource-dependent interventions, including primary prevention in low-income, supplemented with early detection in high-income settings, are needed to reduce the number of patients with CRC in future decades.

Describing the distribution of disease between different populations and over time has been a highly successful way of devising hypotheses about causation and for quantifying the potential for preventive activities.1 Statistical data are also essential components of disease surveillance programs. These play a critical role in the development and implementation of health policy, through identification of health problems, decisions on priorities for preventive and curative programs and evaluation of outcomes of programs of prevention, early detection/screening and treatment in relation to resource inputs. Over the last 12 years, a series of estimates of the global burden of cancer have been published in the International Journal of Cancer.2-6 The methods have evolved and been refined, but basically they rely upon the best available data on cancer incidence and/or mortality at country level to build up the global picture. The results are more or less accurate for different countries, depending on the extent and accuracy of locally available data. This “data-based” approach is rather different from the modeling method used in other estimates.7-10 Essentially, these use sets of regression models, which predict cause-specific mortality rates of different populations from the corresponding all-cause mortality.11 The constants of the regression equations derive from datasets with different overall mortality rates (often including historic data from western countries). Cancer deaths are then subdivided into the different cancer types, according to the best available information on relative frequencies. GLOBOCAN 2000 updates the previously published data-based global estimates of incidence, mortality and prevalence to the year 2000.12 The data sources that have been used to build up the global estimates are as follows. Incidence, the number of new cases occurring, can be expressed as the annual number of cases (the volume of new patients presenting for treatment) or as a rate per 100,000 persons per year. Incidence data are produced by population-based cancer registries.13 Registries may cover national populations or, more often, certain regions. In developing countries in particular, coverage is often confined to the capital city and its environs. It was estimated that, in 1990, about 18% of the world population were covered by registries, 64% of developed countries and 5% of developing countries, although the situation is improving each year. The most recent volume of “Cancer Incidence in Five Continents” (CI5) contains comparable incidence information from 150 registries in 50 countries, primarily over the period 1988–1992.14 Survival statistics are also produced by cancer registries by the follow-up of registered cancer cases. Population-based figures are published by registries in many developed countries, for example, the SEER program covering 10% of the U.S. population15 and the EUROCARE II project, including 17 countries of Europe.16 Survival data from populations of China, the Philippines, Thailand, India and Cuba have been published by Sankaranarayanan et al.17 Mortality is the number of deaths occurring and the mortality rate the number of deaths per 100,000 persons per year. It is the product of incidence and fatality (the inverse of survival) of a given cancer. Mortality rates measure the average risk to the population of dying from a specific cancer, while fatality (1-survival) represents the probability that an individual with cancer will die from it. Mortality data are derived from vital registration systems, where the fact and “underlying” cause of death are certified, usually by a medical practitioner. Their great advantage is comprehensive coverage and availability. By 1990, about 42% of the world population was covered by vital registration systems producing mortality statistics on cancer. Not all are, however, of the same quality in all countries. National-level statistics are collated and made available by the World Health Organiztion (http://www-dep.iarc.fr/dataava/globocan/who.htm), although for some countries coverage of the population is manifestly incomplete (so that the so-called mortality rates produced are implausibly low) and in others, quality of cause of death information is poor. Frequency data, e.g., case series from hospitals and pathology laboratories, provide an indication of the relative importance of different cancers in a country or region in the absence of a population-based registry and mortality statistics. There are problems in extrapolating the results to the general population, since such series are subject to various forms of selection bias. Such data are generally published locally or in journal articles, although a few compendia are available.18, 19 Prevalence is the proportion of a population that has the disease at a given point in time.20 For many diseases (e.g., hypertension, diabetes), prevalence usefully describes the number of individuals requiring care. For cancer, however, many persons diagnosed in the past have been “cured”—they no longer have an excess risk of death (although some residual disability may be present, for example, following a resective operation). A straightforward comparison of need for cancer services can be made using partial prevalence, cases diagnosed within 1, 3 and 5 years, to indicate the numbers of persons undergoing initial treatment (cases within 1 year of diagnosis), clinical follow-up (within 3 years) or not considered “cured” (before 5 years). Patients alive 5 years after diagnosis are usually considered cured since, for most cancers, the death rates of such patients are similar to those in the general population. The methods used to produce the estimates are summarised in several recent articles.5, 6, 21, 22 The “Help” option of GLOBOCAN 2000 lists the sources of data and methods used for each country. National incidence data from good-quality cancer registries. National mortality data, with estimation of incidence using sets of regression models specific for site, sex and age, derived from local cancer registry data (incidence plus mortality). Local (regional) incidence data from 1 or more regional cancer registries within a country. When there are several cancer registries in the country, their incidence rates must be combined into a common set of values by some weighted average. Local mortality data from some sort of sample survey of deaths, converted to incidence using specific models. Frequency data. For several developing countries, only data on the relative frequency of different cancers (by age and sex) are available. These are applied to an estimated “all sites” incidence rate, derived from existing cancer registry results, in 7 world regions (Eastern Africa, Middle Africa, Northern Africa, Southern Africa, Western Africa, Middle East and Other Oceania). No data. The country-specific rates are those of the corresponding world area (calculated from the other countries for which estimates could be made). There are few large countries that fall into this category. Those with a population greater than 10 million were Morocco, Afghanistan, Nepal, Sri Lanka, Mozambique, Madagascar and Yemen. National mortality rates, with for some countries a correction factor applied to account for known and quantified underreporting of deaths. Rates for missing sites were computed using proportions from mortality files provided by cancer registries. When no national mortality data are available, local (regional) mortality rates derived from the data of 1 or more cancer registries covering a part of a country (state, province, etc.) were used. When mortality data were unavailable or known to be of poor quality, mortality was estimated from incidence, using country/region-specific survival (see prevalence data). In the absence of any data, country-specific rates are calculated from the average of those of neighbouring countries in the same regions. Estimates of partial prevalence in each country were derived by combining the annual number of new cases and the corresponding probability of survival by time. For example, 1-year prevalence at a fixed point in mid-2000 was estimated from the number of new cases in 2000 multiplied by the probability of surviving at least 6 months, and 3-year prevalence sums the numbers alive at 0.5, 1.5 and 2.5 years. Relative survival data were obtained from the sources cited above and converted to observed survival using “normal” mortality probability (derived from the corresponding life tables). The shape of the survival curve from 0 to 5 years postdiagnosis was assumed to follow a Weibull distribution.22 GLOBOCAN 2000 presents incidence, mortality and prevalence data for 5 broad age groups (0–14, 15–44, 45–54, 55–64 and 65 and over) and sex for all countries of the world for 24 different types of cancer. Since cancer data are collected and compiled sometime after the events to which they relate, the most recent statistics available are from periods from 3–10 years earlier. The actual number of cancer cases, deaths and prevalent cases are calculated by applying these rates to the estimated world population for 2000, obtained from the most recent projections prepared by the United Nations Population Division.23 On the CD-ROM are computer programs to analyse and present the cancer database. The database itself may be downloaded from the Internet (http://www-dep.iarc.fr/globocan/globocan.htm). This site contains the most recently available estimates of the incidence and mortality rates in different countries worldwide. GLOBOCAN 2000 can present the statistics described at any level of geographical aggregation and in tabular or graphical format (maps, bar charts, age-specific curves and pie charts). Some examples of these graphical presentations are shown on the cover of this issue. Tabulations of numbers and rates may also be displayed and printed. Incorporation of population projections for 5-year intervals, from 2005 to 2050,23 allows GLOBOCAN 2000 to be used to prepare projections of future burden, assuming current rates of incidence and mortality, or incorporating age/sex-specific rates of change in the rates. Table I shows the most basic summary data of all—the global numbers of cases, deaths and prevalent cancers (within 5 years of diagnosis) by cancer site in males, females and both sexes. There are an estimated 10.1 million new cases, 6.2 million deaths and 22.4 million persons living with cancer in the year 2000. No attempt has been made to estimate incidence or mortality of nonmelanoma skin cancer because of the difficulties of measurement and consequent lack of data. The total “All Cancer” therefore excludes such tumours. The 2000 estimate represents an increase of around 22% in incidence and mortality since our most recent comprehensive estimates (for 1990). Lung cancer is the main cancer in the world today, whether considered in terms of numbers of cases (1.2 million) or deaths (1.1 million), because of the high case fatality (ratio of mortality:incidence = 0.9). However, breast cancer, although it is the second most common cancer overall (1.05 million new cases) ranks much less highly (5th) as a cause of death because of the relatively favourable prognosis (ratio of mortality:incidence = 0.4). Colon plus rectum is third in importance in terms of new cases (945,000 cases, 492,000 deaths), and stomach cancer (876,000 cases, 647,000 deaths) fourth. In terms of prevalence, the most common cancers are breast (3.9 million breast cancer cases), colorectal cancers (2.4 million) and prostate (1.6 million). The ratio between prevalence and incidence is an indicator of prognosis. This explains why breast cancer appears as the most prevalent cancer in the world, despite there being fewer new cases than for lung cancer, for which the outlook is considerably poorer. Table II shows incidence rates for all cancers (excluding skin) by world area and sex. Two indices are used, the age standardized rate per 100,000 (standardized to the world standard population) and the cumulative rate (percent), from birth to age 65. Both of these indicators allow comparisons between populations that are not influenced by differences in their age structures. Age standardized rates in developed countries are about twice those in developing countries; the differential is less for the cumulative rate, which ignores disease rates in the 65 and over age groups. On average, worldwide, there is about a 10% chance of getting a cancer before age 65. Incidence (and mortality) rates are highest in North America, Australia/New Zealand and Western Europe, and lowest in parts of Africa. This overall risk is, of course, dependent upon the contributions of different types of cancer. For example, in West Africa, incidence of almost all cancers is low (except for cervix cancer in women and liver cancer in men). This contrasts with Southern Africa, which has, in addition, high rates of lung and oesophagus cancer, and with East Africa, with high rates of AIDS-related tumours, notably Kaposi's sarcoma. The statistics used to assess the importance (burden) of cancer and of different types of cancer in the population either quantify the disease itself (the “need” for services) or the demand that it places upon them.24 Incidence rates provide a measure of the risk of developing specific cancers in different populations. Changes in incidence are the appropriate indicator of the impact of primary prevention strategies. Mortality rates are sometimes used as a convenient proxy measure of the risk of acquiring the disease (incidence) when comparing different groups, since they may be more generally available. However, this use assumes equal survival in the populations being compared, and this assumption may well be incorrect, for example, there are well-documented differences between countries. Mortality does provide an unambiguous measure of the outcome or impact of cancer and, used in conjunction with data on incidence, is the index of choice for the evaluation of the effects of early diagnosis or treatment. Prevalence, as the number of persons ever diagnosed with cancer (lifetime prevalence), does not have much apparent utility. The data can be derived from cancer registries that have very long-term registration of cases and complete follow-up for vital status over many years.25, 26 Population surveys are another approach, although they underestimate true prevalence.27 In the absence of complete data, an estimate can be prepared using models that incorporate longtime series of incidence and survival.28, 29 Other workers have attempted to define the proportion and timing of “cure” for different cancers, so that only patients not cured are considered prevalent.30 The data needed for such calculations are rarely available, however, and, for international comparisons, a simpler approach is needed. Partial prevalence, as estimated in GLOBOCAN, as well as approximating the numbers of patients under treatment or follow-up, does not require long time series of incidence or survival data (or a further set of assumptions required to estimate them). Compound indicators, which use information on the duration or severity of disease, have a genuine utility in setting priorities within health-care systems. They include person-years of life lost (how many years of normal life span are lost due to deaths from cancer)31 and disability or quality-adjusted life-years lost.32, 33 The latter measures require that a numerical score is given to the years lived with a reduced quality of life between diagnosis and death (where quality = 0) or cure (quality = 1). The problem with such indicators, however, is that there is simply insufficient quantitative information on quality or disability following a cancer diagnosis in different cultures (or countries) worldwide to permit calculation of valid comparative statistics. The GLOBOCAN estimates of incidence, mortality and (5-year) prevalence help to define priorities for cancer control program (prevention and treatment, aided by early detection, if appropriate). For countries with well-established sources of data, changes in the estimates over time indicate progress against cancer. Incidence trends can monitor the success of prevention and the success of treatment (resulting from earlier diagnosis or more effective therapies). In addition, the geographic patterns of cancer internationally serve one of the classic roles of descriptive epidemiology: observing whether the distribution of specific cancers follows the patterns expected from the distribution of known risk factors between populations or whether there are apparent anomalies that merit further investigation. GLOBOCAN 2000 incorporates the best currently available national statistics, but as information systems extend to all countries of the world and improve their coverage and accuracy, we expect that our knowledge of the world cancer burden will improve and so too will our ability to mount effective strategies against it.

International Journal of CancerVolume 149, Issue 4 p. 778-789 Cancer EpidemiologyFree Access Cancer statistics for the year 2020: An overview Jacques Ferlay, Corresponding Author Jacques Ferlay [email protected] orcid.org/0000-0003-4927-6932 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, France Correspondence Jacques Ferlay, Cancer Surveillance Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France. Email: [email protected]Search for more papers by this authorMurielle Colombet, Murielle Colombet Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorIsabelle Soerjomataram, Isabelle Soerjomataram Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorDonald M. Parkin, Donald M. Parkin orcid.org/0000-0002-3229-1784 School of Cancer & Pharmaceutical Sciences, King's College London, London, UK CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UKSearch for more papers by this authorMarion Piñeros, Marion Piñeros Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorAriana Znaor, Ariana Znaor orcid.org/0000-0002-5849-4782 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorFreddie Bray, Freddie Bray orcid.org/0000-0002-3248-7787 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this author Jacques Ferlay, Corresponding Author Jacques Ferlay [email protected] orcid.org/0000-0003-4927-6932 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, France Correspondence Jacques Ferlay, Cancer Surveillance Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France. Email: [email protected]Search for more papers by this authorMurielle Colombet, Murielle Colombet Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorIsabelle Soerjomataram, Isabelle Soerjomataram Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorDonald M. Parkin, Donald M. Parkin orcid.org/0000-0002-3229-1784 School of Cancer & Pharmaceutical Sciences, King's College London, London, UK CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UKSearch for more papers by this authorMarion Piñeros, Marion Piñeros Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorAriana Znaor, Ariana Znaor orcid.org/0000-0002-5849-4782 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this authorFreddie Bray, Freddie Bray orcid.org/0000-0002-3248-7787 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, FranceSearch for more papers by this author First published: 05 April 2021 https://doi.org/10.1002/ijc.33588Citations: 92 As part of the latest International Agency for Research on Cancer (IARC) GLOBOCAN cancer statistics update, here the authors provide a comprehensive description of the data sources and methods used to compute the global incidence and mortality estimates for 38 cancers corresponding to the year 2020. The reported uncertainty intervals incorporate the major sources of error that may contribute to the uncertainty of these estimations. In addition to providing a global snapshot of the cancer burden in 2020, the estimates presented here can support the planning and prioritization of cancer control efforts at the global and national levels. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Our study briefly reviews the data sources and methods used in compiling the International Agency for Research on Cancer (IARC) GLOBOCAN cancer statistics for the year 2020 and summarises the main results. National estimates were calculated based on the best available data on cancer incidence from population-based cancer registries (PBCR) and mortality from the World Health Organization mortality database. Cancer incidence and mortality rates for 2020 by sex and age groups were estimated for 38 cancer sites and 185 countries or territories worldwide. There were an estimated 19.3 million (95% uncertainty interval [UI]: 19.0-19.6 million) new cases of cancer (18.1 million excluding non-melanoma skin cancer) and almost 10.0 million (95% UI: 9.7-10.2 million) deaths from cancer (9.9 million excluding non-melanoma skin cancer) worldwide in 2020. The most commonly diagnosed cancers worldwide were female breast cancer (2.26 million cases), lung (2.21) and prostate cancers (1.41); the most common causes of cancer death were lung (1.79 million deaths), liver (830000) and stomach cancers (769000). Abstract What's new? As part of the latest International Agency for Research on Cancer (IARC) GLOBOCAN cancer statistics update, here the authors provide a comprehensive description of the data sources and methods used to compute the global incidence and mortality estimates for 38 cancers corresponding to the year 2020. The reported uncertainty intervals incorporate the major sources of error that may contribute to the uncertainty of these estimations. In addition to providing a global snapshot of the cancer burden in 2020, the estimates presented here can support the planning and prioritization of cancer control efforts at the global and national levels. Abbreviations ASR age-standardised rate CI5 Cancer Incidence in Five Continents CSU Cancer Surveillance Branch GCO Global Cancer Observatory GICR Global Initiative for Cancer Registry Development HDI Human Development Index IARC International Agency for Research on Cancer LMIC low- and middle-income countries NMSC non-melanoma skin cancer PBCR population-based cancer registry UI uncertainty interval UN United Nations WHO World Health Organization 1 INTRODUCTION One of the remits of the Cancer Surveillance Branch (CSU) at the International Agency for Research on Cancer (IARC) is the regular provision of global estimates of the cancer burden. GLOBOCAN 2020 updates the previously published estimates of cancer incidence and mortality for the year 2018.1 As previously, the basic units for estimation are countries, together with aggregated results globally and in 20 world regions, as defined by the United Nations (UN).2 The estimates were developed for 38 cancer sites including other, and unspecified cancers, by sex and for 18 age groups. The methods of estimation together with the computation of uncertainty intervals continue to rely upon the best available data on cancer incidence and mortality nationally. Interactive facilities for the tabulation and graphical visualisation of the GLOBOCAN data set of 185 countries and world regions by sex can be accessed via the Global Cancer Observatory (GCO) (https://gco.iarc.fr). A detailed description of the geographic variability observed across 20 world regions is provided elsewhere.3 Our study aims to summarise the data sources and methods used in compiling the cancer incidence and mortality estimates for 2020 worldwide and presents a summary of the major findings. 2 METHODS Data The basic sources of the estimates are the high-quality cancer registry incidence data, as compiled in the Cancer Incidence in Five Continents (CI5) series,4 as well as new data sources most notably in sub-Saharan Africa via the expansion of the African Cancer Registry Network,5 through targeted searches for new registry data online, and the most recent mortality data from the World Health Organization (WHO).6 As a result, the current estimates for 2020 are more accurate for several countries and some world areas than previously and therefore not fully comparable with previous sets of estimation. The geographical definition of the regions follows the UN country classification, except for Cyprus, which is included in Southern Europe rather than Western Asia. The source(s) of information used to develop corresponding estimates of the national burden of cancer in each country is provided in Annex A. National population estimates for 2020 were extracted from the UN website.2 Methods of estimation Cancer incidence and mortality rates for 2020 by sex and for 18 age groups (0-4, 5-9, 10-14, 15-19, …, 75-79, 80-84, 85 and over) were estimated for the 185 countries or territories of the world with populations of more than 150 000 inhabitants in the same year.2 Results are presented for 38 cancer sites or cancer types as defined by the 10th edition of the International Classification of Diseases (ICD-10, version 2014)7 and for all cancers combined. These are listed in Annex B. The estimates for non-melanoma skin cancers (NMSC) exclude basal-cell carcinoma in incidence, while mortality includes deaths from all types of NMSC. The major difference with previous editions of GLOBOCAN estimates with respect to the rubrics is that gallbladder cancer (ICD-10 C23) now excludes neoplasms of extra hepatic ducts (ICD-10 C24). The methods of incidence and mortality estimation and the computation of uncertainty intervals are similar to those used in the previous estimates.1 These are reproduced in Annex A and summarised later. 2.2.1 Estimates of cancer incidence by country The methods used to estimate the sex- and age-specific incidence rates of cancer in a specific country in 2020 fall into the following broad categories, in order of priority: Observed national incidence rates were projected to 2020 (45 countries). The most recently observed incidence rates (national (2a) or subnational (2b)) were used as proxy for 2020 (54 countries). Rates were estimated from national mortality data by modelling, using mortality-to-incidence ratios derived from: Cancer registries in that country (14 countries). Cancer registries in neighbouring countries (37 countries). These comprised one model for Africa; one for Caribbean; two for Asia; two for Europe and one for Oceania (see Annex C). Age- and sex-specific national incidence rates for all cancers combined were obtained by averaging overall rates from neighbouring countries. These rates were then partitioned to obtain the national incidence for specific sites using available cancer-specific relative frequency data in the country (five countries). Rates were estimated as an average of those from selected neighbouring countries (30 countries). 2.2.2 Estimates of cancer mortality by country Depending on the coverage, completeness and degree of detail of the mortality data available, four methods were utilised to estimate the sex- and age-specific mortality rates of cancer in a country: Observed national mortality rates were projected to 2020 (80 countries). The most recently observed mortality rates (national [2a] or subnational [2b]) were used as proxy for 2020 (21 countries). Rates were estimated from the corresponding national incidence estimates by modelling, using incidence-to-mortality ratios derived from cancer registries in neighbouring countries (81 countries). These comprised two models for Africa; three for Asia and one for Oceania (see Annex C). Rates were estimated as an average of those from selected neighbouring countries (three countries). Random fluctuations in the predicted age-specific incidence and mortality rates were smoothed using a lowess function, a locally weighted regression, by country, sex and cancer site. Estimates for the 20 world regions were obtained by the population-weighted average of the incidence and mortality rates of the component countries. These rates were applied to the corresponding population estimate for the region for 2020 to obtain the estimated numbers of new cancer cases and deaths in 2020. The rates were age-standardised rates (ASRs per 100 000 person-years) using the direct method and the World standard population as proposed by Segi8 and modified by Doll.9 The cumulative risk of developing or dying from cancer before the age of 75 in the absence of competing causes of death was also calculated using the age-specific rates and expressed as a percentage.4 2.2.3 Uncertainty intervals Uncertainty intervals (95% UI) of the estimated sex- and site-specific number of new cancer cases and cancer deaths for all ages were computed using the SE of the crude incidence or mortality rate used in the estimation. The SE is corrected for three major causes of uncertainty in the final estimate: Coverage: the catchment population used in the computations only covers part of the national population (not the entire country/subnational). The lag time: the most recent data are available prior to the year 2020. The quality of the data: the extent to which the data are considered complete and accurate. Penalties were used to correct the SE for each factor above in the UI calculation. The formulae used to compute the corrected SE are provided in Annex D. The values of the penalties are given by country in Annex E. 3 RESULTS Tables 1 and 2 show the estimated number of cases and deaths for all cancers combined and for 38 specific cancers in males, females and both sexes, with the corresponding 95% uncertainty intervals, ASRs and the cumulative risk. We estimated that there were 19.3 million (95% UI: 19.0-19.6 million) new cancer cases (18.1 million excluding NMSC) and 10.0 million (95% UI: 9.7-10.2 million) cancer deaths (9.9 million excluding NMSC) in 2020 worldwide. There is about a 20% risk of getting a cancer in a lifetime (before the age of 75), and a 10% risk of dying from the cancer; one in five persons will get cancer in their lifetimes and one in 10 will die from the disease. With 2.26 million (95% UI: 2.24-2.28) new cases estimated in 2020, female breast cancer has now become the most commonly diagnosed cancer worldwide, followed closely by lung cancer (2.21 million, 95% UI: 2.18-2.24). The most common cause of cancer death remains by far lung cancer (1.80 million deaths, 95% UI: 1.77-1.82), followed by liver (0.83 million, 95% UI 0.81-0.85) and stomach cancer (0.77 million, 95% UI: 0.75-0.79). TABLE 1. Estimated new cancer cases and uncertainty intervals (95% UI, all ages, in thousands), age-standardised rates (ASRs, per 100 000) and cumulative risk to age 75 (percent) by sex and cancer type worldwide, 2020 Both sexes Males Females Cancer Numbers 95% UI ASR (World) Cum. risk (0-74) Numbers 95% UI ASR (World) Cum. risk (0-74) Numbers 95% UI ASR (World) Cum. risk (0–74) Lip, oral cavity 377.7 (362.4-393.7) 4.1 0.46 264.2 (251.2-277.9) 6.0 0.68 113.5 (105.6-122.0) 2.3 0.26 Salivary glands 53.6 (48.2-59.5) 0.6 0.06 29.7 (25.9-34.1) 0.7 0.07 23.9 (20.3-28.1) 0.5 0.05 Oropharynx 98.4 (91.3-106.1) 1.1 0.13 79.0 (72.8-85.9) 1.8 0.22 19.4 (16.3-23.0) 0.4 0.05 Nasopharynx 133.4 (124.7-142.6) 1.5 0.16 96.4 (89.1-104.3) 2.2 0.24 37.0 (32.6-42.0) 0.8 0.09 Hypopharynx 84.3 (76.7-92.6) 0.9 0.11 70.3 (63.5-77.8) 1.6 0.19 14.0 (10.8-18.1) 0.3 0.03 Oesophagus 604.1 (587.1-621.6) 6.3 0.78 418.4 (404.5-432.6) 9.3 1.15 185.8 (176.0-196.0) 3.6 0.44 Stomach 1089.1 (1066.6-1112.1) 11.1 1.31 719.5 (701.4-738.2) 15.8 1.87 369.6 (356.4-383.2) 7.0 0.79 Colon 1148.5 (1138.3-1158.8) 11.4 1.30 600.9 (593.6-608.3) 13.1 1.49 547.6 (540.5-554.8) 10.0 1.12 Rectum 732.2 (724.7-739.8) 7.6 0.91 443.4 (437.7-449.1) 9.8 1.18 288.9 (284.0-293.8) 5.6 0.65 Anus 50.9 (46.0-56.3) 0.5 0.06 21.7 (18.4-25.6) 0.5 0.06 29.2 (25.7-33.1) 0.6 0.07 Liver 905.7 (884.7-927.2) 9.5 1.11 632.3 (615.0-650.1) 14.1 1.65 273.4 (261.7-285.6) 5.2 0.60 Gallbladder 115.9 (108.3-124.1) 1.2 0.13 41.1 (36.6-46.0) 0.9 0.10 74.9 (68.8-81.6) 1.4 0.16 Pancreas 495.8 (489.0-502.7) 4.9 0.55 262.9 (258.0-267.8) 5.7 0.66 232.9 (228.1-237.8) 4.1 0.45 Larynx 184.6 (174.3-195.6) 2.0 0.25 160.3 (150.6-170.5) 3.6 0.45 24.4 (20.8-28.4) 0.5 0.06 Lung 2206.8 (2176.5-2237.4) 22.4 2.74 1435.9 (1410.9-1461.5) 31.5 3.78 770.8 (753.9-788.1) 14.6 1.77 Melanoma of skin 324.6 (314.2-335.4) 3.4 0.37 173.8 (166.4-181.6) 3.8 0.42 150.8 (143.5-158.4) 3.0 0.33 Non-melanoma skin 1198.1 (1056.5-1358.6) 11.0 1.06 722.3 (605.2-862.1) 15.1 1.40 475.7 (397.8-568.9) 7.9 0.75 Mesothelioma 30.9 (27.0-35.3) 0.3 0.03 21.6 (18.4-25.2) 0.5 0.05 9.3 (7.2-12.1) 0.2 0.02 Kaposi sarcoma 34.3 (26.0-45.2) 0.4 0.03 23.4 (17.1-32.0) 0.5 0.05 10.9 (6.0-19.6) 0.3 0.02 Breast 2261.4 (2244.3-2278.7) 47.8 5.20 — 2261.4 (2244.3–2278.7) 47.8 5.20 Vulva 45.2 (40.7-50.3) 0.9 0.09 — 45.2 (40.7–50.3) 0.9 0.09 Vagina 17.9 (14.7-21.8) 0.4 0.04 — 17.9 (14.7-21.8) 0.4 0.04 Cervix uteri 604.1 (582.0-627.1) 13.3 1.39 — 604.1 (582.0–627.1) 13.3 1.39 Corpus uteri 417.4 (410.4-424.4) 8.7 1.05 — 417.4 (410.4–424.4) 8.7 1.05 Ovary 314.0 (300.8-327.6) 6.6 0.73 — 314.0 (300.8–327.6) 6.6 0.73 Penis 36.1 (31.0-42.0) 0.8 0.09 36.1 (31.0–42.0) 0.8 0.09 — Prostate 1414.3 (1395.3-1433.5) 30.7 3.86 1414.3 (1395.3–1433.5) 30.7 3.86 — Testis 74.5 (68.2-81.3) 1.8 0.14 74.5 (68.2–81.3) 1.8 0.14 — Kidney 431.3 (418.1-444.8) 4.6 0.52 271.2 (260.8-282.1) 6.1 0.70 160.0 (152.2-168.3) 3.2 0.36 Bladder 573.3 (557.2-589.8) 5.6 0.64 440.9 (426.8-455.4) 9.5 1.05 132.4 (124.9-140.4) 2.4 0.26 Brain, central nervous system 308.1 (295.7-321.0) 3.5 0.35 168.3 (159.2-178.1) 3.9 0.40 139.8 (131.6-148.5) 3.0 0.31 Thyroid 586.2 (579.1-593.4) 6.6 0.68 137.3 (134.0-140.7) 3.1 0.33 448.9 (442.7-455.3) 10.1 1.02 Hodgkin lymphoma 83.1 (78.8-87.6) 1.0 0.09 49.0 (45.8-52.3) 1.2 0.10 34.1 (31.2-37.3) 0.8 0.07 Non-Hodgkin lymphoma 544.4 (536.0-552.8) 5.8 0.62 304.2 (297.9-310.6) 6.9 0.73 240.2 (234.8-245.8) 4.8 0.52 Multiple myeloma 176.4 (167.9-185.3) 1.8 0.21 98.6 (92.3-105.3) 2.2 0.25 77.8 (72.3-83.7) 1.5 0.17 Leukaemia 474.5 (459.8-489.7) 5.4 0.50 269.5 (258.5-281.0) 6.3 0.59 205.0 (195.5-215.0) 4.5 0.41 Other specified cancers 643.3 (625.2-661.8) 7.0 0.72 357.1 (343.6-371.1) 8.2 0.85 286.2 (274.4-298.5) 6.0 0.61 Unspecified cancers 418.7 (403.1-434.9) 4.3 0.47 227.4 (215.9-239.5) 5.1 0.56 191.3 (181.0-202.3) 3.7 0.39 All cancers 19 292.8 (18 993.0-19 597.3) 201.0 20.44 10 065.3 (9832.4-10 303.7) 222.0 22.60 9227.5 (9035.1-9424.0) 186.0 18.55 All cancers excl. non-melanoma skin cancer 18 094.7 (17 812.8-18 381.1) 190.0 19.59 9343.0 (9126.0-9565.0) 206.9 21.50 8751.8 (8568.9-8938.6) 178.1 17.94 TABLE 2. Estimated cancer deaths and uncertainty intervals (95% UI, all ages, in thousands), age-standardised rates (ASRs, per 100 000) and cumulative risk to age 75 (percent) by sex and cancer type worldwide, 2020 Both sexes Males Females Cancer Numbers 95% UI ASR (World) Cum. Risk (0–74) Numbers 95% UI ASR (World) Cum. Risk (0–74) Numbers 95% UI ASR (World) Cum. Risk (0–74) Lip, oral cavity 177.8 (167.8-188.3) 1.9 0.22 125.0 (116.6-134.1) 2.8 0.32 52.7 (47.7-58.3) 1.0 0.12 Salivary glands 22.8 (19.1-27.1) 0.2 0.03 13.4 (10.7-16.7) 0.3 0.03 9.4 (7.1-12.5) 0.2 0.02 Oropharynx 48.1 (43.3-53.5) 0.5 0.06 39.6 (35.3-44.5) 0.9 0.11 8.6 (6.7-10.9) 0.2 0.02 Nasopharynx 80.0 (72.8-87.9) 0.9 0.10 58.1 (52.1-64.8) 1.3 0.16 21.9 (18.3-26.3) 0.5 0.05 Hypopharynx 38.6 (34.2-43.5) 0.4 0.05 32.3 (28.4-36.8) 0.7 0.09 6.3 (4.7-8.5) 0.1 0.01 Oesophagus 544.1 (526.2-562.5) 5.6 0.68 374.3 (359.9-389.3) 8.3 1.01 169.8 (159.3-180.9) 3.2 0.38 Stomach 768.8 (748.6-789.5) 7.7 0.90 502.8 (486.5-519.6) 11.0 1.29 266.0 (254.3-278.3) 4.9 0.55 Colon 576.9 (569.8-584.0) 5.4 0.55 302.1 (297.1-307.2) 6.4 0.66 274.7 (269.8-279.7) 4.6 0.45 Rectum 339.0 (333.0-345.1) 3.3 0.37 204.1 (200.4-207.9) 4.4 0.50 134.9 (127.1-143.2) 2.4 0.26 Anus 19.3 (16.2-23.0) 0.2 0.02 9.4 (7.3-12.2) 0.2 0.02 9.9 (7.8-12.5) 0.2 0.02 Liver 830.2 (807.1-853.9) 8.7 1.01 577.5 (558.3-597.4) 12.9 1.49 252.7 (240.2-265.8) 4.8 0.55 Gallbladder 84.7 (79.0-90.8) 0.8 0.09 30.3 (27.1-33.8) 0.7 0.07 54.4 (49.8-59.5) 1.0 0.11 Pancreas 466.0 (459.5-472.6) 4.5 0.51 246.8 (242.2-251.5) 5.3 0.62 219.2 (214.6-223.8) 3.8 0.41 Larynx 99.8 (92.8-107.4) 1.0 0.13 85.4 (78.9-92.3) 1.9 0.23 14.5 (11.9-17.6) 0.3 0.03 Lung 1796.1 (1767.6-1825.2) 18.0 2.18 1188.7 (1164.9-1212.9) 25.9 3.08 607.5 (591.6-623.7) 11.2 1.34 Melanoma of skin 57.0 (52.2-62.4) 0.6 0.06 32.4 (28.8-36.4) 0.7 0.07 24.7 (21.5-28.3) 0.4 0.05 Non-melanoma skin 63.7 (58.3-69.7) 0.6 0.05 37.6 (33.5-42.2) 0.8 0.07 26.1 (22.7-30.1) 0.4 0.04 Mesothelioma 26.3 (22.8-30.3) 0.3 0.03 18.7 (15.8-22.1) 0.4 0.04 7.6 (5.8-10.0) 0.1 0.02 Kaposi sarcoma 15.1 (10.2-22.3) 0.2 0.01 9.9 (6.2-16.0) 0.2 0.02 5.2 (2.6-10.2) 0.1 0.01 Breast 685.0 (675.5-694.6) 13.6 1.49 — 685.0 (675.5–694.6) 13.6 1.49 Vulva 17.4 (14.5-20.9) 0.3 0.03 — 17.4 (14.5–20.9) 0.3 0.03 Vagina 8.0 (6.0-10.7) 0.2 0.02 — 8.0 (6.0–10.7) 0.2 0.02 Cervix uteri 341.8 (324.2-360.4) 7.3 0.82 — 341.8 (324.2–360.4) 7.3 0.82 Corpus uteri 97.4 (91.0-104.2) 1.8 0.22 — 97.4 (91.0–104.2) 1.8 0.22 Ovary 207.3 (197.0-218.1) 4.2 0.49 — 207.3 (197.0–218.1) 4.2 0.49 Penis 13.2 (10.7-16.3) 0.3 0.03 13.2 (10.7–16.3) 0.3 0.03 — Prostate 375.3 (367.8-382.9) 7.7 0.63 375.3 (367.8–382.9) 7.7 0.63 — Testis 9.3 (7.5-11.7) 0.2 0.02 9.3 (7.5–11.7) 0.2 0.02 — Kidney 179.4 (175.2-183.7) 1.8 0.20 115.6 (112.3-119.0) 2.5 0.28 63.8 (61.2-66.5) 1.2 0.12 Bladder 212.5 (204.9-220.4) 1.9 0.18 158.8 (150.2-167.9) 3.3 0.30 53.8 (51.2-56.4) 0.9 0.08 Brain, central nervous system 251.3 (244.4-258.4) 2.8 0.30 138.3 (129.5-147.7) 3.2 0.34 113.1 (109.7-116.5) 2.4 0.26 Thyroid 43.6 (40.0-47.6) 0.4 0.05 15.9 (13.6-18.6) 0.3 0.04 27.7 (25.0-30.8) 0.5 0.05 Hodgkin lymphoma 23.4 (20.2-27.1) 0.3 0.02 14.3 (11.9-17.2) 0.3 0.03 9.1 (7.1-11.6) 0.2 0.02 Non-Hodgkin lymphoma 259.8 (254.4-265.2) 2.6 0.27 147.2 (143.2-151.4) 3.3 0.33 112.6 (109.1-116.1) 2.1 0.21 Multiple myeloma 117.1 (109.9-124.7) 1.1 0.13 65.2 (59.9-71.0) 1.4 0.15 51.9 (47.2-57.0) 0.9 0.10 Leukaemia 311.6 (304.3-319.1) 3.3 0.32 177.8 (173.3-182.4) 4.0 0.38 133.8 (125.8-142.2) 2.7 0.26 Other specified cancers 367.3 (353.4-381.7) 3.9 0.39 200.2 (189.8-211.1) 4.5 0.46 167.1 (158.0-176.7) 3.3 0.33 Unspecified cancers 383.1 (370.3-396.4) 3.8 0.40 209.3 (199.8-219.3) 4.6 0.49 173.8 (165.3-182.7) 3.2 0.33 All cancers 9958.1 (9721.1-10 200.9) 100.7 10.65 5528.8 (5351.7-5711.8) 120.8 12.59 4429.3 (4273.6-4590.8) 84.2 8.86 All cancers excl. non-melanoma skin cancer 9894.4 (9658.5-10 136.0) 100.1 10.61 5491.2 (5315.0-5673.3) 120.0 12.53 4403.2 (4248.1-4563.9) 83.7 8.83 Table 3 shows the most common types of cancer in terms of new cases and deaths in each of the 20 world regions in 2020. Prostate cancer was the most frequently diagnosed cancer in males in 12 regions of the world, followed by lung cancer (four regions), NMSC (two regions), lip and oral cavity, and liver cancer in one region. Lung cancer was the most frequent cause of death from cancer in 13 regions of the world, followed by prostate and liver cancer in five and two areas, respectively. In females, breast cancer was the most frequently diagnosed cancer in all regions of the world, except in Eastern Africa and in Australia/New Zealand where cervical cancer and NMSC dominated, respectively. Breast cancer was also the most frequent cause of death from cancer in 12 regions of the world, lung cancer in five regions (including Eastern Asia) and cervical cancer in three sub-Saharan Africa regions. These seven cancers represent almost half of the global incidence and mortality burden in 2020. TABLE 3. Leading types of cancer in terms of new cases (incidence) and deaths (mortality) by sex in each of the 20 world regions in 2020 [Color table can be viewed at wileyonlinelibrary.com] Male Female Incidence Mortality Incidence Mortality First Second Third First Second Third First Second Third First Second Third World Lung Prostate Non-melanoma skin Lung Liver Stomach Breast Lung Cervix uteri Breast Lung Cervix uteri Africa Prostate Liver Lung Prostate Liver Lung Breast Cervix uteri Liver Breast Cervix uteri Liver Eastern Africa Prostate Kaposi sarcoma NHL Prostate Oesophagus Liver Cervix uteri Breast Oesophagus Cervix uteri Breast Oesophagus Middle Africa Prostate Liver NHL Prostate Liver NHL Breast Cervix uteri NHL Cervix uteri Breast Liver Northern Africa Liver Lung Prostate Liver Lung Bladder Breast Liver Cervix uteri Breast Liver Ovary Southern Africa Prostate Lung Non-melanoma skin Lung Prostate Oesophagus Breast Cervix uteri Non-melanoma skin Cervix uteri Breast Lung Western Africa Prostate Liver NHL Prostate Liver NHL Breast Cervix uteri Ovary Breast Cervix uteri Liver Americas Prostate Non-melanoma skin Lung Lung Prostate Colon Breast Non-melanoma skin Lung Lung Breast Colon Northern America Non-melanoma skin Prostate Lung Lung Prostate Pancreas Breast Non-melanoma skin Lung Lung Breast Pancreas Caribbean Prostate Lung Colon Prostate Lung Colon Breast Colon Lung Breast Lung Colon Central America Prostate Stomach Colon Prostate Stomach Liver Breast Cervix uteri Thyroid Breast Cervix uteri Liver South America Prostate Lung Colon Lung Prostate Stomach Breast Cervix uteri Thyroid Breast Lung Cervix uteri Asia Lung Stomach Liver Lung Liver Stomach Breast Lung Cervix uteri Lung Breast Cervix uteri Eastern Asia Lung Stomach Liver Lung Liver Stomach Breast Lung Colon Lung Breast Stomach South-Eastern Asia Lung Liver Prostate Lung Liver Stomach Breast Cervix uteri Lung Breast Cervix uteri Lung South-Central Asia Lip and oral cavity Lung Stomach Lung Lip and oral cavity Oesophagus Breast Cervix uteri Ovary Breast Cervix uteri Ovary Western Asia Lung Prostate Bladder Lung Stomach Prostate Breast Thyroid Lung Breast Lung Stomach Europe Prostate Lung Non-melanoma skin Lung Prostate Colon Breast Lung Colon Breast Lung Colon Eastern Europe Lung Prostate Colon Lung Prostate Stomach Breast Corpus uteri Colon Breast Lung Colon Northern Europe Prostate Non-melanoma skin Lung Lung Prostate Colon Breast Lung Colon Lung Breast Colon Southern Europe Prostate Lung Bladder Lung Colon Prostate Breast Colon Lung Breast Lung Colon Western Europe Prostate Non-melanoma skin Lung Lung Prostate Colon Breast Non-melanoma skin Lung Breast Lung Pancreas Oceania Non-melanoma skin Prostate Melanoma of skin Lung Prostate Colon Non-melanoma skin Breast Melanoma of skin Lung Breast Colon Australia/New Zealand Non-melanoma skin Prostate Melanoma of skin Lung Prostate Colon Non-melanoma skin Breast Melanoma of skin Lung Breast Colon Melanesia Prostate Lip and oral cavity Lung Liver Lung Prostate Breast Cervix uteri Thyroid Breast Cervix uteri Liver Micronesia/Polynesia Prostate Lung Liver Lung Prostate Liver Breast Lung Thyroid Lung Breast Ovary Abbreviation: NHL, non-Hodgkin lymphoma. Figure 1A,B summarises the estimated numbers of new cancer cases and cancer deaths worldwide in 2020 by type of cancer and by sex, while Figure 2 shows the distribution of the global cancer cases and deaths (all cancers combined) by world region. Most cases (6.0 million, 31.1% of the total) and deaths (3.6 million, 36.3%) occurred in Eastern Asia with its vast population (1.7 billion, 22% of the global population in 2020). Northern America ranks second in terms of number of new cases (2.6 million, 13.3%) but third (699 000, 7.0%) in terms of cancer deaths after South-Central Asia (1.3 million, 12.6%). Almost a quarter of the new cases (4.4 million) and one fifth of the deaths (1.9 million) occurred in Europe, despite containing only one-tenth of the global population FIGURE 1Open in figure viewerPowerPoint Distribution of the estimated new cases and deaths for the 10 most common cancers in 2020 in males (A) and females (B). For each sex, the area of the pie chart reflects the proportion of the total number of cases or deaths. NHL, non-Hodgkin lymphoma [Color figure can be viewed at wileyonlinelibrary.com] FIGURE 2Open in figure viewerPowerPoint Estimated global numbers of new cases and deaths with proportions by world regions in 2020 in males (A), females (B) and both sexes (C) [Color figure can be viewed at wileyonlinelibrary.com] 4 DISCUSSION The main aim of our study is to document the data sources and methods used to compile the global and region-specific estimates of the cancer burden. Although IARC's estimation methods have been refined in the last decades to account for the increasing availability and quality of data, the underlying methodological principles have remained unchanged: wherever possible, national estimates are based upon local sources of cancer incidence (from population-based cancer registries) and cancer mortality (mainly from vital registration systems). These methods are objective and easy to reproduce and have been adopted by the Joint Research Centre (JRC) of the European Commission10 for their estimates of the cancer burden in Europe in 2020. The uncertainty intervals (95% UI) that accompany the estimates aim to capture, alongside inherent random variation, the uncertainty in the source information, taking into account three

In 1966, following the Ninth International Cancer Congress in Tokyo, the Commission on Epidemiology and Prevention of the International Union against Cancer formed a new Committee on Cancer Incidence.

The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative.For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis.Approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed.Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem.Belgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.

Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. An update of their respective contribution to the global burden of cancer is warranted.We considered infectious agents classified as carcinogenic to humans by the International Agency for Research on Cancer. We calculated their population attributable fraction worldwide and in eight geographical regions, using statistics on estimated cancer incidence in 2008. When associations were very strong, calculations were based on the prevalence of infection in cancer cases rather than in the general population. Estimates of infection prevalence and relative risk were extracted from published data.Of the 12·7 million new cancer cases that occurred in 2008, the population attributable fraction (PAF) for infectious agents was 16·1%, meaning that around 2 million new cancer cases were attributable to infections. This fraction was higher in less developed countries (22·9%) than in more developed countries (7·4%), and varied from 3·3% in Australia and New Zealand to 32·7% in sub-Saharan Africa. Helicobacter pylori, hepatitis B and C viruses, and human papillomaviruses were responsible for 1·9 million cases, mainly gastric, liver, and cervix uteri cancers. In women, cervix uteri cancer accounted for about half of the infection-related burden of cancer; in men, liver and gastric cancers accounted for more than 80%. Around 30% of infection-attributable cases occur in people younger than 50 years.Around 2 million cancer cases each year are caused by infectious agents. Application of existing public health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on the future burden of cancer worldwide.Fondation Innovations en Infectiologie (FINOVI) and the Bill & Melinda Gates Foundation (BMGF).

Although the general idea of ‘burden’ of a disease to a community seems fairly straightforward, there are multiple dimensions in which it may be expressed, either in terms of disease frequency (the ‘need’ for services) or the demand which it places upon them. In this review, we confine ourselves to three elementary measures of cancer frequency: incidence, mortality and prevalence. Corrigendum to “Cancer burden in the year 2000. The global picture” [European Journal of Cancer,37(Suppl. 8) (2001) S4–S66]European Journal of CancerVol. 39Issue 6Preview Full-Text PDF

Bladder cancer has become a common cancer globally, with an estimated 430 000 new cases diagnosed in 2012. We examine the most recent global bladder cancer incidence and mortality patterns and trends, the current understanding of the aetiology of the disease, and specific issues that may influence the registration and reporting of bladder cancer. Global bladder cancer incidence and mortality statistics are based on data from the International Agency for Research on Cancer and the World Health Organisation (Cancer Incidence in Five Continents, GLOBOCAN, and the World Health Organisation Mortality). Bladder cancer ranks as the ninth most frequently-diagnosed cancer worldwide, with the highest incidence rates observed in men in Southern and Western Europe, North America, as well in certain countries in Northern Africa or Western Asia. Incidence rates are consistently lower in women than men, although sex differences varied greatly between countries. Diverging incidence trends were also observed by sex in many countries, with stabilising or declining rates in men but some increasing trends seen for women. Bladder cancer ranks 13th in terms of deaths ranks, with mortality rates decreasing particularly in the most developed countries; the exceptions are countries undergoing rapid economic transition, including in Central and South America, some central, southern, and eastern European countries, and the Baltic countries. The observed patterns and trends of bladder cancer incidence worldwide appear to reflect the prevalence of tobacco smoking, although infection with Schistosoma haematobium and other risk factors are major causes in selected populations. Differences in coding and registration practices need to be considered when comparing bladder cancer statistics geographically or over time. The main risk factor for bladder cancer is tobacco smoking. The observed patterns and trends of bladder cancer incidence worldwide appear to reflect the prevalence of tobacco smoking.

Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018.Estimates of national incidence and mortality rates for 2018 were based on statistical models applied to the most recently published data, with predictions obtained from recent trends, where possible. The estimated rates in 2018 were applied to the 2018 population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2018.There were an estimated 3.91 million new cases of cancer (excluding non-melanoma skin cancer) and 1.93 million deaths from cancer in Europe in 2018. The most common cancer sites were cancers of the female breast (523,000 cases), followed by colorectal (500,000), lung (470,000) and prostate cancer (450,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (388,000 deaths), colorectal (243,000), breast (138,000) and pancreatic cancer (128,000). In the EU-28, the estimated number of new cases of cancer was approximately 1.6 million in males and 1.4 million in females, with 790,000 men and 620,000 women dying from the disease in the same year.The present estimates of the cancer burden in Europe alongside a description of the profiles of common cancers at the national and regional level provide a basis for establishing priorities for cancer control actions across Europe. The estimates presented here are based on the recorded data from 145 population-based cancer registries in Europe. Their long established role in planning and evaluating national cancer plans on the continent should not be undervalued.

Background Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world. We aimed to assess the changing patterns of cancer according to varying levels of human development. Methods We used four levels (low, medium, high, and very high) of the Human Development Index (HDI), a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in 2008 (on the basis of GLOBOCAN estimates) and trends 1988–2002 (on the basis of the series in Cancer Incidence in Five Continents), and to produce future burden scenario for 2030 according to projected demographic changes alone and trends-based changes for selected cancer sites. Findings In the highest HDI regions in 2008, cancers of the female breast, lung, colorectum, and prostate accounted for half the overall cancer burden, whereas in medium HDI regions, cancers of the oesophagus, stomach, and liver were also common, and together these seven cancers comprised 62% of the total cancer burden in medium to very high HDI areas. In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across 184 countries, with cancers of the prostate, lung, and liver being the most common. Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum. If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from 12·7 million new cases in 2008 to 22·2 million by 2030. Interpretation Our findings suggest that rapid societal and economic transition in many countries means that any reductions in infection-related cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors. Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes. Funding None.

Recent estimates of global cancer incidence and survival were used to update previous figures of limited duration prevalence to the year 2008. The number of patients with cancer diagnosed between 2004 and 2008 who were still alive at the end of 2008 in the adult population is described by world region, country and the human development index. The 5-year global cancer prevalence is estimated to be 28.8 million in 2008. Close to half of the prevalence burden is in areas of very high human development that comprise only one-sixth of the world's population. Breast cancer continues to be the most prevalent cancer in the vast majority of countries globally; cervix cancer is the most prevalent cancer in much of Sub-Saharan Africa and Southern Asia and prostate cancer dominates in North America, Oceania and Northern and Western Europe. Stomach cancer is the most prevalent cancer in Eastern Asia (including China); oral cancer ranks as the most prevalent cancer in Indian men and Kaposi sarcoma has the highest 5-year prevalence among men in 11 countries in Sub-Saharan Africa. The methods used to estimate point prevalence appears to give reasonable results at the global level. The figures highlight the need for long-term care targeted at managing patients with certain very frequently diagnosed cancer forms. To be of greater relevance to cancer planning, the estimation of other time-based measures of global prevalence is warranted.

We present here worldwide estimates of annual mortality from all cancers and for 25 specific cancer sites around 1990. Crude and age-standardised mortality rates and numbers of deaths were computed for 23 geographical areas. Of the estimated 5.2 million deaths from cancer (excluding non-melanoma skin cancer), 55% (2.8 million) occurred in developing countries. The sex ratio is 1.33 (M:F), greater than that of incidence (1.13) due to the more favourable prognosis of cancer in women. Lung cancer is still the most common cause of death from cancer worldwide with over 900,000 deaths per year, followed by gastric cancer with over 600,000 deaths and colorectal and liver cancers accounting for at least 400,000 deaths each. In men, deaths from liver cancer exceed those due to colo-rectal cancer by 38%. Over 300,000 deaths of women are attributed to breast cancer, which remains the leading cause of death from cancer in women, followed by cancers of the stomach and lung with 230,000 annual deaths each. In men, the risk of dying from cancer is highest in eastern Europe, with an age-standardised rate for all sites of 205 deaths per 100,000 population. Mortality rates in all other developed regions are around 180. The only developing area with an overall rate of the same magnitude as that in developed countries is southern Africa. All of eastern Asia, including China, has mortality rates above the world average, as do all developed countries. The region of highest risk among women is northern Europe (age-standardised rate = 125.4), followed by North America, southern Africa and tropical South America. Only south-central and western Asia (Indian subcontinent, central Asia and the middle-eastern countries) and Northern Africa are well below the world average of 90 deaths per 100,000 population annually. Our results indicate the potential impact of preventive practices. It is estimated that 20% of all cancer deaths (1 million) could be prevented by eliminating tobacco smoking. Infectious agents account for a further 16% of deaths.

The worldwide prevalence of infection with human papillomavirus (HPV) in women without cervical abnormalities is 11–12% with higher rates in sub-Saharan Africa (24%), Eastern Europe (21%) and Latin America (16%). The two most prevalent types are HPV16 (3.2%) and HPV18 (1.4%). Prevalence increases in women with cervical pathology in proportion to the severity of the lesion reaching around 90% in women with grade 3 cervical intraepithelial neoplasia and invasive cancer. HPV infection has been identified as a definite human carcinogen for six types of cancer: cervix, penis, vulva, vagina, anus and oropharynx (including the base of the tongue and tonsils). Estimates of the incidence of these cancers for 2008 due to HPV infection have been calculated globally. Of the estimated 12.7 million cancers occurring in 2008, 610,000 (Population Attributable Fraction [PAF] = 4.8%) could be attributed to HPV infection. The PAF varies substantially by geographic region and level of development, increasing to 6.9% in less developed regions of the world, 14.2% in sub-Saharan Africa and 15.5% in India, compared with 2.1% in more developed regions, 1.6% in Northern America and 1.2% in Australia/New Zealand. Cervical cancer, for which the PAF is estimated to be 100%, accounted for 530,000 (86.9%) of the HPV attributable cases with the other five cancer types accounting for the residual 80,000 cancers. Cervical cancer is the third most common female malignancy and shows a strong association with level of development, rates being at least four-fold higher in countries defined within the low ranking of the Human Development Index (HDI) compared with those in the very high category. Similar disparities are evident for 5-year survival—less than 20% in low HDI countries and more than 65% in very high countries. There are five-fold or greater differences in incidence between world regions. In those countries for which reliable temporal data are available, incidence rates appear to be consistently declining by approximately 2% per annum. There is, however, a lack of information from low HDI countries where screening is less likely to have been successfully implemented. Estimates of the projected incidence of cervical cancer in 2030, based solely on demographic factors, indicate a 2% increase in the global burden of cervical cancer, i.e., in balance with the current rate of decline. Due to the relative small numbers involved, it is difficult to discern temporal trends for the other cancers associated with HPV infection. Genital warts represent a sexually transmitted benign condition caused by HPV infection, especially HPV6 and HPV11. Reliable surveillance figures are difficult to obtain but data from developed countries indicate an annual incidence of 0.1 to 0.2% with a peak occurring at teenage and young adult ages. This article forms part of a special supplement entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.

Wide variation exists internationally for prostate cancer (PCa) rates due to differences in detection practices, treatment, and lifestyle and genetic factors. We present contemporary variations in PCa incidence and mortality patterns across five continents using the most recent data from the International Agency for Research on Cancer. PCa incidence and mortality estimates for 2008 from GLOBOCAN are presented. We also examine recent trends in PCa incidence rates for 40 countries and mortality rates for 53 countries from 1985 and onward via join-point analyses using an augmented version of Cancer Incidence in Five Continents and the World Health Organization mortality database. Estimated PCa incidence rates remain most elevated in the highest resource counties worldwide including North America, Oceania, and western and northern Europe. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa. Increasing PCa incidence rates during the most recent decade were observed in 32 of the 40 countries examined, whereas trends tended to stabilize in 8 countries. In contrast, PCa mortality rates decreased in 27 of the 53 countries under study, whereas rates increased in 16 and remained stable in 10 countries. PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries. In contrast, the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries.

Infections with certain viruses, bacteria, and parasites are strong risk factors for specific cancers. As new cancer statistics and epidemiological findings have accumulated in the past 5 years, we aimed to assess the causal involvement of the main carcinogenic agents in different cancer types for the year 2012.We considered ten infectious agents classified as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases and the relative risk for the infection (for some sites). Estimates of infection prevalence, relative risk, and corresponding 95% CIs for AF were obtained from systematic reviews and pooled analyses.Of 14 million new cancer cases in 2012, 2·2 million (15·4%) were attributable to carcinogenic infections. The most important infectious agents worldwide were Helicobacter pylori (770 000 cases), human papillomavirus (640 000), hepatitis B virus (420 000), hepatitis C virus (170 000), and Epstein-Barr virus (120 000). Kaposi's sarcoma was the second largest contributor to the cancer burden in sub-Saharan Africa. The AFs for infection varied by country and development status-from less than 5% in the USA, Canada, Australia, New Zealand, and some countries in western and northern Europe to more than 50% in some countries in sub-Saharan Africa.A large potential exists for reducing the burden of cancer caused by infections. Socioeconomic development is associated with a decrease in infection-associated cancers; however, to reduce the incidence of these cancers without delay, population-based vaccination and screen-and-treat programmes should be made accessible and available.Fondation de France.

<h2>Summary</h2><h3>Background</h3> Infectious pathogens are strong and modifiable causes of cancer. The aim of this study was to improve estimates of the global and regional burden of infection-attributable cancers to inform research priorities and facilitate prevention efforts. <h3>Methods</h3> We used the GLOBOCAN 2018 database of cancer incidence and mortality rates and estimated the attributable fractions and global incidence for specific anatomical cancer sites, subsites, or histological subtypes known to be associated with ten infectious pathogens classified as human carcinogens. We calculated absolute numbers and age-standardised incidence rates (ASIR) of infection-attributable cancers at the country level. Estimates were stratified for sex, age group, and country, and were aggregated according to geographical regions and World Bank income groups. <h3>Findings</h3> We found that, for 2018, an estimated 2·2 million infection-attributable cancer cases were diagnosed worldwide, corresponding to an infection-attributable ASIR of 25·0 cases per 100 000 person-years. Primary causes were <i>Helicobacter pylori</i> (810 000 cases, ASIR 8·7 cases per 100 000 person-years), human papillomavirus (690 000, 8·0), hepatitis B virus (360 000, 4·1) and hepatitis C virus (160 000, 1·7). Infection-attributable ASIR was highest in eastern Asia (37·9 cases per 100 000 person-years) and sub-Saharan Africa (33·1), and lowest in northern Europe (13·6) and western Asia (13·8). China accounted for a third of worldwide cancer cases attributable to infection, driven by high ASIR of <i>H pylori</i> (15·6) and hepatitis B virus (11·7) infection. The cancer burden attributed to human papillomavirus showed the clearest relationship with country income level (from ASIR of 6·9 cases per 100 000 person-years in high-income countries to 16·1 in low-income countries). <h3>Interpretation</h3> Infection-attributable cancer incidence, in addition to the absolute number of cases, allows for refined geographic analyses and identification of populations with a high infection-associated cancer burden. When cancer prevention is largely considered in a non-communicable disease context, there is a crucial need for resources directed towards cancer prevention programmes that target infection, particularly in high-risk populations. Such interventions can markedly reduce the increasing cancer burden and associated mortality. <h3>Funding</h3> International Agency for Research on Cancer.

On the basis of current evidence regarding human papillomavirus (HPV) and cancer, this chapter provides estimates of the global burden of HPV-related cancers, and the proportion that are actually "caused" by infection with HPV types, and therefore potentially preventable. We also present trends in incidence and mortality of these cancers in the past, and consider their likely future evolution.

Human papillomavirus (HPV) has been identified as the cause of the increasing oropharyngeal cancer (OPC) incidence in some countries. To investigate whether this represents a global phenomenon, we evaluated incidence trends for OPCs and oral cavity cancers (OCCs) in 23 countries across four continents.We used data from the Cancer Incidence in Five Continents database Volumes VI to IX (years 1983 to 2002). Using age-period-cohort modeling, incidence trends for OPCs were compared with those of OCCs and lung cancers to delineate the potential role of HPV vis-à-vis smoking on incidence trends. Analyses were country specific and sex specific.OPC incidence significantly increased during 1983 to 2002 predominantly in economically developed countries. Among men, OPC incidence significantly increased in the United States, Australia, Canada, Japan, and Slovakia, despite nonsignificant or significantly decreasing incidence of OCCs. In contrast, among women, in all countries with increasing OPC incidence (Denmark, Estonia, France, the Netherlands, Poland, Slovakia, Switzerland, and United Kingdom), there was a concomitant increase in incidence of OCCs. Although increasing OPC incidence among men was accompanied by decreasing lung cancer incidence, increasing incidence among women was generally accompanied by increasing lung cancer incidence. The magnitude of increase in OPC incidence among men was significantly higher at younger ages (< 60 years) than older ages in the United States, Australia, Canada, Slovakia, Denmark, and United Kingdom.OPC incidence significantly increased during 1983 to 2002 predominantly in developed countries and at younger ages. These results underscore a potential role for HPV infection on increasing OPC incidence, particularly among men.

The relative importance of cardiovascular disease (CVD) and cancer as leading causes of premature death are examined in this communication. CVD and cancer are now the leading causes in 127 countries, with CVD leading in 70 countries (including Brazil and India) and cancer leading in 57 countries (including China). Such observations can be seen as part of a late phase of an epidemiologic transition, taking place in the second half of the 20th century and the first half of the present one, in which the dominance of infectious diseases is progressively superseded by noncommunicable diseases. According to present ranks and recent trends, cancer may surpass CVD as the leading cause of premature death in most countries over the course of this century. Clearly, governments must factor in these transitions in developing cancer policies for the local disease profile.

Cancer is a major cause of death in children worldwide, and the recorded incidence tends to increase with time. Internationally comparable data on childhood cancer incidence in the past two decades are scarce. This study aimed to provide internationally comparable local data on the incidence of childhood cancer to promote research of causes and implementation of childhood cancer control.This population-based registry study, devised by the International Agency for Research on Cancer in collaboration with the International Association of Cancer Registries, collected data on all malignancies and non-malignant neoplasms of the CNS diagnosed before age 20 years in populations covered by high-quality cancer registries with complete data for 2001-10. Incidence rates per million person-years for the 0-14 years and 0-19 years age groups were age-adjusted using the world standard population to provide age-standardised incidence rates (WSRs), using the age-specific incidence rates (ASR) for individual age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years). All rates were reported for 19 geographical areas or ethnicities by sex, age group, and cancer type. The regional WSRs for children aged 0-14 years were compared with comparable data obtained in the 1980s.Of 532 invited cancer registries, 153 registries from 62 countries, departments, and territories met quality standards, and contributed data for the entire decade of 2001-10. 385 509 incident cases in children aged 0-19 years occurring in 2·64 billion person-years were included. The overall WSR was 140·6 per million person-years in children aged 0-14 years (based on 284 649 cases), and the most common cancers were leukaemia (WSR 46·4), followed by CNS tumours (WSR 28·2), and lymphomas (WSR 15·2). In children aged 15-19 years (based on 100 860 cases), the ASR was 185·3 per million person-years, the most common being lymphomas (ASR 41·8) and the group of epithelial tumours and melanoma (ASR 39·5). Incidence varied considerably between and within the described regions, and by cancer type, sex, age, and racial and ethnic group. Since the 1980s, the global WSR of registered cancers in children aged 0-14 years has increased from 124·0 (95% CI 123·3-124·7) to 140·6 (140·1-141·1) per million person-years.This unique global source of childhood cancer incidence will be used for aetiological research and to inform public health policy, potentially contributing towards attaining several targets of the Sustainable Development Goals. The observed geographical, racial and ethnic, age, sex, and temporal variations require constant monitoring and research.International Agency for Research on Cancer and the Union for International Cancer Control.

There were an estimated 4.8 million new cases of gastrointestinal (GI) cancers and 3.4 million related deaths, worldwide, in 2018. GI cancers account for 26% of the global cancer incidence and 35% of all cancer-related deaths. We investigated the global burden from the 5 major GI cancers, as well as geographic and temporal trends in cancer-specific incidence and mortality.Data on primary cancers of the esophagus, stomach, colorectum, liver, and pancreas were extracted from the GLOBOCAN database for the year 2018, as well as from the Cancer Incidence in 5 Continents series, and the World Health Organization mortality database from 1960 onward. Age-standardized incidence and mortality rates were calculated by sex, country, and level of human development.We observed geographic and temporal variations in incidence and mortality for all 5 types of GI cancers. Esophageal, gastric, and liver cancers were more common in Asia than in other parts of the world, and the burden from colorectal and pancreatic cancers was highest in Europe and North America. There was a uniform decrease in gastric cancer incidence, but an increasing incidence of colorectal cancer in formerly low-incidence regions during the studied time period. We found slight increases in incidence of liver and pancreatic cancer in some high-income regions.Although the incidence of some GI cancer types has decreased, this group of malignancies continues to pose major challenges to public health. Primary and secondary prevention measures are important for controlling these malignancies-most importantly reducing consumption of tobacco and alcohol, obesity control, immunizing populations against hepatitis B virus infection, and screening for colorectal cancer.

<h2>Summary</h2><h3>Background</h3> From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. <h3>Methods</h3> We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0–99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003–05, 2006–08, 2009–11, and 2012–15). <h3>Findings</h3> There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003–05 to 2012–15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6–31·2) to 40·5% (40·3–40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5–8·5]), thyroid (5·4% [3·2–7·6]), cervix (4·5% [2·9–6·2]), and bone (3·2% [2·1–4·4]). In 2012–15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5–47·0) than in rural areas (33·6%, 33·3–33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. <h3>Interpretation</h3> There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. <h3>Funding</h3> National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.

Despite the improvement in renal cell carcinoma (RCC) diagnosis and management observed during the last 2 decades, RCC remains one of the most lethal urological malignancies. With the expansion of routine imaging for many disorders, an increasing number of patients who harbour RCC are identified incidentally.To summarise and compare RCC incidence and mortality rates, analyse the magnitude of risk factors, and interpret these epidemiological observations in the context of screening and disease management.The primary objective of the current review was to retrieve and describe worldwide RCC incidence/mortality rates. Secondly, a narrative literature review about the magnitude of the known risk factors was performed. Finally, data retrieved from the first two steps were elaborated to define the clinical implications for RCC screening.RCC incidence and mortality significantly differ among individual countries and world regions. Potential RCC risk factors include behavioural and environmental factors, comorbidities, and analgesics. Smoking, obesity, hypertension, and chronic kidney disease represent established risk factors. Other factors have been associated with an increased RCC risk, although selection biases may be present and controversial results have been reported.Incidence of RCC varies worldwide. Within the several RCC risk factors identified, smoking, obesity, and hypertension are most strongly associated with RCC. In individuals at a higher risk of RCC, the cost effectiveness of a screening programme needs to be assessed on a country-specific level due to geographic heterogeneity in incidence and mortality rates, costs, and management implications. Owing to the low rates of RCC, implementation of accurate biomarkers appears to be mandatory.The probability of harbouring kidney cancer is higher in developed countries and among smokers, obese individuals, and individuals with hypertension.

The knowledge that persistent human papillomavirus infection is the main cause of cervical cancer has resulted in the development of assays that detect nucleic acids of the virus and prophylactic vaccines. Up-to-date and reliable data are needed to assess impact of existing preventive measures and to define priorities for the future.Best estimates on cervical cancer incidence and mortality are presented using recently compiled data from cancer and mortality registries for the year 2008.There were an estimated 530,000 cases of cervical cancer and 275,000 deaths from the disease in 2008. It is the third most common female cancer ranking after breast (1.38 million cases) and colorectal cancer (0.57 million cases). The incidence of cervical cancer varies widely among countries with world age-standardised rates ranging from <1 to >50 per 100,000. Cervical cancer is the leading cause of cancer-related death among women in Eastern, Western and Middle Africa; Central America; South-Central Asia and Melanesia. The highest incidence rate is observed in Guinea, with ∼6.5% of women developing cervical cancer before the age of 75 years. India is the country with the highest disease frequency with 134,000 cases and 73 000 deaths. Cervical cancer, more than the other major cancers, affects women <45 years.In spite of effective screening methods, cervical cancer continues to be a major public health problem. New methodologies of cervical cancer prevention should be made available and accessible for women of all countries through well-organised programmes.

One in ten of all new cancers diagnosed worldwide each year is a cancer of the female breast, and it is the most common cancer in women in both developing and developed areas. It is also the principal cause of death from cancer among women globally. We review the descriptive epidemiology of the disease, focusing on some of the key elements of the geographical and temporal variations in incidence and mortality in each world region. The observations are discussed in the context of the numerous aetiological factors, as well as the impact of screening and advances in treatment and disease management in high-resource settings.

Dramatic increases have been seen over recent decades in the reported incidence of thyroid cancer, but owing to new modes of screening, hundreds of thousands of cases may be overdiagnoses — diagnosis of tumors that would not, if left alone, result in symptoms or death.

Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015–35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015–35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries—a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015–35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015–35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and $284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015–35 (–$14·9 billion in low-income countries; –$18·7 billion in lower-middle-income countries, and $50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (–$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and $95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.

Renal cell carcinoma (RCC) incidence rates are higher in developed countries, where up to half of the cases are discovered incidentally. Declining mortality trends have been reported in highly developed countries since the 1990s.To compare and interpret geographic variations and trends in the incidence and mortality of RCC worldwide in the context of controlling the future disease burden.We used data from GLOBOCAN, the Cancer Incidence in Five Continents series, and the World Health Organisation mortality database to compare incidence and mortality rates in more than 40 countries worldwide. We analysed incidence and mortality trends in the last 10 yr using joinpoint analyses of the age-standardised rates (ASRs).RCC incidence in men varied in ASRs (World standard population) from approximately 1/100,000 in African countries to >15/100,000 in several Northern and Eastern European countries and among US blacks. Similar patterns were observed for women, although incidence rates were commonly half of those for men. Incidence rates are increasing in most countries, most prominently in Latin America. Although recent mortality trends are stable in many countries, significant declines were observed in Western and Northern Europe, the USA, and Australia. Southern European men appear to have the least favourable RCC mortality trends.Although RCC incidence is still increasing in most countries, stabilisation of mortality trends has been achieved in many highly developed countries. There are marked absolute differences and opposing RCC mortality trends in countries categorised as areas of higher versus lower human development, and these gaps appear to be widening.Renal cell cancer is becoming more commonly diagnosed worldwide in both men and women. Mortality is decreasing in the most developed settings, but not in low- and middle-income countries, where access to and the availability of optimal therapies are likely to be limited.

Previous studies have reported significant variation in prostate cancer rates and trends mainly due to differences in detection practices, availability of treatment, and underlying genetic susceptibility.To assess recent worldwide prostate cancer incidence, mortality rates, and trends using up-to-date incidence and mortality data.We present estimated age-standardized prostate cancer incidence and mortality rates by country and world regions for 2018 based on the GLOBOCAN database. We also examined rates and temporal trends for incidence (44 countries) and mortality (76 countries) based on data series from population-based registries.The highest estimated incidence rates were found in Australia/New Zealand, Northern America, Western and Northern Europe, and the Caribbean, and the lowest rates were found in South-Central Asia, Northern Africa, and South-Eastern and Eastern Asia. The highest estimated mortality rates were found in the Caribbean (Barbados, Trinidad and Tobago, and Cuba), sub-Saharan Africa (South Africa), parts of former Soviet Union (Lithuania, Estonia, and Latvia), whereas the lowest rates were found in Asia (Thailand and Turkmenistan). Prostate cancer incidence rates during the most recent 5 yr declined (five countries) or stabilized (35 countries), after increasing for many years; in contrast, rates continued to increase for four countries in Eastern Europe and Asia. During the most recent 5 data years, mortality rates among the 76 countries examined increased (three countries), remained stable (59 countries), or decreased (14 countries).As evident from available data, prostate cancer incidence and mortality rates have been on the decline or have stabilized recently in many countries, with decreases more pronounced in high-income countries. These trends may reflect a decline in prostate-specific antigen testing (incidence) and improvements in treatment (mortality).We examined recent trends in prostate cancer incidence and mortality rates in 44 and 76 countries, respectively, and found that rates in most countries stabilized or decreased.

Aim To provide a comprehensive evaluation of the quality of the data collected on both solid and non-solid tumours at the Cancer Registry of Norway (CRN). Methods Established quantitative and semi-quantitative methods were used to assess comparability, completeness, accuracy and timeliness of data for the period 1953–2005, with special attention to the registration period 2001–2005. Results The CRN coding and classification system by and large follows international standards, with some further subdivisions of morphology groupings performed in-house. The overall completeness was estimated at 98.8% for the registration period 2001–2005. There remains a variable degree of under-reporting particularly for haematological malignancies (C90–95) and tumours of the central nervous system (C70–72). For the same period, 93.8% of the cases were morphologically verified (site-specific range: 60.0–99.8%). The under-reporting in 2005 due to timely publication is estimated at 2.2% overall, based on the number of cases received at the registry during the following year. Conclusion This review suggests the routines in place at the CRN yields comparable data that can be considered reasonably accurate, close-to-complete and timely, thereby justifying our policy of the reporting of annual incidence one year after the year of diagnosis.

Lung cancer rates have peaked among men in many areas of the world, but rates among women continue to rise. Most lung cancers are squamous cell carcinoma, small cell carcinoma, or adenocarcinoma; trends vary according to type. We compiled population-based morphology-specific incidence data from registries contributing to the International Agency for Research on Cancer (IARC) databases. Unspecified cancers and carcinomas were reallocated based on a registry, time period, sex and age group-specific basis. Where available, data from several registries within a country were pooled for analysis. Rates per 100,000 person-years for 1980-1982 to 1995-1997 were age-adjusted by the direct method using the world standard. Squamous cell carcinoma rates among males declined 30% or more in North America and some European countries while changing less dramatically in other areas; small cell carcinoma rates decreased less rapidly. Squamous and small cell carcinoma rates among females generally rose, with the increases especially pronounced in the Netherlands and Norway. In contrast, adenocarcinoma rates rose among males and females in virtually all areas, with the increases among males exceeding 50% in many areas of Europe; among females, rates also rose rapidly and more than doubled in Norway, Italy and France. Rates of all lung cancer types among women and adenocarcinoma among men continue to rise despite declining cigarette use in many Western countries and shifts to filtered/low-tar cigarettes. Renewed efforts toward cessation and prevention are mandatory to curb the prevalence of cigarette smoking and to reduce lung cancer rates eventually.

Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.

Abstract In health services planning, in addition to the basic measures of disease occurrence incidence and mortality, other indexes expressing the demand of care are also required to develop strategies for service provision. One of these is prevalence of the disease, which measures the absolute number, and relative proportion in the population, of individuals affected by the disease and that require some form of medical attention. For most cancer sites, cases surviving 5 years from diagnosis experience thereafter the same survival as the general population, so most of the workload is therefore due to medical acts within these first 5 years. This article reports world‐wide estimates of 1‐, 2–3‐ and 4–5‐year point prevalence in 1990 in the population aged 15 years or over, and hence describes the number of cancer cases diagnosed between 1986 and 1990 who were still alive at the end of 1990. These estimates of prevalence at 1, 2–3 and 4–5 years are applicable to the evaluation of initial treatment, clinical follow‐up and point of cure, respectively, for the majority of cancers. We describe the computational procedure and data sources utilised to obtain these figures and compare them with data published by 2 cancer registries. The highest prevalence of cancer is in North America with 1.5% of the population affected and diagnosed in the previous 5 years (about 0.5% of the population in years 4–5 and 2–3 of follow‐up and 0.4% within the first year of diagnosis). This corresponds to over 3.2 million individuals. Western Europe and Australia and New Zealand show very similar percentages with 1.2% and 1.1% of the population affected (about 3.9 and 0.2 million cases respectively). Japan and Eastern Europe form the next batch with 1.0% and 0.7%, followed by Latin America and the Caribbean (overall prevalence of 0.4%), and all remaining regions are around 0.2%. Cancer prevalence in developed countries is very similar in men and women, 1.1% of the sex‐specific population, while in developing countries the prevalence is some 25% greater in women than men, reflecting a preponderance of cancer sites with poor survival such as liver, oesophagus and stomach in males. The magnitude of disease incidence is the primary determinant of crude prevalence of cases diagnosed within 1 year so that differences by region mainly reflect variation in risk. In the long‐term period however different demographic patterns with long‐life expectancy in high‐income countries determine a higher prevalence in these areas even for relatively uncommon cancer sites such as the cervix. © 2002 Wiley‐Liss, Inc.

<h2>Summary</h2><h3>Background</h3> Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. <h3>Methods</h3> In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. <h3>Findings</h3> In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995–2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010–14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. <h3>Interpretation</h3> The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. <h3>Funding</h3> Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network.

Cancer incidence and mortality estimates for 1995 are presented for the 38 countries in the four United Nations-defined areas of Europe, using World Health Organization mortality data and published estimates of incidence from national cancer registries. Additional estimation was required where national incidence data was not available, and the method involved incorporating the high quality incidence and mortality data available from the expanding number of population-based cancer registries in Europe. There were an estimated 2.6 million new cases of cancer in Europe in 1995, representing over one-quarter of the world burden of cancer. The corresponding number of deaths from cancer was approximately 1.6 million. After adjusting for differing population age structures, overall incidence rates in men were highest in the Western European countries (420.9 per 100,000), with only Austria having a rate under 400. Eastern European men had the second highest rates of cancer (414.2), with extremely high rates being observed in Hungary (566.6) and in the Czech Republic (480.5). The lowest male all-cancer rate by area was observed in the Northern European countries, with fairly low rates seen in Sweden (356.6) and the UK (377.8). In contrast to men, the highest rates in women were observed in Northern Europe (315.9) and were particularly high in Denmark (396.2) and the other Nordic countries excepting Finland. The rates of cancer in Eastern European women were lower than in the other three areas, although as with men, female rates were very high in Hungary (357.2) and in the Czech Republic (333.6). There was greater disparity in the mortality rates within Europe--generally, rates were highest in Eastern European countries, notably in Hungary, reflecting a combination of poorer cancer survival rates and a higher incidence of the more lethal neoplasms, notably cancer of the lung. Lung cancer, with an estimated 377,000 cases, was the most common cancer in Europe in 1995. Rates were particularly high in much of Eastern Europe reflecting current and past tobacco smoking habits of many of its inhabitants. Together with cancers of colon and rectum (334,000), and female breast (321,000), the three cancers represented approximately 40% of new cases in Europe. In men, the most common primary sites were lung (22% of all cancer cases), colon and rectum (12%) and prostate (11%), and in females, breast (26%), colon and rectum (14%) and stomach (7%). The number of deaths is determined by survival, as well as incidence; by far the most common cause of death was lung cancer (330,000)--about one-fifth of the total number of cancer deaths in Europe in 1995. Deaths from cancers of the colon and rectum (189,000) ranked second, followed by deaths from stomach cancer (152,000), which due to poorer survival ranked higher than breast cancer (124,000). Lung cancer was the most common cause of death from cancer in men (29%). Breast cancer was the leading cause of death in females (17%). Cancer registries are a unique source of information on cancer incidence and survival, and are used here with national mortality to demonstrate the very substantial burden of cancer in Europe, and the scope for prevention. Despite some provisos about data quality, the general patterns which emerge in Europe verify the role of past exposures and interventions, and more importantly, firmly establish the need for cancer control measures which target specific populations. In particular, there is a clear urgency to combat the ongoing tobacco epidemic, now prevalent in much of Europe, particularly in the Eastern countries.

BackgroundSince 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths.MethodsBetween Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level.FindingsFrom June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39–55 million) received the full course of vaccine, representing a total population coverage of 1·4% (95% CI 1·1–1·6), and 59 million women (48–71 million) had received at least one dose, representing a total population coverage of 1·7% (1·4–2·1). In more developed regions, 33·6% (95% CI 25·9–41·7) of females aged 10–20 years received the full course of vaccine, compared with only 2·7% (1·8–3·6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178 192 averted cases by age 75 years) than in high-income countries (165 033 averted cases), despite the lower number of vaccinated women (13·3 million vs 32·2 million).InterpretationMany women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention.FundingPATH, Instituto de Salud Carlos III, and Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR).

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. Herein, we examine global trends in female breast cancer rates using the most up-to-date data available.Breast cancer incidence and mortality estimates were obtained from GLOBOCAN 2012 (globocan.iarc.fr). We analyzed trends from 1993 onward using incidence data from 39 countries from the International Agency for Research on Cancer and mortality data from 57 countries from the World Health Organization.Of 32 countries with incidence and mortality data, rates in the recent period diverged-with incidence increasing and mortality decreasing-in nine countries mainly in Northern/Western Europe. Both incidence and mortality decreased in France, Israel, Italy, Norway, and Spain. In contrast, incidence and death rates both increased in Colombia, Ecuador, and Japan. Death rates also increased in Brazil, Egypt, Guatemala, Kuwait, Mauritius, Mexico, and Moldova.Breast cancer mortality rates are decreasing in most high-income countries, despite increasing or stable incidence rates. In contrast and of concern are the increasing incidence and mortality rates in a number of countries, particularly those undergoing rapid changes in human development. Wide variations in breast cancer rates and trends reflect differences in patterns of risk factors and access to and availability of early detection and timely treatment.Increased awareness about breast cancer and the benefits of early detection and improved access to treatment must be prioritized to successfully implement breast cancer control programs, particularly in transitioning countries.

Abstract The incidence of cutaneous malignant melanoma has steadily increased over the past 50 years in predominately fair‐skinned populations. This increase is reported to have leveled off recently in several Northern and Western European countries, Australia, New Zealand and in North America. We studied the global patterns and time trends in incidence of melanoma by country and sex, with a focus on and age‐ and cohort‐specific variations. We analyzed the incidence data from 39 population‐based cancer registries, examining all‐ages and age‐truncated standardized incidence rates of melanoma, estimating the annual percentage change and incidence rate ratios from age‐period‐cohort models. Incidence rates of melanoma continue to rise in most European countries (primarily Southern and Eastern Europe), whereas in Australia, New Zealand, the U.S., Canada, Israel and Norway, rates have become rather stable in recent years. Indications of a stabilization or decreasing trend were observed mainly in the youngest age group (25–44 years). Rates have been rising steadily in generations born up to the end of the 1940s, followed by a stabilization or decline in rates for more recently born cohorts in Australia, New Zealand, the U.S., Canada and Norway. In addition to the birth cohort effect, there was a suggestion of a period‐related influence on melanoma trends in certain populations. Although our findings provide support that primary and secondary prevention can halt and reverse the observed increasing burden of melanoma, they also indicate that those prevention measures require further endorsement in many countries.

By using data from the International Agency for Research on Cancer publication Cancer Incidence in 5 Continents and GLOBOCAN, this report provides the first consolidated global estimation of the subsite distribution of new cases of lip, oral cavity, and pharyngeal cancers by country, sex, and age for the year 2012. Major geographically based, sex-based, and age-based variations in the incidence of lip, oral cavity, and pharyngeal cancers by subsite were observed. Lip cancers were highly frequent in Australia (associated with solar radiation) and in central and eastern Europe (associated with tobacco smoking). Cancers of the oral cavity and hypopharynx were highly common in south-central Asia, especially in India (associated with smokeless tobacco, bidi, and betel-quid use). Rates of oropharyngeal cancers were elevated in northern America and Europe, notably in Hungary, Slovakia, Germany, and France and were associated with alcohol use, tobacco smoking, and human papillomavirus infection. Nasopharyngeal cancers were most common in northern Africa and eastern/southeast Asia, indicative of genetic susceptibility combined with Epstein-Barr virus infection and early life carcinogenic exposures (nitrosamines and salted foods). The global incidence of lip, oral cavity, and pharyngeal cancers of 529,500, corresponding to 3.8% of all cancer cases, is predicted to rise by 62% to 856,000 cases by 2035 because of changes in demographics. Given the rising incidence of lip, oral cavity, and pharyngeal cancers and the variations in incidence by subsites across world regions and countries, there is a need for local, tailored approaches to prevention, screening, and treatment interventions that will optimally reduce the lip, oral cavity, and pharyngeal cancer burden in future decades. CA Cancer J Clin 2017;67:51-64. © 2016 American Cancer Society.

Background Country comparisons that consider the effect of fatal and non-fatal disease outcomes are needed for health-care planning. We calculated disability-adjusted life-years (DALYs) to estimate the global burden of cancer in 2008. Methods We used population-based data, mostly from cancer registries, for incidence, mortality, life expectancy, disease duration, and age at onset and death, alongside proportions of patients who were treated and living with sequelae or regarded as cured, to calculate years of life lost (YLLs) and years lived with disability (YLDs). We used YLLs and YLDs to derive DALYs for 27 sites of cancers in 184 countries in 12 world regions. Estimates were grouped into four categories based on a country's human development index (HDI). We applied zero discounting and uniform age weighting, and age-standardised rates to enable cross-country and regional comparisons. Findings Worldwide, an estimated 169·3 million years of healthy life were lost because of cancer in 2008. Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs in most world regions and caused 18–50% of the total cancer burden. We estimated an additional burden of 25% from infection-related cancers (liver, stomach, and cervical) in sub-Saharan Africa, and 27% in eastern Asia. We noted substantial global differences in the cancer profile of DALYs by country and region; however, YLLs were the most important component of DALYs in all countries and for all cancers, and contributed to more than 90% of the total burden. Nonetheless, low-resource settings had consistently higher YLLs (as a proportion of total DALYs) than did high-resource settings. Interpretation Age-adjusted DALYs lost from cancer are substantial, irrespective of world region. The consistently larger proportions of YLLs in low HDI than in high HDI countries indicate substantial inequalities in prognosis after diagnosis, related to degree of human development. Therefore, radical improvement in cancer care is needed in low-resource countries. Funding Dutch Scientific Society, Erasmus University Rotterdam, and International Agency for research on Cancer.

Cancers of the corpus uteri-primarily of the endometrium-rank as the sixth most common neoplasm in women worldwide. Analyses of the global patterns and trends of uterine cancer rates are needed in view of the ongoing obesity epidemic, a major risk factor for the disease.Data on endometrial cancer (ICD-10 C54) incidence from population-based cancer registries in 43 populations, published in CI5plus or by registries, were extracted for 1978 to 2013. Age-standardized incidence rates were computed for all ages and for pre- (25-49 years) and postmenopausal ages (50 years and older). Temporal trends were assessed with Joinpoint analysis, and the effects of birth cohort and year of diagnosis on the overall trends were examined using age-period-cohort modeling.In 2006 to 2007, rates varied 10-fold across countries. The highest rates were in North America, Eastern and Northern Europe (19 cases per 100 000 among whites in the United States, 95% confidence interval [CI] = 18 to 20, and in Slovakia, 95% CI = 18 to 21), and the lowest rates were in middle-income countries (South Africa 1, 95% CI = 0 to 3, and India 3, 95% CI = 3 to 4). Rates during the most recent 10 data years increased in 26 of the 43 populations considered in this study, with South Africa and several countries in Asia showing the largest increase. The risk of endometrial cancer increased both in consecutive generations and over time in 11 of 23 populations, with the increases more pronounced in Japan, the Philippines, Belarus, Singapore, Costa Rica, and New Zealand.Endometrial cancer incidence rates increased over time and in successive generations in several countries, especially in those countries with rapid socioeconomic transitions.

Members of the European Network of Cancer Registries (ENCR) provide population-based data on cancer incidence for some countries and regions of Europe. These were supplemented by estimates in order to provide comparable information on cancer incidence and mortality in the 15 member states of the European Union (EU). The estimated numbers of new cases of cancer (excluding nonmelanoma skin cancer) in 1990 were approximately 706,900 in men and 644,200 in women. Approximately 497,500 men and 398,200 women died of cancer in the same year. The main sites of incident cases in men were lung (21%), large bowel (13%), prostate (12%), bladder (7%) and stomach (7%). For women, the predominant sites were breast (28%), large bowel (15%), lung (6%), uterine corpus (5%) and stomach (5%). The overall incidence rates for males were highest in continental Western Europe (France, The Netherlands, Austria, Luxembourg, Belgium, Germany and Italy) while the rates of Greece, Portugal, Sweden, Ireland, Spain, Finland, the U.K. and Denmark were below the average value for the EC. Rates for females were highest in Northern and Western Europe, with the exception of France, which had a relatively low rate for females, in common with Greece, Spain and Portugal. The geographical variations in incidence of the major cancers are discussed in relation to risk factors. The estimates show the substantial burden of cancer in European Union populations, but there are also indications of effects of past preventive measures and there is scope for further intervention. Cancer registries are an important source of information for cancer control since they provide population-based incidence and survival statistics. These, along with mortality data, are required to obtain a full picture of the frequency of cancer and its effects at the population level. Some 44% of the EU population is covered by registries. The European Network of Cancer Registries aims to standardise the information provided by existing registries and to provide practical assistance to those in development.

The NORDCAN database and program ( www.ancr.nu ) include detailed information and results on cancer incidence, mortality and prevalence in each of the Nordic countries over five decades and has lately been supplemented with predictions of cancer incidence and mortality; future extensions include the incorporation of cancer survival estimates.The data originates from the national cancer registries and causes of death registries in Denmark, Finland, Iceland, Norway, Sweden, and Faroe Islands and is regularly updated. Presently 41 cancer entities are included in the common dataset, and conversions of the original national data according to international rules ensure comparability.With 25 million inhabitants in the Nordic countries, 130 000 incident cancers are reported yearly, alongside nearly 60 000 cancer deaths, with almost a million persons living with a cancer diagnosis. This web-based application is available in English and in each of the five Nordic national languages. It includes comprehensive and easy-to-use descriptive epidemiology tools that provide tabulations and graphs, with further user-specified options available.The NORDCAN database aims to provide comparable and timely data to serve the varying needs of policy makers, cancer societies, the public, and journalists, as well as the clinical and research community.

The value of the modern cancer registry and its ability to carry out cancer control activities rely heavily on the underlying quality of its data and the quality control procedures in place. This two-part review provides an update of the practical aspects and techniques for addressing data quality at the cancer registry. This first installment of the review examines the factors influencing three of the four key aspects, namely, the comparability, validity and timeliness of cancer registry data. Comparability of cancer data may be established through a comprehensive review of the registration routines in place. Validity is examined via numerical indices of that permit comparisons with other registries, or, within a registry, over time, or with respect to specified subsets of cases. There are no international guidelines for timeliness at present, although specific standards for the abstraction and reporting of registry have been set out by certain organisations.

Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults &lt;50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults &lt;50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.

Cancer Incidence in Five Continents (CI5), a longstanding collaboration between the International Agency for Research on Cancer and the International Association of Cancer Registries, serves as a unique source of cancer incidence data from high‐quality population‐based cancer registries around the world. The recent publication of Volume X comprises cancer incidence data from 290 registries covering 424 populations in 68 countries for the registration period 2003–2007. In this article, we assess the status of population‐based cancer registries worldwide, describe the techniques used in CI5 to evaluate their quality and highlight the notable variation in the incidence rates of selected cancers contained within Volume X of CI5. We also discuss the Global Initiative for Cancer Registry Development as an international partnership that aims to reduce the disparities in availability of cancer incidence data for cancer control action, particularly in economically transitioning countries, already experiencing a rapid rise in the number of cancer patients annually.

BackgroundThe WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination.MethodsThe WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions.FindingsGirls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4–19·8) to 2·1 (2·0–2·6) cases per 100 000 women-years over the next century (89·4% [86·2–90·1] reduction), and to avert 61·0 million (60·5–63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6–1·6) cases per 100 000 women-years (96·7% [91·3–96·7] reduction) and averted an extra 12·1 million (9·5–13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58–65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89–100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37–99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71–100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11–31 years. Long-term vaccine protection was required for elimination.InterpretationPredictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.FundingWHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.

Population ageing has substantially contributed to the rising number of new cancer cases worldwide. We document cancer incidence patterns in 2012 among older adults globally, and examine the changing magnitude of cancer in this age group over the next decades. Using GLOBOCAN 2012 data, we presented the number and proportion of new cancer cases, and the truncated age‐standardised incidence rates among adults aged 65 years and older for all cancer sites combined and for the five most common cancer sites by world region. We calculated the incidence in 2035 by applying population projections, assuming no changes in rates. In 2012, 6.7 million new cancer cases (47.5% of all cancers) were diagnosed among older adults worldwide, with marked regional disparities. Nearly 48% of these cases occurred in less developed regions. Lung, colorectal, prostate, stomach and breast cancers represented 55% of the global incidence, yet distinct regional patterns were observed. We predict 14 million new cancer cases by 2035, representing almost 60% of the global cancer incidence. The largest relative increase in incidence is predicted in the Middle East and Northern Africa (+157%), and in China (+155%). Less developed regions will see an increase of new cases by 144%, compared to 54% in more developed regions. The expected increase in cancer incidence at older ages will have substantial economic and social impacts globally, posing considerable and unique challenge to healthcare systems in every world region, especially in those with limited resources and weaker health systems.

BackgroundTo date, the burden of cancer among young adults has rarely been studied in depth. Our aim was to describe the scale and profile of cancer incidence and mortality worldwide among 20–39 year-olds, highlighting major patterns by age, sex, development level, and geographical region.MethodsWe did a population-based study to quantify the burden of young adult cancers worldwide. We defined young adult cancers as those occurring between the ages of 20 and 39 years because these individuals will have passed puberty and adolescence, but not yet experienced the effects of hormonal decline, immune response deterioration, or organ dysfunction associated with chronic health conditions. Global, regional, and country-specific (n=184) data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2012 among young adults were extracted in four 5-year bands from the International Agency for Research on Cancer's GLOBOCAN 2012 for all cancers combined and for 27 major types as defined by the International Classification of Disease, tenth revision. We report the number of new cancer cases and cancer-associated deaths overall and by sex alongside corresponding age-standardised rates (ASR) per 100 000 people per year. We also present results using four levels of the Human Development Index (HDI; low [least developed], medium, high, and very high [most developed]), which is a composite indicator for socioeconomic development comprising life expectancy, education, and gross national income.Findings975 396 new cancer cases and 358 392 cancer-associated deaths occurred among young adults worldwide in 2012, which equated to an ASR of 43·3 new cancer cases per 100 000 people per year and 15·9 cancer-associated deaths per 100 000 people per year. The burden was disproportionally greater among women and the most common cancer types overall in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukaemia, and colorectal cancer; in terms of deaths, female breast cancer, liver cancer, leukaemia, and cervical cancer were the main contributors. When assessed by development level and geographical region, the cancer profile varied substantially; generally, the burden of infection-associated cancers was greater in regions under transition. Cancer incidence was elevated in very high-HDI regions compared with low-HDI regions (ASR 64·5 vs 46·2 cancer cases per 100 000 people per year); however, the mortality burden was 3 times higher in low-HDI regions (ASR 25·4 vs 9·2 cancer-associated deaths per 100 000 people per year), reflecting differences in cancer profiles and inferior outcomes.InterpretationThe global cancer burden among 20–39 year-olds differs from that seen in younger or older ages and varies substantially by age, sex, development level, and geographical region. Although the cancer burden is lower in this age group than that observed in older ages, the societal and economic effects remain great given the major effects of premature morbidity and mortality. Targeted surveillance, prevention, and treatment are needed to reduce the cancer burden in this underserved age group.FundingInternational Agency for Research on Cancer (IARC) and European Commission's FP-7 Marie Curie Actions–People–COFUND.

The completeness of cancer registry data -- the extent to which all of the incident cancers occurring in the population are included in the registry database -- is an extremely important attribute of a cancer registry. Only a high degree of completeness in case-finding procedures will ensure cancer incidence rates and survival proportions are close to their true value. This second instalment of a two-part review of data quality methods at the cancer registry, focuses on the principles and techniques available for estimating completeness, separating methods into those that are semi-quantitative -- in that they give an indication of the degree of completeness relative to other registries or over time, and more quantitative techniques -- those that provide a numerical evaluation of the extent to which all eligible cases have been registered.

The age-specific mortality rates and total deaths from specific cancers have not been documented for the various regions and subpopulations of India. We therefore assessed the cause of death in 2001-03 in homes in small areas that were chosen to be representative of all the parts of India.At least 130 trained physicians independently assigned causes to 122,429 deaths, which occurred in 1·1 million homes in 6671 small areas that were randomly selected to be representative of all of India, based on a structured non-medical surveyor's field report.7137 of 122,429 study deaths were due to cancer, corresponding to 556,400 national cancer deaths in India in 2010. 395,400 (71%) cancer deaths occurred in people aged 30-69 years (200,100 men and 195,300 women). At 30-69 years, the three most common fatal cancers were oral (including lip and pharynx, 45,800 [22·9%]), stomach (25,200 [12·6%]), and lung (including trachea and larynx, 22,900 [11·4%]) in men, and cervical (33,400 [17·1%]), stomach (27,500 [14·1%]), and breast (19,900 [10·2%]) in women. Tobacco-related cancers represented 42·0% (84,000) of male and 18·3% (35,700) of female cancer deaths and there were twice as many deaths from oral cancers as lung cancers. Age-standardised cancer mortality rates per 100,000 were similar in rural (men 95·6 [99% CI 89·6-101·7] and women 96·6 [90·7-102·6]) and urban areas (men 102·4 [92·7-112·1] and women 91·2 [81·9-100·5]), but varied greatly between the states, and were two times higher in the least educated than in the most educated adults (men, illiterate 106·6 [97·4-115·7] vs most educated 45·7 [37·8-53·6]; women, illiterate 106·7 [99·9-113·6] vs most educated 43·4 [30·7-56·1]). Cervical cancer was far less common in Muslim than in Hindu women (study deaths 24, age-standardised mortality ratio 0·68 [0·64-0·71] vs 340, 1·06 [1·05-1·08]).Prevention of tobacco-related and cervical cancers and earlier detection of treatable cancers would reduce cancer deaths in India, particularly in the rural areas that are underserved by cancer services. The substantial variation in cancer rates in India suggests other risk factors or causative agents that remain to be discovered.Bill & Melinda Gates Foundation and US National Institutes of Health.

Background Cervical cancer trends in a given country mainly depend on the existence of effective screening programmes and time changes in disease risk factors, notably exposure to human papillomavirus (HPV). Screening primarily influences variations by period of diagnosis, whereas changes in risk factors chiefly manifest themselves as variations in risk across successive birth cohorts of women. Methods We assessed trends in cervical cancer across 38 countries in five continents, age group 30–74 years, using age-standardised incidence rates (ASRs) and age-period-cohort (APC) models. Non-identifiability in APC models was circumvented by making assumptions based on a consistent relationship between age and cervical cancer incidence (i.e. approximately constant rates after age 45 years). Findings ASRs decreased in several countries, except in most of Eastern European populations, Thailand as well as Uganda, although the direction and magnitude of period and birth cohort effects varied substantially. Strong downward trends in cervical cancer risk by period were found in the highest-income countries, whereas no clear changes by period were found in lower-resourced settings. Successive generations of women born after 1940 or 1950 exhibited either an increase in risk of cervical cancer (in most European countries, Japan, China), no substantial changes (North America and Australia) or a decrease (Ecuador and India). Interpretation In countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging. Funding Bill and Melinda Gates Foundation (BMGF).

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer.

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of cancer death. Predictions of the future burden of the disease inform health planners and raise awareness of the need for cancer control action. Data from the World Health Organization (WHO) mortality database for 1989–2016 were used to project colon and rectal cancer mortality rates and number of deaths in 42 countries up to the year 2035, using age‐period‐cohort (APC) modelling. Mortality rates for colon cancer are predicted to continue decreasing in the majority of included countries from Asia, Europe, North America and Oceania, except Latin America and Caribbean countries. Mortality rates from rectal cancer in general followed those of colon cancer, however rates are predicted to increase substantially in Costa Rica (+73.6%), Australia (+59.2%), United States (+27.8%), Ireland (+24.2%) and Canada (+24.1%). Despite heterogeneous trends in rates, the number of deaths is expected to rise in all countries for both colon and rectal cancer by 60.0% and 71.5% until 2035, respectively, due to population growth and ageing. Reductions in colon and rectal cancer mortality rates are probably due to better accessibility to early detection services and improved specialized care. The expected increase in rectal cancer mortality rates in some countries is worrisome and warrants further investigations.

We analyzed time trends in incidence of and mortality from malignant cutaneous melanoma in European populations since 1953. Data were extracted from the EUROCIM database of incidence data from 165 cancer registries. Mortality data were derived from the WHO database. During the 1990s, incidence rates were by far highest in northern and western Europe, whereas mortality was higher in males in eastern and southern Europe. Melanoma rates have been rising steadily, albeit with substantial geographic variation. In northern Europe, a deceleration in these trends occurred recently in persons aged under 70. Joinpoint analyses indicated that changes in these trends took place in the early 1980s. In western Europe, mortality rates have also recently leveled off [estimated annual percentage change (EAPC) from -13.6% (n.s.) to 3.3%], whereas in eastern and southern Europe both incidence and mortality rates are still increasing [incidence EAPCs 2.3-8.9%, mortality EAPCs -1.8% (n.s.) to 7.2%]. Models including the effects of age, period and birth cohort were required to adequately describe the rising incidence trends in most European populations, with a few exceptions. Time trends in mortality were adequately summarized on fitting either an age-cohort model (with the leveling off of rates starting in birth cohorts between 1930 and 1940) or an age-period-cohort model. The most plausible explanations for the deceleration or decline in the incidence and mortality trends in recent years in northern (and to a lesser extent western) Europe are earlier detection and more frequent excision of pigmented lesions and a growing public awareness of the dangers of excessive sunbathing.

Pisani, P., Parkin, D.M., Bray, F. and Ferlay, J. Estimates of the worldwide mortality from 25 cancers in 1990. Int. J. Cancer, 83, 18–29 (1999). Due to a printer's error, incorrect table headings were entered in Tables II–IV after the proofs of the article had been approved by the author. The correct tables are reprinted on the following pages. The publisher regrets this error.

Rapid increases in cervical adenocarcinoma incidence have been observed in Western countries in recent decades. Postulated explanations include an increasing specificity of subtype-the capability to diagnose the disease, an inability of cytologic screening to reduce adenocarcinoma, and heterogeneity in cofactors related to persistent human papillomavirus infection. This study examines the possible contribution of these factors in relation with trends observed in Europe. Age-period-cohort models were fitted to cervical adenocarcinoma incidence trends in women ages <75 in 13 European countries. Age-adjusted adenocarcinoma incidence rates increased throughout Europe, the rate of increase ranging from around 0.5% per annum in Denmark, Sweden, and Switzerland to >/=3% in Finland, Slovakia, and Slovenia. The increases first affected generations born in the early 1930s through the mid-1940s, with risk invariably higher in women born in the mid-1960s relative to those born 20 years earlier. The magnitude of this risk ratio varied considerably from around 7 in Slovenia to almost unity in France. Declines in period-specific risk were observed in United Kingdom, Denmark, and Sweden, primarily among women ages >30. Whereas increasing specificity of subtype with time may be responsible for some of the increases in several countries, the changing distribution and prevalence of persistent infection with high-risk human papillomavirus types, alongside an inability to detect cervical adenocarcinoma within screening programs, would accord with the temporal profile observed in Europe. The homogeneity of trends in adenocarcinoma and squamous cell carcinoma in birth cohort is consistent with the notion that they share a similar etiology irrespective of the differential capability of screen detection. Screening may have had at least some impact in reducing cervical adenocarcinoma incidence in several countries during the 1990s.

BackgroundHIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV.MethodsWe did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer.Findings24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa.InterpretationWomen living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden.FundingWHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.

Colorectal cancer (CRC) is the third most common cancer worldwide. The geographical and temporal burden of this cancer provides insights into risk factor prevalence and progress in cancer control strategies. We examine the current and future burden of CRC in 185 countries in 2020 and 2040.Data on CRC cases and deaths were extracted from the GLOBOCAN database for the year 2020. Age-standardised incidence and mortality rates were calculated by sex, country, world region and Human Development Index (HDI) for 185 countries. Age-specific rates were also estimated. The predicted number of cases and deaths in 2040 were calculated based on global demographic projections by HDI.Over 1.9 million new CRC cases and 930 000 deaths were estimated in 2020. Incidence rates were highest in Australia/ New Zealand and European regions (40.6 per 100 000, males) and lowest in several African regions and Southern Asia (4.4 per 100 000, females). Similar patterns were observed for mortality rates, with the highest observed in Eastern Europe (20.2 per 100 000, males) and the lowest in Southern Asia (2.5 per 100 000, females). The burden of CRC is projected to increase to 3.2 million new cases and 1.6 million deaths by 2040 with most cases predicted to occur in high or very high HDI countries.CRC is a highly frequent cancer worldwide, and largely preventable through changes in modifiable risk factors, alongside the detection and removal of precancerous lesions. With increasing rates in transitioning countries and younger adults, there is a pressing need to better understand and act on findings to avert future cases and deaths from the disease.

WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90-70-90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality from non-communicable diseases by 2030.The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10-14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions.In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9-14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1-0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3-37·8), averting 300 000 (300 000-400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4-66·1), averting 4·8 million (4·1-4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0-89·3), averting 13·3 million (13·1-13·6) deaths (with once-lifetime screening), or by 92·3% (88·4-93·0), averting 14·6 million (14·1-14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6-89·9), averting 45·8 million (44·7-46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0-98·0), averting 60·8 million (60·2-61·2) deaths (with once-lifetime screening), or by 98·6% (96·5-98·6), averting 62·6 million (62·1-62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45-55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29-34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30-69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4-37·9) by 2030, 96·2% (94·3-96·8) by 2070, and 98·6% (96·9-98·8) by 2120.These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec-Santé.

Despite there being sufficient evidence for the effectiveness of screening by cytology in preventing cancer of the cervix uteri, screening policies vary widely among European countries, and incidence is increasing in younger women. This study analyzes trends in squamous cell carcinoma (SCC) of the cervix uteri in 13 European countries to evaluate effectiveness of screening against a background of changing risk. Age-period-cohort models were fitted and period and cohort effects were estimated; these were considered as primarily indicative of screening interventions and changing etiology, respectively. A unique set of estimates was derived by fixing age slopes to one of several plausible age curves under the assumption that the relation between age and cervical cancer incidence is biologically determined. There were period-specific declines in cervical SCC in several countries, with the largest decreases seen in northern Europe. A pattern emerged across Europe of escalating risk in successive generations born after 1930. In the western European countries, a decrease followed by a stabilization of risk by cohort was accompanied by period-specific declines. In southern Europe, stable period, but increasing cohort trends, were observed. Substantial changes have occurred in cervical SCC incidence in Europe and well-organized screening programs have been highly effective in reducing the incidence of cervical SCC. Screening and changing sexual mores largely explain the changing period- and cohort-specific patterns, respectively. The increasing risk in recent cohorts is of obvious concern particularly in countries where no screening programs are in place. Further investigation of the effectiveness of opportunistic screening is warranted as is the observation of differing risk patterns in young cohorts in countries with relatively similar societal structures.

Objectives: Rapid increases in the incidence of esophageal adenocarcinoma (EAC) in high-income countries in the past decades have raised public health concerns. This study is the first to predict the future burden of esophageal cancer by histological subtype using international incidence data. Methods: Data on esophageal cancer incidence by year of diagnosis, sex, histology, and age group were extracted from 42 registries in 12 countries included in the last three volumes (VIII–X) of Cancer Incidence in Five Continents, contributing at least 15 years of consecutive data. Numbers of new cases and incidence rates were predicted up to 2030 by fitting and extrapolating age–period–cohort models; the differential impact of demographic vs. risk changes on future cases were examined. Results: The number of new AC cases is expected to increase rapidly 2005–2030 in all studied countries as a combined result of increasing risk and changing demographics. In contrast, the incidence of esophageal squamous cell carcinoma (ESCC) is predicted to continue decreasing in most countries. By 2030, 1 in 100 men in the Netherlands and the United Kingdom are predicted to be diagnosed with EAC during their lifetime. Conclusions: The burden from EAC is expected to rise dramatically across high-income countries and has already or will surpass ESCC incidence in the coming years, especially among men. Notwithstanding the inherent uncertainties in trend-based predictions and in subtype misclassification, these findings highlight an ongoing transition in the epidemiology of esophageal cancer that is highly relevant to future cancer control planning and clinical practice.

Primary liver cancer, the major histology of which is hepatocellular carcinoma (HCC), is the second leading cause of cancer death worldwide. We comprehensively examined recent international trends of primary liver cancer and HCC incidence using population-based cancer registry data. Incidence for all primary liver cancer and for HCC by calendar time and birth cohort was examined for selected countries between 1978 and 2012. For each successive 5-year period, age-standardized incidence rates were calculated from Volumes V to XI of the Cancer Incidence in Five Continents (CI5) series using the online electronic databases, CI5plus. Large variations persist in liver cancer incidence globally. Rates of liver cancer remain highest in Asian countries, specifically in the East and South-East, and Italy. However, rates in these high-risk countries have been decreasing in recent years. Rates in India and in most countries of Europe, the Americas and Oceania are rising. As the population seroprevalence of hepatitis B virus (HBV) continues to decline, we anticipate rates of HCC in many high-risk countries will continue to decrease. Treatment of hepatitis C virus (HCV) is likely to bring down rates further in some high-rate, as well as low-rate, countries with access to effective therapies. However, such gains in the control of liver cancer are at risk of being reversed by the growing obesity and diabetes epidemics, suggesting diabetes treatment and primary prevention of obesity will be key in reducing liver cancer in the longer-term.

Introduction: Pancreatic cancer currently ranks below female breast cancer in terms of the number of deaths in both males and females in the EU. While breast cancer mortality rates have been declining in many higher income EU countries during recent decades, rates of pancreatic cancer in contrast are either stable or moderately increasing; a comparative analysis of the short-term future rates of both is warranted.Methods: We extracted the annual number of deaths from cancers of the pancreas and breast by gender together with population at risk in each of 28 countries of the EU for the period 2001–2010. We fitted cancer- and gender-specific time-linear regression models and predicted deaths from pancreatic and breast cancer mortality for the years 2011–2025.Results: We estimated that by the year 2017 more deaths from pancreatic cancer will occur (91 500 annual deaths) than breast cancer (91 000) in the EU. By 2025, deaths from cancer of the pancreas are predicted to be 25% higher (111 500 and 90 000, respectively). Pancreatic cancer may become the third leading cause of death from cancer in the EU after lung and colorectal cancers.Conclusion: Although strategies may emerge in the near future that will enhance the prospects of improving the very poor five-year survival from pancreatic cancer, coordinated efforts are necessary to reduce the foreseeable high mortality burden of disease within the EU.

Trends in overall lung cancer incidence in different countries reflect the maturity of the smoking epidemic. Further understanding of the underlying causes for trends over time can be gained by assessing the trends by sex and histological subtype. We provide a temporal analysis of lung cancer incidence in 12 populations (11 countries), with a focus on cohort-specific trends for the main histological subtypes (squamous cell carcinomas (SCC), adenocarcinomas (AdC), and small cell carcinoma).We restrict the analysis to population-based registry data of sufficient quality to provide meaningful interpretation, using data in Europe, North America and Oceania, extracted from successive Cancer Incidence in Five Continents Volumes. Poorly specified morphologies were reallocated to a specified grouping on a population, 5-year period and age group basis.In men, lung cancer rates have been declining overall and by subtype, since the beginning of the study period, except for AdC. AdC incidence rates have risen and surpassed those of SCC (historically the most frequent subtype) in the majority of these populations, but started to stabilize during the mid-1980s in North America, Australia and Iceland. In women, AdC has been historically the most frequent subtype and rates continue to increase in most populations studied. Early signs of a decline in AdC can however be observed in Canada, Denmark and Australia among very recent female cohorts, born after 1950.The continuing rise in lung cancer among women in many countries reinforces the need for targeted smoking cessation efforts alongside preventive actions.

Abstract This study profiles testicular cancer incidence and mortality across Europe, and the effects of age, period and generational influences, using age‐period‐cohort modeling. Despite a 5‐fold variation in incidence rates, there were consistent mean increases in incidence in each of the 12 European countries studied, ranging from around 6% per annum (Spain and Slovenia) to 1–2% (Norway). In contrast, declines in testicular cancer mortality of 3–6% per annum were observed in the 1980s and 1990s for the majority of the 22 countries studied, particularly in Northern and Western Europe. The mortality trends in several European countries were rather stable (Romania and Bulgaria) or increasing (Portugal and Croatia). Short‐term attenuations in increasing cohort‐specific risk of incidence were indicated among men born between 1940 and 1945 in 7 European countries. In Switzerland, successive generations born from the mid 1960s may have experienced a steadily declining risk of disease occurrence. While the underlying risk factors responsible remain elusive, the temporal and geographical variability in incidence may point to an epidemic in different phases in different countries—the result of country‐specific differences in the prevalence of one or several ubiquitous and highly prevalent environmental determinants of the disease. Advances in treatment have led to major declines in mortality in many European countries from the mid 1970s, which has translated to cohorts of men at successively lower risk of death from the disease. Slower progress in the delivery of optimal care is however evident from the mortality trends in several lower‐resource countries in Southern and Eastern Europe. The first beneficiaries of therapy in these populations may be those men born—rather than diagnosed—in the era of major breakthrough in testicular cancer care. © 2006 Wiley‐Liss, Inc.

Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality. To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC). Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively. The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe). Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure.

Cervical screening and human papillomavirus (HPV) vaccination have been implemented in most high-income countries; however, coverage is low in low-income and middle-income countries (LMICs). In 2018, the Director-General of WHO announced a call to action for the elimination of cervical cancer as a public health problem. WHO has called for global action to scale-up vaccination, screening, and treatment of precancer, early detection and prompt treatment of early invasive cancers, and palliative care. An elimination threshold in terms of cervical cancer incidence has not yet been defined, but an absolute rate of cervical cancer incidence could be chosen for such a threshold. In this study, we aimed to quantify the potential cumulative effect of scaled up global vaccination and screening coverage on the number of cervical cancer cases averted over the 50 years from 2020 to 2069, and to predict outcomes beyond 2070 to identify the earliest years by which cervical cancer rates could drop below two absolute levels that could be considered as possible elimination thresholds-the rare cancer threshold (six new cases per 100 000 women per year, which has been observed in only a few countries), and a lower threshold of four new cases per 100 000 women per year.In this statistical trends analysis and modelling study, we did a statistical analysis of existing trends in cervical cancer worldwide using high-quality cancer registry data included in the Cancer Incidence in Five Continents series published by the International Agency for Research on Cancer. We then used a comprehensive and extensively validated simulation platform, Policy1-Cervix, to do a dynamic multicohort modelled analysis of the impact of potential scale-up scenarios for cervical cancer prevention, in order to predict the future incidence rates and burden of cervical cancer. Data are presented globally, by Human Development Index (HDI) category, and at the individual country level.In the absence of further intervention, there would be 44·4 million cervical cancer cases diagnosed globally over the period 2020-69, with almost two-thirds of cases occurring in low-HDI or medium-HDI countries. Rapid vaccination scale-up to 80-100% coverage globally by 2020 with a broad-spectrum HPV vaccine could avert 6·7-7·7 million cases in this period, but more than half of these cases will be averted after 2060. Implementation of HPV-based screening twice per lifetime at age 35 years and 45 years in all LMICs with 70% coverage globally will bring forward the effects of prevention and avert a total of 12·5-13·4 million cases in the next 50 years. Rapid scale-up of combined high-coverage screening and vaccination from 2020 onwards would result in average annual cervical cancer incidence declining to less than six new cases per 100 000 individuals by 2045-49 for very-high-HDI countries, 2055-59 for high-HDI countries, 2065-69 for medium-HDI countries, and 2085-89 for low-HDI countries, and to less than four cases per 100 000 by 2055-59 for very-high-HDI countries, 2065-69 for high-HDI countries, 2070-79 for medium-HDI countries, and 2090-2100 or beyond for low-HDI countries. However, rates of less than four new cases per 100 000 would not be achieved in all individual low-HDI countries by the end of the century. If delivery of vaccination and screening is more gradually scaled up over the period 2020-50 (eg, 20-45% vaccination coverage and 25-70% once-per-lifetime screening coverage by 2030, increasing to 40-90% vaccination coverage and 90% once-per-lifetime screening coverage by 2050, when considered as average coverage rates across HDI categories), end of the century incidence rates will be reduced by a lesser amount. In this scenario, average cervical cancer incidence rates will decline to 0·8 cases per 100 000 for very-high-HDI countries, 1·3 per 100 000 for high-HDI countries, 4·4 per 100 000 for medium-HDI countries, and 14 per 100 000 for low-HDI countries, by the end of the century.More than 44 million women will be diagnosed with cervical cancer in the next 50 years if primary and secondary prevention programmes are not implemented in LMICs. If high coverage vaccination can be implemented quickly, a substantial effect on the burden of disease will be seen after three to four decades, but nearer-term impact will require delivery of cervical screening to older cohorts who will not benefit from HPV vaccination. Widespread coverage of both HPV vaccination and cervical screening from 2020 onwards has the potential to avert up to 12·5-13·4 million cervical cancer cases by 2069, and could achieve average cervical cancer incidence of around four per 100 000 women per year or less, for all country HDI categories, by the end of the century. A draft global strategy to accelerate cervical cancer elimination, with goals and targets for the period 2020-30, will be considered at the World Health Assembly in 2020. The findings presented here have helped inform initial discussions of elimination targets, and ongoing comparative modelling with other groups is supporting the development of the final goals and targets for cervical cancer elimination.National Health and Medical Research Council (NHMRC) Australia, part-funded via the NHMRC Centre of Excellence for Cervical Cancer Control (C4; APP1135172).

<h2>Summary</h2> Cancer has become a leading cause of death in China, with an increasing burden of cancer incidence and mortality observed over the past half century. Population-based cancer registries have been operating in China for about 60 years, and, in 2018, their role has expanded to include the formulation and evaluation of national cancer control programmes and the care of patients with cancer. The purpose of this Review is to provide an overview of the key milestones in the development of cancer registration in China, the current status of registry coverage and quality, and a description of the changing cancer profile in China from 1973 to 2015. This Review is a comprehensive and updated review on the development of population-based cancer registries in China over a 60-year time span. We highlight some aspects of cancer control plans that illustrate how cancer registration data have become central to the identification of health priorities for China and provide a means to track progress in cancer control for the country.

Prostate cancer has emerged as the most frequent cancer amongst men in Europe, with incidence increasing rapidly over the past two decades. Incidence has been uniformly increasing in the 24 countries with comparable data available, although in a few countries with very high rates (Sweden, Finland and The Netherlands), incidence has begun to fall during the last 3-4 years. The highest prostate cancer mortality rates are in the Baltic region (Estonia, Latvia and Lithuania) and in Denmark, Norway and Sweden. Prostate cancer mortality has been decreasing in 13 of the 37 European countries considered - predominantly in higher-resource countries within each region - beginning in England and Wales (1992) and more recently in the Czech Republic (2004). There was considerable variability in the magnitude of the annual declines, varying from approximately 1% in Scotland (from 1994) to over 4% for the more recent declines in Hungary, France and the Czech Republic. There appears little relation between the extent of the increases in incidence (in the late 1990s) and the recent mortality declines. It remains unclear to what extent the increasing trends in incidence indicate true risk and how much is due to detection of latent disease. The decreasing mortality after 1990 may be attributable to improvements in treatment and to an effect of prostate specific antigen (PSA) testing. The increase in mortality observed in the Baltic region and in several Central and Eastern European countries appear to reflect a real increase in risk and requires further monitoring.

<h3>Importance</h3> Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts. <h3>Objective</h3> To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040. <h3>Design, Setting, and Participants</h3> This population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma. <h3>Main Outcomes and Measures</h3> Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040. <h3>Results</h3> A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). Melanoma continued to be rare in most African and Asian countries, with incidence rates commonly less than 1 per 100 000 person-years. Mortality rates peaked at 5 per 100 000 person-years in New Zealand, and geographic variations were less pronounced than for incidence. Melanoma was more frequent among males than females in most world regions. If 2020 rates continue, the burden from melanoma is estimated to increase to 510 000 new cases (a roughly 50% increase) and to 96 000 deaths (a 68% increase) by 2040. <h3>Conclusions and Relevance</h3> This epidemiological assessment suggests that melanoma remains an important challenge to cancer control and public health globally, especially in fair-skinned populations of European descent.

<h2>Abstract</h2><h3>Introduction</h3> Europe is an important focus for compiling accurate and up-to-date world cancer statistics owing to its large share of the world's total cancer burden. This article presents incidence and mortality estimates for 25 major cancers across 40 individual countries within European areas and the European Union (EU-27) for the year 2020. <h3>Methods</h3> The estimated national incidence and mortality rates are based on statistical methodology previously applied and verified using the most recently collected incidence data from 151 population-based cancer registries, mortality data and 2020 population estimates. <h3>Results</h3> Estimates reveal 4 million new cases of cancer (excluding non-melanoma skin cancer) and 1.9 million cancer-related deaths. The most common cancers are: breast in women (530,000 cases), colorectum (520,000), lung (480,000) and prostate (470,000). These four cancers account for half the overall cancer burden in Europe. The most common causes of cancer deaths are: lung (380,000), colorectal (250,000), breast (140,000) and pancreatic (130,000) cancers. In EU-27, the estimated new cancer cases are approximately 1.4 million in males and 1.2 million in females, with over 710,000 estimated cancer deaths in males and 560,000 in females. <h3>Conclusion</h3> The 2020 estimates provide a basis for establishing priorities in cancer-control measures across Europe. The long-established role of cancer registries in cancer surveillance and the evaluation of cancer control measures remain fundamental in formulating and adapting national cancer plans and pan-European health policies. Given the estimates are built on recorded data prior to the onset of coronavirus disease 2019 (COVID-19), they do not take into account the impact of the pandemic.

Background The overall incidence of colorectal cancer is decreasing in many high-income countries, yet analyses in the USA and other high-income countries such as Australia, Canada, and Norway have suggested increasing incidences among adults younger than 50 years. We aimed to examine longitudinal and generational changes in the incidence of colon and rectal cancer in seven high-income countries. Methods We obtained data for the incidence of colon and rectal cancer from 20 population-based cancer registries in Australia, Canada, Denmark, Norway, New Zealand, Ireland, and the UK for the earliest available year until 2014. We used age–period–cohort modelling to assess trends in incidence by age group, period, and birth cohort. We stratified cases by tumour subsite according to the 10th edition of the International Classification of Diseases. Age-standardised incidences were calculated on the basis of the world standard population. Findings An overall decline or stabilisation in the incidence of colon and rectal cancer was noted in all studied countries. In the most recent 10-year period for which data were available, however, significant increases were noted in the incidence of colon cancer in people younger than 50 years in Denmark (by 3·1%; per year), New Zealand (2·9% per year), Australia (2·9% per year), and the UK (1·8% per year). Significant increases in the average annual percentage change in the incidence of rectal cancer were also noted in this age group in Canada (by 3·4% per year), Australia (2·6% per year), and the UK (1·4% per year). Contemporaneously, in people aged 50–74 years, the average annual percentage change in the incidence of colon cancer decreased significantly in Australia (by 1·6% per year), Canada (1·9% per year), and New Zealand (3·4% per year) and of rectal cancer in Australia (2·4% per year), Canada (1·2% per year), and the UK (1·2% per year). Increases in the incidence of colorectal cancer in people younger than 50 years were mainly driven by increases in distal (left) tumours of the colon. In all countries, we noted non-linear cohort effects, which were more pronounced for rectal than for colon cancer. Interpretation We noted a substantial increase in the incidence of colorectal cancer in people younger than 50 years in some of the countries in this study. Future studies are needed to establish the root causes of this rising incidence to enable the development of potential preventive and early-detection strategies. Funding Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, National Cancer Registry Ireland, the Cancer Society of New Zealand, NHS England, Norwegian Cancer Society, Public Health Agency Northern Ireland, Scottish Government, Western Australia Department of Health, and Wales Cancer Network.

Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.

Primary liver cancer, the most common histologic types of which are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), is the second leading cause of cancer death worldwide. While rising incidence of liver cancer in low‐risk areas and decreasing incidence in some high‐risk areas has been reported, trends have not been thoroughly explored by country or by histologic type. We examined liver cancer incidence overall and by histology by calendar time and birth cohort for selected countries between 1978 and 2007. For each successive 5‐year period, age‐standardized incidence rates were calculated from volumes V‐IX of the Cancer Incidence in Five Continents electronic database (CI5 plus ) and the newly released CI5X (volume X) database. Wide global variations persist in liver cancer incidence. Rates of liver cancer remain highest in Asian countries, specifically Eastern and South‐Eastern Asian countries. While rates in most of these high‐risk countries have been decreasing in recent years, rates in India and several low‐risk countries of Africa, Europe, the Americas, and Oceania have been on the rise. Liver cancer rates by histologic type tend to convey a similar temporal profile. However, in Thailand, France, and Italy, ICC rates have increased while HCC rates have declined. We expect rates in high‐risk countries to continue to decrease, as the population seroprevalence of hepatitis B virus (HBV) continues to decline. In low‐risk countries, targeted screening and treatment of the hepatitis C virus (HCV), treatment of diabetes and primary prevention of obesity, will be key in reducing future liver cancer incidence.

Thyroid cancer (TC) incidence is rising in many countries, but the corresponding mortality is constant or declining. Incidence increases appear largely restricted to small papillary TC in young/middle-age individuals. We compared age-specific incidence rates across countries and time periods in order to estimate the fraction of TC possibly attributable to increased surveillance of the thyroid gland (diagnostic changes) following the introduction of neck ultrasonography in the 1980s.We focused on high-resource countries, including four Nordic countries, England and Scotland, France, Italy, the United States, Australia, Japan, and the Republic of Korea. Before the 1970s, TC incidence in Nordic countries increased proportionally to the second power of age, consistent with the multistage model of carcinogenesis. Using this historical observation for reference, we attributed the progressive departure from linearity of the age curves in each country to an increased detection of asymptomatic disease in young/middle-age individuals. The proportion of cases attributable to diagnostic changes was estimated from the difference between observed rates and those expected using the Nordic countries as reference.Diagnostic changes may account for ≥60% of TC cases diagnosed in 2003-2007 in women aged under 80 years in France, Italy, the United States, Australia, and the Republic of Korea, and approximately 50% in other assessed countries, except Japan (30%). The proportions attributable to diagnostic changes were higher in countries with largest incidence increases and were consistent across sexes, although increases were smaller and delayed in men.A large proportion of TC cases diagnosed in high-resource countries in the last two decades are likely to be due to diagnostic changes. This proportion has progressively increased over time, and it is likely to grow further in the future. Since there is evidence of harm but no proof of benefit from the intense scrutiny of the thyroid, the dangers of overdiagnosis and overtreatment of TC should be urgently addressed.

Cervical cancer mortality can be avoided to a large extent by screening and treatment of screen-detected cervical lesions. However, in 2004, more than 16,000 women died from cervical cancer in the European Union (EU). In the current paper, we analyse cervical cancer mortality trends in the 27 member states since 1970 and, subsequently, try to explain how screening and other factors have driven changes.Data on number of deaths from uterine cancers and overall female populations from EU member states were extracted from the World Health Organisation mortality database. Three different reallocation rules were applied to correct cervical cancer mortality for inaccuracies in certification of cause of death of not otherwise specified uterine cancer. Joinpoint regression was used to study annual variation of corrected cervical cancer mortality in all member states. We distinguished the 15 old from the 12 new member states, which acceded to the EU in 2004 or later. For Finland, France and Romania, age-specific trends by calendar period and the standardised cohort mortality ratios by birth cohort were analysed.Corrected age-standardised cervical cancer mortality rates have decreased significantly over the past decades in the old member states. Member states in Eastern Europe and also the Baltic states showed mortality rates that decreased at a lower intensity (Czech Republic, Poland), remained constant at a high rate (Estonia, Slovakia) or even increased (Bulgaria, Latvia, Lithuania, Romania). The standardised cohort mortality ratio indicated that mortality does not decrease further or even increase among women born after 1940.Remarkable contrasts were observed on cervical cancer mortality, in particular, between the old and new member states of the EU, which might probably be explained by differences in preventive strategies. This contrast might increase in the future, unless adequate preventive measures are adopted.

<h2>Summary</h2><h3>Background</h3> The incidence of thyroid cancer has increased in different populations worldwide in the past 30 years. We present here an overview of international trends of thyroid cancer incidence by major histological subtypes. <h3>Methods</h3> We did a population-based study with data for thyroid cancer incidence collected by the International Agency for Research on Cancer (IARC) for the period 1998–2012. Data were extracted from the Cancer Incidence in Five Continents <i>plus</i> compendium. We selected data for 25 countries that had a population of more than 2 million individuals covered by cancer registration (87 registries in total). Further criteria were that the selected registration areas had to have a proportion of unspecified thyroid cancer of less than 10% and analyses were restricted to individuals aged 20–84 years. We calculated age-specific incidence rates and age-standardised rates per 100 000 person-years for individuals aged 20 to 84 years, and assessed trends by country, sex, and major histological subtype (papillary, follicular, medullary, or anaplastic) based on absolute changes in age-standardised incidence rates between 1998–2002 and 2008–12. <h3>Findings</h3> Papillary thyroid cancer was the main contributor to overall thyroid cancer in all the studied countries, and was the only histological subtype that increased systematically in all countries, although with large variability between countries. In women, the age-standardised incidence rate of papillary thyroid cancer during 2008–12 ranged from 4·3–5·3 cases per 100 000 person-years in the Netherlands, the UK, and Denmark, to 143·3 cases per 100 000 women in South Korea. For men during the same period, the age-standardised incidence rates of papillary thyroid cancer per 100 000 person-years ranged from 1·2 cases per 100 000 in Thailand to 30·7 cases per 100 000 in South Korea. In many countries in Asia, the increase in papillary thyroid cancer rates in women was particularly pronounced after the year 2000; rates stabilised since around 2009 in the USA, Austria, Croatia, Germany, Slovenia, Spain, Lithuania, and Bulgaria. Temporal trends for follicular and medullary thyroid cancer did not show consistent patterns across countries, but slight decreases were seen for anaplastic thyroid cancer in 21 of 25 countries between 1998–2002, and 2008–12. In 2008–12, age-standardised rates for the follicular subtype ranged between 0·5 and 2·5 cases per 100 000 women (and between 0·3 and 1·5 per 100 000 men), while those for the medullary subtype were always less than 1 case per 100 000 women or men, and for anaplastic thyroid cancer less than 0·2 cases per 100 000 women or men. <h3>Interpretation</h3> In the period from 1998 to 2012, the rapid increases in thyroid cancer incidence were observed only for papillary thyroid cancer, the subtype more likely to be found in a subclinical form and therefore detected by intense scrutiny of the thyroid gland. <h3>Funding</h3> French Institut National du Cancer, Italian Association for Cancer Research, Italian Ministry of Health.

Internationally, ovarian cancer is the 7th leading cancer diagnosis and 8th leading cause of cancer mortality among women. Ovarian cancer incidence varies by region, particularly when comparing high vs. low-income countries. Temporal changes in reproductive factors coupled with shifts in diagnostic criteria may have influenced incidence trends of ovarian cancer and relative rates by histologic subtype. Accordingly, we evaluated trends in ovarian cancer incidence overall (1973–1977 to 2003–2007) and by histologic subtype (1988–1992 to 2003–2007) using volumes IV–IX of the Cancer Incidence in Five Continents database (CI5plus) and CI5X (volume X) database. Annual percent changes were calculated for ovarian cancer incidence trends, and rates of histologic subtypes for individual countries were compared to overall international incidence. Ovarian cancer incidence rates were stable across regions, although there were notable increases in Eastern/Southern Europe (e.g., Poland: Annual Percent Change (APC) 1.6%, p = 0.02) and Asia (e.g., Japan: APC 1.7%, p = 0.01) and decreases in Northern Europe (e.g., Denmark: APC −0.7%, p = 0.01) and North America (e.g., US Whites: APC −0.9%, p < 0.01). Relative proportions of histologic subtypes were similar across countries, except for Asian nations, where clear cell and endometrioid carcinomas comprised a higher proportion of the rate and serous carcinomas comprised a lower proportion of the rate than the worldwide distribution. Geographic variation in temporal trends of ovarian cancer incidence and differences in the distribution of histologic subtype may be partially explained by reproductive and genetic factors. Thus, histology-specific ovarian cancer should continue to be monitored to further understand the etiology of this neoplasm.

Abstract Background: Noncommunicable diseases, and especially cancers, are recognized as an increasing problem for low and middle income countries. Effective control programs require adequate information on the size, nature, and evolution of the health problem that they pose. Methods: We present estimates of the incidence and mortality of cancer in Africa in 2012, derived from “GLOBOCAN 2012,” published by the International Agency for Research on Cancer. Results: There were 847,000 new cancer cases (6% of the world total) and 591,000 deaths (7.2% of the world total) in the 54 countries of Africa in 2012, with about three quarters in the 47 countries of Sub-Saharan Africa. While the cancer profiles often differ markedly between regions, the most common cancers in men were prostate (16.4% of new cancers), liver (10.7%), and Kaposi sarcoma (6.7%); in women, by far the most important are cancers of the breast (27.6% of all cancers) and cervix uteri (20.4%). Conclusions: There are still deficiencies in surveillance systems, particularly in Sub-Saharan Africa and, specifically, of their most vital component, population-based cancer registries. With the number of annual cancer cases and deaths likely to increase by at least 70% by 2030, there is a pressing need for a coordinated approach to improving the extent and quality of services for cancer control in Africa, and better surveillance systems with which they can be planned and monitored. Impact: The results are the best data currently available and provide a reasonable appraisal of the cancer situation in Africa. Cancer Epidemiol Biomarkers Prev; 23(6); 953–66. ©2014 AACR.

5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents.

Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects.For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO.Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda).The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today.French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.

Prostate cancer is a significant public health burden and a major cause of morbidity and mortality among men worldwide. Analyzing geographic patterns and temporal trends may help identify high‐risk populations, suggest the degree of PSA testing, and provide clues to etiology. We used incidence data available from the International Agency for Research on Cancer (IARC) and certain cancer registries for 43 populations across five continents during a median period of 24 years. Trends in overall prostate cancer rates showed five distinct patterns ranging from generally monotonic increases to peaking of rates followed by declines, which coincide somewhat with changes in the prevalence of PSA testing. Trends in age‐specific rates generally mirrored those in the overall rates, with several notable exceptions. For populations where overall rates increased rapidly and then peaked, exemplified in North America and Oceania, the highest incidence tended to be most pronounced and occurred during earlier calendar years among older men compared with younger ones. For populations with almost continual increases in overall rates, exemplified in Eastern Europe and Asia, peaks were evident among men aged ≥75 years in many instances. Rates for ages 45–54 years did not clearly stabilize or decline in the majority of studied populations. Global geographic variation remained substantial for both overall and age‐specific incidence rates regardless of levels of PSA testing, with the lowest rates consistently in Asia. Explanations for the persistent geographic differences and the continuing increases of especially early‐onset prostate cancer remain unclear.

Primary liver cancer (PLC) is the sixth most common cancer worldwide and the second most common cause of cancer death. Future predictions can inform health planners and raise awareness of the need for cancer control action. We predicted the future burden of PLC in 30 countries around 2030. Incident cases of PLC (International Classification of Diseases, Tenth Revision, C22) were obtained from 30 countries for 1993-2007. We projected new PLC cases to 2030 using age-period-cohort models (NORDPRED software). Age-standardized incidence rates per 100,000 person-years were calculated by country and sex. Increases in new cases and rates of PLC are projected in both sexes. The largest increases in rates are, among men, in Norway (2.9% per annum), US whites (2.6%), and Canada (2.4%) and, among women, in the United States (blacks 4.0%), Switzerland (3.4%), and Germany (3.0%). The projected declines are in China, Japan, Singapore, and parts of Europe (e.g., Estonia, Czech Republic, Slovakia). A 35% increase in the number of new cases annually is expected compared to 2005. This increasing burden reflects both increasing rates (and the underlying prevalence of risk factors) and demographic changes. Japan is the only country with a predicted decline in the net number of cases and annual rates by 2030. Conclusion: Our reporting of a projected increase in PLC incidence to 2030 in 30 countries serves as a baseline for anticipated declines in the longer term through the control of hepatitis B virus and hepatitis C virus infections by vaccination and treatment; however, the prospect that rising levels of obesity and its metabolic complications may lead to an increased risk of PLC that potentially offsets these gains is a concern. (Hepatology 2018;67:600-611).

Testicular cancer (TC) is the most common cancer in men aged 15-44 yr in many countries that score high or very high on the Human Development Index (HDI). Despite the very good prognosis for TC, wide variations in mortality rates have been reported internationally.To describe and contrast global variations and recent trends in TC incidence and mortality rates.To compare TC incidence and mortality rates, we used GLOBOCAN 2008 estimates. We used the Cancer Incidence in Five Continents series to analyse recent trends in TC incidence in 41 countries by way of joinpoint analysis. To examine recent trends in mortality, we used the World Health Organisation mortality database.Northern Europe remains the highest TC incidence area, with the highest rates observed in Norway and Denmark. Incidence rates continue to increase in most countries worldwide, more markedly in Southern Europe and Latin America, while attenuating in Northern Europe, the United States, and Australia. Mortality from TC shows a different pattern, with higher rates in some countries of medium to high HDI. The highest mortality rates were seen in Chile and Latvia, as well as in selected Central European and Eastern European countries. In high-income countries, TC mortality rates are declining or stable at very low levels of magnitude, while no significant decreases were observed in middle-income regions in Latin America and Asia.The rises in TC incidence appear to be recently attenuating in countries with the highest HDIs, with corresponding mortality rates either continuing to decline or stabilising at very low levels. In a number of countries transiting towards higher levels of development, the TC incidence is increasing while mortality rates are stable or increasing.In this study we looked at international testicular cancer trends. We found that testicular cancer is becoming more common in low- and middle-income countries, where the optimal treatment might not yet be available.

In view of the growing global obesity epidemic, this paper reviews the relation between recent trends in body mass index (BMI) and the changing profile of cancer worldwide. By examining seven selected countries, each representing a world region, a pattern of increasing BMI with region and gender-specific diversity is noted: increasing levels of BMI were most pronounced in the Middle East (Saudi Arabia), rather modest in Eastern Asia (India) and generally more rapid in females than in males. This observation translates into a disproportionate distribution of cancer attributable to high levels of BMI, ranging by sex from 4-9% in Saudi Arabia and from 0.2-1.2% in India. Overweight and obesity may also influence cancer outcomes, and hence have a varying impact on cancer survival and death in different world regions. Future challenges in cancer studies exploring the association with overweight and obesity concern the measurement of adiposity and its potentially cumulative effect over the life course. Given the limitations of BMI as an imperfect measure of body fatness, routine anthropometric data collection needs to be extended to develop more informative measures, such as waist circumference in settings where the gold standard tools remain unaffordable. Furthermore, questions surrounding the dose-response and timing of obesity and their associations with cancer remain to be answered. Improved surveillance of health risk factors including obesity as well as the scale and profile of cancer in every country of the world is urgently needed. This will enable the design of cost-effective actions to curb the growing burden of cancer related to excess body weight.

Worldwide, prostate cancer (PCa) represents the second most common solid tumor in men.To assess the geographical distribution of PCa, epidemiological differences, and the most relevant risk factors for the disease.Estimated incidence, mortality, and prevalence of PCa for the year 2020 in 185 countries were derived from the IARC GLOBOCAN database. A review of English-language articles published between 2010 and 2020 was conducted using MEDLINE, EMBASE, and Scopus to identify risk factors for PCa.In the year 2020, there were over 1414000 estimated new cases of PCa worldwide, with an age-standardized rate (ASR) incidence of 31 per 100000 (lifetime cumulative risk: 3.9%). Northern Europe has the highest all-age incidence ASR (83), while the lowest ASR was in South-Central Asia (6.3). In the year 2020, there were over 375000 estimated deaths worldwide, and the overall mortality ASR was 7.7 per 100000, with the highest ASR in the Caribbean (28) and the lowest in South-Central Asia (3.1). Family history, hereditary syndromes, and race are the strongest risk factors for PCa. Metabolic syndrome was associated with the risk of developing PCa, high-grade disease, and adverse pathology. Diabetes and exposure to ultraviolet rays were found to be inversely associated to PCa incidence. Cigarette smoking and obesity may increase PCa-specific mortality, while regular physical activity may reduce disease progression. Although 5-alpha reductase inhibitors are known to be associated with a reduced incidence of PCa, available studies failed to show an effect on overall mortality.Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.Prostate cancer (PCa) rates vary profoundly worldwide, with incidence and mortality rates being highest in Northern Europe and Caribbean, respectively. South-Central Asia has the lowest epidemiological burden. Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease itself, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.

Socioeconomic factors are associated with cancer incidence through complex and variable pathways. We assessed cancer incidence for all cancers combined and 27 major types according to national human development levels. Using GLOBOCAN data for 184 countries, age‐standardized incidence rates (ASRs) were assessed by four levels (low, medium, high, very high) of the Human Development Index (HDI), a composite index of life expectancy, education, and gross national income. A strong positive relationship between overall cancer incidence and HDI level was observed. When comparing the ASR in very high HDI regions with that in low HDI regions, we observed a positive association ranging from 2 to 14 and 2 to 11 times higher in males and females, respectively, depending on the cancer type. Positive dose–response relationships between the ASR and HDI level were observed in both sexes for the following cancer types: lung, pancreas, leukemia, gallbladder, colorectum, brain/nervous system, kidney, multiple myeloma, and thyroid. Positive associations were also observed for testicular, bladder, lip/oral cavity, and other pharyngeal cancers, Hodgkin lymphoma, and melanoma of the skin in males, and corpus uteri, breast, and ovarian cancers and non‐Hodgkin lymphoma in females. A negative dose–response relationship was observed for cervical and other pharyngeal cancers and Kaposi sarcoma in females. Although the relationship between incidence and the HDI remained when assessed at the country‐specific level, variations in risk within HDI levels were also observed. We highlight positive and negative associations between incidence and human development for most cancers, which will aid the planning of cancer control priorities among countries undergoing human development transitions.