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Lancet Oncol. 2019 Jul 29. pii: S1470-2045(19)30339-0. doi: 10.1016/S1470-2045(19)30339-0. [Epub ahead of print]

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017.

Collaborators (171)

Force LM, Abdollahpour I, Advani SM, Agius D, Ahmadian E, Alahdab F, Alam T, Alebel A, Alipour V, Allen CA, Almasi-Hashiani A, Alvarez EM, Amini S, Amoako YA, Anber NH, Arabloo J, Artaman A, Atique S, Awasthi A, Bagherzadeh M, Basaleem H, Bekru ET, Bijani A, Bogale KA, Car M, Carvalho F, Castro C, Catalá-López F, Chu DT, Costa VM, Darwish AH, Demeke FM, Demis AB, Demoz GT, Dharmaratne SD, Do HP, Doan LP, Dubey M, Eftekhari A, El-Khatib Z, Emamian MH, Farhangi MA, Fernandes E, Fischer F, Fouladi Fard R, Friedrich PM, Fukumoto T, Gedefaw GA, Ghashghaee A, Gholamian A, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Harvey JD, Hassen HY, Hay SI, Hoang CL, Hole MK, Horita N, Hosseini SN, Hosseinzadeh M, Hsairi M, Hudson MM, Innos K, Jalilian F, James SL, Kasaeian A, Kassa TD, Kassebaum NJ, Keiyoro PN, Khader YS, Khubchandani J, Kianipour N, Kirby J, Kisa A, Kisa S, Kocarnik JM, Lauriola P, Lopez AD, Mägi M, Malik MA, Manafi A, Manafi N, Mansournia MA, Massenburg BB, Mehta V, Meles HG, Meretoja TJ, Mestrovic T, Mir SM, Mirzaei-Alavijeh M, Mohammad DK, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadibakhsh R, Mohammadoo-Khorasani M, Mokdad AH, Moodley Y, Moosazadeh M, Moossavi M, Moradpour F, Morrison SD, Muchie KF, Naghavi M, Nazari J, Ngunjiri JW, Nguyen CT, Nguyen LH, Nguyen SH, Nguyen TH, Nixon MR, Olagunju AT, Olagunju TO, Ong SK, Paapsi K, Pennini A, Pereira DM, Pillay JD, Qorbani M, Rabiee M, Rabiee N, Raoofi S, Rawaf DL, Rawaf S, Reiner RC, Rezaei N, Rezapour A, Roba KT, Robison LL, Rodriguez-Galindo C, Roshandel G, Safiri S, Salahshoor M, Salehi Zahabi S, Samy AM, Santric Milicevic MM, Satpathy M, Sawyer SM, Seyedmousavi S, Shabaninejad H, Shaikh MA, Shamshirian A, Shamsizadeh M, Shirkoohi R, Siabani S, Singh JA, SiRamlee K, Tabarés-Seisdedos R, Temsah MH, Tran BX, Ullah I, Vahedian-Azimi A, Vollset SE, Vos T, Waheed Y, Weldesamuel GT, Workie HM, Xu R, Yaseri M, Yonemoto N, Yu C, Zadnik V, Zahirian Moghadam T, Zaidi Z, Zangeneh A, Zewale TA, Ziapour A, Zodpey S, Murray CJL, Bhakta N, Fitzmaurice C.



Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs).


Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals.


Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6-12·3) DALYs due to childhood cancer, 97·3% (97·3-97·3) of which were attributable to YLLs and 2·7% (2·7-2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1-82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3-50·3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5-26·5) of global childhood cancer DALYs.


The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern.


Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.

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