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JAMA Oncol. 2018 Nov 1;4(11):1553-1568. doi: 10.1001/jamaoncol.2018.2706.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study.

Global Burden of Disease Cancer Collaboration, Fitzmaurice C1,2,3, Akinyemiju TF4, Al Lami FH5, Alam T2, Alizadeh-Navaei R6, Allen C2, Alsharif U7, Alvis-Guzman N8, Amini E9,10, Anderson BO11, Aremu O12, Artaman A13, Asgedom SW14, Assadi R15, Atey TM14, Avila-Burgos L16, Awasthi A17, Ba Saleem HO18, Barac A19, Bennett JR2, Bensenor IM20, Bhakta N21, Brenner H22, Cahuana-Hurtado L16, Castañeda-Orjuela CA23,24, Catalá-López F25,26, Choi JJ27,28, Christopher DJ29, Chung SC30, Curado MP31,32, Dandona L2,33, Dandona R2,33, das Neves J34,35, Dey S36, Dharmaratne SD37, Doku DT38,39, Driscoll TR40, Dubey M41, Ebrahimi H9,42, Edessa D43, El-Khatib Z44,45, Endries AY46, Fischer F47, Force LM21, Foreman KJ2,48, Gebrehiwot SW49, Gopalani SV50, Grosso G51,52, Gupta R53, Gyawali B54, Hamadeh RR55, Hamidi S56, Harvey J2, Hassen HY57, Hay RJ58,59, Hay SI2,60, Heibati B61, Hiluf MK62, Horita N63, Hosgood HD64, Ilesanmi OS65, Innos K66, Islami F67, Jakovljevic MB68,69, Johnson SC2, Jonas JB70, Kasaeian A71,72, Kassa TD14, Khader YS73, Khan EA74, Khan G75, Khang YH76,77, Khosravi MH78,79, Khubchandani J80, Kopec JA81, Kumar GA33, Kutz M2, Lad DP82, Lafranconi A83, Lan Q84, Legesse Y14, Leigh J85, Linn S86, Lunevicius R87,88, Majeed A89, Malekzadeh R90, Malta DC91, Mantovani LG83, McMahon BJ92, Meier T93, Melaku YA94,95, Melku M96, Memiah P97, Mendoza W98, Meretoja TJ99,100, Mezgebe HB14, Miller TR101,102, Mohammed S103,104, Mokdad AH2, Moosazadeh M105, Moraga P106, Mousavi SM107, Nangia V108, Nguyen CT109, Nong VM109, Ogbo FA110, Olagunju AT111,112,113, Pa M114, Park EK115, Patel T116, Pereira DM117, Pishgar F10,118, Postma MJ119,120, Pourmalek F81, Qorbani M121, Rafay A122,123, Rawaf S48, Rawaf DL124,125,126, Roshandel G90,127, Safiri S128, Salimzadeh H129, Sanabria JR130,131, Santric Milicevic MM132,133, Sartorius B134,135, Satpathy M136, Sepanlou SG90, Shackelford KA2, Shaikh MA137, Sharif-Alhoseini M138, She J139, Shin MJ140, Shiue I141,142, Shrime MG143, Sinke AH144, Sisay M43, Sligar A2, Sufiyan MB145, Sykes BL146, Tabarés-Seisdedos R25, Tessema GA96,147, Topor-Madry R148,149, Tran TT109, Tran BX150,151, Ukwaja KN152, Vlassov VV153, Vollset SE2, Weiderpass E154,155,156,157, Williams HC158, Yimer NB159, Yonemoto N160, Younis MZ161, Murray CJL2, Naghavi M2.

Author information

1
Division of Hematology, Department of Medicine, University of Washington, Seattle.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
3
Fred Hutchinson Cancer Research Center, Seattle, Washington.
4
Department of Epidemiology, University of Alabama at Birmingham.
5
Baghdad College of Medicine, Baghdad, Baghdad, Iraq.
6
Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
7
Charite University Medicine Berlin, Charité Universitätsmedizin, Berlin, Berlin, Germany.
8
ALZAK Foundation-Universidad de la Costa, Universidad de Cartagena, Universidad de Cartagena, Cartagena de Indias, Colombia.
9
Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
10
Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
11
University of Washington, Seattle.
12
Birmingham City, University Department of Public Health and Therapies, Birmingham, England.
13
University of Manitoba, Winnipeg, Manitoba, Canada.
14
Mekelle University, Mekelle, Ethiopia.
15
Mashhad University of Medical Sciences, Mashhad, Iran.
16
National Institute of Public Health, Cuernavaca, Morelos, Mexico.
17
Indian Institute of Public Health, Gandhinagar, Gujarat, India.
18
Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen.
19
Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia.
20
University of São Paulo, São Paulo, São Paulo, Brazil.
21
St Jude Children's Research Hospital, Memphis, Tennessee.
22
German Cancer Research Center, Heidelberg, Germany.
23
Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Bogota, DC, Colombia.
24
Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogota, Colombia.
25
Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain.
26
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
27
Seoul National University Hospital, Seoul, South Korea.
28
Seoul National University Medical Library, Seoul, South Korea.
29
Christian Medical College, Vellore, Tamilnadu, India.
30
The Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, England.
31
Accamargo Cancer Center, Sao Paulo, Sao Paulo, Brazil.
32
International Prevention Research Institute, Ecully, France.
33
Public Health Foundation of India, Gurugram, National Capital Region, India.
34
INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.
35
i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
36
Indian Institute of Public Health, Delhi, India.
37
Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
38
University of Cape Coast, Cape Coast, Ghana.
39
University of Tampere, Tampere, Finland.
40
Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
41
International Institute for Population Sciences, Mumbai, Maharashtra, India.
42
Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
43
Haramaya University, Harar, Ethiopia.
44
Department of Global Health and Social Medicine, Harvard Medical School, Kigali, Rwanda.
45
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
46
Arba Minch University, Arba Minch, SNNPR, Ethiopia.
47
School of Public Health, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.
48
Imperial College London, London, England.
49
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
50
Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia.
51
University Hospital Policlinico "Vittorio Emanuele," Catania, Italy.
52
NNEdPro Global Centre for Nutrition and Health, Cambridge, England.
53
West Virginia Bureau for Public Health, Charleston.
54
Aarhus University, Aarhus, Denmark.
55
Arabian Gulf University, Manama, Bahrain.
56
Haan Bin Mohammed Smart University, Dubai, United Arab Emirates.
57
Mizan Tepi University, Mizan Teferi, Ethiopia.
58
International Foundation for Dermatology, London, England.
59
King's College London, London, England.
60
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England.
61
Air Pollution Research Center, Iran University of Medical Sciences, Tehran, Iran.
62
Samara University, Samara, Ethiopia.
63
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
64
Albert Einstein College of Medicine, Bronx, New York, USA.
65
National Public Health Institute, Monrovia, Monserrado County, Liberia.
66
National Institute for Health Development, Tallinn, Estonia.
67
Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
68
Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Central Serbia, Serbia.
69
Center for Health Trends and Forecasts, University of Washington, Seattle.
70
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
71
Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
72
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
73
Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan.
74
Health Services Academy, Islamabad, Punjab, Pakistan.
75
Department of Microbiology and Immunology, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.
76
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.
77
Institute of Health Policy and Management, Seoul National University Medical Center, Seoul, South Korea.
78
Baqiyatallah University of Medical Sciences, Tehran, Iran.
79
International Otorhinolaryngology Research Association (IORA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
80
Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
81
University of British Columbia, Vancouver, British Columbia, Canada.
82
Post Graduate Institute of Medical Education and Research, Chandigarh, India.
83
University of Milano Bicocca, Monza, MB, Italy.
84
National Cancer Institute, Rockville, Maryland.
85
University of Sydney, Sydney, New South Wales, Australia.
86
University of Haifa, Haifa, Israel.
87
Aintree University Hospital National Health Service Foundation Trust, Liverpool, England.
88
School of Medicine, University of Liverpool, Liverpool, England.
89
Department of Primary Care & Public Health, Imperial College London, London, England.
90
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
91
Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
92
Alaska Native Tribal Health Consortium, Anchorage.
93
Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Martin Luther University Halle-Wittenberg, Saale, Germany.
94
School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
95
School of Public Health, Mekelle University, Mekelle, Ethiopia.
96
University of Gondar, Gondar, Ethiopia.
97
University of West Florida, Pensacola, Florida.
98
United Nations Population Fund, Lima, Peru.
99
Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland.
100
University of Helsinki, Helsinki, Finland.
101
Pacific Institute for Research & Evaluation, Calverton, Maryland.
102
School of Public Health, Curtin University, Perth, Western Australia, Australia.
103
Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.
104
Institute of Public Health, Heidelberg University, Heidelberg, Baden Wuettemberg, Germany.
105
Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
106
Lancaster Medical School, Lancaster University, Lancaster, England.
107
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
108
Suraj Eye Institute, Nagpur, Maharashtra, India.
109
Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
110
Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia.
111
Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Lagos State, Nigeria.
112
Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria.
113
Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia.
114
JSS Medical College (PA), JSS University, Mysore, Karnataka, India.
115
Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
116
White Plains Hospital, White Plains, New York.
117
REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal.
118
Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
119
University Medical Center Groningen, Groningen, the Netherlands.
120
University of Groningen, Groningen, the Netherlands.
121
Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
122
Contech International Health Consultants, Lahore, Pakistan.
123
Contech School of Public Health, Lahore, Pakistan.
124
North Hampshire Hospitals, Basingstroke, England.
125
University College London Hospitals, London, England.
126
WHO Collaborating Centre, Imperial College of London, London, England.
127
Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
128
Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran.
129
Tehran University of Medical Sciences, Tehran, Iran.
130
Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
131
Case Western Reserve University, Cleveland, Ohio.
132
Centre School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia.
133
Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia.
134
Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
135
UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa.
136
Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India.
137
Independent Consultant, Karachi, Pakistan.
138
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
139
Department of Pulmonary Medicine, Zhongshan Hospital (She), Fudan University, Shanghai, China.
140
Department of Public Health Sciences, Korea University, Seoul, South Korea.
141
Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, Scotland.
142
Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin Luther University Halle-Wittenberg, Saale, Germany.
143
Harvard Medical School, Kigali, Rwanda.
144
Ethiopian Medical Association, Addis Ababa, Ethiopia.
145
Ahmadu Bello University, Zaria, Nigeria.
146
Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine.
147
University of Adelaide, Adelaide, South Australia, Australia.
148
Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
149
Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
150
Johns Hopkins University, Baltimore, Maryland.
151
Hanoi Medical University, Hanoi, Vietnam.
152
Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
153
National Research University Higher School of Economics, Moscow, Russia.
154
Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
155
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
156
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
157
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
158
Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, England.
159
Woldia University, Woldia, Amhara, Ethiopia.
160
Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
161
Jackson State University, Jackson, Mississippi.

Abstract

Importance:

The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.

Objective:

To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.

Evidence Review:

Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.

Findings:

In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories.

Conclusions and Relevance:

Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

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