Changing Profiles of Cancer Burden Worldwide and in China

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Changing Profiles of Cancer Burden Worldwide and in China: A Secondary Analysis of the Global Cancer Statistics 2020

Introduction

Cancer remains a leading cause of global mortality, with significant disparities in burden across regions. The GLOBOCAN 2020 database provides updated estimates of cancer incidence and mortality, revealing critical shifts in global cancer profiles. This analysis highlights key changes from 2018 to 2020, emphasizing China’s evolving cancer epidemiology and its implications for public health strategies.

Global Cancer Burden in 2020

In 2020, an estimated 19.3 million new cancer cases and 10 million cancer-related deaths occurred worldwide. Breast cancer surpassed lung cancer as the most diagnosed cancer, with 2.26 million new cases (11.7% of global cases). Lung cancer remained the deadliest, causing 1.8 million deaths (18% of total mortality). Liver cancer rose to the second-leading cause of cancer deaths, displacing stomach cancer, which saw a decline in mortality.

Key trends include:

  1. Breast cancer dominance: Increased incidence linked to reproductive changes (delayed childbirth, reduced breastfeeding) and rising obesity in postmenopausal women.
  2. Liver cancer mortality: Driven by hepatitis B/C infections and alcohol consumption, accounting for over 80% of cases.
  3. Regional disparities: High-income regions reported higher rates of colorectal and prostate cancers, while low-income areas faced elevated burdens of infection-related cancers like cervical cancer.

Asia bore nearly 50% of global cases and 58% of deaths, reflecting its large population and varying human development indices (HDI). Europe and North America had higher age-standardized incidence rates (ASIRs: 285.2 and 360.7 per 100,000, respectively), while Africa had the lowest ASIR (132.1 per 100,000) but high mortality due to late-stage diagnoses.

China’s Cancer Burden in Global Context

China accounted for 24% of global new cases (4.57 million) and 30% of deaths (3 million) in 2020. Its ASIR of 204.8 per 100,000 ranked 65th globally, while its ASMR of 129.4 per 100,000 ranked 13th, exceeding global averages. Key findings include:

Incidence and Mortality Trends

  • Lung cancer: Remained the most common cancer (0.82 million new cases) and leading cause of death (0.72 million deaths), representing 38% of global lung cancer cases in men.
  • Breast cancer: Became the most diagnosed cancer in women (416,371 cases), reflecting lifestyle shifts and increased screening.
  • Gastrointestinal cancers: Stomach, colorectal, liver, and esophageal cancers collectively caused 45% of deaths, highlighting persistent challenges in early detection and treatment.

Sex-Specific Patterns

  • Men: Lung (38% of global male cases), stomach, colorectal, liver, and esophageal cancers dominated. Prostate cancer ranked sixth in incidence but had low mortality.
  • Women: Breast cancer surged, with thyroid cancer rising to the fourth most common. Cervical cancer accounted for 18% of global cases, underscoring gaps in prevention.

Temporal Shifts (2015–2020)

  • Colorectal cancer incidence increased rapidly, aligning with Westernized diets.
  • Liver cancer diagnoses declined slightly but remained a major killer due to hepatitis prevalence.
  • Mortality rankings remained stable, emphasizing the need for targeted interventions.

Regional and International Comparisons

China’s cancer profile contrasts with neighboring countries:

  • Japan and South Korea: Higher ASIRs (285.1 and 242.7 per 100,000) but lower ASMRs due to advanced healthcare.
  • High-HDI regions: Lower gastrointestinal cancer mortality, attributed to screening and treatment access.

Projections to 2040

Global cancer cases are projected to rise by 49% (28.4 million) and deaths by 62% (16.2 million) by 2040. China anticipates 6.85 million new cases and 5.07 million deaths, driven by aging and population growth. Asia, Africa, and Latin America will face the steepest increases, necessitating scalable prevention strategies.

Implications for Cancer Control

Global Priorities

  1. Breast cancer prevention: Promote breastfeeding, reduce obesity, and expand mammography.
  2. Liver cancer reduction: Scale up hepatitis vaccination and antiviral therapies.
  3. Tobacco control: Critical for reducing lung cancer mortality.

China’s Challenges

  1. Gastrointestinal cancers: Improve early detection via endoscopic screening and public awareness.
  2. Healthcare infrastructure: Address disparities in rural vs. urban access to diagnostics and treatment.
  3. Registry systems: Enhance data quality from 1,152 registries to guide policy.

Conclusion

The transition in cancer profiles—marked by rising breast and colorectal cancers—reflects global socioeconomic shifts. China’s high mortality from lung and gastrointestinal cancers underscores the urgency of tailored interventions. Strengthening prevention, early detection, and healthcare equity will be vital to mitigate the growing burden.

doi.org/10.1097/CM9.0000000000001474

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