Global Cancer Statistics
Ahmedin Jemal,DVM,PhD1;Freddie Bray,PhD2;Melissa M.Center,MPH3;Jacques Ferlay,ME4;
Elizabeth Ward,PhD5;David Forman,PhD6
Abstract
The global burden of cancer continues to increa largely becau of the aging and growth of the world population alongside
an increasing adoption of cancer-causing behaviors,particularly smoking,in economically developing countries.Bad on the GLOBOCAN2008estimates,about12.7million cancer cas and7.6million cancer deaths are estimated to have occurred in 2008;of the,56%of the cas and64%of the deaths occurred in the economically developing world.Breast cancer is the most frequently diagnod cancer and the leading cau of cancer death among females,accounting for23%of the total cancer cas and14%of the cancer deaths.Lung cancer is the leading cancer site in males,comprising17%of the total new cancer cas and23%of the total cancer deaths.Breast cancer is now also the leading cau of cancer death among females in eco-nomically developing countries,a shift from the previous decade d
uring which the most common cau of cancer death was cer-vical cancer.Further,the mortality burden for lung cancer among females in developing countries is as high as the burden for cer-vical cancer,with each accounting for11%of the total female cancer deaths.Although overall cancer incidence rates in the developing world are half tho en in the developed world in both xes,the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries,most likely becau of a combination of a late stage at diagnosis and limited access to timely and standard treatment.A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control,vaccination(for
liver and cervical cancers),and early detection and treatment,as well as public health campaigns promoting physical activity and
a healthier dietary intake.Clinicians,public health professionals,and policy makers can play an active role in accelerating the application of such interventions globally.CA Cancer J Clin2011;61:69–90.V C2011American Cancer Society,Inc. Introduction
Cancer is the leading cau of death in economically developed countries and the cond leading cau of death
in developing countries.1The burden of cancer is increasing in economically developing countries as a result of population aging and growth as well as,increasingly,an adoption of cancer-associated lifestyle choices including smoking,physical inactivity,and‘‘westernized’’diets.In this article,we provide an overview of the global cancer burden,including the estimated number of new cancer cas and deaths in2008and the incidence and mortality rates by region for lected cancer sites.The statistics are bad on GLOBOCAN2008,2the standard t of worldwide estimates of cancer incidence and mortality produced by the International Agency for Rearch on Cancer(IARC)for2008.We comment on the recent incidence and mortality patterns obrved for a number of common cancer forms,alongside established preventive measures that can reduce the worldwide cancer burden. Data Sources and Methods
Incidence data(the number of newly diagnod cas each year)are derived from population-bad cancer registries,which may cover entire national populations but more often cover smaller,subnational areas,and, particularly in developing countries,only urban environments,such as major cities.Although the quality of
1Vice President,Surveillance Rearch,American Cancer Society,Atlanta,GA;2Deputy Head,Section of Cancer Information,International Agency for Rearch on Cancer,Lyon,France;3Epidemiologist,Su
rveillance Rearch,American Cancer Society,Atlanta,GA;4Informatics Officer,Section of Cancer Information,International Agency for Rearch on Cancer,Lyon,France;5National Vice President,Intramural Rearch,American Cancer Society,Atlanta, GA;6Head,Section of Cancer Information,International Agency for Rearch on Cancer,Lyon,France.
Corresponding author:Ahmedin Jemal,DVM,PhD,Surveillance Rearch,American Cancer Society,250Williams Street,NW,Atlanta,GA30303-1002; ahmedin.
DISCLOSURES:The authors report no conflicts of interest.
V C2011American Cancer Society,Inc.doi:10.3322/caac.20107.
Available online at and
VOLUME61_NUMBER2_MARCH/APRIL201169
information from most of the developing countries might be considered,in relative terms,of limited qual-ity,it often remains the only source of information available on the profile of cancer and as such provides valuable information.The total number of cancer deaths by country are collected annually and are made available by the World Health Organization (WHO).3The advantages of this source of
data are its national coverage and long-term availability,although not all datats are of the same quality or complete-ness.Provisional estimates of the age-and x-specific deaths from cancer(of all types)for2008have been ud1in regions of the world with either no death in-formation or where official statistics are deemed unre-liable,and corrected for possible incompleteness. Incidence and mortality rates(number of cas or deaths per100,000persons per year)were estimated in GLOBOCAN2by country,using the most recently available data collected at the IARC or avail-able in routine reports from the registries themlves. National incidence rates were estimated using one of veral methods,dependant on the availability and quality of data,in the following order of priority:
1.National incidence data.When historical data
and a sufficient number of recorded cas were available,incidence rates were projected to2008.
2.National mortality data and local registry data.
Estimation of incidence bad on regression models,specific for x,site,and age,derived from subnational or regional cancer registry data.
3.Regional incidence data from one or more can-
cer registries but no mortality data.National incidence derived from a single t or a weighted average of local rates.
4.Frequency data.Only data on the relative fre-
quency of different cancers(by x,site,and age groups)available.The proportions are applied to estimates of the all-cancer incidence rate for the country,derived from cancer registry data within the same region.
5.No data available.Country-specific rates equated to
tho of neighboring countries in the same region. Similar procedures were ud to estimate country-specific mortality rates,in the following order of priority:
1.National mortality data.Projections to2008
where possible.
2.Sample mortality data.The age-and x-specific
all-cancer mortality envelopes provided nationally
for2008by the WHO were partitioned by site using the sample mortality data.
3.No mortality data.National mortality was derived
from incidence and cancer-and country-specific survival probabilities(bad on level of gross domestic product),and then scaled to the WHO all-cancer mortality envelope for2008. Country-specific incidence and mortality rates were prepared for27types of cancer(including Kaposi sarcoma[KS]for sub-Saharan African coun-tries),by x and for10age groups(0-14,15-39, 40-44,45-49,…70-74,and75þyears).A full description of the data and methods ud for each country and the corresponding results are available in GLOBOCAN2008(available at www. globocan.iarc.fr).4Estimates for the20world regions (Fig.1)and for more and less developed regions,as defined by the United Nations(UN),5were obtained as the population-weighted average of the incidence and mortality rates of the component countries. The rates were age-standardized(ASRs)(per 100,000person-years)using the World Standard Population as propod by Segi and modified by Doll et al.6,7The cumulative risk of developing or dying from cancer before the age of75years(in the abnce of competing caus of death)was also calculated and is expresd as a percentage. Results and Discussion
Estimated Number of New Cancer
Cas and Deaths
About12.7million cancer cas and7.6million cancer deaths are estimated to have occurred in2008world-wide(Fig.2),with56%of the cas and64%of the deaths in the economically developing world.Breast cancer in females and lung cancer in males are the most frequently diagnod cancers and the leading cau of cancer death for each x in both economically developed and developing countries,except lung can-cer is preceded by prostate cancer as the most frequent cancer among males in economically developed coun-tries.The cancers were followed,without specific rank order,by stomach and liver cancers in males and cervix and lung cancers in females in economically developing countries and by colorectal and lung can-cers in females and colorectal and lung or prostate cancers in males in the economically developed world.
70CA:A Cancer Journal for Clinicians
Incidence
and Mortality Rates for All Cancers Combined and Top 22Cancer Sites
While incidence rates for all cancers combined in economically developed countries are nearly twice as high as in economically developing countries in both males and females (Table 1),mortality rates for all cancers combined in developed countries are only 21%higher in males and only 2%higher in females.Such disparities in incidence and mortality patterns between developed and developing countries will reflect,for a given cancer,regional differences in the prevalence and distribution of the major risk factors,detection practices,and/or the availability and u of treatment rvices.Prostate,colorectal,female breast,and lung cancer rates are 2to 5times higher in developed countries compared with developing countries,a result of variations in a disparate t of risk factors and diagnostic practices.The conver is true for cancers related to infections such as stomach,liver,and cervical cancers (Table 1).Table 2shows the overall cancer incidence and mortality rates by x according to world areas.The incidence rate for both xes combined is more than 3times as high in Australia/New Zealand as that in Middle Africa.It should also be noted that cancer tends to be diagnod at later stages in many developing coun-
tries compared with developed countries and this,combined with reduced access to appropriate thera-peutic facilities and drugs (Fig.3),has an adver effect on survival.A recent comparative surve
y of cancer survival rates in Africa,Asia,and Central America 8bad on patients diagnod in the 1990s indicates substantially lower survival rates in parts of Africa,India,and the Philippines than for tho diagnod in Singapore,South Korea,and parts of China.For example,breast cancer 5-year survival rates were 50%or less in the former populations and over 75%in the latter.Such comparisons were simi-lar to tho obrved in the CONCORD study 9for an earlier time period.
Selected Cancers
Female Breast Cancer
Breast cancer is the most frequently diagnod can-cer and the leading cau of cancer death in females worldwide,accounting for 23%(1.38million)of the total new cancer cas and 14%(458,400)of the total cancer deaths in 2008(Fig.2).About half the breast cancer cas and 60%of the deaths are estimated to occur in economically developing countries.In general,incidence rates are high in Western and
FIGURE 1.Twenty World Areas.
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FIGURE2.Estimated New Cancer Cas and Deaths Worldwide for Leading Cancer Sites by Level of Economic Development,2008.Source:GLOBOCAN 2008.
72CA:A Cancer Journal for Clinicians
TABLE1.Incidence and Mortality Rates and Cumulative Probability of Developing Cancer by Age75by Sex and Cancer Site for More Developed and Less Developed Areas,2008
MORE DEVELOPED AREAS LESS DEVELOPED AREAS
INCIDENCE MORTALITY INCIDENCE MORTALITY
ASR CUMULATIVE RISK
(%)[AGE0-74]ASR
CUMULATIVE RISK
(%)[AGE0-74]ASR
CUMULATIVE RISK
(%)[AGE0-74]ASR
CUMULATIVE RISK
(%)[AGE0-74]
Males
All cancers*(C00-97,but C44)300.130.1143.915.0160.317.0119.312.7
Bladder(C67)16.6 1.9 4.60.5 5.40.6 2.60.3
Brain,nervous system(C70-72) 6.00.6 3.90.4 3.20.3 2.60.3
Colorectum(C18-21)37.6 4.415.1 1.712.1 1.4 6.90.8
Esophagus(C15) 6.50.8 5.30.611.8 1.410.1 1.2
Gallbladder(C23-24) 2.40.3 1.60.2 1.40.2 1.10.1
Hodgkin lymphoma(C81) 2.20.20.40.00.90.10.60.1
Kidney(C64-66)11.8 1.4 4.10.5 2.50.3 1.30.1
Larynx(C32) 5.50.7 2.40.3 3.50.4 2.10.3
Leukemia(C91-95)9.10.9 4.80.5 4.50.4 3.70.3
Liver(C22)8.1 1.07.20.918.9 2.217.4 2.0
Lung(C33-34)47.4 5.739.4 4.727.8 3.324.6 2.9
Melanoma of skin(C43)9.5 1.0 1.80.20.70.10.30.0
Multiple myeloma(C88þC90) 3.30.4 1.90.20.90.10.80.1
Nasopharynx(C11)0.60.10.30.0 2.10.2 1.40.2
Non-Hodgkin lymphoma(C82-85,C96)10.3 1.1 3.60.4 4.20.5 3.00.3
Oral cavity(C00-08) 6.90.8 2.30.3 4.60.5 2.70.3
Other pharynx(C09-10,C12-14) 4.40.5 2.20.3 3.00.4 2.50.3
Pancreas(C25)8.2 1.07.90.9 2.70.3 2.50.3
Prostate(C61)62.07.810.60.912.0 1.4 5.60.5
Stomach(C16)16.7 2.010.4 1.221.1 2.516.0 1.9
Testis(C62) 4.60.40.30.00.80.10.30.0
Thyroid(C73) 2.90.30.30.0 1.00.10.30.0
Females
All cancers*(C00-97,but C44)225.522.087.39.1138.014.085.49.0
Bladder(C67) 3.60.4 1.00.1 1.40.20.70.1
Brain,nervous system(C70-72) 4.40.4 2.60.3 2.80.3 2.00.2
Breast(C50)66.47.115.3 1.727.3 2.810.8 1.2
Cervix uteri(C53)9.00.9 3.20.317.8 1.99.8 1.1
Colorectum(C18-21)24.2 2.79.7 1.09.4 1.1 5.40.6
Corpus uteri(C54)12.9 1.6 2.40.3 5.90.7 1.70.2
Esophagus(C15) 1.20.1 1.00.1 5.70.7 4.70.5
Gallbladder(C23-24) 2.10.2 1.50.2 2.20.3 1.70.2
Hodgkin lymphoma(C81) 1.90.20.30.00.50.10.30.0
Kidney(C64-66) 5.80.7 1.70.2 1.40.20.80.1
Larynx(C32)0.60.10.20.00.60.10.40.0
Leukemia(C91-95) 6.00.6 2.90.3 3.60.3 2.90.3
Liver(C22) 2.70.3 2.50.37.60.97.20.8
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