Elsevier

The Lancet

Volume 380, Issue 9856, 24–30 November 2012, Pages 1840-1850
The Lancet

Articles
Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions

https://doi.org/10.1016/S0140-6736(12)60919-2Get rights and content

Summary

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.

Introduction

Cancer is a major cause of mortality worldwide, contributing to 7·6 million deaths in 2008.1 In the past few decades, combined successes of cancer prevention, early detection, screening, and treatment have reduced overall mortality in some developed countries because of declines in incidence or mortality from specific cancers, including lung, cervical, breast, and stomach cancer, and leukaemia.2, 3 With increases in cancer survivors in medium-resource to high-resource settings, interest has grown in the improvement of quality of life via reduction of cancer-related sequelae that lead to disability.4, 5, 6, 7 By contrast, cancer mortality in many low-income and middle-income countries continues to rise,3 whereas the extent to which survival has improved is variable.8, 9 In these settings, globalisation has doubled the burden of cancer with a residuum of infection-related cancers (particularly in sub-Saharan Africa) and a rise in incidence of cancers associated with progressively westernised lifestyles (eg, breast, colorectal, and prostate cancer) as levels of human development improve.10 Furthermore, increases in life expectancy have contributed to the rise in the global burden of cancer. Future changes in incidence aside, projections that consider population growth and ageing suggest that new cancer cases worldwide will increase from 12·7 million in 2008 to 21·4 million in 2030. This increase will be more substantial in low-resource and medium-resource countries than in high-resource countries (76% vs 25%).11, 12

Information about fatal and non-fatal cancer-related outcomes is needed to establish priorities in cancer control. Disability-adjusted life-years (DALYs) are a key measure for such purposes because they link the burden of cancer mortality with the degree of illness and disability in patients and long-term survivors.13

We present DALYs and their two components—years of life lost because of premature mortality (YLLs) and years lived with disability (YLDs)—for 27 cancers sites, separately and combined, for 184 countries and 12 world regions in 2008. We took account of global indicators of human development.

Section snippets

Data collection

A detailed description of the data sources and methods of estimation used to obtain the measures for calculation of DALYs have been described previously.14 We used the following country-specific and cancer-specific estimates to compute DALYs: population data (UN Population Division15); incidence and mortality (GLOBOCAN 200812); estimates of the proportion of cured and treated individuals14 (based on incidence to mortality ratios, survival estimates, and treatment data from cancer registries);

Results

An estimated 169·3 million healthy life-years were lost because of cancer in 2008. In absolute terms, Asia and Europe contributed to 73% of the overall burden of DALYs lost because of cancer (appendix p 3). DALYs in China accounted for 25% of the overall burden and those in India for 11%; these two regions accounted for 67% of the burden in Asia. Lung, liver, breast, stomach, colorectal, cervical, and oesophageal cancers, and leukaemia had the highest proportion of DALYs with a combined

Discussion

Worldwide, an estimated 169·3 million healthy life-years were lost because of cancer in 2008, with an estimated variation of five times in rates of DALYS by country. Asia and Europe were the main contributors to the overall burden of DALYs lost because of cancer, and breast, prostate, colorectal, and lung cancers made the largest combined contribution to total DALYs. Of YLLs and YLDs, YLLs were the most important component of DALYs in all world regions; however, the relative contribution to the

References (45)

  • P Farmer et al.

    Expansion of cancer care and control in countries of low and middle income: a call to action

    Lancet

    (2010)
  • RH Verhoeven et al.

    Testicular cancer: trends in mortality are well explained by changes in treatment and survival in the southern Netherlands since 1970

    Eur J Cancer

    (2007)
  • DM Parkin et al.

    Evaluation of data quality in the cancer registry: principles and methods Part II. Completeness

    Eur J Cancer

    (2009)
  • R Sankaranarayanan et al.

    Research on cancer prevention, detection and management in low- and medium-income countries

    Ann Oncol

    (2010)
  • J Ferlay et al.

    Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008

    Int J Cancer

    (2010)
  • G Engholm et al.

    NORDCAN—a Nordic tool for cancer information, planning, quality control and research

    Acta Oncol

    (2010)
  • A Jemal et al.

    Global patterns of cancer incidence and mortality rates and trends

    Cancer Epidemiol Biomarkers Prev

    (2010)
  • Cancer survivors: living longer, and now, better

    Lancet

    (2004)
  • R Sankaranarayanan

    Cancer survival in Africa, Asia, the Caribbean and Central America. Introduction

    IARC Sci Publ

    (2011)
  • R Sankaranarayanan et al.

    Cancer survival developing countries

    IARC Sci Publ

    (1998)
  • DM Parkin et al.

    Changing cancer incidence in Kampala, Uganda, 1991–2006

    Int J Cancer

    (2010)
  • GLOBOCAN 2008: cancer incidence, mortality, and prevalence worldwide in 2008

  • Cited by (0)

    View full text