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