ArticlesGlobal cancer transitions according to the Human Development Index (2008–2030): a population-based study
Introduction
Global action is needed to stem the increasing burden of non-communicable diseases, especially in low-income and middle-income countries1, 2, 3, 4, 5, 6, 7, 8, 9 which now bear 80% of the worldwide burden of such diseases.10 Cancer, already the leading cause of death in many high-income countries, is set to become a major cause of morbidity and mortality in the next few decades in every region of the world, irrespective of level of resource.10, 11, 12
The UN has forecast that the global population will reach 7 billion by 2012 and 8·3 billion by 2030.13 The effect of population ageing and growth will be greatest in low-income and middle-income countries. These changes translate to a predicted global burden of 20·3 million new cancer cases by 2030 compared with an estimated 12·7 million cases in 2008, and a predicted 13·2 million cancer-related deaths worldwide by 2030, up from 7·6 million in 2008.11 Such a demographic transition and the resulting upsurge in cancer incidence and mortality are contingent on population projections that assume decreases in human fertility and population growth as a result of continuous social and economic development,14 and on incidence and mortality rates of all cancer types combined remaining unaltered over the next few decades.
The static trends in the risk of cancer in future decades seems the less robust of these two assumptions, especially in view of the cancer-specific incidence and mortality trends seen over the past half century. Rather than describing constant rates over time, many reports have documented lagged changes in lung and other tobacco-related cancers according to the country-specific and sex-specific phases of the tobacco epidemic, uniform decreases in stomach cancer as a result of primary prevention efforts, and a rising incidence of breast, colorectal, and prostate cancers, initially in affluent populations and, within the last couple of decades, in historically less-affluent populations at lower cancer risk. The changes are likely to be attributable to a combination of unfavourable changes in several ill defined reproductive, dietary, metabolic, hormonal, and other behavioural determinants that increase the risk of these cancers. The so-called cancer transition—an analogy to Omran's epidemiological transition15—thus fits well with the occurrence of socioeconomic transition in several historically low-resource to medium-resource populations. The result has been a reduction in the prevalence of predominantly infection-based diseases, and a concomitant rise in those with apparently little or no established associations with infection.16
By linking geographical and temporal patterns of cancer to corresponding levels of social and economic progress, we provide an overview of the key characteristics of the global cancer transition. We used the Human Development Index (HDI)17 as an indicator of socioeconomic development, and rates of cancer incidence and mortality as markers of the extent of the cancer transition globally. We aimed to draw attention to geographical variations and trends in cancer-specific rates in each of the HDI areas and in different world regions, and to offer a global, trends-based profile of the possible cancer burden in 2030.
Section snippets
Data sources
The International Agency for Research on Cancer has compiled estimates of the worldwide incidence and mortality for 27 cancers in 184 countries in 2008 by age group and sex in the GLOBOCAN 2008 database.11 Details are provided elsewhere.11 The methods used to estimate cancer-specific incidence and mortality rates at the national level are dependent on the availability and accuracy of local data sources. Generally, there is a paucity of high quality cancer incidence and mortality data in
Results
Within higher (high and very high) HDI areas, cancers of the lung, female breast, and colorectum each account for a very similar number of new cases (about 830 000) in 2008, with prostate cancer accounting for about 766 000 cases (figure 2). Together, these four cancers comprised almost half (49%) the total cancer burden in these areas. In lower (low and medium) HDI areas, lung cancer was also the most commonly diagnosed cancer (778 000). However, several types of cancer were more common in
Discussion
Cancers of the breast, lung, colorectum, and prostate account for about 50% of the cancer burden in high HDI and very high HDI regions, whereas in medium HDI regions, cancers of the oesophagus, stomach, and liver are also common, and together these seven cancers account for about 62% of the burden in low HDI and high HDI areas. Within low HDI regions, cervical cancer is more common than both breast cancer and liver cancer. We identified the nine most common cancers in men in the 184 countries
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