The Global Burden of Cancer Attributable to Risk Factors, 2010-19: a Systematic Analysis for the Global Burden of Disease Study 2019

Overview

Journal Lancet

Publisher Elsevier

Specialty General Medicine

Date 2022 Aug 21

PMID 35988567

Affiliations

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Abstract

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.

Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.

Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]).

Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden.

Funding: Bill & Melinda Gates Foundation.

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References

Poirier A, Ruan Y, Volesky K, King W, OSullivan D, Gogna P . The current and future burden of cancer attributable to modifiable risk factors in Canada: Summary of results. Prev Med. 2019; 122:140-147. DOI: 10.1016/j.ypmed.2019.04.007. View

Evans J, van Donkelaar A, Martin R, Burnett R, Rainham D, Birkett N . Estimates of global mortality attributable to particulate air pollution using satellite imagery. Environ Res. 2012; 120:33-42. DOI: 10.1016/j.envres.2012.08.005. View

Lichtenstein P, Holm N, Verkasalo P, Iliadou A, Kaprio J, Koskenvuo M . Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med. 2000; 343(2):78-85. DOI: 10.1056/NEJM200007133430201. View

Kocarnik J, Compton K, Dean F, Fu W, Gaw B, Harvey J . Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2021; 8(3):420-444. PMC: 8719276. DOI: 10.1001/jamaoncol.2021.6987. View

Wang J, Jiang Y, Liang H, Li P, Xiao H, Ji J . Attributable causes of cancer in China. Ann Oncol. 2012; 23(11):2983-2989. PMC: 8890481. DOI: 10.1093/annonc/mds139. View

Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P . WHO European review of social determinants of health and the health divide. Lancet. 2012; 380(9846):1011-29. DOI: 10.1016/S0140-6736(12)61228-8. View

Takala J . Eliminating occupational cancer. Ind Health. 2015; 53(4):307-9. PMC: 4551060. DOI: 10.2486/indhealth.53-307. View

Brundtland G . Achieving worldwide tobacco control. JAMA. 2000; 284(6):750-1. DOI: 10.1001/jama.284.6.750. View

Winn A, Ekwueme D, Guy Jr G, Neumann P . Cost-Utility Analysis of Cancer Prevention, Treatment, and Control: A Systematic Review. Am J Prev Med. 2015; 50(2):241-8. PMC: 5846573. DOI: 10.1016/j.amepre.2015.08.009. View

10.

Szreter S . The population health approach in historical perspective. Am J Public Health. 2003; 93(3):421-31. PMC: 1449802. DOI: 10.2105/ajph.93.3.421. View

11.

Monteiro C, Moura E, Conde W, Popkin B . Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2005; 82(12):940-6. PMC: 2623095. DOI: /S0042-96862004001200011. View

12.

Sharpless N . COVID-19 and cancer. Science. 2020; 368(6497):1290. DOI: 10.1126/science.abd3377. View

13.

Polk D, Peek Jr R . Helicobacter pylori: gastric cancer and beyond. Nat Rev Cancer. 2010; 10(6):403-14. PMC: 2957472. DOI: 10.1038/nrc2857. View

14.

Foreman K, Lozano R, Lopez A, Murray C . Modeling causes of death: an integrated approach using CODEm. Popul Health Metr. 2012; 10:1. PMC: 3315398. DOI: 10.1186/1478-7954-10-1. View

15.

Schottenfeld D, Beebe-Dimmer J, Buffler P, Omenn G . Current perspective on the global and United States cancer burden attributable to lifestyle and environmental risk factors. Annu Rev Public Health. 2013; 34:97-117. DOI: 10.1146/annurev-publhealth-031912-114350. View

16.

. Solar and ultraviolet radiation. IARC Monogr Eval Carcinog Risks Hum. 1992; 55:1-316. PMC: 5220266. View

17.

Arriaga M, Vajdic C, Canfell K, MacInnis R, Hull P, Magliano D . The burden of cancer attributable to modifiable risk factors: the Australian cancer-PAF cohort consortium. BMJ Open. 2017; 7(6):e016178. PMC: 5726120. DOI: 10.1136/bmjopen-2017-016178. View

18.

Hecht S . Cigarette smoking and lung cancer: chemical mechanisms and approaches to prevention. Lancet Oncol. 2002; 3(8):461-9. DOI: 10.1016/s1470-2045(02)00815-x. View

19.

. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1223-1249. PMC: 7566194. DOI: 10.1016/S0140-6736(20)30752-2. View

20.

Bianchini F, Kaaks R, Vainio H . Overweight, obesity, and cancer risk. Lancet Oncol. 2002; 3(9):565-74. DOI: 10.1016/s1470-2045(02)00849-5. View