Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020

Abstract

Background: Cancer is one of the leading causes of death and a main economic burden in China. Investigating the differences in cancer patterns and control strategies between China and developed countries could provide reference for policy planning and contribute to improving cancer control measures. In this study, we reviewed the rates and trends of cancer incidence and mortality and disability-adjusted life year (DALY) burden in China, and compared them with those in the United States (US) and the United Kingdom (UK).

Methods: Cancer incidence, mortality, and DALY data for China, US and UK were obtained from the GLOBOCAN 2020 online database, Global Burden of Disease (GBD) 2019 study, and Cancer Incidence in Five Continents plus database (CI5 plus). Trends of cancer incidence and mortality in China, US, and UK were analyzed using Joinpoint regression models to calculate annual percent changes (APCs) and identify the best-fitting joinpoints.

Results: An estimated 4,568,754 newly diagnosed cancer cases and 3,002,899 cancer deaths occurred in China in 2020. Additionally, cancers resulted in 67,340,309 DALYs in China. Compared to the US and UK, China had lower cancer incidence but higher cancer mortality and DALY rates. Furthermore, the cancer spectrum of China was changing, with a rapid increase incidence and burden of lung, breast, colorectal, and prostate cancer in addition to a high incidence and heavy burden of liver, stomach, esophageal, and cervical cancer.

Conclusions: The cancer spectrum of China is changing from a developing country to a developed country. Population aging and increase of unhealthy lifestyles would continue to increase the cancer burden of China. Therefore, the Chinese authorities should adjust the national cancer control program with reference to the practices of cancer control which have been well-established in the developed countries, and taking consideration of the diversity of cancer types by of different regions in China at the same time.

Keywords: China; GLOBOCAN 2020; United Kingdom; United States; cancer pattern; disability-adjusted life year; incidence; mortality; risk factor; trend.

FIGURE 1

ASIR and ASMR per 100,000 population of selected types of cancers in China, US, UK, and worldwide in 2020. ASIR and ASMR data of cancers in both sexes (A), male (B), and female (C). The data used to generate this figure were from the GLOBOCAN 2020 database. ASIR data from China were used to rank the order of cancer sites. Abbreviations: ASIR, age‐standardized rates of cancer incidence; ASMR, age‐standardized rates of cancer mortality; US, United States; UK, United Kingdom.

FIGURE 2

Trends in ASIR (A) and ASMR (B) of all cancer sites by gender in China, US, and UK. The ASIR data used to generate this figure were from the CI5 plus database. The ASMR data used to generate this figure were from the WHO cancer mortality database. Abbreviations: ASIR, age‐standardized rates of cancer incidence; ASMR, age‐standardized rates of cancer mortality; US, United States; UK, United Kingdom; WHO, World Health Organization.

FIGURE 3

Trends in ASIR by cancer site and gender in China, US, and UK. The data used to generate this figure were from the CI5 plus database. Abbreviations: ASIR, age‐standardized rates of cancer incidence; US, United States; UK, United Kingdom; APC, annual percent change.

FIGURE 4

Numbers of DALYs attributable to cancers by age and gender in China, US, and UK in 2019. The estimates used to generate this figure were from the GBD study. Abbreviations: DALY, disability‐adjusted life year; GBD, Global Burden of Disease; US, United States; UK, United Kingdom.

FIGURE 5

Rank changes in DALYs attributable to cancers and percentage change in all age and age‐standardized DALY rates in China, US, and UK from 1990 to 2019. The estimates used to generate this figure were from the GBD study. Age‐standardized rates were calculated using the GBD reference population. Abbreviations: DALY, disability‐adjusted life year; GBD, Global Burden of Disease; US, United States; UK, United Kingdom.