A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors

Abstract

Background: Gastrointestinal (GI) cancers were responsible for 26.3% of cancer cases and 35.4% of deaths worldwide in 2018. This study aimed to analyze the global incidence, mortality, prevalence, and contributing risk factors of the 6 major GI cancer entities [esophageal cancer (EC), gastric cancer (GC), liver cancer (LC), pancreatic cancer (PC), colon cancer, and rectal cancer].

Methods: Using the Global Cancer Observatory and the Global Health Observatory databases, we reviewed the current GI cancer incidence, prevalence, and mortality, analyzed the association of GI cancer prevalence with national human development indices (HDIs), identified the contributing risk factors, and estimated developing age- and sex-specific trends in incidence and mortality.

Results: In 2020, the trend in age-standardized rate of incidence of GI cancers closely mirrored that of mortality, with the highest rates of LC, EC, and GC in Asia and of colorectal cancer (CRC) and PC mainly in Europe. Incidence and mortality were positively, but the mortality-to-incidence ratio (MIR) was inversely correlated with the national HDI levels. High MIRs in developing countries likely reflected the lack of preventive strategies and effective treatments. GI cancer prevalence was highest in Europe and was also positively correlated with HDIs and lifestyle-associated risk factors, such as alcohol consumption, smoking, obesity, insufficient physical activity, and high blood cholesterol level, but negatively correlated with hypertension and diabetes. Incidences of EC were consistently and those of GC mostly decreasing, whereas incidences of CRC were increasing in most countries/regions, especially in the younger populations. Incidences of LC and PC were also increasing in all age-gender populations except for younger males. Mortalities were decreasing for EC, GC, and CRC in most countries/regions, and age-specific trends were observed in PC and LC with a decrease in the younger but an increase in the older population.

Conclusions: On the global scale, higher GI cancer burden was accompanied, for the most part, by factors associated with the so-called Western lifestyle reflected by high and very high national HDI levels. In countries/regions with very high HDI levels, patients survived longer, and increasing GI cancer cases were observed with increasing national HDI levels. Optimizing GI cancer prevention and improving therapies, especially for patients with comorbid metabolic diseases, are thus urgently recommended.

Keywords: annual percentage change (APC); diabetes; gastrointestinal (GI) cancer; high blood cholesterol; human development indices (HDI); hypertension; incidence; lifestyle; mortality; prevalence.

FIGURE 1

Epidemiologic profiles of GI cancers in 2020. (A) The global age‐standardized rates of incidence of GI cancers (data source from GLOBOCAN 2020: https://gco.iarc.fr/today); (B) The global age‐standardized rates of mortality of GI cancers (data source from GLOBOCAN 2020: https://gco.iarc.fr/today); (C) The global age‐standardized rates of incidence and mortality of 6 GI cancers stratified by world area. Abbreviations: GI, gastrointestinal; EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer

FIGURE 2

Epidemiologic profiles of 6 GI cancers stratified by national HDI levels. (A) Age‐standardized rates of incidence of 6 GI cancers stratified by HDI; (B) Age‐standardized rates of mortality of 6 GI cancers stratified by HDI; (C) MIR of 6 GI cancers stratified by HDI. Abbreviations: GI, gastrointestinal; HDI, human development indices; MIR, mortality‐to‐incidence ratio; EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer

FIGURE 3

Prevalences of 6 GI cancers in 2020 and their correlations with national HDI levels. (A) Global 5‐year prevalence of 6 GI cancers (data source from GLOBOCAN 2020: https://gco.iarc.fr/today); (B) Correlation analyses between GI cancers’ prevalence and national HDI. Abbreviations: GI, gastrointestinal; HDI, human development indices; EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer

FIGURE 4

Correlation analyses between 5‐year prevalences of (A) EC, (B) GC, (C) CC, (D) RC, (E) LC and (F) PC and risk factors on the country level. Abbreviations: EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer

FIGURE 5

Determination of risk factors for (A) EC, (B) GC, (C) CC, (D) RC, (E) LC and (F) PC on the country level. Abbreviations: EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer; ORs, odds ratios; CIs, confidence intervals; AUCs, area under the curves

FIGURE 6

Correlations of 1‐MIR of GI cancers with (A) hypertension and (B) diabetes on the country level. Abbreviations: GI, gastrointestinal; MIR, mortality‐to‐incidence ratio; EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer.

FIGURE 7

Heat map of APCs in incidence and mortality of 6 GI cancers. Abbreviations: GI, gastrointestinal; EC, esophageal cancer; GC, gastric cancer; LC, liver cancer; PC, pancreatic cancer; CC, colon cancer; RC, rectal cancer; APCs, annual percent changes