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. 2022 Jan;23(1):27-52.
doi: 10.1016/S1470-2045(21)00581-7. Epub 2021 Dec 3.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Adolescent Young Adult Cancer Collaborators
Collaborators

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Adolescent Young Adult Cancer Collaborators. Lancet Oncol. 2022 Jan.

Abstract

Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.

Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults.

Findings: There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.

Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.

Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.

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Conflict of interest statement

Declaration of interests R Ancuceanu reports consulting fees from Abbvie; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Sandoz and B. Braun, all outside the submitted work. H Ariffin reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen, all outside the submitted work. M Atashzar reports support for the present manuscript from medical writing and analysis of data. M Atashzar reports paid consulting fees; and receipt of equipment, materials, drugs, medical writing, gifts or other services from medical writing, all outside the submitted work. P Atorkey reports support for the present manuscript from the School of Medicine and Public Health, University of Newcastle, Australia, Hunter Medical Research Institute, University of Newcastle, Australia, and Hunter New England, Population Health. A Aujayeb reports grants or contracts from Rocket Medical Plc; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Rocket Medical Plc for talks given on pneumothorax and work done on digital suction device; and leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Mesothelioma UK as Trustee, all outside the submitted work. M Ausloos reports grants or contracts from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084 “Understanding and modelling time-space patterns of psychology-related inequalities and polarization”; all outside the submitted work. T Bärnighausen reports grants or contracts from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kräner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, UNAIDS, and WHO; consulting fees from KfW on the OSCAR initiative in Vietnam; participation on a Data Safety Monitoring Board or Advisory Board with NIH-funded study “Healthy Options” as Chair of the Data Safety and Monitoring Board (DSMB), German National Committee on the “Future of Public Health Research and Education”; Chair of the scientific advisory board to the EDCTP Evaluation; Member of the UNAIDS Evaluation Expert Advisory Committee; National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH), US National Academies of Sciences, Engineering, and Medicine's Committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President's Emergency Plan for AIDS Relief (PEPFAR)”, University of Pennsylvania (UPenn) Population Aging Research Center (PARC) as an External Advisory Board Member; leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid as a Co-chair of the Global Health Hub Germany (which was initiated by the German Ministry of Health); all outside the submitted work. N Bekele reports participation on a Data Safety Monitoring Board or Advisory Board as Ethical review board member for two years; and leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Wollo University as an unpaid graduate program coordinator for three years, all outside the submitted work. S Bhaskar reports grants or contracts from NSW Ministry of Health, NSW Brain Clot Bank; and leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Rotary Club of Sydney, Australia as Board Director, International Rotary Fellowship of Rotarian Healthcare Professionals (IRFRHP), UK as Board Director, and BMC Neurology as Editorial Board Member, all outside the submitted work. J Conde reports grants or contracts from European Research Council Starting Grant, ERC-StG-2019-848325; patents planned, issued or pending, as Functionalized nanoparticles and compositions for cancer treatment and methods, U.S. Application No. 62/334538 and TRPV2 Antagonists, WO Application No. PCT/PT2018/050035; and support from TargTex S.A. as co-founder and shareholder, all outside the submitted work. X Dai reports support for the present manuscript from Bloomberg Philanthropies and the Bill and Melinda Gates Foundation through their employment at IHME. I Filip reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute, all outside the submitted work. L Force reports support for the present manuscript from the Bill and Melinda Gates Foundation and American Lebanese Syrian Associated Charities for providing funding, related to their employment at IHME. L. Force reports grants or contracts from St Baldrick's Foundation; leadership or fiduciary role in board, society, committee or advocacy group, unpaid with the Lancet Oncology International Advisory Board; and payments towards federal student loans from the NIH Loan Repayment Award, all outside the submitted work. F Ghassemi reports support for the present manuscript for medical writing and literature review. N Ghith reports grants or contracts from NovoNordisc Foundation through salary covered by grant NNF16OC0021856, all outside the submitted work. A Guha reports grants or contracts from American Heart Association-Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740,#863620), all outside the submitted work. V Gupta reports grants or contracts from National Health and Medical research Council (NHMRC) Australia, all outside the submitted work. J Haro reports grants or contracts from Eli Lilly and Co., all outside the submitted work. H Henrikson reports support for the present manuscript from the Bill and Melinda Gates Foundation, American Lebanese Syrian Associated Charities, and Saint Baldrick's Foundation, all for providing funding, related to their employment at IHME. C Herteliu reports grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, grant title “Understanding and modelling time-space patterns of psychology-related inequalities and polarization” as research team member, and from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351, grant title “Approaches within public health management in the context of COVID-19 pandemic,” as project manager, all outside the submitted work. K Innos reports support for the present manuscript from Estonian Research Council, Grant No PRG722. S M S Islam reports grants or contracts from the NHMRC Emerging Leadership Fellowship and the National Heart Foundation of Australia Fellowship, all outside the submitted work. N E Ismail reports leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Malaysian Academy of Pharmacy as an unpaid Council Member, all outside the submitted work. I Karaye reports support for the present manuscript from the Bill and Melinda Gates Foundation, American Lebanese Syrian Associated Charities, and Saint Baldrick's Foundation, all for providing funding, related to their employment at IHME. J Kauppila reports grants or contracts from Sigrid Juselius Foundation, Finnish Cancer Foundation, and Päivikki and Sakari Sohlberg Foundation, all outside the submitted work. T Ketterl reports consulting fees from Fennec Pharmaceuticals, Inc for advisory services, all outside the submitted work. J Kocarnik reports support for the present manuscript from the Bill and Melinda Gates Foundation and American Lebanese Syrian Associated Charities for providing funding, related to their employment at IHME. M-C Li reports support for the present manuscript from Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). J A Loureiro reports support for the present manuscript from Scientific Employment Stimulus (FCT), CEECINST/00049/2018, for salary support and Base Funding, UIDB/00511/2020 of the LEPABE, funded by national funds through the FCT/MCTES (PIDDAC) for research support. M Mahmoudi reports support from the Academic Parity Movement, as co-founder and director; support from Partners in Global Wound Care (PGWC) as Founding Partner; and reports royalties/honoraria for published books, plenary lectures, and licensed patent, all outside the submitted work. O Odukoya reports support for the present manuscript from the Fogarty International Center of the National Institutes of Health under the Award Number K43TW010704. A Pana reports grants or contracts from ARPIM, Amgen, Janssen, Astra Zeneca, Novartis Oncology, BMS, Angelini, and Servier; and participation on a Data Safety Monitoring Board or Advisory Board with Novartis Oncology and Pfizer, all outside the submitted work. M Postma reports stock or stock options in Pharmacoeconomics Advice Groningen and Health-Ecore, all outside the submitted work. A Radfar reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute, all outside the submitted work. A Riad reports grants or contracts from Masaryk University; and support from Cochrane Collaboration as deputy director of Cochrane Czech Republic center, all outside the submitted work. M Saylan reports support from their employer Bayer, all outside the submitted work. M Šekerija reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Roche and Johnson & Johnson, all outside the submitted work. D A Santos Silva reports support for the present manuscript from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES) and National Council for Scientific and Technological Development (CNPq), Brazil. D A Santos Silva reports grants or contracts from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and is supported in part by National Council for Scientific and Technological Development (CNPq), Brazil (302028/2018-8), all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Simply Speaking; support for attending meetings and/or travel from OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when traveling to OMERACT meetings; participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a chair member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as Director and editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Charlotte's Web Holdings Inc. and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; all outside the submitted work.

Figures

Figure 1
Figure 1
Global map of age-standardised DALY rates for both sexes combined in 2019, categorised by age-standardised DALY rate quintiles, excluding non-melanoma skin cancers, for malignant adolescent and young adult cancers (A), malignant childhood cancers (B), and malignant adult cancers (C) Quintiles are based on age-standardised DALY rates per 100 000 person-years. For adolescent and young adult cancers (age 15–39 years), quintile 1 (0–20%) corresponds to less than 597 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 597 to less than 729 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 729 to less than 833 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 833 to less than 1010 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 1010 or more DALYs per 100 000 person-years. For childhood cancers (age 0–14 years), quintile 1 (0–20%) corresponds to less than 250 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 250 to less than 311 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 311 to less than 396 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 396 to less than 495 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 495 or more DALYs per 100 000 person-years. For adult cancers (age ≥40 years), quintile 1 (0–20%) corresponds to less than 6680 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 6680 to less than 7390 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 7390 to less than 8580 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 8580 to less than 9890 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 9890 or more DALYs per 100 000 person-years. There are several geographical locations (shown in white) where estimates are not available (eg, Western Sahara and French Guiana) as they were not modelled locations in GBD 2019. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 1
Figure 1
Global map of age-standardised DALY rates for both sexes combined in 2019, categorised by age-standardised DALY rate quintiles, excluding non-melanoma skin cancers, for malignant adolescent and young adult cancers (A), malignant childhood cancers (B), and malignant adult cancers (C) Quintiles are based on age-standardised DALY rates per 100 000 person-years. For adolescent and young adult cancers (age 15–39 years), quintile 1 (0–20%) corresponds to less than 597 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 597 to less than 729 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 729 to less than 833 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 833 to less than 1010 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 1010 or more DALYs per 100 000 person-years. For childhood cancers (age 0–14 years), quintile 1 (0–20%) corresponds to less than 250 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 250 to less than 311 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 311 to less than 396 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 396 to less than 495 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 495 or more DALYs per 100 000 person-years. For adult cancers (age ≥40 years), quintile 1 (0–20%) corresponds to less than 6680 DALYs per 100 000 person-years, quintile 2 (21–40%) corresponds to 6680 to less than 7390 DALYs per 100 000 person-years, quintile 3 (41–60%) corresponds to 7390 to less than 8580 DALYs per 100 000 person-years, quintile 4 (61–80%) corresponds to 8580 to less than 9890 DALYs per 100 000 person-years, and quintile 5 (81–100%) corresponds to 9890 or more DALYs per 100 000 person-years. There are several geographical locations (shown in white) where estimates are not available (eg, Western Sahara and French Guiana) as they were not modelled locations in GBD 2019. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 2
Figure 2
Global age-specific DALY rates (A) and proportional DALY burden (B) of adolescent and young adult cancer types by age group, in 2019, for both sexes combined Rates are expressed per 100 000 person-years. “Other malignant neoplasms” comprise all malignancies without a separate GBD cause category listed; this category does not include non-melanoma skin cancers and myelodysplastic or myeloproliferative neoplasms, which are separate GBD cause categories not included in this analysis. Other leukaemia included leukaemias not otherwise specified. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 3
Figure 3
Age-standardised DALY rates (A) and proportional adolescent and young adult cancer DALY burden (B) by Socio-demographic Index, in 2019, for both sexes combined Rates are expressed per 100 000 person-years. “Other malignant neoplasms” comprise all malignancies without a separate GBD cause category listed; this category does not include non-melanoma skin cancers and myelodysplastic or myeloproliferative neoplasms, which are separate GBD cause categories not included in this analysis. Other leukaemia included leukaemias not otherwise specified. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. SDI=Socio-demographic Index.
Figure 4
Figure 4
Global absolute (A) and proportional (B) adolescent and young adult cancer DALY burden by sex in 2019 Other malignant neoplasms comprise all malignancies without a separate GBD cause category listed; this category does not include non-melanoma skin cancers and myelodysplastic or myeloproliferative neoplasms, which are separate GBD cause categories not included in this analysis. Other leukaemia included leukaemias not otherwise specified. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 5
Figure 5
Ranking of absolute DALYs (A) and deaths (B) due to cancer compared to other disease groups in adolescents and young adults in 2019, for both sexes combined, globally and by SDI Disease rank assigned by total absolute DALYs (A) or absolute deaths (B) globally in 2019 in the adolescent and young adult age group (15–39 years), with 1 representing the highest rank. Values in parentheses are 95% uncertainty intervals (UIs). Colour intensity is proportional to rank number (from 1 denoted by dark red to 22 [or 21 in panel B] denoted by dark green). Cancers comprise all malignant neoplasms, excluding non-melanoma skin cancers. Panels A and B included different causes because some causes do not have mortality estimated in this age range. Other non-communicable diseases comprise congenital birth defects; urinary diseases and male infertility; gynaecological diseases; haemoglobinopathies and haemolytic anaemias; endocrine, metabolic, blood, and immune disorders; and oral disorders. Other infectious diseases comprise meningitis, encephalitis, diphtheria, whooping cough, tetanus, measles, varicella and herpes zoster, acute hepatitis, and other unspecified infectious diseases. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
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