Global, regional, and national lifetime risks of developing and dying from gastrointestinal cancers in 185 countries: a population-based systematic analysis of GLOBOCAN

Abstract

Background: Gastrointestinal cancers account for a quarter of the global cancer incidence and a third of cancer-related deaths. We sought to estimate the lifetime risks of developing and dying from gastrointestinal cancers at the country, world region, and global levels in 2020.

Methods: For this population-based systematic analysis, we obtained estimates of gastrointestinal cancer incidence and mortality rates from GLOBOCAN for 185 countries, alongside all-cause mortality and population data from the UN. Countries were categorised into quartiles of the Human Development Index (HDI). The lifetime risk of gastrointestinal cancers was estimated with a standard method that adjusts for multiple primaries, taking into account competing risks of death from causes other than cancer and life expectancy.

Findings: The global lifetime risks of developing and dying from gastrointestinal cancers from birth to death was 8·20% (95% CI 8·18-8·21) and 6·17% (6·16-6·18) in 2020. For men, the risk of developing gastrointestinal cancers was 9·53% (95% CI 9·51-9·55) and of dying from them 7·23% (7·22-7·25); for women, the risk of developing gastrointestinal cancers was 6·84% (6·82-6·85) and of dying from them 5·09% (5·08-5·10). Colorectal cancer presented the highest risk, accounting for 38·5% of the total lifetime risk of developing, and 28·2% of dying from, gastrointestinal cancers, followed by cancers of the stomach, liver, oesophagus, pancreas, and gallbladder. Eastern Asia has the highest lifetime risks for cancers of the stomach, liver, oesophagus, and gallbladder, Australia and New Zealand for colorectal cancer, and Western Europe for pancreatic cancer. The lifetime risk of gastrointestinal cancers increased consistently with increasing level of HDI; however, high HDI countries (the third HDI quartile) had the highest death risk.

Interpretation: The global lifetime risk of gastrointestinal cancers translates to one in 12 people developing, and one in 16 people dying from, gastrointestinal cancers. The identified high risk and observed disparities across countries warrants context-specific targeted gastrointestinal cancer control and health systems planning.

Funding: Beijing Nova Program, CAMS Innovation Fund for Medical Sciences, and Talent Incentive Program of Cancer Hospital, CAMS (Hope Star).

Figure 1

Lifetime risks of developing or dying from gastrointestinal cancer in 2020, by sex (A) Lifetime risk of developing gastrointestinal cancer for males in 2020. (B) Lifetime risk of developing gastrointestinal cancer for females in 2020. (C) Lifetime risk of dying from gastrointestinal cancer for males in 2020. (D) Lifetime risk of dying from gastrointestinal cancer for females in 2020.

Figure 2

Lifetime risks of developing or dying from gastrointestinal cancer within selected age intervals in 2020, both sexes (A) Developing gastrointestinal cancer. (B) Dying from gastrointestinal cancer. The curves represent the probabilities of developing or dying from gastrointestinal cancer from an age free of gastrointestinal cancer to a specific age range. The age-conditional risk of gastrointestinal cancer is available in the appendix (p 5).

Figure 3

Lifetime risks of developing or dying from gastrointestinal cancer in 2020 by region and country, both sexes (A) Developing gastrointestinal cancer. (B) Dying from gastrointestinal cancer. Green diamonds indicate the average lifetime risk of gastrointestinal cancer in each selected geographic region. Vertical lines represent the estimated lifetime risk of gastrointestinal cancer in each selected country, with the name of the country representing the one with the lowest or highest risk within that geographic region. Details of the results of the statistical test comparing lifetime risk at the geographic regional level with the global average level are available in the appendix (pp 6–10). *French Overseas Territory.

Figure 4

Distribution of the leading gastrointestinal cancer type with the highest lifetime incidence or death risk in 2020, both sexes (A) Lifetime incidence risk. (B) Lifetime death risk. Number in parentheses indicates the number of countries for which that cancer is the highest risk among other gastrointestinal cancers.