Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019

Abstract

Objective: This study aimed to explore the global burden of early-onset cancer based on the Global Burden of Disease (GBD) 2019 study for 29 cancers worldwid.

Methods and analysis: Incidence, deaths, disability-adjusted life years (DALYs) and risk factors for 29 early-onset cancer groups were obtained from GBD.

Results: Global incidence of early-onset cancer increased by 79.1% and the number of early-onset cancer deaths increased by 27.7% between 1990 and 2019. Early-onset breast, tracheal, bronchus and lung, stomach and colorectal cancers showed the highest mortality and DALYs in 2019. Globally, the incidence rates of early-onset nasopharyngeal and prostate cancer showed the fastest increasing trend, whereas early-onset liver cancer showed the sharpest decrease. Early-onset colorectal cancers had high DALYs within the top five ranking for both men and women. High-middle and middle Sociodemographic Index (SDI) regions had the highest burden of early-onset cancer. The morbidity of early-onset cancer increased with the SDI, and the mortality rate decreased considerably when SDI increased from 0.7 to 1. The projections indicated that the global number of incidence and deaths of early-onset cancer would increase by 31% and 21% in 2030, respectively. Dietary risk factors (diet high in red meat, low in fruits, high in sodium and low in milk, etc), alcohol consumption and tobacco use are the main risk factors underlying early-onset cancers.

Conclusion: Early-onset cancer morbidity continues to increase worldwide with notable variances in mortality and DALYs between areas, countries, sex and cancer types. Encouraging a healthy lifestyle could reduce early-onset cancer disease burden.

Keywords: Epidemiology; Mortality; Neoplasms.

Figure 1

Distribution of cases and deaths for the early-onset cancers of different systems in 1990 and 2019. The early-onset cancer types in bold are the top three. Respiratory system cancers include larynx cancer, nasopharynx cancer, other pharynx cancer and tracheal, bronchus, and lung cancer; digestive system cancers include colon and rectum cancer, oesophageal cancer, gallbladder and biliary tract cancer, lip and oral cavity cancer, liver cancer, pancreatic cancer and stomach cancer; haematological system cancers include Hodgkin’s lymphoma, leukaemia, multiple myeloma and non-Hodgkin’s lymphoma; reproductive system cancers include cervical cancer, ovarian cancer, testicular cancer and uterine cancer; urinary system cancer include bladder cancer, kidney cancer and prostate cancer; skin cancers include malignant skin melanoma and non-melanoma skin cancer.

Figure 2

The global incidence, death and DALYs rates of 29 specified early-onset cancers in 1990 and 2019 by sex. DALYs, disability-adjusted life years.

Figure 3

Among 204 countries and territories, the relative change of incident (A), death (B) and DALYs (C) cases of early-onset cancers from 1990 to 2019, and ASIR (D), ASDR (E), age-standardised DALYs rate (F) in 2019. ASIR, age-standardised incidence rate; ASDR, age-standardised death rate; DALYs, disability-adjusted life years.

Figure 4

The risk factors of early-onset breast cancer (A), TBL cancer (B), CRC (C) and stomach cancer (D) worldwide, in 21 GBD and 5 SDI regions, 2019. CRC, colorectal cancer; DALYs, disability-adjusted life years; GBD, Global Burden of Disease; SDI, Sociodemographic Index; TBL, tracheal, bronchus and lung.

Figure 5

Trends of ASIR and ASDR in the early-onset cancer in female (A), male (B) and both sex (C): observed (1990–2019) and predicted rates (2020–2030). The blue region in (A) and (B) shows the upper and lower limits of the 95% uncertainty intervals (95% UI). ASIR, age-standardised incidence rate; ASDR, age-standardised death rate.