Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000

1471-2407-2-37 1471-2407 Research article Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000 Shibuya Kenji shibuyak@who.int Mathers D Colin mathersc@who.int Boschi-Pinto Cynthia pintoc@who.int Lopez D Alan lopeza@who.int Murray JL Christopher murrayc@who.int

Global Program on Evidence for Health Policy, World Health Organization, Geneva, Switzerland

Family and Community Health/Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

Executive Director, Evidence and Information for Policy, World Health Organization, Geneva, Switzerland

BMC Cancer 1471-2407 2002 2 1 37 http://www.biomedcentral.com/1471-2407/2/37 12502432 10.1186/1471-2407-2-37 11 10 2002 26 12 2002 26 12 2002 2002 Shibuya et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Abstract

Background

Mortality estimates alone are not sufficient to understand the true magnitude of cancer burden. We present the detailed estimates of mortality and incidence by site as the basis for the future estimation of cancer burden for the Global Burden of Disease 2000 study.

Methods

Age- and sex- specific mortality envelope for all malignancies by region was derived from the analysis of country life-tables and cause of death. We estimated the site-specific cancer mortality distributions from vital records and cancer survival model. The regional cancer mortality by site is estimated by disaggregating the regional cancer mortality envelope based on the mortality distribution. Estimated incidence-to-mortality rate ratios were used to back calculate the final cancer incidence estimates by site.

Results

In 2000, cancer accounted for over 7 million deaths (13% of total mortality) and there were more than 10 million new cancer cases world wide in 2000. More than 60% of cancer deaths and approximately half of new cases occurred in developing regions. Lung cancer was the most common cancers in the world, followed by cancers of stomach, liver, colon and rectum, and breast. There was a significant variations in the distribution of site-specific cancer mortality and incidence by region.

Conclusions

Despite a regional variation, the most common cancers are potentially preventable. Cancer burden estimation by taking into account both mortality and morbidity is an essential step to set research priorities and policy formulation. Also it can used for setting priorities when combined with data on costs of interventions against cancers.

Background

Mortality estimates alone are not sufficient to understand the true magnitude and trends of cancer problems and to evaluate the interventions against cancer, in particular preventive programmes 1. Although cancer is still a fatal disease in many developing countries2, the disability among cancer survivors should be taken into account since there is a growing evidence that cancer survival in some developing countries are continuously improving 34 and, when setting priorities, cancer control interventions are compared with other health interventions which aims at reducing morbidity 5. For this reason, estimates of both mortality and incidence of cancer by region are essential inputs for setting research and intervention priorities in cancer control policies.

The present study is aimed at estimating the magnitude of global and regional cancer mortality and incidence as a part of detailed analysis of all-cause levels and cause of death distributions for 191 Member States of the World Health Organization (WHO) for the Global Burden of Disease 2000 (GBD 2000) study 6. GBD 2000 employs a time-based composite measure of disease burden in terms of disability-adjusted life years (DALYs) which consist of years lived with disability (morbidity) and years of life lost (mortality). To estimate the burden from each disease sequelae, detailed information of incidence, duration, and mortality by age, sex and region is required 5. This study serves as a basis for the future estimation of cancer burden for the GBD 2000.

The GBD 2000 project classified WHO's 6 regions into 17 sub regions according to the levels of child and adult mortality (Table 1). On the basis of available published information on age-, sex-, and site-specific cancer incidence and survival, we developed an algorithm to estimate region-specific overall cancer mortality, and site-specific survival, death distributions, and incidence for the year 2000.

Table 1

Global Burden of Disease 2000 (GBD 2000) project: regions and sub regions

WHO region

Mortality stratum

Sub region

WHO Member States

AFRO

AfrD

Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Comoros, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, Sao Tome And Principe, Senegal, Seychelles, Sierra Leone, Togo, Djibouti, Somalia, Sudan

AFRO

AfrE

Botswana, Burundi, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic Of The Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe

AMRO

AmrA

Canada, United States Of America

AMRO

AmrB

Antigua And Barbuda, Argentina, Bahamas, Barbados, Belize, Brazil, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, El Salvador, Grenada, Guyana, Honduras, Jamaica, Mexico, Panama, Paraguay, Saint Kitts And Nevis, Saint Lucia, Saint Vincent And The Grenadines, Suriname, Trinidad And Tobago, Uruguay, Venezuela Cuba

AMRO

AmrD

Bolivia, Ecuador, Guatemala, Haiti, Nicaragua, Peru

EMRO

EmrB

Bahrain, Cyprus, Iran (Islamic Republic Of), Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates

EMRO

EmrD

Egypt, Iraq, Morocco, Yemen

EURO

EurA

Andorra, Austria, Belgium, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland, United Kingdom

EURO

EurB1

Albania, Bosnia And Herzegovina, Bulgaria, Georgia, Poland, Romania, Slovakia, The Former Yugoslav Republic Of Macedonia, Turkey, Yugoslavia

EURO

EurB2

Armenia, Azerbaijan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan

EURO

EurC

Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine

SEARO

SearB

Indonesia, Sri Lanka, Thailand Malaysia, Philippines Brunei Darussalam, Singapore

SEARO

SearD

Bangladesh, Bhutan, India, Maldives, Nepal Afghanistan, Pakistan

WPRO

WprA

Australia, Japan, New Zealand

WPRO

WprB1

China, Mongolia, Republic Of Korea DPR Korea

WPRO

WprB2

Cambodia, Lao People's Democratic Republic, Viet Nam Myanmar

WPRO

WprB3

Cook Islands, Fiji, Kiribati, Marshall Island s, Micronesia (Federated States Of), Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu

In the previous paper, we presented the cancer survival model as a key input to estimate the distribution of cancer deaths by site for the regions where mortality data are either scarce or unavailable and tested its performance and validity 7. In this paper, we present a detailed approach to estimating mortality and incidence of cancer by site and the results of mortality and incidence estimation by site for the year 2000.

Material and Methods

Overview of analysis

The Global Burden of Disease 2000 (GBD 2000) study deals with the problem of systemic bias in cause-specific mortality by estimating total mortality for each Member State, starting from an analysis of the overall mortality envelope for each region, in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex and that there is not systematic over- or under- estimation or double counting of deaths. This regional cause-specific mortality envelope serves as an upper bond of mortality from a certain cause and partly ensures the internal consistency among incidence, prevalence and mortality rates 6. The approaches to estimating mortality and incidence of cancer by site also follows this process (Figure 1).

Figure 1

Approaches to estimating global and regional cancer mortality and incidence by site for the Global Burden of Disease 2000 (GBD 2000)

Firstly, we obtained the age- and sex- specific mortality envelope for all malignancies by region derived from the analysis of country life-tables and cause of death models in each region. Secondly, we estimated the site-specific cancer mortality distributions from vital records or cancer survival models depending on the availability and quality of detailed cause of death data. Cancer sites for which survival was calculated were: mouth and pharynx (ICD-10 C00-C14), oesophagus (C15), stomach (C16), colon and rectum (C18-C21), liver (C22), pancreas (C25), trachea, bronchus and lung (C33-C34), melanoma (C43), female breast (C50), cervix uterine (C53), corpus uteri (C54-55), ovary (C56), prostate (C61), bladder (C67), lymphomas and multiple myeloma (C81-C90, C96), leukaemia (C91-C95), and other malignant neoplasms (balance of ICD-10 C00-C97). The GBD 2000 assigns Kaposi's sarcoma and non-Hodgkin lymphomas (NHL) attributable to HIV/AIDS among AIDS sequela and their burden is included separately with HIV/AIDS. Thirdly, the final regional cancer mortality by site is estimated by disaggregating the regional cancer envelope based on the mortality distribution by site. Finally, we applied the incidence-to-mortality rate ratios to back calculate the final cancer incidence estimates by site.

GBD 2000 regional mortality estimates by age, sex, and cause

Complete or incomplete vital registration data together with sample registration systems now cover 74% of global mortality in 128 countries. Survey data and indirect demographic techniques provide information on levels of child and adult mortality for the remaining 26% of estimated global mortality. The available sources of mortality data for the WHO sub regions of the GBD 2000 are summarised in Table 1.

Causes of death for the WHO sub regions and the world have been estimated based on data from national vital registration systems that capture about 17 million deaths annually. In addition, information from sample registration systems, population laboratories and epidemiological analyses of specific conditions have been used to improve estimates of the cause of death patterns 689. As a general rule, vital registration data, suitably corrected for ill-defined coding and probable systematic biases in certifying deaths to non-specific vascular, cancer and injury codes were used to estimate the cause of death pattern. The GBD 2000 approach adjusts the cause-specific mortality to include a proportion of deaths coded to ill-defined causes in vital registration data and redistributes these deaths pro-rata among broader communicable and non-communicable causes.

Cause of death data have been carefully analysed to take into account incomplete coverage of vital registration in countries and the likely differences in cause of death patterns that would be expected in the uncovered and often poorer sub-populations 10. For countries lacking sufficient vital registration data, cause of death models were used to firstly estimate the maximum likelihood distribution of deaths across the broad categories of communicable, non-communicable and injuries, based on estimated total mortality rates and income 8. A regional model pattern of specific causes of death was then constructed based on local vital registration and verbal autopsy data, and this proportionate distribution was then applied within each broad cause group. Finally, the resulting estimates were then adjusted based on other epidemiological evidence from specific disease studies. Methods used to estimate global all-cause and cause-specific mortality from these data are described elsewhere 6.

In the GBD 1990 5, deaths coded to ICD-9 195–199 (i.e., malignant neoplasm of other and unspecified sites including those whose point of origin cannot be determined, secondary and unspecified neoplasm) were redistributed pro-rata across all malignant neoplasm categories within each age-sex group, so that the category 'Other malignant neoplasms' includes only malignant neoplasms of other specified sites. Reviews of the cancer registry and methods of diagnosis suggest that four sites (month and pharynx, liver, breast and cervix uteri) where there did not appear to be any significant mis-coding of cancer deaths, since these can be diagnosed clinically without any further diagnostic tests even in developing regions 11. Accordingly, the cancer garbage code redistribution algorithm was revised for the GBD 2000 to redistribute cancer deaths in ICD C76-C80 pro-rata across the sites other than the four sites above.

Estimation of cancer mortality and incidence

Given the regional cancer mortality envelope by age and sex, the site-specific distributions of cancer mortality are necessary to disagreggate the estimated total cancer deaths by age and sex for each region. The approaches to estimating mortality distributions were different depending on the availability and quality of data on detailed causes of death.

Direct estimates of the site-specific distributions of cancer mortality were possible for the regions where established vital registration records with high coverage and ICD-coding are available, including countries in the A sub regions (AmrA, EurA and WprA) and countries in AmrB, EurB1, EurB2 and EurC 6. For the other regions of the world (AfrD, AfrE, AmrD, EmrB, EmrD, SearB, SearD, WprB1, WprB2 and WprB3 sub regions), a site-specific model for relative interval survival adjusted for each region was developed and applied to the regional incidence estimated by International Agency for Research on Cancer (IARC) to calculate the mortality distribution by site for the year 2000 712. The region-specific incidence estimates of the Globocan 2000 was adjusted to ensure the consistency with the GBD 2000 definitions 7. Our survival model and adjusted incidence estimates of the Globocan 2000 were primarily used to estimate the distribution, but not the magnitude, of cancer by site, sex, and age group.

The final site-specific cancer mortality was then estimated by multiplying age- and sex- specific regional cancer mortality envelope by estimated cancer mortality distribution by site. The cancer survival model is flexible enough to yield the survival estimates of various age, years and period as well as mean duration of time of cancer by site 7. We estimated incidence-to-mortality rate ratios at each age group form the survival model and, by using the final cancer mortality, applied the ratios to back calculate the final incidence by age and sex for each cancer site in all regions of the world for the year 2000.

Results

Cancer mortality by region

The GBD 2000 classifies the cause of deaths into three broad categories: communicable disease, non-communicable disease, and injuries. In 2000, approximately 56 million deaths occurred world wide and non-communicable disease accounted for 58% of total number of deaths, followed by communicable disease (33%) and injuries (9%) (Figure 2). Cancer was estimated to account for over 7 million deaths (13% of total mortality and 22% of non-communicable disease mortality) world wide in 2000, only preceded by cardiovascular diseases (29 % of total) and infectious and parasitic diseases (19%). Depending on the extent of health transition, cancer mortality as a proportion of total mortality differed substantially by region, from less than 5% in AfrE to approximately 30% in WprA sub region.

Figure 2

Regional distribution of mortality by cause, 2000

Tables 2,3,4,5 show the regional estimates of total number of deaths and age-specific mortality rates of all cancers for the GBD 2000. More than 60% of cancer deaths occurred in developing regions, particularly in SearD (mainly India) and WprB1(mainly China) sub regions due to their large population size. On average global cancer mortality rates among males and females were 128.2 and 104.6 per 100,000, respectively. Not surprisingly crude mortality rates from all cancers vary significantly and are much higher in developed regions (AmrA, EurA, and WprA). However, since age-specific mortality rate is generally higher in developing regions, regional mortality rates, age-standardised to the world population, showed less variations compared to crude mortality rates and higher mortality rates were observed in regions such as AfrD, AfrE, AmrB, EurC, and WprB (Figure 3).

Figure 3

Age-standardised mortality rate from all cancers by region, 2000

Table 2

Mortality data sources (number of Member States with recent deaths coverage) by WHO sub region for the GBD2000

Subregion

Category I: Complete vital statistics (95%+ coverage)

Category II: Incomplete vital statistics

Category III: Sample registration and surveillance systems

Category IV: Child mortality estimated from surveys and censuses

Category V: No recent data on child or adult mortality

Number of countries

AfrD

AfrE

AmrA

AmrB

AmrD

EmrB

EmrD

EurA

EurB

EurC

SearB

SearD

WprA

WprB

World

191

Table 3

Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, both sexes, 2000

Region

Age-group

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of deaths (000s)

World

46.0

49.4

141.3

462.1

1,503.0

1,852.4

1,901.0

1,078.7

7,033.9

AfrD

5.0

2.5

10.7

26.3

59.2

70.0

66.5

31.5

271.6

AfrE

4.9

2.6

15.2

33.1

65.0

76.4

72.1

31.5

300.8

AmrA

0.6

1.2

3.9

23.1

102.4

132.3

194.5

168.1

626.2

AmrB

3.2

4.4

10.7

31.7

86.4

94.3

103.5

66.6

400.8

AmrD

1.0

1.4

2.7

6.4

14.8

16.0

18.9

11.5

72.9

EmrB

1.2

2.0

3.8

8.0

19.2

18.2

17.8

7.7

77.8

EmrD

1.9

2.5

4.3

10.6

17.8

15.1

13.2

4.3

69.7

EurA

0.7

1.5

5.3

31.3

154.1

238.2

350.9

279.8

1,061.7

EurB1

0.7

1.1

3.9

16.6

59.3

76.6

69.8

26.5

254.5

EurB2

0.2

0.6

1.4

4.3

7.9

10.9

7.5

1.9

34.8

EurC

0.8

1.7

5.8

28.4

114.2

162.1

146.1

44.5

503.7

SearB

2.9

4.0

7.9

30.9

90.0

79.8

59.1

25.9

300.6

SearD

12.9

11.9

32.7

65.1

189.0

262.1

192.2

109.2

875.1

WprA

0.2

0.4

1.6

7.7

49.6

77.6

104.2

90.4

331.6

WprB1

8.9

10.6

28.5

128.2

451.6

503.1

467.5

165.6

1,764.0

WprB2

0.9

1.0

3.0

9.5

21.4

18.9

16.7

13.3

84.8

WprB3

0.0

0.1

0.2

0.6

1.2

0.7

0.4

0.2

3.4

Age-specific mortality rate per 100,000

World

7.6

4.1

9.0

36.3

186.8

548.2

965.1

1,702.1

116.5

AfrD

9.1

2.8

11.6

49.5

210.0

667.6

1,386.4

2,799.0

81.4

AfrE

8.5

2.7

16.3

63.6

243.8

798.9

1,612.8

2,932.2

89.1

AmrA

2.9

2.6

6.3

31.5

178.2

581.8

1,074.1

1,901.0

203.1

AmrB

7.0

4.9

8.6

34.1

159.9

463.9

895.3

1,773.8

90.7

AmrD

10.7

8.2

13.3

51.0

211.0

593.4

1,354.4

2,827.8

102.3

EmrB

7.3

5.7

9.1

31.5

144.0

374.6

688.6

1,182.8

55.8

EmrD

10.2

7.5

11.0

41.5

129.5

305.6

540.6

716.3

50.5

EurA

3.2

3.1

6.6

33.1

196.8

570.4

1,109.9

2,089.7

259.6

EurB1

5.7

4.2

9.0

47.1

226.3

602.5

874.0

1,325.3

153.5

EurB2

3.7

4.8

10.0

41.5

172.8

450.4

584.6

550.4

68.4

EurC

6.7

5.1

10.4

51.3

266.1

656.0

911.4

1,012.8

205.4

SearB

7.1

5.0

7.0

36.7

192.9

442.1

679.3

1,109.6

76.2

SearD

8.0

3.9

8.8

24.9

124.6

448.9

681.4

1,499.2

64.9

WprA

2.4

2.3

5.1

25.9

153.3

471.8

927.3

1,907.7

222.6

WprB1

8.6

4.5

8.4

38.1

218.2

617.6

1,080.7

1,435.2

130.0

WprB2

5.9

3.3

7.2

31.7

152.4

312.2

525.6

1,540.4

59.7

WprB3

4.3

8.2

47.8

173.4

280.3

378.4

1,162.9

49.1

Table 4

Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, males, 2000

Region

Age-group

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of deaths (000s)

World

22.6

27.4

79.9

228.3

844.8

1,121.7

1,074.6

502.6

3,901.9

AfrD

2.1

1.3

6.2

14.3

29.2

34.2

34.8

17.1

139.3

AfrE

2.6

1.5

9.6

20.3

33.3

36.2

36.1

17.0

156.8

AmrA

0.3

0.6

2.3

10.5

54.0

74.5

105.8

77.1

325.1

AmrB

1.7

2.5

6.0

12.4

41.4

51.7

57.6

33.9

207.1

AmrD

0.4

0.8

1.4

2.2

5.4

7.5

9.6

5.9

33.3

EmrB

0.7

1.2

1.9

3.0

10.0

11.6

4.8

44.9

EmrD

1.2

1.5

2.4

5.1

9.0

8.8

7.6

2.7

38.2

EurA

0.4

0.9

3.2

15.2

90.1

151.1

205.8

127.8

594.3

EurB1

0.4

0.7

2.1

8.7

37.2

49.5

39.9

12.1

150.5

EurB2

0.1

0.3

0.8

2.0

4.4

6.6

3.9

0.7

18.9

EurC

0.4

1.0

3.3

13.8

70.1

101.2

73.5

15.9

279.2

SearB

1.5

2.0

4.2

11.8

45.4

48.4

35.7

12.8

161.8

SearD

6.0

15.5

31.0

88.4

148.3

106.4

48.7

450.1

WprA

0.1

0.2

0.8

3.4

29.2

52.8

67.0

44.9

198.5

WprB1

4.1

6.2

18.7

69.7

285.7

327.5

268.6

73.8

1,054.3

WprB2

0.5

0.6

1.6

4.6

11.4

11.7

10.3

7.2

47.9

WprB3

0.0

0.1

0.2

0.6

0.4

0.2

0.1

1.6

Age-specific mortality rate per 100,000

World

7.3

4.5

10.0

35.3

209.6

694.5

1,264.5

2,095.6

128.2

AfrD

7.6

2.9

13.5

54.6

214.0

697.7

1,607.5

3,446.7

83.9

AfrE

9.0

3.3

20.6

78.4

258.1

824.4

1,866.5

4,078.5

93.5

AmrA

3.0

2.8

7.2

28.4

190.0

689.9

1,353.3

2,286.9

213.1

AmrB

7.4

5.4

9.6

27.1

158.5

546.5

1,139.1

2,145.2

94.5

AmrD

9.0

8.9

13.5

36.2

158.0

583.7

1,505.9

3,264.8

93.6

EmrB

8.9

6.6

9.1

22.2

137.7

461.9

904.8

1,444.8

62.1

EmrD

12.9

8.9

11.8

39.2

134.5

385.5

704.1

1,014.3

54.8

EurA

3.4

3.6

7.7

31.7

230.9

762.6

1,576.8

2,711.7

295.6

EurB1

6.3

5.0

9.7

48.8

288.5

847.1

1,225.6

1,657.4

183.0

EurB2

4.8

5.6

10.9

38.8

197.1

598.0

772.0

676.4

75.0

EurC

7.0

5.6

11.6

50.4

351.0

1,001.0

1,453.4

1,541.1

242.3

SearB

7.0

4.9

7.3

28.0

199.0

569.2

905.5

1,264.7

82.0

SearD

7.1

3.8

8.0

22.7

113.7

516.9

792.8

1,419.2

64.8

WprA

2.9

5.4

22.9

181.1

668.2

1,387.3

2,603.3

270.5

WprB1

7.5

5.1

10.6

40.3

267.2

796.0

1,372.3

1,729.7

151.1

WprB2

5.9

3.8

7.6

31.3

175.1

431.4

784.9

2,303.2

68.1

WprB3

5.1

5.5

7.0

29.3

162.4

329.5

476.3

1,404.1

46.7

Table 5

Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, females, 2000

Region

Age-group

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of deaths (000s)

World

23.4

22.0

61.4

233.8

658.2

730.6

826.4

576.2

3,132.0

AfrD

2.9

1.2

4.4

12.0

30.0

35.8

31.7

14.4

132.3

AfrE

2.3

1.0

5.6

12.8

31.7

40.2

35.9

14.4

144.0

AmrA

0.3

0.5

1.6

12.6

48.4

57.8

88.7

91.1

301.1

AmrB

1.5

2.0

4.7

19.3

45.0

42.6

45.9

32.7

193.8

AmrD

0.6

1.4

4.2

9.4

8.5

9.3

5.6

39.6

EmrB

0.4

0.8

1.8

5.0

9.2

6.6

6.2

2.9

32.9

EmrD

0.7

1.0

1.9

5.5

8.8

6.4

5.6

1.6

31.4

EurA

0.3

0.6

2.1

16.2

64.0

87.1

145.1

152.0

467.4

EurB1

0.3

0.4

1.8

7.9

22.1

27.1

29.9

14.4

104.0

EurB2

0.1

0.2

0.6

2.3

3.6

4.3

3.6

1.1

15.9

EurC

0.4

0.7

2.5

14.6

44.1

60.9

72.6

28.7

224.5

SearB

1.5

2.0

3.7

19.1

44.6

31.4

23.4

13.1

138.8

SearD

6.9

5.9

17.2

34.2

100.6

113.8

85.8

60.5

425.0

WprA

0.1

0.7

4.3

20.4

24.9

37.2

45.5

133.1

WprB1

4.8

4.3

9.8

58.5

165.9

175.7

198.8

91.8

709.7

WprB2

0.4

1.4

5.0

9.9

7.2

6.4

6.2

36.9

WprB3

0.0

0.1

0.4

0.6

0.3

0.2

0.1

1.7

Age-specific mortality rate per 100,000

World

8.0

3.8

8.0

37.3

163.9

414.3

737.9

1,462.6

104.6

AfrD

10.6

2.6

9.6

44.6

206.1

641.3

1,204.5

2,286.7

78.9

AfrE

8.1

2.2

12.0

48.9

230.4

777.2

1,418.8

2,202.6

84.8

AmrA

2.7

2.4

5.3

34.7

166.6

484.1

862.1

1,663.3

193.4

AmrB

6.6

4.4

7.7

40.9

161.3

392.0

705.7

1,504.1

86.9

AmrD

12.5

7.5

13.2

65.1

260.9

602.3

1,226.6

2,479.1

110.8

EmrB

5.5

4.8

9.2

42.1

151.7

280.7

474.5

909.5

49.0

EmrD

7.4

5.9

10.1

43.8

124.7

237.8

411.1

481.1

46.1

EurA

2.9

2.6

5.4

34.6

162.9

397.0

781.7

1,751.8

224.7

EurB1

5.0

3.4

8.3

45.3

166.0

394.8

632.1

1,134.8

124.4

EurB2

2.5

4.1

9.1

44.1

150.2

326.0

463.3

491.3

61.9

EurC

6.4

4.5

9.1

52.2

192.2

417.0

661.6

851.5

172.7

SearB

7.3

5.1

6.6

45.4

187.2

329.0

491.8

991.1

70.5

SearD

8.8

4.0

9.7

27.2

136.1

383.2

580.4

1,570.4

65.1

WprA

2.0

1.7

4.7

29.0

125.6

290.5

580.5

1,509.3

176.2

WprB1

9.9

3.9

6.0

35.7

165.9

435.6

839.7

1,262.3

107.6

WprB2

6.0

2.9

6.8

32.1

132.6

215.4

342.3

1,113.7

51.5

WprB3

3.5

3.0

9.5

68.4

184.5

233.3

294.1

960.7

51.7

Cancer mortality envelope was disaggregated by applying the distribution of cancer mortality by site estimated from both the detailed analysis of vital records and the use of survival model and incidence data from the International Agency for Research on Cancer (IARC). Tables 6 and 7 show the estimated global and regional numbers of deaths and age-standardised mortality rates by sex for 17 cancer sites. Generally higher mortality rates were observed in developing regions except cancers of lung and pancreas which are more prevalent in developed regions and highly fatal.

Table 6

Estimated global and regional number of cancer deaths and age-standardised mortality rate by site, males, 2000

WHO sub region

World

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Site

Number of deaths (000s)

Mouth and oropharynx cancers

222.4

10.7

14.3

6.6

8.5

0.7

2.0

1.5

19.2

6.0

0.8

14.7

13.1

88.9

4.1

25.5

5.4

0.4

Oesophagus cancer

273.6

4.9

13.8

11.6

10.5

0.7

1.8

0.7

21.4

3.4

1.7

10.0

3.3

41.9

9.4

135.7

2.9

0.0

Stomach cancer

512.0

12.0

9.8

10.0

25.8

7.6

7.5

2.3

38.9

14.9

3.5

42.2

7.1

28.1

34.3

261.1

6.8

0.1

Colon and rectum cancers

311.8

7.4

8.8

36.1

14.4

1.6

2.2

2.3

72.1

14.3

1.0

28.7

13.9

19.6

23.1

63.3

2.9

0.1

Liver cancer

414.9

20.6

23.5

8.7

9.3

2.8

3.0

2.3

25.3

5.8

0.7

7.8

25.9

17.3

23.8

231.5

6.3

0.2

Pancreas cancer

117.0

1.5

2.7

16.0

7.9

1.1

0.9

1.0

26.7

5.8

1.0

11.2

3.5

7.6

11.2

18.4

0.5

0.0

Trachea, bronchus, lung cancers

877.3

7.0

9.4

101.4

36.1

1.6

8.7

7.1

158.0

46.6

3.8

83.6

40.8

102.7

43.2

214.6

12.4

0.3

Melanoma of the skin

35.1

2.4

2.2

7.7

3.3

0.6

0.2

0.1

8.3

2.0

0.2

2.5

0.7

1.4

1.7

1.6

0.1

0.0

Breast cancer

2.6

0.0

0.5

0.3

0.0

0.9

0.2

0.1

0.5

0.0

0.1

0.0

Cervix uteri cancer

0.0

Corpus uteri cancer

0.0

Ovary cancer

0.0

Prostate cancer

263.6

26.0

19.2

39.6

30.4

5.8

2.1

1.7

70.2

9.4

0.5

13.3

8.1

19.8

10.4

6.1

0.9

0.0

Bladder cancer

123.9

6.9

4.3

10.3

4.9

0.5

2.6

7.7

27.1

7.1

0.7

10.4

4.4

15.9

4.1

15.9

1.0

0.0

Lymphomas, multiple myeloma

168.6

15.9

13.7

23.1

9.6

2.1

4.1

3.6

27.6

5.6

0.9

5.4

9.6

26.1

7.8

11.2

2.0

0.1

Leukaemia

145.3

5.2

6.9

14.5

9.6

2.0

2.3

3.7

20.0

5.4

0.8

7.8

7.6

21.0

4.9

31.9

1.7

0.1

Other malignant neoplasms

425.2

18.7

25.6

39.0

36.5

6.0

7.5

4.2

79.1

24.0

3.2

41.3

16.6

60.5

20.4

37.4

5.0

0.2

Age-standardized mortality rate per 100,000

Mouth and oropharynx cancers

7.3

11.7

16.6

2.8

4.5

2.8

4.0

3.1

5.5

5.9

4.0

9.0

8.0

16.7

2.8

3.4

10.7

18.4

Oesophagus cancer

9.0

5.5

16.4

4.8

5.6

3.0

3.6

1.6

5.6

3.2

9.0

5.9

2.1

7.9

6.1

18.3

6.1

1.9

Stomach cancer

16.8

13.5

11.7

3.9

13.7

31.5

15.1

4.9

9.3

14.2

18.7

25.1

4.5

5.3

21.5

35.5

14.2

3.3

Colon and rectum cancers

10.2

8.1

11.0

13.7

7.6

6.5

4.2

4.8

17.0

13.6

5.2

17.0

8.9

3.7

14.6

8.7

6.0

4.1

Liver cancer

13.6

20.9

25.6

3.6

4.9

11.1

6.2

5.0

6.2

5.6

3.6

4.6

15.9

3.1

15.7

30.5

12.2

10.1

Pancreas cancer

3.8

1.6

3.4

6.3

4.2

4.7

1.8

2.2

6.6

5.6

5.3

6.7

2.2

1.5

7.1

2.5

1.0

0.2

Trachea, bronchus, lung cancers

28.8

7.9

11.5

40.1

19.3

6.5

17.7

15.9

39.5

44.2

19.7

48.9

26.0

19.4

26.3

29.1

25.1

13.8

Melanoma of the skin

1.2

2.7

2.6

3.2

1.7

2.5

0.4

0.2

2.2

2.0

1.1

1.6

0.5

0.3

1.1

0.2

2.4

Breast cancer

0.1

0.0

0.2

0.1

0.0

0.2

0.3

0.0

0.1

0.0

Cervix uteri cancer

0.0

Corpus uteri cancer

0.0

Ovary cancer

0.0

Prostate cancer

8.7

33.3

27.9

12.7

16.2

24.9

4.5

4.3

14.3

8.8

2.9

7.8

5.6

4.1

5.7

0.9

1.9

1.5

Bladder cancer

4.1

8.4

5.8

3.6

2.6

2.2

5.6

17.7

6.0

6.7

4.0

6.1

2.9

3.1

2.3

0.8

Lymphomas, multiple myeloma

5.5

15.1

13.5

9.2

4.9

8.3

7.3

6.3

7.1

5.7

4.4

3.5

5.8

4.6

5.1

1.5

3.6

5.5

Leukaemia

4.8

4.9

6.7

5.9

4.7

6.5

3.7

5.9

5.4

5.7

3.4

5.3

4.2

3.3

3.9

4.6

2.6

Other malignant neoplasms

14.0

20.2

31.0

16.6

18.9

23.0

14.6

8.4

21.4

23.6

16.0

26.1

10.2

11.3

13.6

5.2

10.3

8.5

Table 7

Estimated global and regional number of cancer deaths and age-standardised mortality rate by site, females, 2000

WHO sub region

World

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Site

Number of deaths (000s)

Mouth and oropharynx cancers

97.2

5.3

7.1

3.3

2.7

0.5

1.1

0.6

5.7

1.5

0.3

2.9

5.5

42.7

1.7

13.6

2.6

0.2

Oesophagus cancer

157.6

4.0

6.8

3.7

3.8

0.3

1.5

0.5

7.8

1.0

1.3

3.5

2.3

33.6

2.0

83.6

2.0

0.0

Stomach cancer

324.2

8.9

7.2

7.0

16.5

7.1

3.7

1.6

27.9

8.6

2.2

30.6

5.5

16.1

19.0

157.7

4.6

0.1

Colon and rectum cancers

295.5

5.6

5.3

37.2

16.1

2.1

2.2

1.7

69.7

11.8

1.1

33.61

3.6

14.01

9.4

59.72

2.2

0.1

Liver cancer

191.0

11.0

9.8

5.3

9.1

3.2

1.2

1.1

13.3

3.8

0.5

5.6

10.6

10.4

10.5

93.5

2.2

0.2

Pancreas cancer

105.6

1.5

2.5

16.9

8.7

1.2

0.7

0.6

26.9

4.6

0.7

9.8

3.3

5.2

9.4

13.0

0.5

0.0

Trachea, bronchus, lung cancers

323.8

2.9

4.5

70.5

14.9

0.9

2.5

2.3

49.2

9.8

1.1

16.2

7.5

23.2

16.9

97.6

3.7

0.2

Melanoma of the skin

30.1

2.4

3.0

4.3

2.7

0.6

0.2

0.1

7.2

1.9

0.2

3.0

1.0

1.1

1.2

0.1

0.0

Breast cancer

466.3

18.6

23.0

53.3

30.7

4.0

5.1

7.0

91.8

18.5

2.5

39.4

29.0

67.0

12.4

57.5

6.3

0.2

Cervix uteri cancer

259.6

24.1

36.8

5.3

19.3

4.6

3.5

2.6

8.3

6.3

1.0

11.7

15.4

86.2

2.6

26.1

5.4

0.3

Corpus uteri cancer

72.9

1.4

1.7

8.2

10.4

3.5

0.4

0.3

16.0

4.3

0.8

11.0

4.0

3.2

3.3

4.1

0.2

0.0

Ovary cancer

128.6

3.9

6.7

15.5

7.0

1.1

0.9

25.7

5.7

0.6

12.9

8.7

18.5

4.9

13.8

1.6

0.1

Prostate cancer

0.0

Bladder cancer

53.5

2.3

2.0

4.9

2.1

0.3

0.5

2.0

10.5

1.7

0.2

2.8

1.4

14.2

1.9

6.3

0.6

0.0

Lymphomas, multiple myeloma

163.7

6.6

5.2

21.7

8.0

1.6

2.8

2.4

27.4

4.3

0.5

4.8

6.1

54.8

6.2

9.4

1.8

0.1

Leukaemia

114.7

4.4

4.9

12.0

8.4

1.9

1.7

2.5

17.2

3.8

0.7

7.2

14.7

3.6

23.1

1.4

0.1

Other malignant neoplasms

344.5

29.4

14.8

32.0

33.2

6.9

5.1

63.0

16.4

2.4

29.6

15.5

19.9

18.3

49.5

3.4

0.2

Age-standardized mortality rate per 100,000

Mouth and oropharynx cancers

3.2

6.6

8.8

1.3

1.5

2.2

2.5

1.3

1.4

1.3

3.7

9.9

1.0

2.0

4.9

10.8

Oesophagus cancer

5.3

5.0

8.8

1.3

2.1

1.4

3.8

1.1

1.6

0.9

6.1

1.4

1.6

7.7

1.2

12.7

3.8

1.7

Stomach cancer

10.8

11.3

9.2

2.5

9.1

32.2

9.0

3.6

5.8

7.9

10.6

13.0

3.7

3.8

11.5

24.1

8.7

2.6

Colon and rectum cancers

9.9

7.0

13.0

8.9

9.4

5.6

3.7

14.4

10.7

5.3

13.9

9.3

3.3

11.6

9.1

4.2

2.6

Liver cancer

6.4

12.4

11.5

2.0

5.0

13.9

3.0

2.4

2.9

3.4

2.2

2.4

7.1

2.1

6.2

13.9

3.9

6.9

Pancreas cancer

3.5

1.7

3.4

6.1

4.8

5.6

1.7

1.5

5.7

4.1

3.4

4.1

2.3

1.2

5.5

2.0

0.9

0.3

Trachea, bronchus, lung cancers

10.8

3.2

5.3

27.4

8.0

4.0

6.0

5.2

11.6

9.0

5.1

6.9

4.9

10.1

14.5

6.8

7.7

Melanoma of the skin

1.0

3.1

4.1

1.7

1.5

2.6

0.4

0.3

1.7

1.8

1.0

1.5

0.7

0.2

0.7

0.2

0.1

1.5

Breast cancer

15.6

21.4

27.7

21.1

16.0

16.1

12.2

14.4

22.8

17.4

12.0

18.7

17.6

14.5

9.4

8.1

11.3

12.0

Cervix uteri cancer

8.7

27.4

43.8

2.4

9.8

18.7

8.7

5.5

2.3

6.1

4.7

5.9

9.3

18.0

2.0

3.9

9.7

15.5

Corpus uteri cancer

2.4

1.9

2.3

3.1

5.5

1.5

1.0

0.8

3.5

3.9

3.8

4.7

2.6

0.8

2.1

0.6

0.4

1.2

Ovary cancer

4.3

8.1

6.1

3.7

4.4

2.2

1.8

6.3

5.3

3.0

6.0

5.3

4.1

3.5

2.0

2.9

3.2

Prostate cancer

0.0

Bladder cancer

1.8

2.9

2.6

1.6

1.2

1.4

4.6

2.0

1.5

0.9

1.1

3.1

1.0

1.1

0.2

Lymphomas, multiple myeloma

5.5

6.7

5.6

7.9

4.2

6.5

6.3

4.8

6.1

4.1

2.4

2.3

3.9

11.7

3.8

1.4

3.0

3.1

Leukaemia

3.8

4.7

5.1

4.6

4.1

6.5

3.1

4.3

4.1

3.8

2.8

3.8

4.1

2.6

2.7

3.6

2.1

2.2

Other malignant neoplasms

11.5

34.3

18.0

12.5

17.6

28.6

12.5

10.9

14.6

15.3

11.0

14.1

10.1

4.9

11.0

7.7

6.3

8.2

Tables 8 and 9 represent the ranking of the number of deaths by cancer site in the world and three selected sub regions: a high child and adult mortality/low income region (AfrE), a very low child and adult mortality/high income region (EurA), and a low child and adult mortality/middle income region (SearB). Lung cancer was the leading cause of cancer deaths in the world, accounting for 17% of total cancer mortality, followed by cancers of stomach (12% of total), liver (9%), colon and rectum (9%), and breast (7%). In males, lung, stomach, and liver cancers were the three most common cause of cancer deaths. The leading cause of cancer deaths among females was breast but lung cancer was already the second largest cause of cancer deaths.

Table 8

Ranking of the global cancer deaths by site, 2000

site

Number of death (000s)

Proportion of total (%)

Both sexes

Trachea, bronchus, and lung

1211.5

17.2

Stomach

835.1

11.9

Liver

611.4

8.7

Colon and rectum

608.0

8.6

Breast

473.8

6.7

Oesophagus

430.4

6.1

Lymphomas and myeloma

329.9

4.7

Mouth and oropharynx

320.0

4.5

Prostate

264.0

3.8

Leukaemia

263.8

3.8

Cervix uteri

254.2

3.6

Pancreas

222.3

3.2

Bladder

179.4

2.6

Ovary

130.1

1.8

Corpus uteri

73.5

1.0

Melanoma of the skin

65.3

0.9

Males

Trachea, bronchus, and lung

877.2

22.5

Stomach

511.3

13.1

Liver

419.4

10.7

Colon and rectum

312.3

8.0

Oesophagus

272.8

7.0

Prostate

264.0

6.8

Mouth and oropharynx

222.0

5.7

Lymphomas and myeloma

169.6

4.3

Leukaemia

145.4

3.7

Bladder

126.1

3.2

Pancreas

116.8

3.0

Melanoma of the skin

35.0

0.9

Females

Breast

471.2

15.0

Trachea, bronchus, and lung

334.2

10.7

Stomach

323.7

10.3

Colon and rectum

295.7

9.4

Cervix uteri

254.2

8.1

Liver

192.1

6.1

Lymphomas and myeloma

160.2

5.1

Oesophagus

157.6

5.0

Ovary

130.1

4.2

Leukaemia

118.4

3.8

Pancreas

105.5

3.4

Mouth and oropharynx

98.0

3.1

Corpus uteri

73.5

2.3

Bladder

53.4

1.7

Melanoma of the skin

30.3

1.0

Table 9

Ranking of selected regional cancer deaths by site, 2000

WHO sub region

AfrE (high child and adult mortality)

EurA (very low child and adult mortality)

SearB (low child and adult mortality)

site

Number of death (000s)

Proportion of total (%)

site

Number of death (000s)

Proportion death of total (%)

site

Number of death (000s)

Proportion death of total (%)

Both sexes

Cervix uteri

37.3

12.4

Trachea, bronchus, and lung

207.1

19.5

Trachea, bronchus, and lung

48.3

16.1

Liver

35.3

11.7

Colon and rectum

141.6

13.3

Liver

39.4

13.1

Breast

23.8

7.9

Breast

92.7

8.7

Breast

29.4

9.8

Mouth and oropharynx

21.6

7.2

Prostate

70.1

6.6

Colon and rectum

28.5

9.5

Oesophagus

20.7

6.9

Stomach

66.7

6.3

Mouth and oropharynx

19.4

6.5

Lymphomas and myeloma

19.2

6.4

Lymphomas and myeloma

55.0

5.2

Lymphomas and myeloma

16.2

5.4

Prostate

19.2

6.4

Pancreas

53.6

5.0

Cervix uteri

15.6

5.2

Stomach

17.1

5.7

Liver

38.5

3.6

Leukaemia

15.1

5.0

Colon and rectum

14.3

4.8

Bladder

37.6

3.5

Stomach

13.1

4.3

Trachea, bronchus, and lung

14.0

4.6

Leukaemia

37.2

3.5

Ovary

8.8

2.9

Leukaemia

12.4

4.1

Oesophagus

29.2

2.7

Prostate

8.5

2.8

Ovary

6.9

2.3

Ovary

25.7

2.4

Pancreas

7.0

2.3

Bladder

6.3

2.1

Mouth and oropharynx

24.9

2.3

Bladder

6.2

2.1

Melanoma of the skin

5.3

1.8

Corpus uteri

16.0

1.5

Oesophagus

5.9

2.0

Pancreas

5.3

1.8

Melanoma of the skin

15.5

1.5

Corpus uteri

4.1

1.4

Corpus uteri

1.7

0.6

Cervix uteri

8.3

0.8

Melanoma of the skin

1.8

0.6

Males

Liver

24.9

15.9

Trachea, bronchus, and lung

158.0

26.6

Trachea, bronchus, and lung

40.8

25.2

Prostate

19.2

12.2

Colon and rectum

72.0

12.1

Liver

28.4

17.6

Mouth and oropharynx

14.4

9.2

Prostate

70.1

11.8

Colon and rectum

14.6

9.1

Lymphomas and myeloma

14.0

8.9

Stomach

38.8

6.5

Mouth and oropharynx

13.8

8.5

Oesophagus

13.8

8.8

Lymphomas and myeloma

27.6

4.6

Lymphomas and myeloma

10.0

6.2

Stomach

9.9

6.3

Bladder

27.1

4.6

Prostate

8.5

5.3

Trachea, bronchus, and lung

9.4

6.0

Pancreas

26.7

4.5

Leukaemia

7.8

4.8

Colon and rectum

9.0

5.7

Liver

25.3

4.3

Stomach

7.5

4.6

Leukaemia

7.3

4.7

Oesophagus

21.4

3.6

Bladder

4.7

2.9

Bladder

4.3

2.7

Leukaemia

20.0

3.4

Pancreas

3.6

2.2

Pancreas

2.8

1.8

Mouth and oropharynx

19.2

3.2

Oesophagus

3.6

2.2

Melanoma of the skin

2.3

1.4

Melanoma of the skin

8.3

1.4

Melanoma of the skin

0.7

0.5

Females

Cervix uteri

37.3

25.9

Breast

91.8

19.6

Breast

29.3

21.1

Breast

23.8

16.5

Colon and rectum

69.6

14.9

Cervix uteri

15.6

11.3

Liver

10.3

7.2

Trachea, bronchus, and lung

49.2

10.5

Colon and rectum

13.9

10.0

Stomach

7.2

5.0

Stomach

27.8

6.0

Liver

11.0

7.9

Mouth and oropharynx

7.2

5.0

Lymphomas and myeloma

27.4

5.9

Ovary

8.8

6.3

Ovary

6.9

4.8

Pancreas

26.9

5.8

Trachea, bronchus, and lung

7.5

5.4

Oesophagus

6.8

4.8

Ovary

25.7

5.5

Leukaemia

7.2

5.2

Colon and rectum

5.3

3.7

Leukaemia

17.2

3.7

Lymphomas and myeloma

6.2

4.5

Lymphomas and myeloma

5.3

3.7

Corpus uteri

16.0

3.4

Mouth and oropharynx

5.6

4.0

Leukaemia

5.1

3.5

Liver

13.3

2.8

Stomach

5.6

4.0

Trachea, bronchus, and lung

4.5

3.2

Bladder

10.5

2.2

Corpus uteri

4.1

2.9

Melanoma of the skin

3.0

2.1

Cervix uteri

8.3

1.8

Pancreas

3.4

2.4

Pancreas

2.5

1.8

Oesophagus

7.8

1.7

Oesophagus

2.4

1.7

Bladder

2.0

1.4

Melanoma of the skin

7.2

1.5

Bladder

1.5

1.1

Corpus uteri

1.7

1.2

Mouth and oropharynx

5.7

1.2

Melanoma of the skin

1.0

0.7

There is a significant variation in the distribution of site-specific cancer mortality by region. In AfrE, the leading causes of cancer mortality in males and females were liver and cervix uteri cancers, respectively, both of which are primarily due to viral infections. Liver cancer accounted for approximately one quarter of all male cancer deaths and cervical cancer accounted for more than one-third of female cancer deaths. In EurA, the pattern of cancer mortality distribution is a typical one observed in industrialised countries: lung, colorectal, and prostate cancers accounted for a large proportion of male cancer mortality while breast, colorectal, and lung cancers were major causes among females. Site-specific cancer mortality distribution in SearB lay somewhere between the two sub regions, although lung and breast cancers were already leading causes of cancer deaths in males and females, respectively.

Cancer incidence by site

Regional incidence was back calculated from multiplying mortality by site-specific incidence-to-mortality rate ratios by age, sex, and region. As shown in Table 10, (age-standardised) incidence-to-mortality rate ratio was generally higher in cancers with relatively better prognosis including lymphoma, leukaemia, and cancers of colon and rectum, breast, uterus, and ovary. As a result, the new cases of such cancers as a proportion of total new cases were higher than the proportion of mortality from same cancers. Although this pattern was consistent across the regions, the ratios varied substantially by age, sex, and region (data not shown).

Table 10

Estimated global site-specific cancer incidence-to-mortality rate ratios by sex

Site

Male

Female

Mouth and oropharynx

1.20

1.57

Oesophagus

1.05

Stomach

1.15

1.19

Colon and rectum

1.69

1.75

Liver

1.01

1.06

Pancreas

1.02

1.01

Trachea, bronchus, and lung

1.07

1.10

Melanoma of the skin

3.37

2.93

Breast

2.19

Cervix uteri

1.91

Corpus uteri

4.45

Ovary

1.70

Prostate

2.08

Bladder

2.21

2.01

Lymphomas and multiple myeloma

1.40

1.51

Leukaemia

1.35

1.44

Other malignant neoplasms

1.49

1.63

Tables 11,12,13 show the regional estimates of total new cases and age-specific incidence rates of all cancers in 2000. More than 10 million new cancers cases occurred world wide. Due to the differences in survival by region, estimated incidence-to-mortality rate ratios were generally much higher in developed regions and the proportion of cancer incidence in developing regions was approximately 50% of total cancer incidence in the world. Despite their much smaller population size, the number of new cases in AmrA and EurA are comparable to those in SearD and WprB1. On average global cancer incidence rates among males and females were 169.7 and 171.1 per 100,000, respectively (Figure 4). Regional age-standardised incidence rates also suggest that female incidence was slightly higher than male incidence in developing regions, particularly in AmrD where the number of deaths female cancers was high. On the other hand, male and female incidence rates were almost the same in all A sub regions (AmrA, EurA, and WprA).

Figure 4

Age-standardised incidence rate from all cancers by region, 2000

Table 11

Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, both sexes, 2000

Age group

Region

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of new cases (000s)

World

136.8

96.5

360.1

923.3

2459.3

2641.4

2514.5

1160.2

10292.1

AfrD

12.5

4.6

24.7

41.9

87.6

90.8

74.5

31.9

368.6

AfrE

12.8

4.9

33.8

49.1

99.2

102.4

81.0

31.9

415.1

AmrA

3.0

3.3

22.7

110.4

306.3

308.4

404.2

176.4

1334.8

AmrB

10.0

8.5

31.5

76.1

150.8

137.5

127.6

69.2

611.1

AmrD

2.9

2.6

7.5

15.6

28.5

23.8

22.7

11.9

115.5

EmrB

3.5

4.3

8.8

15.7

28.4

24.0

20.5

7.9

113.2

EmrD

5.4

4.7

9.3

20.0

28.2

19.9

15.1

4.4

106.9

EurA

2.7

3.6

23.8

96.6

323.0

421.1

531.4

322.2

1724.3

EurB1

2.1

2.2

11.0

33.8

91.6

105.0

84.4

27.1

357.2

EurB2

0.6

1.2

3.7

8.4

11.7

14.0

8.7

1.9

50.2

EurC

2.6

3.5

18.0

60.8

172.9

222.9

180.5

46.1

707.3

SearB

8.8

7.5

18.9

65.1

138.9

103.9

67.6

26.7

437.5

SearD

39.6

24.2

85.1

111.0

277.0

317.7

208.4

110.8

1173.9

WprA

0.9

6.8

25.7

108.2

133.0

153.0

107.7

536.1

WprB1

26.9

18.3

47.7

176.3

575.8

593.2

516.0

170.3

2124.4

WprB2

2.5

2.0

6.6

15.6

29.5

22.9

18.2

13.6

110.8

WprB3

0.1

0.4

1.2

1.9

0.9

0.5

0.2

5.2

Age-specific incidence rate per 100,000

World

22.6

8.1

23.0

72.4

305.6

781.8

1276.6

1830.7

170.4

AfrD

22.9

5.2

26.8

78.9

310.4

866.4

1554.9

2834.8

110.4

AfrE

22.3

5.2

36.3

94.3

371.8

1070.3

1812.2

2975.0

123.0

AmrA

14.4

7.5

36.4

150.7

532.9

1356.3

2232.0

1994.7

433.0

AmrB

21.9

9.5

25.4

82.0

279.1

676.3

1103.7

1842.4

138.2

AmrD

30.8

15.1

36.5

123.3

406.3

881.5

1623.0

2921.2

162.0

EmrB

21.4

12.3

21.4

62.2

213.6

494.3

793.5

1206.4

81.1

EmrD

28.9

14.2

23.8

78.2

205.5

401.7

619.9

728.7

77.5

EurA

12.4

7.5

29.6

102.1

412.5

1008.3

1681.0

2406.4

421.6

EurB1

17.0

8.5

25.3

95.7

349.8

826.0

1056.8

1355.2

215.4

EurB2

10.5

9.7

26.6

81.0

254.7

577.3

674.1

560.0

98.7

EurC

20.6

10.3

32.4

109.7

403.0

901.9

1125.9

1048.5

288.5

SearB

21.4

9.3

16.8

77.4

297.8

575.8

776.5

1142.3

110.9

SearD

24.4

7.9

22.9

42.4

182.7

544.1

738.9

1521.0

87.1

WprA

10.9

5.8

22.1

86.1

334.2

808.6

1361.9

2273.3

360.0

WprB1

26.1

7.8

14.0

52.3

278.2

728.1

1193.0

1475.8

156.5

WprB2

16.6

6.3

15.8

51.7

210.3

378.2

572.8

1565.2

78.0

WprB3

11.7

7.7

21.6

93.3

271.0

364.6

422.9

1174.1

76.4

Table 12

Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, males, 2000

Age group

Region

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of new cases (000s)

World

64.5

50.9

154.0

257.7

1174.2

1528.4

1380.8

556.5

5167.1

AfrD

5.2

2.3

10.4

13.0

37.9

45.1

39.0

17.3

170.2

AfrE

6.6

2.8

15.3

18.3

42.5

47.2

40.0

17.2

189.9

AmrA

1.6

1.7

11.0

28.3

134.7

174.3

226.6

109.9

688.2

AmrB

5.3

4.4

13.9

15.7

56.1

70.5

68.2

34.6

268.7

AmrD

1.2

1.4

2.8

2.6

7.2

10.5

11.2

6.0

42.9

EmrB

2.2

2.5

3.6

3.4

13.2

14.7

13.1

4.9

57.5

EmrD

3.4

2.7

4.3

6.3

13.3

11.5

8.5

2.7

52.8

EurA

1.5

2.0

11.5

26.4

153.8

250.2

291.4

139.6

876.3

EurB1

1.1

1.3

4.8

10.8

49.4

63.2

45.7

12.2

188.5

EurB2

0.4

0.7

1.6

2.2

5.3

7.9

4.3

0.7

23.1

EurC

1.4

1.8

8.1

17.5

90.3

126.3

84.3

16.0

345.6

SearB

4.3

3.3

7.0

11.8

57.2

59.7

39.5

13.0

195.8

SearD

16.2

11.8

27.0

29.8

110.2

173.8

113.7

49.1

531.6

WprA

0.5

3.0

5.8

51.0

86.0

94.3

51.3

292.3

WprB1

12.3

10.5

27.1

61.4

337.9

373.6

289.8

74.8

1187.5

WprB2

1.2

1.0

2.5

4.2

13.5

11.0

7.2

54.2

WprB3

0.1

0.2

0.7

0.5

0.3

0.1

2.0

Age-specific incidence rate per 100,000

World

20.8

8.3

19.2

39.8

291.3

946.2

1624.8

2320.5

169.7

AfrD

18.7

5.2

22.6

49.5

277.5

921.0

1801.5

3472.3

102.4

AfrE

23.1

5.9

32.8

70.5

328.9

1075.5

2067.8

4109.5

113.2

AmrA

15.3

7.6

34.8

76.6

474.1

1614.6

2897.4

3261.5

451.0

AmrB

22.6

9.6

22.4

34.4

215.1

745.8

1347.6

2190.5

122.6

AmrD

25.6

16.0

27.0

42.0

212.4

814.8

1742.9

3320.7

120.7

EmrB

26.0

13.8

17.2

25.2

181.4

584.4

1018.0

1464.3

79.6

EmrD

36.1

16.2

21.6

48.4

199.2

503.8

791.2

1024.4

75.6

EurA

13.3

8.2

27.9

55.2

394.2

1262.9

2233.2

2960.3

435.9

EurB1

18.5

9.5

21.8

60.5

383.2

1081.9

1403.2

1668.1

229.1

EurB2

13.5

10.6

22.9

43.2

238.3

710.9

851.6

678.2

91.7

EurC

21.4

10.7

28.7

63.8

451.9

1248.4

1667.0

1551.3

299.9

SearB

20.3

8.0

12.3

28.1

250.5

702.6

1001.8

1284.1

99.2

SearD

19.4

7.5

14.0

21.8

141.7

606.1

847.2

1430.6

76.5

WprA

12.8

6.7

18.9

38.6

316.3

1088.7

1953.2

2971.8

398.4

WprB1

22.7

8.6

15.4

35.5

316.0

908.2

1480.4

1753.4

170.2

WprB2

15.4

6.6

11.6

28.6

207.3

500.1

835.9

2327.7

77.2

WprB3

13.5

9.0

10.5

27.9

214.4

400.7

515.2

1412.7

57.5

Table 13

Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, females, 2000

Age group

Region

0–4

5–14

15–29

30–44

45–59

60–69

70–79

80+

Total

Number of new cases (000s)

World

72.3

45.6

206.1

665.6

1285.1

1112.9

1133.6

603.7

5125.0

AfrD

7.4

2.3

14.2

28.9

49.6

45.8

35.6

14.7

198.4

AfrE

6.1

2.1

18.5

30.8

56.7

55.1

41.0

14.8

225.2

AmrA

1.4

1.6

11.7

82.1

171.6

134.2

177.7

66.5

646.7

AmrB

4.7

4.1

17.5

60.4

94.7

66.9

59.5

34.6

342.4

AmrD

1.7

1.2

4.7

13.0

21.3

13.3

11.5

5.9

72.6

EmrB

1.3

1.8

5.2

12.4

15.2

9.3

7.4

3.0

55.6

EmrD

1.9

2.0

5.0

13.7

14.9

8.4

6.6

1.7

54.1

EurA

1.2

1.6

12.3

70.2

169.2

170.9

240.0

182.7

848.0

EurB1

0.9

6.2

23.0

42.2

41.8

38.7

14.9

168.8

EurB2

0.2

0.5

2.1

6.2

6.4

6.1

4.4

1.2

27.1

EurC

1.2

1.6

9.9

43.3

82.7

96.7

96.2

30.2

361.7

SearB

4.5

4.2

11.9

53.3

81.7

44.2

28.1

13.7

241.7

SearD

23.4

12.4

58.1

81.2

166.8

143.8

94.7

61.7

642.2

WprA

0.3

0.4

3.8

19.9

57.2

47.1

58.7

56.4

243.8

WprB1

14.6

7.8

20.6

114.8

237.8

219.6

226.2

95.5

936.9

WprB2

1.3

0.9

4.1

11.4

15.9

9.3

7.2

6.3

56.5

WprB3

0.0

0.1

0.3

1.0

1.1

0.4

0.2

0.1

3.2

Age-specific incidence rate per 100,000

World

24.6

7.9

27.0

106.1

320.0

631.1

1012.3

1532.5

171.1

AfrD

27.2

5.1

30.9

107.8

341.2

818.6

1352.1

2330.7

118.3

AfrE

21.6

4.6

39.8

117.9

412.0

1065.8

1616.9

2253.0

132.6

AmrA

13.5

7.4

38.1

226.2

590.3

1123.0

1726.5

1214.7

415.3

AmrB

21.2

9.3

28.4

127.8

339.0

615.8

914.1

1589.7

153.5

AmrD

36.2

14.2

46.1

200.8

588.6

942.4

1521.8

2602.4

203.0

EmrB

16.6

10.7

25.8

104.3

252.3

397.3

571.2

937.3

82.8

EmrD

21.5

12.1

26.1

109.2

211.4

315.0

484.3

495.4

79.3

EurA

11.5

6.8

31.5

150.3

430.7

778.6

1292.8

2105.4

407.8

EurB1

15.4

7.4

29.0

131.6

317.4

608.6

818.5

1175.8

202.0

EurB2

7.5

8.8

30.4

117.2

270.0

464.6

559.4

504.5

105.5

EurC

19.7

9.9

36.1

154.6

360.5

661.9

876.5

895.0

278.3

SearB

22.5

10.8

21.3

126.4

343.1

463.0

589.7

1033.9

122.7

SearD

29.8

8.3

32.6

64.8

225.9

484.2

640.6

1601.5

98.4

WprA

9.0

4.9

25.5

134.4

351.9

550.0

916.0

1873.2

322.7

WprB1

29.8

7.0

12.5

70.1

237.8

544.5

955.4

1312.9

142.1

WprB2

17.9

6.1

20.2

73.7

212.9

279.2

386.9

1138.6

78.8

WprB3

9.6

6.3

33.4

166.5

328.3

330.2

343.6

973.9

96.5

Estimated global and regional numbers of new cases and age-standardised incidence rates for 17 cancer sites by sex are shown in Tables 14 and 15. As in mortality distribution, there is a significant variations in the distribution of site-specific cancer incidence by region (Tables 16 and 17). The distribution of cancer incidence was almost similar to that of mortality: lung cancer was the most common cancer in the world in 2000, accounting for 13% of total cancer mortality, followed by cancers of stomach (10% of total), liver (10%), colon and rectum (10%), and breast (6%). The variations in the distribution of site-specific new cases of cancer by region were also similar to those observed in mortality distribution. In all regions, compared to proportion of total mortality, the proportion of lung cancer decreased while that of colon and rectum, breast, uterus and prostate increased, suggesting the difference in survival by cancer site as suggested above.

Table 14

Estimated global and regional number of new cases and age-standardised incidence rate of cancer by site, males, 2000

WHO sub region

World

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Site

Number of new cases (000s)

Mouth and oropharynx cancers

267.1

12.1

16.5

11.3

10.4

0.9

2.6

1.7

28.7

7.4

0.9

17.8

16.0

98.1

6.5

29.7

6.1

0.5

Oesophagus cancer

286.5

5.1

14.1

12.4

11.1

0.7

1.9

0.8

22.8

3.6

1.8

10.7

3.8

42.0

10.1

142.7

3.0

0.0

Stomach cancer

589.3

13.3

10.9

11.8

29.7

8.7

8.6

2.5

45.6

17.2

4.0

48.6

8.6

30.1

40.6

300.9

7.6

0.1

Colon and rectum cancers

527.8

9.5

12.0

85.6

21.2

2.2

3.2

3.1

133.8

21.5

1.4

42.8

21.4

25.7

49.2

91.0

3.8

0.1

Liver cancer

422.0

20.0

23.6

9.0

9.5

2.9

3.1

2.3

26.1

6.0

0.7

7.9

28.6

18.4

24.6

232.8

6.2

0.2

Pancreas cancer

119.3

1.5

2.8

16.5

8.1

1.2

0.9

1.0

27.4

5.9

1.0

11.4

3.7

7.3

11.5

18.7

0.5

0.0

Trachea, bronchus, lung cancers

939.9

7.4

9.8

112.1

38.5

1.7

9.3

7.4

172.0

49.5

3.9

89.3

43.1

107.8

46.9

227.8

13.1

0.3

Melanoma of the skin

118.2

3.5

3.4

61.8

5.3

0.9

0.3

0.2

22.6

3.2

0.3

4.0

1.2

2.1

6.7

2.6

0.1

Breast cancer

0.0

Cervix uteri cancer

0.0

Corpus uteri cancer

0.0

Ovary cancer

0.0

Prostate cancer

550.2

36.5

28.2

165.7

46.0

8.6

3.2

2.7

139.1

15.2

0.8

22.3

13.4

29.6

28.1

9.5

1.2

0.0

Bladder cancer

277.2

10.6

7.3

60.3

8.1

0.8

4.1

14.4

65.1

12.1

1.2

17.8

7.7

27.8

13.5

24.8

1.5

0.0

Lymphomas, multiple myeloma

238.5

20.3

18.6

36.2

13.4

2.8

6.5

5.2

39.3

7.8

1.3

7.4

13.3

36.5

11.8

15.2

2.6

0.2

Leukaemia

195.2

6.3

9.2

20.6

13.1

2.9

3.4

5.3

25.6

6.6

1.1

9.3

10.7

28.2

6.7

44.0

2.2

0.1

Other malignant neoplasms

635.8

24.2

33.5

84.8

54.2

8.6

10.3

6.2

128.4

32.5

4.7

56.3

24.2

77.8

35.8

47.7

6.4

0.3

Age-standardised incidence rate per 100,000

Mouth and oropharynx cancers

8.8

12.9

18.4

5.0

5.5

3.3

4.9

3.6

8.6

7.4

4.5

10.9

9.3

18.5

4.7

3.9

12.0

21.7

Oesophagus cancer

9.4

5.7

16.8

5.1

5.9

3.1

3.8

1.7

6.0

3.4

9.4

6.3

2.2

8.2

6.6

19.2

6.3

2.0

Stomach cancer

19.4

15.0

13.0

4.6

15.8

35.8

17.4

5.5

11.0

16.4

21.3

28.8

5.2

5.9

25.6

40.8

15.9

3.8

Colon and rectum cancers

17.3

10.4

14.6

34.4

11.3

9.2

6.3

6.5

33.0

20.4

7.1

25.1

12.9

4.9

32.4

12.3

7.8

5.8

Liver cancer

13.7

20.3

24.7

3.7

5.0

11.4

6.4

5.0

6.4

5.7

3.6

4.8

16.0

3.2

16.2

30.8

12.1

9.9

Pancreas cancer

3.9

1.6

3.5

6.5

4.3

4.8

1.8

2.3

6.8

5.7

5.3

6.8

2.2

1.5

7.3

2.5

1.0

0.2

Trachea, bronchus, lung cancers

30.9

8.3

12.0

44.8

20.6

6.9

18.9

16.6

43.3

47.1

20.6

52.2

27.5

20.3

28.9

30.8

26.4

14.7

Melanoma of the skin

3.9

3.8

3.7

27.2

2.8

3.7

0.6

0.3

6.6

3.1

1.6

2.6

0.7

0.4

4.9

0.3

3.6

Breast cancer

0.0

Cervix uteri cancer

0.0

Corpus uteri cancer

0.0

Ovary cancer

0.0

Prostate cancer

18.0

45.0

38.9

63.7

24.8

36.3

6.9

6.5

31.8

14.1

4.4

12.8

8.6

5.8

17.1

1.3

2.5

2.3

Bladder cancer

9.0

12.0

8.8

24.4

4.3

3.3

8.5

30.5

16.1

11.6

6.4

10.7

4.6

4.8

8.7

3.5

3.1

1.4

Lymphomas, multiple myeloma

7.8

18.2

17.0

15.3

6.8

10.7

10.6

8.6

10.9

8.1

6.2

5.1

7.6

6.1

8.2

2.1

4.5

7.1

Leukaemia

6.4

5.5

7.7

8.9

6.3

8.6

5.1

7.8

7.5

7.2

4.3

6.8

5.7

4.3

5.8

6.7

3.3

Other malignant neoplasms

20.8

24.1

37.1

39.9

27.2

31.0

19.1

11.3

39.1

32.8

22.4

37.5

13.5

13.7

27.0

6.6

12.4

11.2

Table 15

Estimated global and regional number of new cases and age-standardised incidence rate of cancer by site, females, 2000

WHO sub region

World

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Site

Number of new cases (000s)

Mouth and oropharynx cancers

153.6

8.2

11.4

5.9

4.6

0.8

2.2

1.1

9.9

2.5

0.5

4.6

9.4

63.6

3.0

21.2

4.2

0.4

Oesophagus cancer

166.2

4.2

7.2

3.3

4.0

0.3

1.6

0.5

8.4

1.0

1.3

3.8

2.5

34.9

2.1

89.0

2.0

0.0

Stomach cancer

383.9

10.3

8.4

7.1

19.7

8.4

4.5

2.0

33.9

10.2

2.6

36.3

6.7

18.1

23.7

186.7

5.1

0.1

Colon and rectum cancers

517.3

8.5

8.2

73.8

26.2

3.3

4.0

2.8

131.0

19.0

1.8

54.1

22.8

21.1

41.7

95.5

3.3

0.1

Liver cancer

204.4

11.9

11.1

4.7

9.7

3.4

1.3

1.2

14.0

4.0

0.5

5.9

11.7

12.0

11.1

99.6

2.2

0.2

Pancreas cancer

106.9

1.6

2.6

14.3

9.1

1.3

0.8

0.7

28.1

4.8

0.7

10.2

3.6

5.3

9.8

13.6

0.5

0.0

Trachea, bronchus, lung cancers

365.7

3.1

5.0

74.6

16.4

1.0

3.0

2.6

55.3

10.8

1.1

17.7

8.3

25.9

18.9

117.7

4.0

0.2

Melanoma of the skin

88.5

3.3

4.3

26.5

5.7

0.9

0.4

0.3

26.5

3.5

0.3

5.9

1.9

1.7

5.0

2.2

0.1

Breast cancer

1031.9

28.3

39.8

226.5

59.3

7.2

10.2

13.6

221.8

32.6

4.5

68.5

53.9

109.0

43.7

102.1

10.2

0.5

Cervix uteri cancer

487.5

43.3

67.9

16.1

40.6

9.2

6.7

5.6

18.8

12.6

1.9

22.5

32.8

146.7

6.6

45.0

10.2

0.8

Corpus uteri cancer

326.3

4.6

6.0

46.0

48.8

8.6

1.6

1.3

68.3

17.9

3.8

43.6

19.9

11.7

17.3

17.4

0.8

0.1

Ovary cancer

221.3

7.1

12.2

22.4

13.2

2.1

2.0

39.4

10.0

1.2

21.6

18.1

31.9

8.4

26.6

2.9

0.2

Prostate cancer

0.0

Bladder cancer

105.7

3.6

3.4

14.9

3.5

0.4

0.8

3.7

21.4

2.7

0.3

4.4

2.4

28.9

4.6

9.7

1.0

0.0

Lymphomas, multiple myeloma

242.6

10.2

8.0

32.2

12.4

2.3

5.0

4.0

40.9

6.9

1.0

7.3

9.6

74.9

9.7

15.2

2.7

0.1

Leukaemia

169.5

5.9

7.0

14.7

12.4

2.9

2.6

3.8

23.0

4.9

0.9

9.0

10.8

24.9

5.2

39.4

1.9

0.1

Other malignant neoplasms

553.9

44.2

22.7

63.6

56.7

11.7

8.9

107.3

25.3

4.4

46.5

27.3

31.7

32.7

56.1

5.3

0.3

Age-standardised incidence rate per 100,000

Mouth and oropharynx cancers

5.1

9.2

12.6

2.6

2.4

3.4

4.6

2.2

2.7

2.5

2.2

5.7

13.5

2.2

3.1

7.7

18.6

Oesophagus cancer

5.6

5.2

9.2

1.3

2.2

1.5

4.0

1.1

1.8

1.0

6.5

1.5

1.7

8.0

1.3

13.4

3.9

1.8

Stomach cancer

12.8

12.7

10.5

2.9

10.7

37.4

10.9

4.3

7.3

9.4

12.4

15.6

4.4

4.3

14.9

28.2

10.1

3.1

Colon and rectum cancers

17.3

9.9

10.2

29.8

14.1

14.4

9.4

5.9

29.2

17.2

8.6

23.0

14.7

4.7

26.7

14.2

6.3

4.2

Liver cancer

6.8

13.0

12.0

1.9

5.2

14.6

3.1

2.5

3.1

3.6

2.3

2.5

7.5

2.3

6.6

14.8

4.2

7.6

Pancreas cancer

3.6

1.8

3.5

5.6

5.0

5.8

1.9

1.6

6.0

4.3

3.6

4.3

2.4

1.3

5.8

2.1

0.9

0.4

Trachea, bronchus, lung cancers

11.9

3.5

5.8

30.5

8.8

4.4

6.7

5.6

13.4

9.9

5.5

7.6

5.4

5.3

11.6

16.0

7.4

8.4

Melanoma of the skin

2.9

3.9

5.3

12.6

2.9

4.0

0.8

0.6

7.9

3.4

1.4

3.2

1.2

0.3

4.2

0.3

0.2

2.8

Breast cancer

34.2

29.9

41.6

103.5

29.7

27.6

22.5

26.2

64.1

32.0

21.2

35.4

30.7

20.9

38.6

14.1

18.5

21.9

Cervix uteri cancer

16.6

43.3

69.8

8.2

19.8

34.9

15.0

10.7

6.2

12.8

9.0

12.7

18.4

30.2

6.0

6.6

18.0

33.1

Corpus uteri cancer

10.8

5.2

6.8

20.3

24.5

32.8

3.7

2.8

18.4

17.1

18.1

21.2

11.5

2.1

13.3

2.4

1.5

5.2

Ovary cancer

7.3

6.8

12.1

9.8

6.6

7.9

4.3

3.7

10.8

9.9

5.6

11.2

10.2

6.2

6.8

3.6

5.0

6.3

Prostate cancer

0.0

Bladder cancer

3.6

4.1

3.9

6.0

1.9

1.8

2.2

7.9

4.6

2.4

1.5

1.9

1.6

5.7

2.7

1.5

1.8

0.6

Lymphomas, multiple myeloma

8.3

9.1

7.7

13.8

6.3

9.2

9.9

7.2

10.6

7.0

4.4

4.0

5.8

15.7

6.7

2.2

4.4

4.8

Leukaemia

5.5

5.6

6.1

6.6

6.0

9.1

4.3

5.9

6.0

5.2

3.8

5.2

6.0

3.9

4.4

5.8

3.0

2.9

Other malignant neoplasms

18.8

45.9

24.0

30.2

28.6

44.0

20.0

17.2

29.6

24.9

19.6

25.8

16.1

6.1

23.3

10.7

9.4

129

Table 16

Ranking of the global cancer incidence by site, 2000

site

Number of death (000s)

Proportion of total (%)

Both sexes

Trachea, bronchus, and lung

1305.6

12.7

Stomach

1045.0

10.2

Liver

1031.9

10.0

Colon and rectum

973.1

9.5

Breast

626.4

6.1

Oesophagus

550.2

5.3

Lymphomas and myeloma

487.5

4.7

Mouth and oropharynx

481.1

4.7

Prostate

452.7

4.4

Leukaemia

420.7

4.1

Cervix uteri

382.9

3.7

Pancreas

364.7

3.5

Bladder

326.3

3.2

Ovary

226.2

2.2

Corpus uteri

221.3

2.2

Melanoma of the skin

206.7

2.0

Males

Trachea, bronchus, and lung

939.9

18.2

Stomach

589.3

11.4

Liver

550.2

10.6

Colon and rectum

527.8

10.2

Oesophagus

422.0

8.2

Prostate

286.5

5.5

Mouth and oropharynx

277.2

5.4

Lymphomas and myeloma

267.1

5.2

Leukaemia

238.5

4.6

Bladder

195.2

3.8

Pancreas

119.3

2.3

Melanoma of the skin

118.2

2.3

Females

Breast

1031.9

20.1

Trachea, bronchus, and lung

517.3

10.1

Stomach

487.5

9.5

Colon and rectum

383.9

7.5

Cervix uteri

365.7

7.1

Liver

326.3

6.4

Lymphomas and myeloma

242.6

4.7

Oesophagus

221.3

4.3

Ovary

204.4

4.0

Leukaemia

169.5

3.3

Pancreas

166.2

3.2

Mouth and oropharynx

153.6

3.0

Corpus uteri

106.9

2.1

Bladder

105.7

2.1

Melanoma of the skin

88.5

1.7

Table 17

Ranking of the selected regional cancer incidence by site, 2000

WHO sub region

AfrE (high child and adult mortality)

EurA (very low child and adult mortality)

SearB (low child and adult mortality)

site

Number of Proportion

site

Number of Proportion

site

Number of Proportion

(000s)

(%)

(000s)

(%)

(000s)

(%)

Both sexes

Cervix uteri

67.9

16.4

Trachea, bronchus, and lung

264.7

15.4

Trachea, bronchus, and lung

53.9

12.3

Liver

39.8

9.6

Colon and rectum

227.3

13.2

Liver

51.4

11.7

Breast

34.7

8.3

Breast

221.8

12.9

Breast

44.3

10.1

Mouth and oropharynx

28.2

6.8

Prostate

139.1

8.1

Colon and rectum

40.3

9.2

Oesophagus

27.9

6.7

Stomach

86.5

5.0

Mouth and oropharynx

32.8

7.5

Lymphomas and myeloma

26.6

6.4

Lymphomas and myeloma

80.2

4.7

Lymphomas and myeloma

25.4

5.8

Prostate

21.2

5.1

Pancreas

79.6

4.6

Cervix uteri

22.9

5.2

Stomach

20.3

4.9

Liver

68.3

4.0

Leukaemia

21.5

4.9

Colon and rectum

19.4

4.7

Bladder

55.5

3.2

Stomach

19.9

4.5

Trachea, bronchus, and lung

16.2

3.9

Leukaemia

49.1

2.8

Ovary

18.1

4.1

Leukaemia

14.8

3.6

Oesophagus

48.6

2.8

Prostate

15.3

3.5

Ovary

12.2

2.9

Ovary

40.1

2.3

Pancreas

13.4

3.1

Bladder

10.7

2.6

Mouth and oropharynx

39.4

2.3

Bladder

10.1

2.3

Melanoma of the skin

7.7

1.8

Corpus uteri

38.6

2.2

Oesophagus

7.2

1.7

Pancreas

6.0

1.4

Melanoma of the skin

31.2

1.8

Corpus uteri

6.2

1.4

Corpus uteri

5.4

1.3

Cervix uteri

18.8

1.1

Melanoma of the skin

3.1

0.7

Males

Liver

28.2

14.8

Trachea, bronchus, and lung

172.0

19.6

Trachea, bronchus, and lung

43.1

22.0

Prostate

23.6

12.4

Colon and rectum

139.1

15.9

Liver

28.6

14.6

Mouth and oropharynx

18.6

9.8

Prostate

133.8

15.3

Colon and rectum

21.4

11.0

Lymphomas and myeloma

16.5

8.7

Stomach

65.1

7.4

Mouth and oropharynx

16.0

8.2

Oesophagus

14.1

7.4

Lymphomas and myeloma

45.6

5.2

Lymphomas and myeloma

13.4

6.9

Stomach

12.0

6.3

Bladder

39.3

4.5

Prostate

13.3

6.8

Trachea, bronchus, and lung

10.9

5.8

Pancreas

28.7

3.3

Leukaemia

10.7

5.5

Colon and rectum

9.8

5.2

Liver

27.4

3.1

Stomach

8.6

4.4

Leukaemia

9.2

4.9

Oesophagus

26.1

3.0

Bladder

7.7

3.9

Bladder

7.3

3.8

Leukaemia

25.6

2.9

Pancreas

3.8

1.9

Pancreas

3.4

1.8

Mouth and oropharynx

22.8

2.6

Oesophagus

3.7

1.9

Melanoma of the skin

2.8

1.5

Melanoma of the skin

22.6

2.6

Melanoma of the skin

1.2

0.6

Females

Cervix uteri

67.9

30.2

Breast

221.8

26.2

Breast

53.9

22.3

Breast

39.8

17.7

Colon and rectum

131.0

15.4

Cervix uteri

32.8

13.6

Liver

12.2

5.4

Trachea, bronchus, and lung

68.3

8.1

Colon and rectum

22.8

9.4

Stomach

11.4

5.1

Stomach

55.3

6.5

Liver

19.9

8.2

Mouth and oropharynx

11.1

4.9

Lymphomas and myeloma

40.9

4.8

Ovary

18.1

7.5

Ovary

8.4

3.7

Pancreas

39.4

4.6

Trachea, bronchus, and lung

11.7

4.8

Oesophagus

8.2

3.7

Ovary

33.9

4.0

Leukaemia

10.8

4.5

Colon and rectum

8.0

3.6

Leukaemia

28.1

3.3

Lymphomas and myeloma

9.6

4.0

Lymphomas and myeloma

7.2

3.2

Corpus uteri

26.5

3.1

Mouth and oropharynx

9.4

3.9

Leukaemia

7.0

3.1

Liver

23.0

2.7

Stomach

8.3

3.4

Trachea, bronchus, and lung

6.0

2.7

Bladder

21.4

2.5

Corpus uteri

6.7

2.8

Melanoma of the skin

5.0

2.2

Cervix uteri

18.8

2.2

Pancreas

3.6

1.5

Pancreas

4.3

1.9

Oesophagus

14.0

1.7

Oesophagus

2.5

1.0

Bladder

3.4

1.5

Melanoma of the skin

9.9

1.2

Bladder

2.4

1.0

Corpus uteri

2.6

1.2

Mouth and oropharynx

8.4

1.0

Melanoma of the skin

1.9

0.8

Discussion

Various attempts have been made to quantify the global burden of cancer and to estimate site-specific cancer mortality and morbidity 112131415. More recently, the efforts made by the International Agency for Research on Cancer (IARC) have led to the Globocan 2000 estimates, which has also used information on incidence and survival to estimate cancer death for the year 2000 from various sources including cancer registries 1213. The analyses reported here have built extensively on the IARC work to synthesis and estimate cancer mortality and incidence distributions by site for all regions of the world. Compared to the estimates of the Globocan 2000, the GBD 2000 estimates for global cancer mortality and incidence are 11% and 3% higher, respectively. Although the overall difference in terms of proportion is small, the absolute difference between the two estimates remains relatively large. This difference is predominantly due to a substantially large difference in the AFRO, EMRO, and SEARO regions.

Some researchers suggest that model-based estimates of cancer mortality in GBD 1990 bear little relation to the actual profile of cancer recorded at the regional registries 116. The proposed approach here is substantially different from the previous estimates and, although broader cause of death to estimate cancer envelope is still based on cause of death models in some countries, majority of the data sources of cause of death is now vital registration and/or sampling data. The total number of mortality from cancer is not extrapolated by model alone and the survival model was used to estimate the distribution of death by site, not the actual magnitude of cancer mortality in regions where no or little data on detailed cause of death is available. The model estimates were consistent with mortality distribution of vital records and the Globocan 2000 7. Therefore, the major source of discrepancy is not the estimated cancer mortality distribution but the overall mortality envelope applied to each region.

The Globocan 2000 estimates are based on either cancer incidence data from cancer registries in the region (with a survival model used to estimate deaths) or on mortality data collected by regional cancer registries or other sources. Both these sources of data are likely to be incomplete and to result in underestimation of cancer deaths. On the other hand, the GBD 2000 starts with data on the level of all-cause mortality, and uses all available data on cause of death and cause of death models where such data is not available, to estimate the distribution of major cause groups, including cancers. For regions with insufficient vital registration such as AFRO and SEARO regions, this process significantly increases the mortality envelope for these two broad cause categories. It is possible that these methods result in an overestimate of total cancer deaths in some regions, and continuos efforts are being made to obtain additional data from these regions in order to check the validity of these estimates, and where appropriate, to improve them.

Although cancer is still a fatal disease in many developing countries2, there is a growing evidence that cancer survival even in developing countries is continuously improving 34. The present study suggests that in all regions mortality was much higher in males while incidence were almost the same due to relatively good prognosis of breast and cervix cancers compared to common cancers among males such as liver and lung cancers. Due to the differences in survival by region, incidence-to-mortality rate ratios were higher in developed in which increasing disability among cancer survivors is warranted 171819. It is suggested that data on incidence as well as mortality are necessary to understand the magnitude and trends of cancer problems and to evaluate the interventions against cancer in the context of prevention 1. When setting priorities, interventions against cancers need to be compared with other health interventions which aims at reducing only morbidity 520.

GBD 2000 employs a composite measure of disease burden in terms of disability-adjusted life years (DALYs) which consist of years lived with disability (morbidity) and years of life lost (mortality) 5. As a part of this exercise, we have estimated both mortality and incidence of cancers by site. We will further estimate the years lived with disability to derive cancer burden in DALYs once weights assigned to disabling conditions are revised based on the estimates from the on-going population-based surveys from more than 70 countries 21.

The presents study also suggests that there is a significant variation in the distribution of cancer mortality and incidence by region depending on age and population structure, distribution of risk factors, and opportunity of detection and treatment 222. However, the frequent cancers such as lung, liver and cervical cancers are potentially preventable 23. For example, Parkin has estimated that there would have been 23% fewer cases of cancers in the developing world in 1990, if infections such as hepatitis B and C virus and human papilloma virus had been prevented 24. Another estimate suggests that 230,000 deaths (more than 4% of all cancer deaths) from liver cancer could have been avoided with only immunisations against hepatitis B 13. Smoking was estimated to be responsible for another 20% of all cancer deaths, all of which are preventable 13.

Given a high incidence of cancers which are potentially preventable in both developed and developing countries, the role of primary prevention, early detection as well as treatment should be evaluated more carefully 2. Cost-effectiveness analysis plays a role for this purpose, which should be generalisable and comparable across various interventions including both currently delivered and potentially feasible ones 20. Estimating the magnitude of cancer mortality and incidence is a key input for setting research and intervention priorities. Combined with costs of each intervention, mortality and incidence estimates provide a basis for effectiveness calculation in cost-effectiveness analysis of cancer control programmes.

Conclusions

Based on the algorithm to estimate region-specific overall cancer mortality, and site-specific survival, death distributions, and incidence as a part of GBD 2000 study, it is estimated that cancers accounted for over 7 million deaths (13% of total mortality) and more than 10 million new cases occurred world wide in 2000. Cancer mortality and incidence in developing countries already accounted for over 60% and about half of the global total, respectively. Although there was a significant variation in the distribution of cancer mortality and incidence by region, many of the common cancers are potentially preventable. Magnitude of cancer burden estimation by taking into account both mortality and morbidity is an essential information to set research priorities and policy formulation and can be used for setting cancer control priorities when combined with data on costs of interventions.

Competing interests

None declared.

Author's Contributions

KS conceived of the study, analysed the data, and drafted the manuscript. CDM participated in the design of the study, and performed statistical analyses. CBP carried out the data compilation and drafted the manuscript. ADL participated in the design of the study and in the mortality analysis. CJLM conceived of the study and participated in its design and coordination. All authors read and approved the final manuscript.

Acknowledgements

Many people are contributing to the analysis of cancer incidence and mortality for the GBD 2000 both inside and outside WHO. We wish to particularly acknowledge the contributions of staff within the Global Program on Evidence for Health Policy who have contributed to the estimation of total cancer deaths for the year 2000: Majid Ezzati, Brodie Ferguson, Mie Inoue, Rafael Lozano, Doris Ma Fat, Chalapati Rao, Joshua Salomon, and Niels Tomijima. We also thank staff of the International Agency for Research on Cancer (IARC) for provision of data, advice on survival analyses carried out by IARC and methods used to estimate cancer incidence and mortality for GLOBOCAN 2000, particularly Max Parkin, Jacques Ferlay, Paola Pisani and Fred Bray.

Estimates of the worldwide incidence of 25 major cancers in 1990. Parkin DM Pisani P Ferlay J Int J Cancer 1999 80 6 827 841 10.1002/(SICI)1097-0215(19990315)80:6<827::AID-IJC6>3.0.CO;2-P 10074914 Global variations in cancer survival. Study Group on Cancer Survival in Developing Countries. Sankaranarayanan R Swaminathan R Black RJ Cancer 1996 78 2461 2464 10.1002/(SICI)1097-0142(19961215)78:12<2461::AID-CNCR2>3.0.CO;2-N 8952551 Trends in survival rates of cancer in Cuba. Graupera Boschmonar MC Jimenez Chaviano PJ Martin Garcia AA Eur J Epidemiol 1999 15 521 528 10.1023/A:1007587507460 10485344 Population-based cancer survival in Singapore, 1968 to 1992: an overview. Chia KS Du WB Sankaranarayanan R Int J Cancer 2001 93 142 147 10.1002/ijc.1293 11391634 The Global Burden of Disease. Murray CJL Lopez AD Cambridge, MA, Harvard University Press 1996 The Global Burden of Disease 2000 project: aims, methods and data sources. Murray CJL Lopez AD Mathers CD Geneva, World Health Organization 2001 Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site. Mathers CD Shibuya K Boschi-Pinto C BMC Cancer 2002 2 36 140322 12502433 10.1186/1471-2407-2-36 The epidemiological transition revisited: compositional models for causes of death by age and sex. Salomon JA Murray CJL Popul Dev Rev 2002 28 205 228 Life tables for 191 countries for 2000: data, methods, results. Lopez AD Ahmad O Guillot M GPE Discussion Paper No. 40. Geneva, World Health Organization 2001 World mortality in 2000: life tables for 191 countries. Lopez AD Ahmad O Guillot M Geneva, World Health Organization 2002 Cancer in Mali, 1987–1988. Bayo S Parkin DM Koumare AK Int J Cancer 1990 45 679 684 2323845 Globocan 2000: Cancer Incidence, Mortality and Prevalence Worldwide, Version 1.0. Ferlay J Bray F Pisani P IARC CancerBase No. 5. Lyon, IARCPress 2001 Estimates of the worldwide mortality from 25 cancers in 1990. Pisani P Parkin DM Bray F Int J Cancer 1999 83 1 18 29 10.1002/(SICI)1097-0215(19990924)83:1<18::AID-IJC5>3.3.CO;2-D 10449602 Mortality by cause for eight regions of the world: global burden of disease study. Murray CJL Lopez AD Lancet 1997 349 1269 1276 10.1016/S0140-6736(96)07493-4 9142060 The global burden of cancer. Parkin DM Semin Cancer Biol 1998 8 219 235 10.1006/scbi.1998.0080 9870029 Cancer death in India: is the model-based approach valid? Gupta P Sankaranarayanan R Ferlay J Bull World Health Organ 1994 72 943 944 7867141 Quality of life in breast and colon cancer long-term survivors: an assessment with the EORTC QLQ-C30 and SF-36 questionnaires. Mosconi P Apolone G Barni S Tumori 2002 88 110 116 12088249 Quality of life in patients with early and advanced carcinoma of the breast. Pandey M Singh S Behere P Eur J Surg Oncol 2001 26 20 24 10.1053/ejso.1999.0734 Patient-rating of distressful symptoms after treatment for early cervical cancer. Bergmark K Avall-Lundqvist E Dickman PW Acta Obstet Gynecol Scand 2002 81 443 450 10.1034/j.1600-0412.2002.810512.x 12027819 Development of WHO guidelines on generalized cost-effectiveness analysis. Murray CJ Evans DB Acharya A Health Econ 2000 9 235 251 10.1002/(SICI)1099-1050(200004)9:3<235::AID-HEC502>3.0.CO;2-O 10790702 WHO Multi-country Household Survey Study on Health and Responsiveness, 2000–2001. Üstün TB Chatterji S Villanueva M GPE discussion paper No. 37. Geneva, World Health Organization 2001 Global variations in cancer survival. Sankaranarayanan R Swminathan R Black RJ Cancer 1996 78 2461 4 10.1002/(SICI)1097-0142(19961215)78:12<2461::AID-CNCR2>3.0.CO;2-N 8952551 The causes of cancer. Quantitative estimates of avoidable risks of cancer in the United States today. Doll D Peto R Oxford, Oxford University Press 1981 The global health burden of infection associated cancers. Parkin DM Cancer Surv 1999 33 5 33

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