Summary
background
Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for the development of effective prevention and mitigation strategies. We analyzed the results of the 2019 Global Burden of Disease, Injury and Risk Factor (GBD) study to inform global cancer control planning efforts.
methods
The GBD 2019 Benchmarking Risk Assessment Framework was used to estimate the burden of cancer attributable to behavioral, environmental, occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included according to the criteria of the World Cancer Research Fund. Estimated cancer deaths and disability-adjusted life years (DALYs) in 2019 and the change in these measures between 2010 and 2019 are presented.
discoveries
Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01–4.94) deaths and 105 million (95.0–116) DALYs for both sexes combined, accounting for 44 ·4% (41.3–48.4) of all cancer deaths and 42.0% (39.1–45.6) of all DALYs. There were 2.88 million (2.60–3.18) risk-attributable cancer deaths in men (50.6% [47·8–54·1] of all male cancer deaths) and 1.58 million (1.36–1.84) risk-attributable cancer deaths in women (36.3% [32·5–41·3] of all women’s cancer deaths). The leading risk factors at the most detailed global level for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol consumption and high BMI. Risk-attributable cancer burden varied by world region and sociodemographic index (SDI), with smoking, unsafe sex, and alcohol consumption the top three risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, while DALYs in high levels. SDI locations reflected the top three global risk factor rankings. Between 2010 and 2019, global risk-attributable cancer deaths increased by 20.4% (12.6–28.4) and DALYs by 16.8% (8.8–25.0), with the greatest percentage increase in metabolic rate. risks (34·7% [27·9–42·8] and 33.3% [25·8–42·0]).
interpretation
The main risk factors contributing to the global burden of cancer in 2019 were behavioural, while metabolic risk factors experienced the largest increases between 2010 and 2019. Reducing exposure to these factors modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be appropriately adapted to local burden of cancer risk factors.
financing
Bill and Melinda Gates Foundation.
Introduction
Cancer is the second leading cause of death worldwide, and exposure to risk factors plays an important role in the biology and burden of many types of cancer.1
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Evidence before this study
We identified previous work that primarily estimated the cancer burden attributable to single risk factors globally or multiple risk factors for a single country. The World Cancer Observatory also provides estimates of the attributable burden of cancer for selected risk factor categories separately. A previous comparative risk assessment project estimated risk-attributable cancer mortality for nine risk factors. We searched PubMed for titles and abstracts for research articles in English that were published between January 1, 2010 and June 1, 2021, using the search terms “cancer or neoplasia or tumor or malignancy” and “attributable risk factor or risk or population”. attributable fraction” and “global or international or global or worldwide” and “burden or metrics or incidence or mortality”, but did not identify additional informative studies. There is a gap in the literature on global estimates of cancer burden attributable to the risk for a comprehensive list of risk factors incorporating both cancer-related mortality and disability.
Added value of this study
We report, for the first time, the global burden of cancer attributable to a comprehensive list of behavioral, metabolic, environmental, and occupational risk factors using the results of the Global Burden of Disease, Injury, and Risk Factors 2019. By estimating the burden of cancer attributable risk at national and global levels using both mortality and disability-adjusted life years (DALYs), this study provides a new perspective on the attributable cancer burden. Globally, a large proportion of cancer deaths and DALYs were attributed to the included modifiable risk factors, with behavioral risks accounting for the largest attributable burden. We identified substantial differences in attributable cancer death and DALY burden between sociodemographic index quintiles and between sexes. Risk-attributable cancer death and DALY burden increased globally from 2010 to 2019, with metabolic risk…