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1、CA CANCER J CLIN 2021;0:1411VOLUME 0|NUMBER 0|MONTH 2021Abstract:This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer.Worldwide,an estimated 19.3 million new cancer

2、cases(18.1 million excluding nonmelanoma skin cancer)and almost 10.0 million cancer deaths(9.9 million excluding nonmelanoma skin cancer)occurred in 2020.Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer,with an estimated 2.3 million new cases(11.7%),followed by lu

3、ng(11.4%),colorectal(10.0%),prostate(7.3%),and stomach(5.6%)cancers.Lung can-cer remained the leading cause of cancer death,with an estimated 1.8 million deaths(18%),followed by colorectal(9.4%),liver(8.3%),stomach(7.7%),and female breast(6.9%)cancers.Overall incidence was from 2-fold to 3-fold high

4、er in transitioned ver-sus transitioning countries for both sexes,whereas mortality varied 2-fold for men and little for women.Death rates for female breast and cervical cancers,however,were considerably higher in transitioning versus transitioned countries(15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 p

5、er 100,000,respectively).The global cancer burden is expected to be 28.4 million cases in 2040,a 47%rise from 2020,with a larger increase in transitioning(64%to 95%)versus transitioned(32%to 56%)countries due to demographic changes,although this may be further exacerbated by increasing risk factors

6、associated with globalization and a growing economy.Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.CA Cancer J Clin 2021;0:1-41.2021 American Cancer Societ

7、y.Keywords:burden,cancer,epidemiology,incidence,mortalityIntroductionCancer ranks as a leading cause of death and an important barrier to increasing life expectancy in every country of the world.1 According to estimates from the World Health Organization(WHO)in 2019,2 cancer is the first or second l

8、eading cause of death before the age of 70 years in 112 of 183 countries and ranks third or fourth in a further 23 countries(Fig.1).Cancers rising prominence as a leading cause of death partly reflects marked declines in mortality rates of stroke and coronary heart disease,relative to cancer,in many

9、 countries.1Overall,the burden of cancer incidence and mortality is rapidly growing world-wide;this reflects both aging and growth of the population as well as changes in the prevalence and distribution of the main risk factors for cancer,several of which are associated with socioeconomic developmen

10、t.3,4 The extent to which the position of cancer as a cause of premature death reflects national levels of social and economic development can be seen by comparing the maps in Figure 1 and Figure 2A,the latter depicting the 4-tier Human Development Index(HDI)based on the United Nations 2019 Human De

11、velopment Report.5In this article,we examine the cancer burden worldwide in 2020 based on the GLOBOCAN estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer.6 The estimates provided herein do Global Cancer Statistics 2020:GLOBOCAN Estimates of Incide

12、nce and Mortality Worldwide for 36 Cancers in 185 CountriesHyuna Sung,PhD1;Jacques Ferlay,MSc,ME2;Rebecca L.Siegel,MPH1;Mathieu Laversanne,MSc2;Isabelle Soerjomataram,MD,MSc,PhD2;Ahmedin Jemal,DMV,PhD1;Freddie Bray,BSc,MSc,PhD21 Surveillance and Health Equity Science,American Cancer Society,Atlanta,

13、Georgia;2 Section of Cancer Surveillance,International Agency for Research on Cancer,Lyon,France.Additional supporting information may be found online in the Supporting Information section at the end of the article.Corresponding Author:Freddie Bray,BSc,MSc,PhD,Section of Cancer Surveillance,Internat

14、ional Agency for Research on Cancer,150,cours Albert Thomas,F-69372 Lyon Cedex 08,France(brayfiarc.fr).DISCLOSURES:Hyuna Sung,Rebecca L.Siegel,and Ahmedin Jemal are employed by the American Cancer Society,which receives grants from private and corporate foundations,including foundations associated w

15、ith companies in the health sector for research outside of the submitted work.They are not funded by or key personnel for any of these grants,and their salary is solely funded through American Cancer Society funds.The remaining authors report no conflicts of interest.Where authors are identified as

16、personnel of the International Agency for Research on Cancer/World Health Organization,the authors alone are responsible for the views expressed in this article,and they do not necessarily represent the decisions,policy,or views of the International Agency for Research on Cancer/World Health Organiz

17、ation.doi:10.3322/caac.21660.Available online at Global Cancer Statistics 20202CA:A Cancer Journal for Cliniciansnot reflect the impact of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for coronavirus disease 2019(COVID-19),7,8 as they are based on extrapolations

18、of cancer data collected in earlier years be-fore the pandemic.Although the full extent of the impact of the COVID-19 pandemic in different world regions is cur-rently unknown,delays in diagnosis and treatment associ-ated with the concerns of individuals,health system closures,including suspension o

19、f screening programs,and reduced availability of and access to care are expected to cause a short-term decline in cancer incidence followed by increases in advanced-stage diagnoses and cancer mortality in some settings.9-13As with previous reports,14-17 the primary focus is on a description of the c

20、ancer incidence and mortality at the global level and an assessment of the geographic variabil-ity observed across 20 predefined world regions(Fig.2B).We describe the magnitude and distribution of the disease overall and for the major cancer types in 2020,commenting briefly on the associated risk fa

21、ctors and prospects for pre-vention of the major cancers observed worldwide,and end-ing with a prediction of the magnitude of the disease in 2040 on the basis of global demographic projections.Data Sources and MethodsThe sources and methods used in compiling the GLOBOCAN estimates for 2020 are descr

22、ibed online at the Global Cancer Observatory(GCO)(gco.iarc.fr).18 The GCO website includes facilities for the tabulation and graphic visualization of the GLOBOCAN database for 185 countries and 36 cancers(as well as all cancers combined),by age and sex.The profile of cancer,globally and by world reg

23、ion,is built up using the best available sources of can-cer incidence and mortality data within a given country.Therefore,the validity of the national estimates depends on the degree of representativeness and quality of the source in-formation.The methods used to compile the 2020 estimates are large

24、ly based on those developed previously,with an em-phasis on the use of short-term predictions and the use of modelled mortality-to-incidence ratios,where applicable.19 The estimates are available in the GCO for 36 cancer types,based on codes from the International Statistical Classification of Disea

25、ses and Related Health Problems 10th Revision(ICD-10),including nonmelanoma skin cancer(NMSC)(C44,excluding basal cell carcinomas for incidence).19 Together with all cancers combined,cancer-specific estimates are provided for 185 countries or territo-ries worldwide by sex and by 18 age groups(ages 0

26、-4,5-9,80-84,and 85 years).The number of new cancer cases and cancer deaths were extracted from the GLOBOCAN 2020 database for all cancers combined(ICD-10 codes C00-C97)and for 36 cancer types:lip,oral cavity(C00-C06),salivary glands(C07-C08),oropharynx(C09-C10),nasopharynx(C11),hypopharynx(C12-C13)

27、,esophagus(C15),stomach(C16),colon(C18),rectum(C19-C20),anus(C21),liver(C22,including intrahepatic bile ducts),gallbladder(C23),pancreas(C25),larynx(C32),lung(C33-C34,including FIGURE 1.National Ranking of Cancer as a Cause of Death at Ages 60%of the newly diagnosed cancer cases and TABLE 1.New Case

28、s and Deaths for 36 Cancers and All Cancers Combined in 2020CANCER SITENO.OF NEW CASES(%OF ALL SITES)NO.OF NEW DEATHS(%OF ALL SITES)Female breast2,261,419(11.7)684,996(6.9)Lung2,206,771(11.4)1,796,144(18.0)Prostate1,414,259(7.3)375,304(3.8)Nonmelanoma of skina1,198,073(6.2)63,731(0.6)Colon1,148,515(

29、6.0)576,858(5.8)Stomach1,089,103(5.6)768,793(7.7)Liver905,677(4.7)830,180(8.3)Rectum732,210(3.8)339,022(3.4)Cervix uteri604,127(3.1)341,831(3.4)Esophagus604,100(3.1)544,076(5.5)Thyroid586,202(3.0)43,646(0.4)Bladder573,278(3.0)212,536(2.1)Non-Hodgkin lymphoma544,352(2.8)259,793(2.6)Pancreas495,773(2.

30、6)466,003(4.7)Leukemia474,519(2.5)311,594(3.1)Kidney431,288(2.2)179,368(1.8)Corpus uteri417,367(2.2)97,370(1.0)Lip,oral cavity377,713(2.0)177,757(1.8)Melanoma of skin324,635(1.7)57,043(0.6)Ovary313,959(1.6)207,252(2.1)Brain,nervous system308,102(1.6)251,329(2.5)Larynx184,615(1.0)99,840(1.0)Multiple

31、myeloma176,404(0.9)117,077(1.2)Nasopharynx133,354(0.7)80,008(0.8)Gallbladder115,949(0.6)84,695(0.9)Oropharynx98,412(0.5)48,143(0.5)Hypopharynx84,254(0.4)38,599(0.4)Hodgkin lymphoma83,087(0.4)23,376(0.2)Testis74,458(0.4)9334(0.1)Salivary glands53,583(0.3)22,778(0.2)Anus50,865(0.3)19,293(0.2)Vulva45,2

32、40(0.2)17,427(0.2)Penis36,068(0.2)13,211(0.1)Kaposi sarcoma34,270(0.2)15,086(0.2)Mesothelioma30,870(0.2)26,278(0.3)Vagina17,908(0.1)7995(0.1)All sites excluding nonmelanoma skin18,094,7169,894,402All sites19,292,7899,958,133aNew cases exclude basal cell carcinoma,whereas deaths include all types of

33、nonmelanoma skin cancer.Source:GLOBOCAN 2020.CA CANCER J CLIN 2021;0:1415VOLUME 0|NUMBER 0|MONTH 202170%of the cancer deaths.Female breast cancer is the most commonly diagnosed cancer(11.7%of total cases),closely followed by lung(11.4%),colorectal(10.0%),prostate(7.3%),and stomach(5.6%)cancers.Lung

34、cancer is the leading cause of cancer death(18.0%of the total cancer deaths),followed by colorectal(9.4%),liver(8.3%),FIGURE 3.Distribution of Cases and Deaths by World Area in 2020 for(A)Both Sexes,(B)Men,and(C)Women.For each sex,the area of the pie chart reflects the proportion of the total number

35、 of cases or deaths.Source:GLOBOCAN 2020.WesternWesternMiddleNorthern Northern NorthernCentral Caribbean South Southern Southern South CentralWesternWesternEastern Eastern Eastern SouthEastern ChinaIndiaMiddleOceania1.3%Europe22.8%Americas20.9%Africa5.7%Asia49.3%19.3 millionnew casesIncidenceNorther

36、n Central Caribbean South WesternNorthern Southern Eastern WesternSouthCentralIndiaEastern ChinaSouthEastern NorthernWesternEastern Southern Africa7.2%Americas14.2%Europe19.6%Oceania0.7%Asia58.3%Mortality9.9 milliondeathsBoth sexesWesternMiddleNorthern Northern NorthernCentral Caribbean South Southe

37、rn Southern South CentralWesternWesternEastern Eastern Eastern SouthEastern ChinaIndiaMiddleOceania1.3%Europe23.3%Americas20.8%Africa4.7%Asia49.9%10.1 millionnew casesIncidenceNorthernCentral Caribbean South WesternNorthernSouthern Eastern WesternSouthCentralIndiaEastern ChinaSouthEastern NorthernWe

38、sternEastern Southern Africa5.9%Americas13.2%Europe19.6%Oceania0.7%Asia60.6%Mortality5.5 milliondeathsMalese l dd iM nret saEWesterne l dd iM nret saEWesternNorthern Northern NorthernCentral Caribbean South Southern Southern South CentralWesternEastern Eastern SouthEastern ChinaIndiaOceania1.3%Europ

39、e22.3%Americas20.9%Africa6.9%Asia48.6%9.2 millionnew casesNorthern Central Caribbean South WesternNorthern Southern Eastern WesternSouthCentralIndiaEastern ChinaSouthEastern NorthernSouthern Africa8.7%Americas15.4%Europe19.7%Oceania0.7%Asia55.5%Mortality4.4 milliondeathsIncidenceFemales(A)(B)(C)Glob

40、al Cancer Statistics 20206CA:A Cancer Journal for Cliniciansstomach(7.7%),and female breast(6.9%)cancers.Lung cancer is the most frequently occurring cancer and the leading cause of cancer death in men,followed by prostate and colorectal cancer for incidence and liver and colorec-tal cancer for mort

41、ality.In women,breast cancer is the most commonly diagnosed cancer and the leading cause FIGURE 4.Distribution of Cases and Deaths for the Top 10 Most Common Cancers in 2020 for(A)Both Sexes,(B)Men,and(C)Women.For each sex,the area of the pie chart reflects the proportion of the total number of case

42、s or deaths;nonmelanoma skin cancers(excluding basal cell carcinoma for incidence)are included in the“other”category.Source:GLOBOCAN 2020.Both sexes11.7%Femalebreast11.4%Lung10.0%Colorectum7.3%Prostate5.6%Stomach4.7%Liver3.1%Esophagus3.1%Cervix uteri3.0%Thyroid3.0%Bladder36.9%OthercancerIncidenceMor

43、tality9.4%Colorectum8.3%Liver7.7%Stomach6.9%Femalebreast5.5%Esophagus4.7%Pancreas3.8%Prostate3.4%Cervix uteri3.1%Leukemia29.2%Othercancer18.0%Lung19.3 millionnew cases9.9 milliondeathsIncidence14.3%Lung14.1%Prostate10.6%Colorectum7.1%Stomach6.3%Liver4.4%Bladder4.2%Esophagus3.0%Non-Hodgkinlymphoma2.7

44、%Kidney2.7%Leukemia30.7%Othercancer10.1 millionnew cases5.5 milliondeaths21.5%Lung10.5%Liver9.3%Colorectum9.1%Stomach6.8%Prostate6.8%Esophagus4.5%Pancreas3.2%Leukemia2.9%Bladder2.7%Non-Hodgkinlymphoma22.9%OthercancerMortalityIncidence24.5%Breast9.4%Colorectum8.4%Lung6.5%Cervix uteri4.9%Thyroid4.5%Co

45、rpus uteri4.0%Stomach3.4%Ovary3.0%Liver2.6%Non-Hodgkinlymphoma28.9%Othercancer9.2 millionnew cases4.4 milliondeaths15.5%Breast13.7%Lung9.5%Colorectum7.7%Cervix uteri6.0%Stomach5.7%Liver4.9%Pancreas4.7%Ovary3.8%Esophagus3.0%Leukemia25.4%OthercancerMalesFemalesMortalityABCCA CANCER J CLIN 2021;0:1417V

46、OLUME 0|NUMBER 0|MONTH 2021of cancer death,followed by colorectal and lung cancer for incidence,and vice versa for mortality.Global Cancer PatternsFigures 5 and 6 show the most commonly diagnosed cancers and leading causes of cancer death,respectively,by sex at the national level.The maps reveal sub

47、stantial global diversity in leading cancer types,particularly for incidence in men(8 dif-ferent cancer types)and for mortality in both men(8 types)and women(7 types).In men,prostate cancer is the most frequently diagnosed cancer in 112 countries,followed by lung cancer in 36 countries,and colorecta

48、l cancer and liver cancer each in 11 countries(Fig.5A).With regard to mor-tality(Fig.6A),lung cancer is the leading cause of cancer death in men in 93 countries,in part because of its high fatality rate,21 followed by prostate cancer(48 countries)and liver cancer(23 countries).In contrast to men,the

49、 most commonly diagnosed cancer in women is dominated by 2 cancer sites:breast cancer(159 countries)and cervical cancer(23 of 26 remaining countries)(Fig.5B).The mortality pro-file in women is more heterogeneous(Fig.6B),with breast and cervical cancer the leading causes of cancer death in 110 FIGURE

50、 5.Most Common Type of Cancer Incidence in 2020 in Each Country Among(A)Men and(B)Women.The numbers of countries represented in each ranking group are included in the legend.However,nonmelanoma skin cancer(excluding basal cell carcinoma),the most common type of cancer in Australia and New Zealand am