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The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
BackgroundUnderstanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.MethodsThe GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.FindingsGlobally, 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, representing 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 males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 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 risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]).InterpretationThe leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden.FundingBill & Melinda Gates Foundation.
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 cancer types.
Understanding the relative contribution of modifiable risk factors to cancer burden and their trends over time is crucial to informing cancer control efforts both locally and globally. In 2015, the UN released the Sustainable Development Goals (SDGs), with SDG target 3.4 focusing on reducing global premature mortality by a third for non-communicable diseases, including cancer, by 2030. Effectively addressing the growing burden of cancer globally will require comprehensive measures that incorporate both curative and preventive interventions, particularly in light of the anticipated challenges that the COVID-19 pandemic will bring in progress towards SDG target 3.4.
Although some cancer cases are not preventable, governments can work on a population level to support an environment that minimises exposure to known cancer risk factors. Primary prevention, or the prevention of a cancer developing, is a particularly cost-effective strategy,
although it must be paired with more comprehensive efforts to address cancer burden, including secondary prevention initiatives, such as screening programmes, and ensuring effective capacity to diagnose and treat those with cancer. As part of cancer control strategies, prevention requires identification of causal risk factors, determination of contribution to local cancer burden, and development of effective strategies for their mitigation. Previous studies have quantified the burden of cancer attributable to individual risk factors globally or for several risk factors in select countries and regions,
providing crucial location and risk-factor-specific information. However, comprehensive cancer risk factor estimates do not exist for many countries, leaving an important void as countries develop and update their cancer control plans. The Global Cancer Observatory from the International Agency for Research on Cancer provides estimates of global, regional, and national risk-attributable cancer burden for a subset of potentially modifiable risk factors (eg, obesity, alcohol consumption, infections, and ultraviolet radiation), but these estimates are not provided together in a comprehensive fashion across time, and some potentially modifiable risk factors are not estimated as part of this effort.
Créditos: Comité científico Covid