GLOBOCAN 2018: counting the toll of cancer

On Sept 12, the International Agency for Research on Cancer published the GLOBOCAN 2018 estimates of worldwide incidence and mortality for 36 cancers and cancer overall. Behind the data, gathered from local registries representing 185 countries, are the stories of 18·1 million people diagnosed with cancer in 2018 and the sorrow of 9·6 million deaths. Cancer incidence is on the rise, propelled by ageing societies, commercial interests, and unhealthy lifestyles. Currently, one in five men and one in six women will be diagnosed with cancer, and one in eight men and one in ten women will die from their disease. Predictions suggest that by 2030, 13 million people will die from cancer each year. Three-quarters of the deaths will be in low-income and middle-income countries. A further blow is that cancer is a leading cause of premature death, thereby reducing a country's productivity. There is no way that sustainable development goal 3.4, to reduce deaths from non-communicable diseases (NCDs) by a third by 2030, can be achieved without improved cancer treatment and control—a fact that should dominate the UN General Assembly's High-Level meeting about NCDs on Sept 27. Cancer types and incidence vary by country. Although breast cancer is the most common type of cancer for women in most countries, it is often surpassed by cervical cancer in sub-Saharan Africa and in southeast Asia. Risk factors such as hepatitis B and aflatoxin determine the distribution of liver cancer. Some countries have a unique burden, such as Malawi with oesophageal cancer. In 2012, the previous GLOBOCAN results showed evolving patterns of cancer in less developed countries, interpreted as signs of economic transition. For instance, an increased incidence of colorectal cancer attributed to changes in diet. The transitions are more pronounced in 2018, influenced strongly by the tobacco epidemic. Lung cancer is now the commonest cancer worldwide, with 2·1 million people diagnosed in 2018 and 1·8 million deaths. The highest rates of cancer were in Australia and New Zealand (571 cases per 100 000 men and 362 cases per 100 000 women). Rates need to be interpreted with care, because they are influenced by competing risks for death and depend on the presence and quality of local registries. Only 15% of the world's population is covered by a high-quality registry. In Asia, home to 60% of the population and half of all the cancer diagnoses in 2018, only 6·5% of people are covered. The absence of high-quality registries, as in Africa, with just 1% coverage, means that many people with cancer become invisible to those who plan and provide health services. Summative data mask the social and health disparities that influence cancer incidence and survival for individuals. Inequalities in exposure to carcinogens, education about symptoms, access to quality diagnostic services, and provision of affordable treatment increase the likelihood of survival for people living in more developed countries—and for more affluent people within any country. Reliable local registry data are essential to uncover inequalities, inform policy, and target effective, sustainable investment in services. Better outcomes rely on data that are accurate, complete, of good coverage, and shared with clinicians and policy makers. However, the best cancer care goes beyond registry data. Quality of life, palliative care, and follow-up needs of survivors must also influence services. The importance of GLOBOCAN for incidence and mortality data, and CONCORD for survival statistics, is not only to assess the performance of prevention and treatment strategies in a cyclical and systematic manner, but also to act as barometers for health systems and to hold governments to account for the cancer outcomes of their people. A heart-breaking truth is that many cancers could be prevented by stronger public health action: tobacco control for lung cancer; alcohol control for respiratory and digestive cancers; hepatitis B vaccine for liver cancer; human papillomavirus vaccine for cervical cancer; better nutrition and weight control for colorectal cancer. The list lengthens each year. But not all cancers can be prevented, so timely and universal access to quality care, diagnostics, and affordable, proven treatments is also necessary. No community is untouched by cancer, but for those without a cancer registry, the burden remains unseen and unaddressed. The value of GLOBOCAN is to aggregate findings in an accessible format that makes cancer burdens visible and unlocks the power of data to kindle ideas and actions. But the real test for GLOBOCAN is the extent to which resulting policies improve outcomes and narrow the shameful inequalities in survival between populations. This online publication has been corrected. The corrected version first appeared at thelancet.com on September 27, 2018 This online publication has been corrected. The corrected version first appeared at thelancet.com on September 27, 2018 Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countriesThe CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Full-Text PDF Department of ErrorThe Lancet. GLOBOCAN 2018: counting the toll of cancer. Lancet 2018; 392: 985—In this Editorial, the estimate of 30 million deaths from cancer by 2030 was incorrect. The number should be 13 million deaths. This correction has been made to the online version as of Sept 27, 2018. Full-Text PDF