GI cancers contribute to 25% of global lifetime cancer risk, with highest risk for death
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Key takeaways:
- In 2020, the global lifetime risk for developing and dying from gastrointestinal cancers was 8.2% and 6.17%.
- Colorectal cancer accounted for 38.5% and 28.2% of total lifetime risk estimates.
Researchers estimated the global lifetime risk for developing gastrointestinal cancer in 2020 was one in 12 people, while one in 16 people will die, with colorectal cancer presenting the highest risk compared with other GI cancers.
“Few studies have assessed the cumulative effect of gastrointestinal cancers, including esophageal, gastric, liver, colorectal, pancreatic and gallbladder cancer, in terms of cancer-specific incidence and mortality from a lifetime risk perspective, despite these cancers accounting for a quarter of all cancer cases and a third of cancer-related deaths worldwide,” Shaoming Wang, PhD, from the Chinese Academy of Medical Sciences and Peking Union Medical College, and colleagues wrote in The Lancet Gastroenterology & Hepatology.
They continued: “Together with other indicators, lifetime risk can aid a complete understanding and interpretation of the profile of gastrointestinal cancers worldwide and in so doing, inform future health care planning given competing priorities and health care constraints.”
In a population-based, systematic analysis, researchers sought to estimate the lifetime risks for developing and dying from six major GI cancers at global, regional and country levels. They used incidence and mortality data from the Global Cancer Observatory 2020 for 185 countries, as well as all-cause mortality and population data from the United Nations World Population Prospects 2019. Researchers categorized countries into quartiles of the Human Development Index (HDI) according to health, education and income.
In 2020, the estimated global lifetime risk for developing and dying from GI cancers was 8.2% (95% CI, 8.18-8.21) and 6.17% (95% CI, 6.16-6.18), respectively. Researchers reported a higher risk among men compared with women for developing (9.53%; 95% CI, 9.51-9.55 vs. 6.84%; 95% CI, 6.82-6.85) and dying from GI cancers (7.23%; 95% CI, 7.22-7.25 vs. 5.09%; 95% CI, 5.08-5.1).
In addition, the risk was highest for CRC, accounting for 38.5% and 28.2% of total lifetime risks for developing and dying of GI cancers, followed by cancers of the stomach, esophagus, pancreas and gallbladder.
Risk for developing GI cancers ranged from 11.39% (95% CI, 11.37-11.41) in very high HDI countries to 2.61% (95% CI, 2.58-2.65) in low HDI countries, with the risk for death ranging from 7.29% (95% CI, 7.27-7.3) to 2.31% (95% CI, 2.28-2.35), respectively. The lifetime risk for GI cancers “increased consistently” with HDI level, although high HDI countries had the highest risk for death.
At the regional level, Eastern Asia had the highest lifetime risks of developing and dying from GI cancers (15.08%; 95% CI, 15.05-15.1 and 11.75%; 95% CI, 11.72-11.77), while Western Africa had the lowest (1.88%; 95% CI, 1.83-1.93 and 1.71%; 95% CI, 1.66-1.76).
Overall, GI cancers contributed to 25.1% (95% CI, 25.08-25.11) of the total lifetime cancer development risk worldwide, as well as the highest lifetime risk for death (6.17%; 95% CI, 6.16-6.18) followed by respiratory cancer (3.21%; 95% CI, 3.2-3.21) and female breast cancer (2.13%; 95% CI, 2.12-2.13).
“The apparent heterogeneity in lifetime risks across regions and countries indicates that there is an urgent need to establish context-specific, targeted cancer prevention plans for different gastrointestinal cancer types according to their underlying cause and causal pathways,” Wang and colleagues wrote.
Perspective
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Adrienna Jirik, MD
This study highlighted the striking burden that GI-related malignancies have worldwide, accounting for a third of all cancer-related deaths.
CRC remains at the top of the lifetime risk for death among GI cancers globally, with overall higher incidence in men than women. Geographic differences were noted to play a role in the incidence of certain GI cancers and appear to correlate not only with socioeconomic status but also certain exposures in the diet and environment.
What is particularly important about this study is that it augments the need to gather more regional data on risk factors and determine how to minimize these risk factors and carry out the most proper and cost-effective screening programs accordingly. Further sex-specific studies also are needed.
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