Over the past three decades, cancer mortality rates in higher-income countries fell approximately 30%, while rates in lower-income countries climbed about 15%, according to the most recent Global Burden of Disease (GBD) analysis.

Similar disparities were observed in cancer incidence and disability-adjusted life-years (DALYs), suggesting that greater efforts are needed to address cancer across regions, lead author Lisa M. Force, MD, of the University of Washington, Seattle, and colleagues reported.

“Crucial work is being done around the world to address the burden of cancer; however, most countries need to accelerate efforts,” the investigators wrote in The Lancet.

Trends Since 1990, Forecasts to 2050

The GBD study has been reporting cancer burden since 1993, with increasing granularity over the years. In this iteration, the team of international investigators characterized global trends across 47 cancer types from 1990 to 2023 and projected figures out to 2050.

From 1990 to 2023, age-standardized mortality rates declined by 27% in high-income countries and by 34% in upper-middle-income countries, while they increased by 17% in lower-middle-income countries and by 14% in low-income countries.

Cancer incidence rates followed a similar pattern. Over the same period, age-standardized incidence rates decreased by 3% in high-income countries and by 9% in upper-middle-income countries, while they increased by 29% in lower-middle-income countries and by 24% in low-income countries.

DALYs echoed this divergence, declining by 31% in high-income countries and by 38% in upper-middle-income countries, while increasing by 13% in lower-middle-income countries and by 10% in low-income countries.

Breast cancer was the most frequently diagnosed cancer in 2023, followed by lung, colorectal, prostate, and stomach cancers. Lung cancer was the leading cause of cancer deaths, followed by colorectal, stomach, breast, and esophageal cancers.

Nearly 42% of cancer deaths in 2023 were attributable to modifiable risk factors, such as tobacco use, alcohol consumption, obesity, and physical inactivity.

Looking to the future, the investigators projected that the 18.5 million new cancer cases and 10.4 million deaths recorded in 2023 will rise to 30.5 million cases and 18.6 million deaths by 2050. Much of that growth will stem from population expansion and aging, rather than from an increased risk at the individual level, they said.

Age-standardized incidence and mortality rates are expected to remain largely flat from 2024 to 2050, with modest declines in some regions and persistent disparities between income groups. Between 2015 and 2030, the probability of dying from cancer between ages 30 and 70 years is forecast to decrease by only 6.5%, falling far short of the United Nations Sustainable Development Goal of reducing premature noncommunicable disease mortality by one third.

Experts Warn of Plateauing Progress

“Despite decades of global effort to reduce the burden of cancer, it remains a major public health challenge now and into the foreseeable future,” Qingwei Luo, PhD, and David P. Smith, PhD, of the University of Sydney, Sydney, Australia, wrote in an accompanying editorial.

The editorialists noted the disproportionately worse findings in lower-income countries, which they attributed to underfunded cancer control efforts and health systems that lack the capacity to provide prevention, early detection, and treatment at scale. They argued that prevention must play a central role because more than 40% of cancer deaths in the study were linked to modifiable risk factors such as tobacco use, alcohol consumption, obesity, and physical inactivity. Tackling these behaviors would reduce cancer deaths while also addressing the burden of other noncommunicable diseases, they added.

Luo and Smith underscored the need for implementation research and context-specific strategies, cautioning that models developed in high-income countries cannot simply be transplanted to resource-limited settings. Instead, sustainable approaches should be tailored to each country’s priorities and capacities, with governments investing in both system strength and equitable access to care.

Julie Gralow, MD, chief medical officer of the American Society of Clinical Oncology, Alexandria, Virginia, said the latest GBD findings “should be a wake-up call for all of us” that prompts action at both clinician and policymaker levels.

At the clinician level, contributions depend upon specialty.

“Reducing cancer incidence is more in the domain of the primary care workforce, since most oncologists don’t meet the patient until they’ve had a cancer diagnosis,” Gralow told Medscape Medical News.

Modifiable risk reduction must occur early in life, she added, requiring pediatricians, primary care providers, and OB-GYNs to educate patients about healthy behaviors, order screening tests, and recommend preventive vaccines such as those for human papillomavirus and hepatitis B.

In contrast, oncologists have the greatest impact after diagnosis, Gralow said, highlighting the importance of diagnostics, treatment, and supportive care in determining survival.

“If every patient had access to high-quality, evidence-based cancer care, we would significantly reduce deaths due to cancer tomorrow,” Gralow said.

Gralow was commenting from New York, where she was attending the United Nations General Assembly, including the Fourth High-Level Meeting on the Prevention of Noncommunicable Diseases and Mental Health.

She described the four strategies being discussed at the meeting to address global cancer rates and outcomes:

• Prioritize prevention and early detection through cost-effective strategies
• Strengthen primary healthcare systems as the backbone of cancer control
• Implement solutions appropriate to local resources rather than importing high-income models wholesale
• Ensure financial protection so all patients have access to care without risk for catastrophic health expenditures

Gralow expressed hope that these latest efforts at the United Nations would lead to a “renewed sense of commitment and resolve, as well as collaboration and partnership.”

This study was supported by the Gates Foundation, St. Jude Children’s Research Hospital, and St. Baldrick’s Foundation. The authors disclosed having relationships with AbbVie, Merck, Reckitt, and others. Luo, Smith, and Gralow disclosed having no conflicts of interest.