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According to the World Health Organization (WHO), cancer is the second most common cause of death in the world (1). China has made considerable efforts to prevent and control cancer, but cancer is still a major national health problem. To understand the current burden of cancer in China, we analyzed the most recent estimates from the Global Burden of Disease Study (GBD 2019). GBD 2019 estimated the burden of disease in China using multiple data sources with unified and internationally comparable methods to comprehensively evaluate cancer mortality and risk factor trends in China. Compared to the standardized incidence of cancer in 2000, the standardized incidence of cancer increased in 2019, the standardized mortality rate decreased, and the number of deaths increased. People older than 70 years of age had the largest burden of cancer in 2019. In particular, breast cancer among females rose in the ranking, ranked by disability-adjusted life years (DALYs), among both sexes in 2019 in China and therefore requires more attention. To reduce the burden of cancer in China, effective cancer prevention and control measures are essential.
Data from 2000 and 2019 GBD studies for comparisons and analyses that included incidence, prevalence, mortality, and burden of cancer were extracted. Standardized rates were based on international populations in 2010 and calculations were based on standardized populations. DALYs refers to the total number of healthy life years lost from the time of illness onset through death, including years of life lost due to premature mortality (years of life lost; YLLs) and years lived with disability (YLDs).
Table 1 shows the incidence, prevalence, and mortality of cancer by gender in China. In 2019, cancer incidence, prevalence, and mortality were 244.75, 973.80, and 140.66 per 100,000 total population — increased by 15.85%, 68.62%, and −18.04%, respectively, compared to those of 2000. The cancer burden among men was significantly higher than among women. The 2019 standardized DALYs, YLLs, and YLDs increased by −24.14%, −25.14%, and 40.77%, respectively, compared to those of 2000.
Gender Year Incidence Prevalence Deaths DALYs YLLs YLDs N P’ N P’ N P’ N P’ N P’ N P’ Male 2000 1,410,333 259.59 3,199,721 547.30 1,170,487 228.45 33,786,674 5,668.74 33,362,468 5,593.31 424,206 75.43 2019 2,860,622 309.56 9,723,166 1,030.87 1,746,217 197.23 43,473,268 4,521.80 42,425,745 4,409.62 1,047,523 112.17 2019 vs.
2000 (%)*102.83 19.25 203.88 88.35 49.19 −13.67 28.67 −20.23 27.17 −21.16 146.94 48.71 Female 2000 1,004,000 170.90 3,824,258 620.22 694,220 124.12 20,530,328 3,385.92 20,149,716 3,323.05 380,612 62.87 2019 1,897,540 191.89 9,056,014 935.05 965,678 95.79 23,867,041 2,402.12 23,055,521 2,319.25 811,520 82.87 2019 vs.
2000 (%)*89.00 12.28 136.80 50.76 39.10 −22.82 16.25 −29.06 14.42 −30.21 113.21 31.81 Both 2000 2,414,332 211.27 7,023,979 577.51 1,864,707 171.62 54,317,002 4,496.44 53,512,183 4,428.32 804,819 68.13 2019 4,758,162 244.75 18,779,180 973.80 2,711,895 140.66 67,340,309 3,411.12 65,481,266 3,315.22 1,859,042 95.90 2019 vs.
2000 (%)*97.08 15.85 167.36 68.62 45.43 −18.04 23.98 −24.14 22.37 −25.14 130.99 40.77 Note: N: Number of cases for incidence, prevalence, and deaths; number of person years for disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs).
P’: Standardized rate calculated using the 2010 National Census as the standard population, expressed as 1/100,000.
* Percent change (%) was calculated as difference value between 2019 and 2000 divided by quantity in 2000.
Abbreviations: DALYs=disability-adjusted life years; YLLs=years of life lost; YLDs=years lived with disability.Table 1. Overall incidence, prevalence, deaths, and burden indicators of all cancers, 2000 and 2019 in China.
As shown in Table 2, the burden of cancer was the greatest in people over 70 years of age, with standardized incidence, prevalence, and mortality of 1,545.58 (per 100,000), 4,137.77 (per 100,000), and 1,173.86 (per 100,000), respectively, in 2019. The incidence of cancer in the 15–49 age group increased 36.72% compared to that of 2000.
Age group
(years)Year Incidence Prevalence Deaths DALYs YLLs YLDs N P’ N P’ N P’ N P’ N P’ N P’ <15 2000 105,651 34.28 711,665 230.88 32,244 10.46 2,713,576 880.34 2,656,207 861.73 57,369 18.61 2019 60,959 27.12 459,596 204.47 11,053 4.92 946,887 421.25 912,783 406.08 34,104 15.17 2019 vs.
2000 (%)*−42.30 −20.88 −35.42 −11.44 −65.72 −52.99 −65.11 −52.15 −65.64 −52.88 −40.55 −18.48 15–49 2000 594,899 79.73 2,481,389 332.56 346,451 46.43 17,176,324 2,302.02 16,933,876 2,269.52 242,448 32.49 2019 785,629 109.01 4,538,621 629.73 257,870 35.78 12,711,343 1,763.69 12,328,951 1,710.63 382,391 53.06 2019 vs.
2000 (%)*32.06 36.72 82.91 89.36 −25.57 −22.94 −25.99 −23.39 −27.19 −24.63 57.72 63.28 50–69 2000 1,021,067 534.20 2,654,155 1,388.59 800,805 418.96 23,665,394 12,381.16 23,343,021 12,212.50 322,373 168.66 2019 2,242,887 608.02 9,313,626 2,524.82 1,175,611 318.70 34,719,458 9,412.07 33,820,598 9,168.39 898,860 243.67 2019vs.
2000 (%)*119.66 13.82 250.91 81.83 46.80 −23.93 46.71 −23.98 44.89 −24.93 178.83 44.48 70+ 2000 692,715 1,261.05 1,176,770 2,142.24 685,208 1,247.38 10,761,709 19,591.10 10,579,080 19,258.63 182,629 332.47 2019 1,668,686 1,545.58 4,467,337 4,137.77 1,267,361 1,173.86 18,962,621 17,563.70 18,418,934 17,060.12 543,687 503.58 2019 vs.
2000 (%)*140.89 22.56 279.63 93.15 84.96 −5.89 76.20 −10.35 74.11 −11.42 197.70 51.47 Note: N: Number of cases for incidence, prevalence, and deaths; number of person years for disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs).
P’: Standardized rate calculated using the 2010 National Census as the standard population, expressed as 1/100,000.
* Percent change (%) was calculated as difference value between 2019 and 2000 divided by the 2000 value.
Abbreviations: DALYs=disability-adjusted life years; YLLs=years of life lost; YLDs=years lived with disability.Table 2. Incidence, prevalence, deaths, and burden indicators of cancer, 2000 and 2019 in China.
As shown in Table 3, the leading five cancer categories, as ranked by DALYs rate, were tracheal, bronchial, and lung cancers; stomach cancer; colon and rectal cancers; esophageal cancer; and liver cancer. There were large differences by gender in 2019, and by 2019, the DALYs rate rankings of cancer, regardless of gender, changed greatly compared to those of 2000. However, for both men and women, lung cancer DALYs rate consistently ranked first. The 2019 DALYs rate rankings significantly changed compared to those of 2000, such that the ranking of colon and rectal cancer changed from sixth to third, liver cancer among men changed from third to fifth, and breast cancer among women changed from fourth to second.
Year Rank Cancer site Both sexes (1/100,000) Cancer site Male Cancer site Female 2019 1 Tracheal, bronchus, and lung 831.27 Tracheal, bronchus, and lung 1,203.78 Tracheal, bronchus, and lung 492.17 2 Stomach 481.15 Stomach 718.79 Breast 277.98 3 Colon and rectal 320.57 Esophageal 458.55 Stomach 260.97 4 Esophageal 277.50 Colon and rectal 434.50 Colon and rectal 217.28 5 Liver 264.31 Liver 414.90 Cervical 157.50 6 Leukemia 163.82 Leukemia 190.81 Leukemia 135.97 7 Breast 144.15 Pancreatic 176.41 Liver 115.85 8 Pancreatic 136.57 Brain and central nervous system 143.02 Brain and central nervous system 109.48 9 Brain and central nervous system 126.24 Prostate 118.94 Esophageal 108.46 10 Cervical 79.10 Non-Hodgkin lymphoma 95.58 Pancreatic 98.93 2000 1 Tracheal, bronchus, and lung 826.23 Tracheal, bronchus, and lung 1173.00 Stomach 519.17 2 Stomach 796.94 Stomach 1085.18 Tracheal, bronchus, and lung 498.15 3 Liver 689.47 Liver 1029.41 Liver 339.82 4 Esophageal 499.63 Esophageal 713.66 Breast 296.44 5 Leukemia 293.96 Colon and rectum 302.27 Esophageal 289.29 6 Colon and rectum 258.69 Leukemia 301.19 Leukemia 288.00 7 Brain and central nervous system 161.76 Brain and central nervous system 175.24 Colon and rectum 220.04 8 Breast 147.71 Prostate 126.41 Cervical 157.07 9 Pancreatic 95.80 Pancreatic 115.71 Brain and central nervous system 148.11 10 Cervical 77.67 Nasopharyngeal 101.15 Pancreatic 76.45 Note: DALY rate: Standardized rate calculated using the 2010 National Census as the standard population, expressed as 1/100,000.
Abbreviation: DALY=disability-adjusted life years.Table 3. Cancers ranked by DALYs rate among both sexes between 2000 and 2019 in China.
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China has a high incidence of cancer. Both incidence and prevalence were on the rise in 2019, while the cancer mortality rate was decreasing. DALYs and YLLs were also decreasing, but YLDs increased. Although mortality rates have declined, the combination of an aging and growing population has resulted in the absolute number of cancer deaths increasing by 45.43% in 2019 compared to that of 2000. In addition, progress in China’s medical technology influences the trends. The burden of cancer is greater in men than women, possibly related to men’s greater exposure to occupational risk factors, high social pressure, and poorer lifestyles. China has taken a series of effective measures in response to cancer, including promoting tobacco control, pushing for hepatitis B and human papilloma virus (HPV) vaccination to strengthen primary prevention, and developing guidelines for early screening, early diagnosis, and early treatment of cancers.
DALYs rate peaked in the 70-year-old age group, indicating that the elderly are living longer. The 15–49-year age group had the largest increase in cancer incidence, indicating that the burden of cancer is shifting to a younger population. This is consistent with the results of a previous study (2), and it shows that it is necessary and important for China to actively conduct cancer screening for early diagnosis and treatment. To effectively reduce the burden of cancer, precise prevention and control of key populations need to be implemented.
The overall DALYs rate rankings of specific cancers only changed slightly from 2000 to 2019, but the DALYs rate rankings among females changed more significantly. Lung cancer rankings did not change from 2000 — lung cancer still ranks first among both men and women. In many countries, lung cancer is the leading cause of cancer death. The high ranking of lung cancer DALYs rate among women may be related to outdoor air pollution and the use of indoor solid fuels for heating and cooking (3-4).
The DALYs rate ranking of colorectal cancer increased from sixth to third from 2000 to 2019. Colorectal cancer risk is closely related to lifestyle. Increased intake of animal-derived foods, obesity caused by prolonged sitting, and unhealthy habits, such as smoking and drinking, are related to the risk of colorectal cancer (5). An important strategy to reduce the burden of colorectal cancer is strengthening primary and secondary prevention.
Breast cancer rose from fourth rank to second rank among women. The change may be due to changes in lifestyle and social culture brought about by economic growth and increases in the proportion of women in the industrial labor force — both of which are associated with breast cancer (6). In 2020, breast cancer surpassed lung cancer as the leading cause of cancer globally. WHO recommended that women with an average risk of breast cancer between the ages of 50 and 69 undergo organized, population-based mammography every 2 years in well-resourced countries (7).
Liver cancer decreased from third to fifth rank overall, and among women, liver cancer decreased from third to seventh rank. Although the results of this study showed that China’s DALYs rate ranking of liver cancer decreased in 2019, the burden of cancer in China will increase further because of population aging. A study showed that limited coverage of health examinations and screenings in China also indicated that the overall 5-year survival rate for liver cancer is low (8). Therefore, China should expand adult vaccination to control hepatitis B virus infection and increase hepatitis B virus screening.
This study was subject to several limitations. The study was at the national level and did not include provincial-level data. Economic and medical development varied by region, which might lead to regional differences in the burden of cancer. GBD 2019 data was estimated by model, and some relevant data were unavailable for earlier years. However, by comparing our data with published articles (9), the trends of cancer in China were shown to be roughly the same as in previous studies. In the future, in-depth research is needed for different provinces in China. In addition, tumor registries should be expanded by area as much as possible to make the data higher quality and as accurate as possible in China.
With China’s aging population, the size of the elderly population will increase, and the burden of cancer will also become greater. In anticipation of this trend, China developed the Healthy China Initiative 2019–2030 (10), which includes cancer prevention and treatment as a major special action, requiring the overall 5-year survival rate of cancer to be greater than 46.6% in 2030 and the early diagnosis rate of key cancer types in high-incidence areas to be greater than 55% in 2022, with further increases required in the future (10). Early cancer screening with early diagnosis and treatment should be promoted by improving health laws and regulations and improving the medical security system, publicity and education should be carried out appropriately, and residents’ attention to cancer prevention and response should be increased so that the overall burden of cancer in China would gradually and steadily decrease.
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The GBD 2019 team and the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention.
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No conflicts of interest.
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