*For medical professionals only
Gastrointestinal cancers, such as esophageal, gastric, liver, colorectal, pancreatic, and gallbladder cancers, account for one-quarter of the total number of cancer cases and one-third of cancer-related deaths worldwide [1].
However, little is known about each person's lifetime risk of developing gastrointestinal cancers (from birth to death), and there are currently no studies that comprehensively assess the lifetime risk of illness or death from gastrointestinal cancers on a global scale.
On the 4th of this month, researchers from the National Cancer Center/National Clinical Research Center for Oncology/Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences, published a blockbuster research result in the prestigious journal Lancet Gastroenterology and Hepatology [2].
Based on data from GLOBOCAN in 2020, they systematically estimated the lifetime risk of gastrointestinal cancer in 185 countries around the world for the first time. Overall, in 2020, a person had an 8.20% chance of developing gastrointestinal cancer from birth to death (i.e., 1 in 12 people worldwide) and 6.17% of people dying from gastrointestinal cancer (i.e., 1 in 16 people worldwide).
Screenshot of the first page of the paper
Influenced by demographic changes, changes in dietary and lifestyle Xi brought about by globalization, and the development of innovative anti-cancer therapies, the incidence and mortality of major gastrointestinal cancer types have disparities between regions and countries around the world over the past three decades.
After systematically searching all relevant research papers up to 2023, the researchers found that no studies had systematically explored the lifetime risk of gastrointestinal cancer. Over the past six decades, the cumulative risk of gastrointestinal cancer morbidity or mortality in people aged 0-74 years has been widely used as a surrogate to assess the lifetime risk of developing or dying from gastrointestinal cancer.
However, with advances in technology, in 2020, more than 100 countries already had a life expectancy of more than 74 years. Therefore, in an age where life expectancy is relatively high, the lifetime risk of gastrointestinal cancer may be greatly underestimated.
Therefore, the researchers believe that it is necessary to use the latest composite indicators to assess the lifetime risk of developing or dying from gastrointestinal cancer in the global population, as well as the differences between countries, to help global health systems develop long-term plans for gastrointestinal cancer prevention and treatment.
Based on data from GLOBOCAN in 2020, Chinese researchers systematically estimated the lifetime risk of gastrointestinal cancer in 185 countries around the world for the first time. In 2020, the probability of a person developing gastrointestinal cancer from birth to death was 8.20% and the probability of dying from gastrointestinal cancer was 6.17%.
Lifetime risk data for gastrointestinal cancers
From the table above, we can also see that countries or regions with a relatively high Human Development Index (HDI) have a higher lifetime risk of gastrointestinal cancer (11.39%) and a higher lifetime risk of death from gastrointestinal cancer (8.42%).
Men had a higher lifetime risk of gastrointestinal cancer (9.53 versus 6.84 percent) and a higher lifetime risk of death from gastrointestinal cancer (7.23 versus 5.09 percent) compared with women.
The lifetime risk of gastrointestinal cancer in different countries and regions: A. Lifetime risk of disease in men, lifetime risk of disease in women B, lifetime risk of death in men C, and lifetime risk of death in women D
Specifically, colorectal cancer has the highest lifetime risk, contributing 38.5% and 28.2% of the lifetime morbidity and mortality of gastrointestinal cancer, followed by gastric cancer, liver cancer, esophageal cancer, pancreatic cancer and gallbladder cancer, respectively.
Countries with very high HDI have a much higher lifetime risk of developing and dying from pancreatic cancer than other HDI country groups. Liver cancer (0.63%) and esophageal cancer (0.61%) have the highest lifetime mortality risk in countries with low- to medium-to-medium levels of the Human Development Index.
From an age perspective, the risk of gastrointestinal cancer from birth to age 40 is extremely low globally, and the cumulative risk from birth to death is similar to that from age 40 to death (8.08%) for both men and women. The risk of death from gastrointestinal cancers shows a similar pattern. In addition, the risk of developing gastrointestinal cancers decreases with age, with a 4.77% risk of gastrointestinal cancer and a 3.91% risk of death after the age of 70.
Relationship between the risk of developing (A) and the risk of death (B) of gastrointestinal cancers with age
There are significant differences in the lifetime risk of different types of gastrointestinal cancers across regions.
The lifetime risk of gastrointestinal cancer was highest in East Asia (15.08%) and death (11.75%), while the risk was lowest in West Africa (1.88%; death 1.71%). At the national level, Japan (23.48%) had the highest risk of gastrointestinal cancer, and Mongolia (16.62%) had the highest risk of dying from gastrointestinal cancer.
Risk of Gastrointestinal Cancer (A) and Risk of Mortality (B) by Region/Country
In terms of specific cancer types, the lifetime risk of gastric cancer, liver cancer, esophageal cancer and gallbladder cancer is highest in East Asia, the highest lifetime risk of colorectal cancer in Australia and New Zealand and southern Europe, and the highest lifetime risk of pancreatic cancer in Western Europe.
Overall, this study, initiated by Chinese scientists, is the first to systematically estimate the lifetime morbidity and mortality risk data of gastrointestinal cancer in the global population, and has made detailed stratification according to region, gender, age, etc., which is of great significance for guiding the prevention and treatment of gastrointestinal cancer.
The study also found that countries with very high HDIs had a 4.4-fold higher risk of developing gastrointestinal cancers and 3.2-fold higher rates of dying from gastrointestinal cancers than countries with low HDIs. Because there is a smaller gap in the lifetime risk of death from gastrointestinal cancer between countries with a very high HDI and countries with a very low HDI compared to the incidence of gastrointestinal cancers, the researchers believe that this highlights the importance of access and affordability of health care, as well as the critical role of national health policy decisions.
In addition, in this study, the ratio of lifetime mortality risk to morbidity risk for esophageal, liver, and pancreatic cancer was extremely high at about 0.95, while the ratio for gastric and gallbladder cancer was about 0.75, and the ratio for colorectal cancer was about 0.55. These figures once again highlight the fact that most cancers of the gastrointestinal tract, including esophageal, pancreatic, stomach, liver, and gallbladder cancers, are difficult to detect at an early stage, and curative treatment options are inadequate.
Therefore, researchers believe that the development of effective prevention and treatment strategies is essential to reduce the burden of gastrointestinal cancers. Examples include reducing exposure to common risk factors, developing targeted gastrointestinal cancer screening programs for high-risk populations, improving accessibility, affordability, and outcomes of cancer treatment, and using technology to improve cancer prevention and control.
Bibliography:
[1]. Arnold M, Abnet CC, Neale RE, et al. Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology. 2020; 159(1):335-349.e15. doi:10.1053/j.gastro.2020.02.068
[2]. Wang S, Zheng R, Li J, et al. Global, regional, and national lifetime risks of developing and dying from gastrointestinal cancers in 185 countries: a population-based systematic analysis of GLOBOCAN. Lancet Gastroenterol Hepatol. 2024. doi:10.1016/S2468-1253(23)00366-7
This article was written by BioTalker