Stark differences in cancer epidemiological data between GLOBOCAN and GBD: Emphasis on oral cancer and wider implications

Analysis of the disease burden of malignancies in the female reproductive system in China from 1990 to 2019: an age-period-cohort study and joinpoint analysis

OBJECTIVE

To analyse the trend of the disease burden of common malignancies of the female reproductive system and the influence of age, period and birth cohort in China from 1990 to 2019.

DESIGN

We used the joinpoint model based on the global burden of disease (GBD 2019) database to explore the trend of the burden of common malignancies of the female reproductive system in China from 1990 to 2019, and further analyzed the impact of age, period, and birth cohort using the age-period-cohort model.

SETTING

GBD data from 1990 to 2019.

PARTICIPANTS

Data were publicly available and individuals were not involved.

MAIN OUTCOMES

Outcomes included age standardised incidence rate, standardised mortality, standardised disability-adjusted life year (DALY), annual percentage change, average annual percentage change, age (period, cohort) effect coefficient, relative coefficient and SE. Akchi information criterion and Bayesian information criterion were used to estimate model goodness of fit.

RESULTS

From 1990 to 2019, the standardised incidence and prevalence of cervical cancer and endometrial cancer increased, while the standardised mortality and DALY rate decreased. The standardised incidence, prevalence, mortality and DALY rates of ovarian cancer increased. The risk of cervical cancer, ovarian cancer and endometrial cancer increased first and then decreased with age, reaching its peak at ages 55, 70 and 55, respectively, while the risk of death increased with age. The risk of the onset and death of cervical cancer and ovarian cancer increased with the period, while those of endometrial cancer increased first and then decreased. The cohort with later female reproductive system malignancies had a lower risk of morbidity and mortality than the previous cohort.

CONCLUSION

From 1990 to 2019, the disease burden of malignant tumours in the female reproductive system in China was high. Relevant departments should pay attention to the prevention and treatment of malignant tumours in the reproductive system. Middle-aged and elderly women are the key target group for prevention and control.

Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021.

METHODS

This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution.

FINDINGS

The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45 900 (95% UI 42 300 to 49 800) per 100 000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27 500 (24 000 to 32 000) per 100 000 population and 12 500 (10 500 to 14 500) per 100 000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990-2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (-68·3% [-79·3 to -46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevalence but a decrease in the DALY rate for orofacial clefts. By WHO region, the African and Eastern Mediterranean regions showed the largest increases in prevalent cases and DALYs for most oral conditions, while the European region showed the smallest increases or no change. The European region was the only region with decreasing age-standardised prevalence of untreated caries in both deciduous (-9·88%; -12·6 to -6·71) and permanent teeth (-5·94% (-8·38 to -3·62). The prevalence and DALY rate of severe periodontitis decreased in the African region, while the prevalence and DALY rate of edentulism decreased in the African region, South-East Asia region, and Western Pacific region. Furthermore, DALY rates of lip and oral cavity cancer decreased in the European region and the region of the Americas, while DALY rates of orofacial clefts decreased in all regions.

INTERPRETATION

The minor changes in the burden of oral conditions over the past 30 years demonstrate that past and current efforts to control oral conditions have not been successful and that different approaches are needed. Many countries now face the double challenge of controlling the occurrence of new cases of oral conditions and addressing the huge unmet need for oral health care.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national mortality of larynx cancer from 1990 to 2021: results from the global burden of disease study

BACKGROUND

Larynx cancer, a major upper respiratory tract malignancy, remains a global public health challenge, driven by smoking, alcohol use, and chronic inflammation, despite medical and public health advancements.

METHODS

Data from the Global Burden of Disease 2021 study were used to assess larynx cancer mortality trends from 1990 to 2021 across global, regional, and national levels. Death rates, absolute mortality numbers, and Estimated Annual Percentage Change (EAPC) were calculated.

RESULTS

Globally, the number of deaths from larynx cancer increased by 36.67% between 1990 and 2021, while death rates slightly declined, with an EAPC of -0.41. Males consistently accounted for the majority of deaths, with 100,393 deaths in 2021, though female mortality showed a larger percentage increase of 60.13% compared to 33.39% in males. Significant regional disparities were evident, with the highest death rates reported in Eastern Europe and Central Latin America, where countries like Bulgaria and Cuba recorded rates exceeding 6 per 100,000 population. In contrast, Oceania reported the lowest rates, below 0.5 per 100,000. The elderly (75 + years) experienced the largest increase in mortality, rising by 85.4%, while deaths among the 15-49 age group remained relatively stable. Additionally, larynx cancer death rates were correlated with SDI.

CONCLUSION

Despite slight declines in global death rates, the absolute burden of larynx cancer has increased due to population growth and aging. Regional disparities emphasize the need for targeted interventions and improved healthcare access. This study offers valuable insights for policy and resource planning.

Lip and oral cavity cancer in Iran from 1990 to 2019 based on the global burden of disease study

The global burden of disease (GBD) provides valid and reliable assessments of the burden of various diseases. The present study aimed to evaluate the trends of incidence, mortality, and morbidity of lips and oral cavity cancers (LOCC) in Iran from 1990 to 2019 according to GBD 2019 data. Indicators including prevalence, incidence, death, years of life lost (YLL), years lived with disability (YLD), disability adjusted life years (DALY), and mortality-to-incidence ratio (MIR) for two genders and three age groups including 15-49 years, 50-69 years, and 70 + years in Iran were extracted from GBD 2019/calculated. The annual percentage changes of different indicators were analyzed. A joinpoint regression analysis was used to examine the pattern of changes. LOCC incidence in Iran has increased during the studied period, in both genders and all age groups. The average annual percent change (AAPC) of incidence increase was much higher in women (1.36) than in men (0.007), while the highest growth was observed in middle-aged women from 2010 to 2015 (6.9). The general trend (AAPC (Confidence interval (CI)) of YLL in total patients (-0.20 (-0.23, -0.17)), and DALY in total patients (-0.17 (-0.21, -0.14)) had a significant decrease. However, YLL in women (0.48 (0.44, 0.50)) and DALY in women (0.51 (0.48, 0.54)) significantly increased. Moreover, MIR has been declining during the studied period except for the time range of 2002 to 2010, in each of the two sexes (-0.46 in men and - 0.64 in women) and both together (-0.53). A declining trend of YLL/DALY/MIR, and an improvement in screening/diagnosis/treatment/patient care of LOCC in Iran has happened that still needs to be improved. Due to the increase in incidence/mortality/morbidity of LOCC in Iranian women, risk factors exposure and disease screening should be followed seriously.

Alcohol-Related Liver Disease, Followed by Metabolic Dysfunction-Associated Steatotic Liver Disease, Emerges as the Fastest-Growing Aetiologies for Primary Liver Cancer in the United States

OBJECTIVE

Primary liver cancer (PLC) is projected to be the third leading cause of cancer mortality in the United States in 2040. We examine the burden of PLC in the United States, stratified by sex, state and aetiological risk factors.

METHODS

Data on PLC prevalence, incidence, death and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease Study 2021. Changes in these parameters were calculated using the Joinpoint regression model.

RESULTS

There were 47,970 cases, 31,450 incident cases, 24,770 deaths and 576,920 DALYs from PLC in the United States. The highest prevalence (16,980), incidence (12,040), death (9840) and DALYs (213,410) from PLC were due to chronic hepatitis C virus infection. From 2000 to 2021, PLC incidences increased by 141%, and PLC deaths increased by 136%. Age-standardised incidence rates (ASIRs) and death rates (ASDRs) per 100,000 population for PLC increased, primarily driven by alcohol-related liver disease (ALD) (ASIR: annual percent change [APC]: +2.40%; ASDR: APC: +2.22%) and metabolic dysfunction-associated steatotic liver disease (MASLD) (ASIR: APC: +2.32%; ASDR: APC: +2.04%).

CONCLUSION

The burden of PLC in the United States has risen in the past two decades, driven mainly by ALD and followed by MASLD. These findings offer policymakers an accurate assessment of the PLC burden and emphasise the need for targeted risk factor mitigation, especially regarding alcohol related policy.

Epidemiological trends and age-period-cohort effects on lip and oral cavity cancer burden across the BRICS from 1992 to 2021

Background

Lip and oral cavity cancer (LOC) is one of the common malignant tumors of the head and neck, posing significant health and economic burdens. The BRICS, including Brazil, Russia, India, China, and South Africa, represent a large global population, presenting unique public health challenges. This study aims to evaluate the epidemiological trends and variations in the burden of LOC across BRICS in a timely manner.

Methods

Data on the number, all-age rate, age-standardized rate, and relative change in LOC incidence from 1992 to 2021 within BRICS were obtained from the Global Burden of Disease study (GBD) 2021, and we analyzed global and BRICS-specific LOC incidence trends over 30 years. Furthermore, age-period-cohort model was applied to estimate net drift, local drift, age, period and cohort effects between 1992 and 2021.

Results

In 2021, the BRICS nations reported 194.74 thousand new LOC cases, constituting 46.2% of the global total. From 1992 to 2021, all BRICS countries witnessed a significant rise in LOC cases, with China leading at 259.06%. The age-standardized incidence of LOC increased by over 20% in the Russian Federation, India, and China, while Brazil and South Africa exhibited marginal changes (Brazil: 0.75%; South Africa: -7.87%). Rising LOC trends were prevalent across most age groups in China, India, and the Russian Federation, particularly affecting older adults (60-94 years). Age, period, and cohort effects were deteriorating in China and India, contrasting with improvements in Brazil and South Africa.

Conclusion

LOC incidence has increased across BRICS, with temporal trends not consistently aligning with economic growth and exhibiting significant variation among countries. Brazil's experience highlights the efficacy of oral health and tobacco control measures in mitigating LOC, especially in fast-developing nations. Prevention should target men and elderly in China and India, and women in other areas.

Global burden of thyroid cancer in adolescents and young adults (aged 15-39 years) from 1990 to 2021: A systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Thyroid cancer (TC) is the most common malignancy of the endocrine system and head-and-neck region, yet data on its burden in adolescents and young adults (AYAs) is lacking. This study aimed to estimate the global burden of TC among AYAs from 1990 to 2021.

METHODS

Utilizing the Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized rates of incidence, prevalence, and disability-adjusted life-years (DALYs) on global, regional, and national scales. Joinpoint regression was employed to determine average annual percentage change (AAPC), with frontier analysis revealing regions for improvement. Decomposition analysis assessed the impacts of population aging, growth, and epidemiological changes. Projections for disease burden extending to 2040 were generated using the Bayesian Age-Period-Cohort model.

RESULT

In 2021, there were 48.2 thousand incident cases, 436.1 thousand prevalent cases, and 183.5 thousand DALYs worldwide. Meantime, the age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALYs rates (ASDR) were 1.6, 14.3 and 6.1 per 100 000, respectively. From 1990 to 2021, the ASIR, ASPR and ASDR increased with AAPCs of 1.73, 1.77, and 0.38, respectively. Socio-demographic resources in Saudi Arabia, Taiwan (Province of China), Iceland, United Arab Emirates, and United States Virgin Islands have the potential to lower ASDR due to TC among AYAs. Furthermore, 13.3 thousand and 34.9 thousand new cases occurred in the males and females in 2021. Among 5 age groups, the highest numbers of incidence, prevalence, and DALYs, along with ASRs, were observed in the 35-39 age group. Global projections indicated a continuous rise in numbers of incidence, prevalence, and DALYs, with estimates of 60.2 thousand, 558.4 thousand, and 199.7 thousand by 2040, respectively.

CONCLUSION

The global burden of TC among AYAs was on the rise, with significant disparities by regions, genders, and age groups, highlighting the necessity for targeted and effective interventions.

Surface receptor-targeted protein-based nanocarriers for drug delivery: advances in cancer therapy

Significant progress has been made in cancer therapy with protein-based nanocarriers targeted directly to surface receptors for drug delivery. The nanocarriers are a potentially effective solution for the potential drawbacks of traditional chemotherapy, such as lack of specificity, side effects, and development resistance. Peptides as nanocarriers have been designed based on their biocompatible, biodegradable, and versatile functions to deliver therapeutic agents into cancer cells, reduce systemic toxicity, and maximize therapy efficacy through utilizing targeted ligands such as antibodies, amino acids, vitamins, and other small molecules onto protein-based nanocarriers and thus ensuring that drugs selectively accumulate in the cancer cells instead of healthy organs/drug release at a target site without effects on normal cells, which inherently caused less systemic toxicity/off-target effect. Moreover, their intrinsic protein backbone naturally degradesin vivo, providing another level of safety over synthetic materials. Various issues like immunogenicity, mass production, and quality control must be addressed for widespread use. However, further studies are necessary to perfect protein engineering and improve drug loading, protein modification, and targeting. Thus, it can be concluded that protein-based nanocarriers targeted against the surface receptors would help achieve cancer management in a more focused manner, thus minimizing toxicity. The further development of these nanoparticles could bring a significant change in cancer treatment so that more personalized, targeted, and safe therapies would be available to all patients.

Increased MASH-associated liver cancer in younger demographics

BACKGROUND

The incidence of cancer and the prevalence of metabolic disease and metabolic dysfunction-associated steatotic liver disease is increasing in young adults. However, updated global data on metabolic dysfunction-associated steatohepatitis (MASH)-associated primary liver cancer (PLC) in young adults remains scarce.

METHODS

This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years rates from MASH-associated PLC in young adults (15-49 y).

RESULTS

In 2021, there were 4300 incidence cases, 3550 deaths, and 179,340 disability-adjusted life years from MASH-associated PLC in young adults. Among various etiologies of PLC in young adults, only MASH-associated PLC had increased incidence rates (annual percent change: +0.26, 95% CI: 0.16%-0.35%), with the Eastern Mediterranean region having the largest observed increase (annual percent change: 1.46%, 95% CI: 1.40%-1.51%). In 2021, MASH-associated PLC in young adults made up 6% (+1% from 2000) incident cases, 6% (+2% from 2000) deaths, and 6% (+2% from 2000) disability-adjusted life years of all PLC in this age group. Over half of the countries exhibited an increase in age-standardized incidence rate from MASH-associated PLC in young adults from 2000 to 2021.

CONCLUSIONS

The incidence of MASH-associated PLC in young adults is significantly increasing, signaling likely future increases in PLC incidence among older adults as this cohort ages. This trend necessitates urgent strategies worldwide to mitigate the epidemics of MASH-associated PLC in young adults.

Temporal trends in disability adjusted life year and mortality for colorectal cancer attributable to a high red meat diet in China from 1990 to 2021: an analysis of the global burden of disease study 2021

BACKGROUND

High red meat consumption is a main modifiable risk factor for colorectal cancer mortality (CRC), but its attributable disease burden remains unclear in China. We aimed to analyze the temporal trends in CRC deaths and disability-adjusted life years (DALYs) attributable to high red meat consumption in China from 1990 to 2021 and to predict the disease burden in the next 15 years.

METHODS

Data was obtained from the Global Burden of Disease (GBD) 2021 study. The Joinpoint regression model was used to calculate the annual percentage change (APC) and the average annual percentage change (AAPC). In addition, the age-period-cohort (APC) model was employed to explore the effects of age, period, and cohort on CRC mortality. The autoregressive integrated moving average (ARIMA) model was utilized to predict the disease burden in 2022-2036. We also compared the CRC burden attributed to high red meat in China with 204 countries worldwide.

RESULTS

The results showed that the number of CRC deaths in China due to high red meat consumption increased nearly 2.5 times, from 17,608 (95% UI: -3 to 36,613) in 1990 to 43,580 (95% UI: -16 to 92,083) in 2021. Male CRC deaths exhibited a more pronounced increase, rising from 9,800 in 1990 to 27,600 in 2021. Additionally, the number of DALYs increased from 518,213 (95% UI: -105,107 to 1,074,174) in 1990 to 1,091,788 (95% UI: -509 to 2,295,779) in 2021. Joinpoint regression analysis confirmed that the AAPC in ASDR and ASMR was - 0.20 (95% CI: -0.40 ∼ 0.00) and - 0.30 (95% CI: -0.40 ~ -0.10). When age, period, and cohort effects were examined as the reference group, the risk of CRC was found to increase with age. However, women experienced a marked decline in both period and cohort effects compared to men.

CONCLUSIONS

Compared to global levels, the burden in China is heavier. In terms of mortality or DALY standardized rates, Chinese women show a similar downward trend to the overall trend, while Chinese men show a striking upward trend. This study provides valuable insights into enhancing CRC prevention and improving dietary patterns in China.

CAR-T cell therapy: Advances in digestive system malignant tumors

Malignant tumors of the digestive system have had a notoriously dismal prognosis throughout history. Immunotherapy, radiotherapy, surgery, and chemotherapy are the primary therapeutic approaches for digestive system cancers. The rate of recurrence and metastasis, nevertheless, remains elevated. As one of the immunotherapies, chimeric antigen receptor T cell (CAR-T) therapy has demonstrated a promising antitumor effect in hematologic cancer. Despite undergoing numerous clinical trials, the ineffective antitumor effect and adverse effects of CAR-T cell therapy in the treatment of digestive system cancers continue to impede its clinical translation. It is necessary to surmount the restricted options for targeting proteins, the obstacles that impede CAR-T cell infiltration into solid tumors, and the limited survival time in vivo. We examined and summarized the developments, obstacles, and countermeasures associated with CAR-T therapy in digestive system cancers. Emphasis was placed on the regulatory functions of potential antigen targets, the tumor microenvironment, and immune evasion in CAR-T therapy. Thus, our analysis has furnished an all-encompassing comprehension of CAR-T cell therapy in digestive system cancers, which will generate tremendous enthusiasm for subsequent in-depth research into CAR-T-based therapies in digestive system cancers.

Cancer and Syria in conflict: a systematic review

BACKGROUND

Armed conflict can disrupt oncology care profoundly, resulting in worsened health outcomes for cancer patients. Syria has endured armed conflict for over a decade, resulting in a severe breakdown of its healthcare services. The aim of this systematic review was to assess the available evidence on the burden of cancer and oncology services in Syria and how they have been affected during the conflict.

METHODS

Eight academic and six grey literature databases were searched for English- and Arabic-language studies published from March 2011 until February 2024. Studies reporting any outcomes relating to the burden of cancer or the state of oncology services in wartime Syria were considered for inclusion, although case reports and scoping reviews were excluded. A narrative synthesis of findings was performed.

RESULTS

Of 5,801 studies identified, 28 studies from academic (23) and grey literature (5) were eligible. Papers which reported on the burden of cancer showed an overall increase in cancer incidence and mortality between 2012 and 2022 (most recent data available). Most services were noted to be concentrated in Syria's capital, Damascus. The main identified themes related to the challenges of providing oncology services with staff shortages, chemotherapeutic drug shortages, insufficient radiotherapy services, and a lack of screening and palliative care noted.

CONCLUSION

There is insufficient high-quality exploration of the burden of cancer and the state of oncology services across Syria in academic and grey literature. Syria's health system is divided, creating disparities in access to oncology services, most of which are concentrated in Damascus, exacerbating pre-existing inequalities. The sparsity of robust data reinforces the need for high-quality data, including the use of national or other cancer registries with data from all regions of Syria, including those under opposition control. As the country rebuilds its healthcare systems, policymakers should focus on addressing inequities in oncology service availability to support equity of services.

Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021

BACKGROUND & AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce.

METHODS

This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex.

RESULTS

There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (annual percent change [APC], +0.46; 95% confidence interval [CI], 0.33%-0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (APC, 0.24%; 95% CI, 0.06%-0.42%), whereas they remained stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC, 2.09%; 95% CI, 2.02%-2.16%), age-standardized death rate (APC, 1.96%; 95% CI, 1.69%-2.23%), and age-standardized DALYs (APC, 1.96%; 95% CI, 1.63%-2.30%) from MASH-associated PLC.

CONCLUSIONS

Over the past 2 decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers.

Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021

BACKGROUND

Cancer is the second most common cause of death globally. Therefore, it is imperative to investigate cancer incidence, mortality rates, and disability-adjusted life years (DALYs) to enhance preventive measures and healthcare resource allocation. This study aimed to assess cancer burden and associated risk factors in 204 countries and territories between 1980 and 2021.

METHODS

We selected data on cancer incidence and mortality rates and associated risk factors from the global burden of disease (GBD) study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence (ASIR) and age-standardized deaths (ASDR) of 34 cancer types categorized as level 3 causes based on the GBD hierarchy.

RESULTS

In 2021, cancer accounted for 14.57% (95% uncertainty interval: 13.65-15.28) of total deaths and 8.8% (7.99-9.67) of total DALYs in both sexes globally. ASIR and ASDR were 790.33 (694.43-893.01) and 116.49 (107.28-124.69), respectively. Additionally, females exhibited higher ASIR than males (923.44 versus 673.09), while males exhibited higher ASDR than females (145.69 versus 93.60). This indicates that policymakers should focus on the importance of gender equality in healthcare. Non-melanoma skin cancer exhibited the highest ASIR (74.10) in both sexes, while digestive cancers accounted for 39.29% of all cancer-related deaths, and Asia exhibited the heaviest cancer burden. In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, tracheal, bronchial, and lung cancer exhibited the highest ASIR (37.85) and ASDR (34.32), highlighting the urgent need for targeted tobacco control measures. Different cancers in various countries exhibit unique characteristics. Therefore, policymakers should formulate specific prevention and control strategies that reflect the cancer in their country. Tobacco was the primary level 2 risk factor for cancer DALYs in males. It accounted for 29.32% (25.32-33.14) of all cancer DALYs. Dietary risks, alcohol consumption, and air pollution accounted for 5.89% (2.01-10.73), 5.48% (4.83-6.11), and 4.30% (2.77-5.95) of male cancer DALYs, respectively. Therefore, policymakers should prioritize smoking regulation and other carcinogenic risks.

CONCLUSION

Cancer is a significant public health concern globally. Understanding the common etiologies of different cancers is essential for developing effective control strategies and targeted interventions.

Global cancer statistics for adolescents and young adults: population based study

BACKGROUND

Accurate and up-to-date estimates of the global cancer burden in adolescents and young adults (AYA) are scarce. This study aims to assess the global burden and trends of AYA cancer, with a focus on socioeconomic disparities, to inform global cancer control strategies.

METHODS

AYA cancer, defined as cancer occurring in individuals aged 15-39, was analyzed using data from the Global Burden of Disease (GBD) 2021 study and the Global Cancer Observatory (GLOBOCAN) 2022 project. We examined the global burden by age, sex, geographic location, and Human Development Index (HDI), as well as its temporal trends. Primary outcomes included age-standardized incidence and mortality rates (ASIR, ASMR) and the average annual percent change (AAPC).

RESULTS

In 2022, an estimated 1,300,196 incidental cases and 377,621 cancer-related deaths occurred among AYAs worldwide, with an ASIR of 40.3 per 100,000 and an ASMR of 11.8 per 100,000. The most common cancers were breast, thyroid, and cervical, while the leading causes of death were breast, cervical, and leukemia. The incidence and mortality were disproportionately higher among females (ASIR: 52.9 for females vs. 28.3 for males; ASMR: 13.1 for females vs. 10.6 for males). Countries with higher HDI experienced a higher incidence of AYA cancers (ASIR: 32.0 [low HDI] vs. 54.8 [very high HDI]), while countries with lower HDI faced a disproportionately higher mortality burden (ASMR: 17.2 [low HDI] vs. 8.4 [very high HDI]) despite their relatively low incidence. Disproportionality and regression measures highlighted significant HDI-related inequalities. AYA cancer incidence was stable from 2000 to 2011 (AAPC: - 0.04) but increased from 2012 to 2021 (AAPC: 0.53), driven by growing gonadal and colorectal cancers. Mortality decreased substantially from 2000 to 2011 (AAPC: - 1.64), but the decline slowed from 2012 (AAPC: - 0.32) probably due to increased deaths from gonadal cancers. These trends varied by sex, cancer type, geography, and HDI.

CONCLUSION

AYA cancers present a significant and growing global burden, with marked disparities across sex, geographic locations, and HDI levels. Policymakers should prioritize equitable resource allocation and implement targeted interventions to reduce these inequalities, particularly in low-HDI regions and with regard to gonadal cancers.

Content analysis of oral (mouth) cancer-related posts on Instagram

OBJECTIVE

To examine the content of Instagram posts about oral cancer and assess its usefulness in promoting oral cancer awareness and early detection practices.

METHODS

A systematic search of Instagram for posts about oral (mouth) cancer was conducted using the hashtags #oral cancer and #mouth cancer. Posts usefulness in promoting awareness and early detection was assessed using the early detection usefulness score, and caption readability was assessed using the Flesch Kincaid readability score.

RESULTS

A total of 81,000 posts were identified, and 200 posts were thoroughly evaluated. Included posts gathered a total of 48,118 (mean = 420.59 likes) and 27,898 views. Most posts (81.5%) were educational to the lay person, and India and the UK were the major contributors. The most discussed topics were prevention and early detection (55%). Representative clinical images were present in 35.5% of posts. Only 9.5% of posts mentioned the source of information, and the mean usefulness score was only 2.1 out of 10. The mean reading ease score was 56.7 ± 43.8 (range from 1 to 98 out of 100).

CONCLUSION

Instagram shows potential for promoting oral cancer awareness, particularly in prevention and early detection. However, concerns regarding content quality, scientific validity, and clarity persist.

Designing Entrustable Professional Activities for Treatment Planning of Oral Cancer by Maxillofacial Surgery Residents: A Modified Delphi Study

Purpose

The aim of this study was to develop a competency framework based on entrustable professional activities (EPAs) in oral cancer management by postgraduate trainees in oral and maxillofacial surgery through expert consensus.

Materials and Methods

The study design was based on a modified Delphi technique and involved iterative online surveys with two rounds of data collection and analysis. Initial development of the questionnaire identified five EPAs based on 42 competencies along with supervision level and assessment strategies. The first Delphi round involved administration of the survey questionnaire online to maxillofacial surgeons meeting the inclusion criteria for experts. Consensus was achieved on five EPAs and 36 competencies (≥80% response rate). Six competencies were rephrased and sent again in the Round 2 questionnaire to achieve a consensus.

Results

A total of 45 experts participated in Round 1 followed by input from 27 experts in Round 2 of the Delphi panel. Following two iterative rounds of online surveys and feedback, expert consensus was achieved to develop an EPA framework in five EPA domains focused on the management of oral cancer by postgraduate trainees in maxillofacial surgery including 38 specific competencies, supervision level, and assessment strategies. High content validity of the study was established through a comprehensive literature search, and expert feedback was evidenced by an excellent response rate (93.34%, and 64.28%) and a stringent criteria of response agreement amongst experts (≥80%).

Conclusion

In conclusion, this study employed expert consensus to identify five EPAs with 38 competencies along with the required supervision level of postgraduate maxillofacial trainees for the management of oral cancer. This EPA framework provides a roadmap for training supervisors to map the learning outcomes in oral oncology for postgraduate trainees in oral and maxillofacial surgery.

Oral cancer preventive behaviors in rural women: application of the theory planned behavior

Background

Oral cancer is becoming a primary concern for non-communicable illnesses and global health care initiatives. Low-income people, people with disabilities, the elderly, residents of detached and rural regions, and people belonging to minority groups bear a greater burden of oral diseases. The purpose of this research is to identify rural women's oral cancer prevention activities using the theory of planned behavior (TPB).

Methods

The current research is a cross-sectional analysis of 700 female hookah users who were referred to rural health facilities in Fasa and Shiraz, Fars, Iran in 2019-2020. The participants were selected by random sampling method. The TPB questionnaire and a demographic information questionnaires were the data gathering instruments used in this study to assess oral cancer prevention practices among participants. Data were analyzed by SPSS 22 using frequency, mean, and standard deviation as descriptive statistics, and Pearson correlation coefficients and linear regression as inferential statistics at a significance level of P < 0.05. The Kolmogorov-Smirnov test was used to determine whether the data were normal.

Results

The average age of the participants was 44.54 ± 8.72 years, and the average age at which they started hookah was 23.8 ± 28.68 years. The average history of hookah use was 15.8 ± 6.65 years, and the average size of the household in the test group was 4.73 ± 1.16. The average scores of the constructs of the TPB and oral cancer prevention behaviors were average or at a low level, while nicotine addiction was relatively high. The constructs of knowledge, attitude, subjective norms, and behavioral intention are significantly correlated with oral cancer prevention behaviors in hookah-user women. There was a significant inverse relationship between nicotine dependence and oral cancer prevention behaviors, and there was a strong link between perceived behavioral control and behavioral intention (P < 0.05).

Conclusion

Based on the results of this study, the average scores of the structures of the TPB and oral cancer prevention behaviors were average or at a low level among rural hookah-user women, which indicates the necessity of an educational program based on this theory for rural women to adopt and maintain oral cancer prevention behaviors.

Oral cancer epidemiology in relation to inter-country disparities in human development in south and Southeast Asia

OBJECTIVES

South Asia (SA) and Southeast Asia (SEA) are geographically close; however, discrepancies in oral cancer (OC) epidemiology exist between the two regions. Socioeconomic disparities may influence the OC burden. The aim of this study was to assess the epidemiology of OC and its relationship with the Inequality Adjusted Human Development Index (IHDI) and its components in SA and SEA.

METHODS

Cancer data for this ecological study was obtained from GLOBOCAN 2020, while the IHDI was obtained from the Human Development Report 2020. Based on data availability, 14 SA and SEA countries were chosen. Poisson log-weighted regression models were employed to examine IHDI and its components in relation to incidence and mortality. Univariate linear regression models were utilized to determine the association between the mortality-to-incidence ratio (MIR) and the IHDI.

RESULTS

Mortality and MIR of OC were negatively correlated with all sub-indices of the IHDI, including education, health and income. However, incidence and mortality of OC were influenced by region and sex.

CONCLUSIONS

Higher IHDI countries tended to have lower MIR. SA and males showed higher incidence and mortality. Reducing intra-country inequalities in development may be a pragmatic approach to enhancing the OC burden and prognosis.

Early-onset pancreatic cancer and associated metabolic risk factors in the Middle East and North Africa: A 20-year analysis of the Global Burden of Disease Study

BACKGROUND AND OBJECTIVE

Early-onset pancreatic cancer (EOPC) is associated with poor prognosis and high disease burden. Metabolic risk factors such as diabetes and obesity are considered risk factors of EOPC. Recently, there has been an increasing number of EOPCs worldwide. However, the analysis of EOPC, including its metabolic risk factors, in the Middle East and North Africa (MENA) region has not been fully addressed.

METHODS

Data from the Global Burden of Disease Study between 2000 and 2019 was used to analyze the prevalence, incidence, deaths and disability-adjusted life years (DALYs) associated with EOPC and its metabolic risk factors. The analysis further categorized the data based on countries, income status and sex and examined the annual percentage change (APC).

RESULTS

Approximately 2800 cases, 2400 deaths and 114,000 DALYs were attributable to EOPC in the MENA region. The incidence (APC + 3.42%), death (APC + 0.73%) and DALYs (APC + 3.23%) rates of EOPC increased. In addition, the death and DALY rates of EOPC attributable to obesity and diabetes increased. High and upper-middle-income countries exhibited a higher burden of EOPC than lower-income countries.

CONCLUSION

Over the past two decades, the burden of EOPC and its associated metabolic risk factors has increased. There is an urgent need for region-wide policy development, including screening methods and risk factor reduction, to mitigate the high and rising burden of EOPC in the MENA region.

The Burden of Overweight and Obesity-Associated Gastrointestinal Cancers in Low and Lower-Middle-Income Countries: A Global Burden of Disease 2019 Analysis

INTRODUCTION

Obesity is associated with cancer, including gastrointestinal (GI). Data from low (LICs) and lower-middle-income countries (MICs) are limited.

METHODS

We utilized data from the Global Burden of Disease Study 2019 to determine the mortality from GI cancer risk of high body mass index (BMI) in these countries.

RESULTS

Mortality rates of GI cancers from high BMI increased in LICs and lower MICs, while burdens decreased or remained stable in high and middle-income countries.

DISCUSSION

The GI cancer-related burden from high BMI increased in LICs and lower MICs, necessitating a concerted effort to tackle the obesity pandemic.

Global epidemiology of kidney cancer

Kidney cancer (KC) is a disease with a rising worldwide incidence estimated at 400 000 new cases annually, and a worldwide mortality rate approaching 175 000 deaths per year. Current projections suggest incidence continuing to increase over the next decade, emphasizing the urgency of addressing this significant global health trend. Despite the overall increases in incidence and mortality, striking social disparities are evident. Low- and middle-income countries bear a disproportionate burden of the disease, with higher mortality rates and later-stage diagnoses, underscoring the critical role of socioeconomic factors in disease prevalence and outcomes. The major risk factors for KC, including smoking, obesity, hypertension and occupational exposure to harmful substances, must be taken into account. Importantly, these risk factors also often contribute to kidney injury, a condition that the review identifies as a significant, yet under-recognized, precursor to KC. Finally, the indispensable role of nephrologists is underscored in managing this complex disease landscape. Nephrologists are at the forefront of detecting and managing kidney injuries, and their role in mitigating the risk of KC is becoming increasingly apparent. Through this comprehensive analysis, we aim to facilitate a more nuanced understanding of KC's epidemiology and determinants providing valuable insights for researchers, clinicians and policymakers alike.

Precursor Lesions, Overdiagnosis, and Oral Cancer: A Critical Review

Despite the profession placing great emphasis on oral potentially malignant disorders (OPMDs) as a gateway for early recognition and consequently better outcomes for oral cancer, the death rates for lip and oral cavity cancer have remained stagnant for three decades. Evidence shows that only a small fraction of oral cancers are in fact preceded by OPMDs, and that most OPMDs have an annual transformation rate of less than 1%. As OPMDs encompass a very heterogeneous group of oral conditions, it could be argued that only patients with oral mucosal diseases bearing a substantial risk of malignant transformation warrant close surveillance and treatment, these include proliferative leukoplakia, erythroplakia, non-homogeneous leukoplakia, as well as diseases presenting with severe dysplasia at biopsy. In this narrative review, I discuss the intricate epidemiology of the malignancies that we colloquially refer to as oral cancer, explore the limitations of focusing on OPMDs to reduce the incidence and mortality of oral cavity cancer, and argue that a may-be cancer label represents overdiagnosis for most OPMDs.

Population-based analysis of the human development index and risk factors for head and neck cancer

BACKGROUND

We aimed to investigate global variations in incidence and mortality and their associations to possible risk factors for prompt cancer prevention and control.

METHODS

Estimates of incidence and mortality rates for six types of head and neck cancer were extracted from the GLOBOCAN 2020 database. Summary exposure values for level-two risk factors were obtained from the Global Burden of Disease. Regression models adjusting for the human development index (HDI) were constructed to analyze correlations between age-standardized rates and risk factors.

RESULTS

The incidence rates of multiple types of head and neck cancer were positively associated with HDI tiers. In addition to tobacco use and alcohol consumption, high systolic blood pressure was associated with the incidence and mortality of cancers of the salivary glands, oropharynx, hypopharynx, and larynx. Dietary risks were linked to cancers of the oropharynx, nasopharynx, and hypopharynx.

CONCLUSIONS

This comprehensive analysis provides valuable insights into possible risk factors for head and neck cancer.

Epidemiology and Socioeconomic Impact of Pancreatic Cancer: An Analysis of the Global Burden of Disease Study 1990-2019

INTRODUCTION

The aim of this study is to estimate the global burden of pancreatic cancer from 1990 to 2019.

METHODS

We reconstructed the Global Burden of Diseases (GBD) study results for pancreatic cancer across 204 countries and territories. Our study generated estimates for key disease burden indicators, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and cost. Linear regression analysis of the natural logarithm of age-standardized outcomes was used to calculate annual percent change.

RESULTS

In 2019, there were a total of 530,296 incident and 442,101 prevalent cases of pancreatic cancer, resulting in 531,107 deaths and 11.5 million DALYs lost. The age-standardized incidence and prevalence of pancreatic cancer has increased from 5.22 (95% CI 4.97-5.40) to 6.57 (CI 6.00-7.09) per 100,000 people per year, and 4.1 (95% CI 3.95-4.26) to 5.4 (CI 4.96-5.87), respectively. This equated to 10 million (95% CI 9.5 to 10.4 million) incident cases of pancreatic cancer. The number of DALYs lost as a result of pancreatic cancer was 225 million years (95% CI 216-234 million years). Mortality from pancreatic cancer increased over the study period from 3.7 (95% CI 3.54-3.83) to 6.9 (95% CI 6.36-7.32). Incidence, prevalence, DALYs, and mortality were higher in countries with a higher socio-demographic index.

CONCLUSIONS

Pancreatic cancer is rising around the world and is associated with a high economic burden. Programs aimed at reducing modifiable risk factors are needed.

Cancer of colon, rectum and anus: the rising burden of disease worldwide from 1990 to 2019

BACKGROUND

Previous studies suggest that trends of cancer of colon, rectum and anus (CRA) incidence and mortality have been decreasing in recent decades. However, the trends are not uniform across age groups. This study aimed to assess the trends of the cancer of CRA burden worldwide.

METHODS

A descriptive study was carried out with a joinpoint regression analysis using the database of the Global Burden of Disease study.

RESULTS

About 2.2 million new cases of cancer of CRA were diagnosed in the world in 2019, whereby cancer of CRA caused ~1.1 million deaths. Globally, the incidence trend in both sexes together was increasing in 1990-2019, while the mortality trend was decreasing. The highest rise both in incidence and mortality was observed in the East Asia region (by 3.6% per year and by 1.4% per year, respectively) and the Andean Latin America region (by 2.7% per year and by 1.2% per year, respectively). However, of particular concern is the significant increase in the incidence (by 1.7% per year) and mortality (by 0.5% per year) from cancer of CRA in people aged 15-49.

CONCLUSIONS

Unfavorable trends in cancer of CRA in the young require more attention in management plans.

Differences in the incidence and mortality of digestive cancer between Global Cancer Observatory 2020 and Global Burden of Disease 2019

The burden of digestive cancers is increasing worldwide. The Global Cancer Observatory (GLOBOCAN) 2020 and the Global Burden of Disease (GBD) 2019 are two primary cancer databases, which have a significant impact on policy formulation and resource allocation. We aim to compare the incidence and mortality of digestive cancers between them. Digestive cancer (esophageal, stomach, colorectal, liver, gallbladder and pancreatic cancer) incidence was obtained from the Cancer Today and GBD 2019 result tool. The top five countries with the most or minor difference between GLOBOCAN 2020 and GBD 2019 in age-standardized incidence rates (ASIRs) of digestive cancers were identified. A systematic search on the incidence of specific digestive cancer in selected countries from PubMed and Embase was conducted, and 20 of 281 publications were included. The most significant differences in digestive cancers incidence were commonly found in Asian countries (70%), particularly Indonesia, Vietnam and Myanmar, located in Southeast Asia. The ASIRs for most digestive cancers, except liver cancer, in GLOBOCAN 2020 were higher than those in GBD 2019. Gallbladder cancer had the highest average ratio, followed by liver cancer. The most commonly used standard population was Segi's standard population, followed by the World Health Organization standard population. The data sources nor the processing methods of GLOBOCAN 2020 and GBD 2019 were not similar. Low- and middle-income countries without population-based cancer registries were more likely to have selection bias in data collection and amplify regional variations of etiological factors. Better judgments on the quality of cancer data can be made.

Public Awareness on Oral Cancer: A Population- Based Study in Asturias

OBJECTIVE

Through awareness campaigns, we can change the patient's abilities to detect oral cancer at an early stage and their ability to seek help. To focus these campaigns, we need to know the level of knowledge of the population and its interest in learning about this disease. The aim of this study was to assess the level of oral cancer awareness in Asturias and the interest of the population in learning about this pathology.

METHODS

A representative community-based survey was carried out online using Google Forms®. Responses were transferred to a Microsoft Excel and analysed using the R-program. The relationship between two qualitative variables was studied using Pearson's Chi-square test or Fisher's test. Univariate and multivariate logistic regression models were used to determine which factors are associated with knowledge of oral cancer.

RESULT

We found that those having over 50 years and being health professionals are more likely to know about the existence of oral cancer. Almost 85.1% of participants mentioned tobacco as a risk factor, only 39.8% identified alcohol. The ulcer was the most frequently recognized alarm sign (70.6%). The primary care physician was chosen as the first option for consultation by the 56.5% of the sample. Only 12.4% of the participants reported knowing how to self-examine their mouth. The number of views of a video of how-to self-inspection oral cavity displayed at the end of the questionnaire increased in a 39.38% during our study period.

CONCLUSION

This survey showed a worrying lack of awareness and knowledge about oral cancer among the population of Asturias, especially among those under 50 years old. The interest shown in increasing their knowledge, give us hope in the success of future awareness campaigns.

National and subnational incidence, mortality and associated factors of colorectal cancer in China: A systematic analysis and modelling study

Background

Due to their known variation by geography and economic development, we aimed to evaluate the incidence and mortality of colorectal cancer (CRC) in China over the past decades and identify factors associated with CRC among the Chinese population to provide targeted information on disease prevention.

Methods

We conducted a systemic review and meta-analysis of epidemiolocal studies on the incidence, mortality, and associated factors of CRC among the Chinese population, extracting and synthesising data from eligible studies retrieved from seven global and Chinese databases. We pooled age-standardised incidence rates (ASIRs) and mortality rates (ASMRs) for each province, subregion, and the whole of China, and applied a joinpoint regression model and annual per cent changes (APCs) to estimate the trends of CRC incidence and mortality. We conducted random-effects meta-analyses to assess the effect estimates of identified associated risk factors.

Results

We included 493 articles; 271 provided data on CRC incidence or mortality, and 222 on associated risk factors. Overall, the ASIR of CRC in China increased from 2.75 to 19.39 (per 100 000 person-years) between 1972 and 2019 with a slowed-down growth rate (APC1 = 5.75, APC2 = 0.42), while the ASMR of CRC decreased from 12.00 to 7.95 (per 100 000 person-years) between 1974 and 2020 with a slight downward trend (APC = -0.89). We analysed 62 risk factors with synthesized data; 16 belonging to the categories of anthropometrics factors, lifestyle factors, dietary factors, personal histories and mental health conditions were graded to be associated with CRC risk among the Chinese population in the meta-analysis limited to the high-quality studies.

Conclusions

We found substantial variation of CRC burden across regions and provinces of China and identified several associated risk factors for CRC, which could help to guide the formulation of targeted disease prevention and control strategies.

Registration

PROSPERO: CRD42022346558.

Exercise intervention and improvement of negative emotions in children: a meta-analysis

BACKGROUND

Anxiety, depression, and stress are the most common mental health problems in childhood. Exercise interventions in childhood help to promote mental health.

OBJECTIVE

To investigate the relationship between exercise interventions and improvement of negative emotions such as anxiety, depression, and stress in children (5-12 years).

METHODS

Articles were searched in five electronic databases from their inception to January 2023. The meta-analysis was performed using Stata 16.0.

RESULTS

Twenty-three intervention studies included 6830 children. 1) The exercise intervention group was significantly better than the control group in improving negative emotions (Standard Mean Difference SMD=-0.25, 95% Confidence Intervals CI: -0.34 to -0.15, P < 0.01). Exercise intervention improved different kinds of negative emotions: anxiety (SMD=-0.19, 95% CI: -0.33 to -0.06, P < 0.01), depression (SMD=-0.22, 95% CI: -0.43 to -0.01, P < 0.01), and stress (SMD=-0.33, 95% CI: -0.53 to -0.14, P < 0.01); it was most effective at relieving problematic stress. Exercise interventions lasting 20-45 min were most effective in improving children's negative emotions (SMD=-0.38, 95% CI: -0.56 to -0.20, P < 0.01). An exercise intervention period of 10 weeks was more effective in improving children's negative mood (SMD=-0.26, 95% CI: -0.34 to -0.17, P = 0.274).

CONCLUSION

Exercise interventions may improve negative emotions such as anxiety, depression, and stress in children. These findings may have clinical implications for children with negative affect. However, these studies showed a large heterogeneity, and the results should be interpreted with caution. Future studies should report the variability of exercise interventions by gender, age group, and type, intensity, and place of exercise.