A global cancer surge is underway and the world is not ready

Cancer cases are exploding worldwide -- and nearly half of the deaths could be prevented with better prevention, early detection, and access to care.

The global burden of cancer has grown dramatically over the past three decades. Since 1990, the number of newly diagnosed cancer cases worldwide has more than doubled, reaching 18.5 million in 2023. Over the same period, annual cancer deaths rose by 74 percent to 10.4 million (both excluding non-melanoma skin cancers). Most of those affected now live in low- and middle-income countries.

A significant share of this burden is linked to preventable causes. More than 40 percent of cancer deaths worldwide are associated with 44 modifiable risk factors, including tobacco use, poor diet, and high blood sugar. This connection highlights major opportunities to reduce cancer deaths through prevention.

Looking ahead, researchers project that new cancer cases will climb another 61 percent over the next 25 years, reaching 30.5 million annually by 2050. Cancer deaths are forecast to rise by nearly 75 percent over the same period, reaching 18.6 million per year. These increases are largely driven by population growth and the continued aging of populations worldwide.

While age-adjusted global cancer death rates have declined overall, this progress has not been evenly shared. In several low- and middle-income countries, both the number of cancer deaths and the rates themselves are still increasing. The authors stress that meeting this growing challenge will require stronger efforts from governments and policymakers to prevent cancer, expand early diagnosis, and improve treatment access at national, regional, and global levels.

Between 1990 and 2023, global cancer cases and deaths rose sharply despite advances in treatment and expanded efforts to address cancer risk factors. Without urgent action and increased funding, researchers estimate that by 2050, 30.5 million people will receive a new cancer diagnosis each year and 18.6 million will die from the disease. More than half of new cases and nearly two-thirds of deaths are expected to occur in low- and middle-income countries (LMICs), according to a major analysis by the Global Burden of Disease Study Cancer Collaborators published in The Lancet.

Although the total number of cancer cases and deaths is projected to increase significantly between 2024 and 2050, age-adjusted incidence and mortality rates are not expected to rise globally. This suggests that most of the growth in cancer burden will be driven by demographic changes rather than worsening individual risk.

Even so, the projected improvements fall well short of the United Nations Sustainable Development Goal (SDG) to cut premature deaths from non-communicable diseases, including cancer, by one-third by 2030.

"Cancer remains an important contributor to disease burden globally and our study highlights how it is anticipated to grow substantially over the coming decades, with disproportionate growth in countries with limited resources," said lead author Dr. Lisa Force from the Institute for Health Metrics and Evaluation (IHME), University of Washington, USA. "Despite the clear need for action, cancer control policies and implementation remain underprioritized in global health, and there is insufficient funding to address this challenge in many settings."

She added, "Ensuring equitable cancer outcomes globally will require greater efforts to reduce disparities in health service delivery such as access to accurate and timely diagnosis, and quality treatment and supportive care."

The analysis draws on data from population-based cancer registries, vital registration systems, and interviews with family members or caregivers of people who died from cancer. It provides updated global, regional, and national estimates covering 1990 to 2023 across 204 countries and territories, examining 47 cancer types or groupings and 44 attributable risk factors.[1] The study also projects the global cancer burden through 2050 and evaluates progress toward the UN SDG target for reducing non-communicable disease deaths between 2015 and 2030.

In 2023, global cancer deaths reached 10.4 million, while new cases climbed to 18.5 million (both excluding non-melanoma skin cancers). Compared with 1990, this represents increases of 74 percent in deaths and 105 percent in new cases.

Despite an overall 24 percent decline in age-standardized cancer death rates worldwide between 1990 and 2023, this improvement has largely occurred in high- and upper-middle-income countries. In contrast, age-standardized cancer incidence increased by 24 percent in low-income countries and by 29 percent in lower-middle-income countries, highlighting growing disparities in regions with fewer resources (see table 1 in paper).

From 1990 to 2023, Lebanon recorded the largest percentage increase in age-standardized cancer incidence and mortality rates for both sexes combined. Over the same period, the United Arab Emirates experienced the greatest decline in age-standardized incidence, while Kazakhstan saw the largest decrease in age-standardized death rates.

Breast cancer was the most commonly diagnosed cancer worldwide in 2023 for both sexes combined. Tracheal, bronchus, and lung (TBL) cancer remained the leading cause of cancer deaths globally (see table 2 in paper).

The study estimates that 42 percent (4.3 million) of the 10.4 million cancer deaths in 2023 were linked to 44 modifiable risk factors, pointing to significant opportunities for prevention.

Behavioral risk factors accounted for the largest share of cancer deaths across all income levels in 2023. Tobacco use alone contributed to 21 percent of cancer deaths worldwide. Tobacco was the leading risk factor in every income group except low-income countries, where unsafe sex was the primary risk factor, linked to 12.5 percent of cancer deaths.

Men were more likely than women to die from cancers associated with modifiable risks. In 2023, 46 percent of cancer deaths in men were linked to factors such as tobacco use, unhealthy diet, high alcohol consumption, occupational risks, and air pollution. Among women, 36 percent of cancer deaths were associated with modifiable risks, with tobacco, unsafe sex, unhealthy diet, obesity, and high blood sugar playing the largest roles (see appendix 2 table 6).

"With four in 10 cancer deaths linked to established risk factors, including tobacco, poor diet, and high blood sugar, there are tremendous opportunities for countries to target these risk factors, potentially preventing cases of cancer and saving lives, alongside improving accurate and early diagnosis and treatment to support individuals who develop cancer," said co-author Dr. Theo Vos from IHME. "Reducing the burden of cancer across countries and worldwide demands both individual action and effective population-level approaches to reduce exposure to known risks."

The researchers emphasize that cancer prevention must be integrated into health policies in LMICs and that equitable cancer control efforts are essential to ensure timely and effective care for all patients.

"The rise of cancer in LMICs is an impending disaster," said co-author Dr. Meghnath Dhimal from the Nepal Health Research Council. "There are cost-effective interventions for cancer in countries at all stages of development. These cancer burden estimates can help broaden the discussion around the importance of cancer and other non-communicable diseases in the global health agenda. To control the growth of non-communicable diseases including cancer in LMICs, an interdisciplinary approach for evidence generation and multi-sectoral collaboration and coordination for implementation are urgently needed."

Dr. Force noted that the findings can help guide future policy. "These new estimates and forecasts can support governments and the global health community in developing data informed policies and actions to improve cancer control and outcomes around the world. They can also support tracking of progress towards global and regional cancer targets."

She added, "Our analysis also highlights the need for more data from sources such as cancer and vital registries, particularly in lower resource settings. Supporting cancer surveillance systems is crucial to informing both a local and global understanding of cancer burden."

The authors acknowledge several limitations. The estimates rely on the best available data but are constrained by gaps in high-quality cancer data, especially in resource-limited countries. Current Global Burden of Disease estimates do not account for several infectious diseases known to increase cancer risk in some lower-income regions, including Helicobacter Pylori and Schistosoma haematobium, which may lead to underestimation of cancer deaths linked to modifiable risks.

The projections also do not incorporate the effects of the COVID-19 pandemic, recent conflicts, or future medical breakthroughs that could significantly alter cancer trends.

In a linked Comment, Dr. Qingwei Luo and Dr. David P Smith from The University of Sydney and Cancer Council NSW, who were not involved in the study, wrote: "To ensure meaningful progress in reducing the global cancer burden, it is imperative that governments prioritize funding, strengthen health systems, reduce inequalities, and invest in robust cancer control initiatives and research on prevention, intervention, and implementation -- because the future of cancer control depends on decisive, collective action today."

The study was funded by the Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation. It was conducted by the GBD 2023 Cancer Collaborators.