The Lancet Oncology

Volume 25, Issue 12, December 2024, Pages 1614-1624
The Lancet Oncology

Articles
The current and future global burden of cancer among adolescents and young adults: a population-based study

https://doi.org/10.1016/S1470-2045(24)00523-0Get rights and content

Summary

Background

Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15–39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality.

Methods

In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15–39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision.

Findings

An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 vs 28·3; mortality ASR 13·1 vs 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase).

Interpretation

Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities.

Funding

None.

Introduction

The global cancer burden is not shared equally across age groups and neither is the focus of cancer research. Childhood cancers are heavily studied because the causes are largely unknown, treatment regimens differ from those recommended for adults, and these cancers are a leading cause of mortality among those aged 0–14 years globally. Cancer research is also heavily focused on older adults as it is a disease of ageing and more than 90% of global cases and deaths occur beyond 40 years of age.1 Correspondingly, there is a large need for resources dedicated to prevention, screening, treatment, and end-of-life care. The group that bridges these age groups, adolescents and young adults, is relatively understudied.2, 3, 4 However, given the transitional nature of this population, in terms of developmental and life stage, cancer profile, and cancer care (ie, spanning paediatric and adult systems), it is clear that surveillance of key indicators specifically among adolescents and young adults is crucial for informing cancer control.
We undertook a comprehensive investigation of the global cancer burden in adolescents and young adults in 2022 and projected its future burden in 2050. By exploring variations in incidence, mortality, and case fatality by sex, geographic setting, human development index, and income level, this report serves as a reference to the adolescent and young adult cancer community, which can then be used to inform global, regional, and national cancer control priorities.
Research in context
Evidence before this study
Descriptive epidemiological research on cancer in adolescents and young adults (people aged 15–39 years) globally is relatively under-investigated compared with cancer in children and older adults. We searched PubMed for papers describing the global cancer burden between the ages of 15 and 39 years on Aug 20, 2024, with no date or language restrictions, using the title terms (teen* OR adolescen* OR young adult* OR youth OR AYA) AND (cancer OR malign* OR neoplasm OR tumor OR tumour OR carcinoma OR leukemia OR leukaemia OR germ cell OR lymphoma OR sarcoma OR melanoma) AND (international OR global OR worldwide) AND (incidence OR case* OR mortality OR death* OR burden). 45 articles published from 1999 to 2024 were identified, although most focused on specific cancer types or primarily paediatric populations. Foundational global reports on incidence, mortality, case fatality, and disability-adjusted life-years in adolescents and young adults used GLOBOCAN data from 2012, and Global Burden of Disease (GBD) Study data from 2019. Global trends in adolescent and young adult cancer incidence were also previously assessed using Cancer Incidence in Five Continents plus (CI5plus) for the period of 1998–2012, and GBD data for 1990–2019. To inform the adolescent and young adult oncology agenda, up-to-date estimates of the current and future cancer burden in this population are needed.
Added value of this study
Using the International Agency for Research on Cancer's GLOBOCAN database, we provide a comprehensive investigation of the current global cancer burden in adolescents and young adults in 2022, and, to our knowledge, project for the first time the future burden of adolescent and young adult cancer in 2050. Compared with previous reports using GLOBOCAN and GBD data, we provide estimates of incidence, mortality, and case fatality for the largest number of specific cancer types (n=33). In our findings, we note that the cancer burden and profile vary by sex, geographic setting, human development index, and income level, and explore reasons for the heterogeneity. We also comment on gross inequities in case fatality, for which the least developed countries face the highest mortality rates despite incidence rates often being lowest in these countries. Since adolescents and young adults represent a substantial proportion of the populations of less developed countries, and these countries are expected to have the greatest increase in burden from 2022 to 2050, this study draws attention to the need for improved cancer control in the developing world.
Implications of all the available evidence
This study serves as a reference to the global adolescent and young adult cancer community that should inform global, regional, and national priorities for cancer surveillance and control. Although increased awareness, vaccination, screening, and access to curative treatments can reduce the cancer incidence or mortality burden in this age group, these initiatives must be adapted to local contexts and be provided in an equitable manner to be successful. Furthermore, global collaboration and knowledge transfer in relation to both care and research will be key to decreasing inequities and moving the adolescent and young adult oncology agenda forward.

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Section snippets

Study design and data sources

In this population-based study, we quantified the current cancer burden in adolescents and young adults, defined as those aged 15–39 years,5 using the International Agency for Research on Cancer's GLOBOCAN 2022. GLOBOCAN estimates incidence and mortality of 36 types of cancer at the global, world region, and national level for 185 countries or territories, as well as by the UN Development Program's Human Development Index (HDI) levels (low [least developed], medium, high, and very high [most

Results

Of the 18 741 966 cancer cases and 9 647 416 cancer-related deaths estimated in 2022 globally, 1 300 196 million cases (6·9%) and 377 621 deaths (3·9%) occurred in adolescents and young adults; equating to 40·3 cases and 11·8 cancer-related deaths per 100 000 people aged 15–39 years (table). Overall incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 in females vs 28·3 in males, and mortality ASR 13·1 in females vs 10·6 in

Discussion

Globally, in 2022, an estimated 1 300 196 adolescents and young adults were diagnosed with cancer and 377 621 died from the disease. There was substantial heterogeneity in the cancer burden and profile by sex, geographic region, HDI, and income level. Despite the most developed countries having the highest incidence rates, these settings had the lowest mortality burdens. Consequently, inequities in the cancer burden among adolescents and young adults were vast, with the worst outcomes occurring

Declaration of interests

MMF-B receives grant funding from the Canadian Institute of Health Research, Alberta Cancer Foundation, Alberta Health, University of Calgary, and Alberta Children's Hospital Foundation. MMF-B is a member of the Cancer in Young People in Canada Management Committee. SG gave a lecture to Amgen Canada employees on the role of blinatumomab in paediatric acute lymphoblastic leukaemia. AJ has received direct payment from AstraZeneca Pharmaceuticals for consulting. All other authors declare no

Acknowledgments

We would like to thank cancer registry staff worldwide as members of the International Association of Cancer Registries, for their willingness to contribute their valuable data for various collaborative projects and support the collective efforts to obtain the best possible national estimates of the current global cancer burden.

References (35)

  • W Ngwa et al.

    Cancer in sub-Saharan Africa: a Lancet Oncology Commission

    Lancet Oncol

    (2022)
  • F Bray et al.

    Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

    CA Cancer J Clin

    (2024)
  • YF Wen et al.

    The global, regional, and national burden of cancer among adolescents and young adults in 204 countries and territories, 1990–2019: a population-based study

    J Hematol Oncol

    (2021)

  • The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

    Lancet Oncol

    (2022)

  • Closing the gap: research and care imperatives for adolescents and young adults with cancer—report of the Adolescent and Young Adult Oncology Progress Review Group

  • World Population Prospects, 2019

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