Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000

  • Kenji Shibuya1Email author,

    Affiliated with

    • Colin D Mathers1,

      Affiliated with

      • Cynthia Boschi-Pinto2,

        Affiliated with

        • Alan D Lopez1 and

          Affiliated with

          • Christopher JL Murray3

            Affiliated with

            BMC Cancer20022:37

            DOI: 10.1186/1471-2407-2-37

            Received: 11 October 2002

            Accepted: 26 December 2002

            Published: 26 December 2002

            Abstract

            Background

            Mortality estimates alone are not sufficient to understand the true magnitude of cancer burden. We present the detailed estimates of mortality and incidence by site as the basis for the future estimation of cancer burden for the Global Burden of Disease 2000 study.

            Methods

            Age- and sex- specific mortality envelope for all malignancies by region was derived from the analysis of country life-tables and cause of death. We estimated the site-specific cancer mortality distributions from vital records and cancer survival model. The regional cancer mortality by site is estimated by disaggregating the regional cancer mortality envelope based on the mortality distribution. Estimated incidence-to-mortality rate ratios were used to back calculate the final cancer incidence estimates by site.

            Results

            In 2000, cancer accounted for over 7 million deaths (13% of total mortality) and there were more than 10 million new cancer cases world wide in 2000. More than 60% of cancer deaths and approximately half of new cases occurred in developing regions. Lung cancer was the most common cancers in the world, followed by cancers of stomach, liver, colon and rectum, and breast. There was a significant variations in the distribution of site-specific cancer mortality and incidence by region.

            Conclusions

            Despite a regional variation, the most common cancers are potentially preventable. Cancer burden estimation by taking into account both mortality and morbidity is an essential step to set research priorities and policy formulation. Also it can used for setting priorities when combined with data on costs of interventions against cancers.

            Background

            Mortality estimates alone are not sufficient to understand the true magnitude and trends of cancer problems and to evaluate the interventions against cancer, in particular preventive programmes [1]. Although cancer is still a fatal disease in many developing countries[2], the disability among cancer survivors should be taken into account since there is a growing evidence that cancer survival in some developing countries are continuously improving [3, 4] and, when setting priorities, cancer control interventions are compared with other health interventions which aims at reducing morbidity [5]. For this reason, estimates of both mortality and incidence of cancer by region are essential inputs for setting research and intervention priorities in cancer control policies.

            The present study is aimed at estimating the magnitude of global and regional cancer mortality and incidence as a part of detailed analysis of all-cause levels and cause of death distributions for 191 Member States of the World Health Organization (WHO) for the Global Burden of Disease 2000 (GBD 2000) study [6]. GBD 2000 employs a time-based composite measure of disease burden in terms of disability-adjusted life years (DALYs) which consist of years lived with disability (morbidity) and years of life lost (mortality). To estimate the burden from each disease sequelae, detailed information of incidence, duration, and mortality by age, sex and region is required [5]. This study serves as a basis for the future estimation of cancer burden for the GBD 2000.

            The GBD 2000 project classified WHO's 6 regions into 17 sub regions according to the levels of child and adult mortality (Table 1). On the basis of available published information on age-, sex-, and site-specific cancer incidence and survival, we developed an algorithm to estimate region-specific overall cancer mortality, and site-specific survival, death distributions, and incidence for the year 2000.
            Table 1

            Global Burden of Disease 2000 (GBD 2000) project: regions and sub regions

            WHO region

            Mortality stratum

            Sub region

            WHO Member States

            AFRO

            D

            AfrD

            Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Comoros, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, Sao Tome And Principe, Senegal, Seychelles, Sierra Leone, Togo, Djibouti, Somalia, Sudan

            AFRO

            E

            AfrE

            Botswana, Burundi, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic Of The Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe

            AMRO

            A

            AmrA

            Canada, United States Of America

            AMRO

            B

            AmrB

            Antigua And Barbuda, Argentina, Bahamas, Barbados, Belize, Brazil, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, El Salvador, Grenada, Guyana, Honduras, Jamaica, Mexico, Panama, Paraguay, Saint Kitts And Nevis, Saint Lucia, Saint Vincent And The Grenadines, Suriname, Trinidad And Tobago, Uruguay, Venezuela Cuba

            AMRO

            D

            AmrD

            Bolivia, Ecuador, Guatemala, Haiti, Nicaragua, Peru

            EMRO

            B

            EmrB

            Bahrain, Cyprus, Iran (Islamic Republic Of), Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates

            EMRO

            D

            EmrD

            Egypt, Iraq, Morocco, Yemen

            EURO

            A

            EurA

            Andorra, Austria, Belgium, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland, United Kingdom

            EURO

            B1

            EurB1

            Albania, Bosnia And Herzegovina, Bulgaria, Georgia, Poland, Romania, Slovakia, The Former Yugoslav Republic Of Macedonia, Turkey, Yugoslavia

            EURO

            B2

            EurB2

            Armenia, Azerbaijan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan

            EURO

            C

            EurC

            Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine

            SEARO

            B

            SearB

            Indonesia, Sri Lanka, Thailand Malaysia, Philippines Brunei Darussalam, Singapore

            SEARO

            D

            SearD

            Bangladesh, Bhutan, India, Maldives, Nepal Afghanistan, Pakistan

            WPRO

            A

            WprA

            Australia, Japan, New Zealand

            WPRO

            B1

            WprB1

            China, Mongolia, Republic Of Korea DPR Korea

            WPRO

            B2

            WprB2

            Cambodia, Lao People's Democratic Republic, Viet Nam Myanmar

            WPRO

            B3

            WprB3

            Cook Islands, Fiji, Kiribati, Marshall Island s, Micronesia (Federated States Of), Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu

            In the previous paper, we presented the cancer survival model as a key input to estimate the distribution of cancer deaths by site for the regions where mortality data are either scarce or unavailable and tested its performance and validity [7]. In this paper, we present a detailed approach to estimating mortality and incidence of cancer by site and the results of mortality and incidence estimation by site for the year 2000.

            Material and Methods

            Overview of analysis

            The Global Burden of Disease 2000 (GBD 2000) study deals with the problem of systemic bias in cause-specific mortality by estimating total mortality for each Member State, starting from an analysis of the overall mortality envelope for each region, in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex and that there is not systematic over- or under- estimation or double counting of deaths. This regional cause-specific mortality envelope serves as an upper bond of mortality from a certain cause and partly ensures the internal consistency among incidence, prevalence and mortality rates [6]. The approaches to estimating mortality and incidence of cancer by site also follows this process (Figure 1).
            http://static-content.springer.com/image/art%3A10.1186%2F1471-2407-2-37/MediaObjects/12885_2002_Article_57_Fig1_HTML.jpg
            Figure 1

            Approaches to estimating global and regional cancer mortality and incidence by site for the Global Burden of Disease 2000 (GBD 2000)

            Firstly, we obtained the age- and sex- specific mortality envelope for all malignancies by region derived from the analysis of country life-tables and cause of death models in each region. Secondly, we estimated the site-specific cancer mortality distributions from vital records or cancer survival models depending on the availability and quality of detailed cause of death data. Cancer sites for which survival was calculated were: mouth and pharynx (ICD-10 C00-C14), oesophagus (C15), stomach (C16), colon and rectum (C18-C21), liver (C22), pancreas (C25), trachea, bronchus and lung (C33-C34), melanoma (C43), female breast (C50), cervix uterine (C53), corpus uteri (C54-55), ovary (C56), prostate (C61), bladder (C67), lymphomas and multiple myeloma (C81-C90, C96), leukaemia (C91-C95), and other malignant neoplasms (balance of ICD-10 C00-C97). The GBD 2000 assigns Kaposi's sarcoma and non-Hodgkin lymphomas (NHL) attributable to HIV/AIDS among AIDS sequela and their burden is included separately with HIV/AIDS. Thirdly, the final regional cancer mortality by site is estimated by disaggregating the regional cancer envelope based on the mortality distribution by site. Finally, we applied the incidence-to-mortality rate ratios to back calculate the final cancer incidence estimates by site.

            GBD 2000 regional mortality estimates by age, sex, and cause

            Complete or incomplete vital registration data together with sample registration systems now cover 74% of global mortality in 128 countries. Survey data and indirect demographic techniques provide information on levels of child and adult mortality for the remaining 26% of estimated global mortality. The available sources of mortality data for the WHO sub regions of the GBD 2000 are summarised in Table 1.

            Causes of death for the WHO sub regions and the world have been estimated based on data from national vital registration systems that capture about 17 million deaths annually. In addition, information from sample registration systems, population laboratories and epidemiological analyses of specific conditions have been used to improve estimates of the cause of death patterns [6, 8, 9]. As a general rule, vital registration data, suitably corrected for ill-defined coding and probable systematic biases in certifying deaths to non-specific vascular, cancer and injury codes were used to estimate the cause of death pattern. The GBD 2000 approach adjusts the cause-specific mortality to include a proportion of deaths coded to ill-defined causes in vital registration data and redistributes these deaths pro-rata among broader communicable and non-communicable causes.

            Cause of death data have been carefully analysed to take into account incomplete coverage of vital registration in countries and the likely differences in cause of death patterns that would be expected in the uncovered and often poorer sub-populations [10]. For countries lacking sufficient vital registration data, cause of death models were used to firstly estimate the maximum likelihood distribution of deaths across the broad categories of communicable, non-communicable and injuries, based on estimated total mortality rates and income [8]. A regional model pattern of specific causes of death was then constructed based on local vital registration and verbal autopsy data, and this proportionate distribution was then applied within each broad cause group. Finally, the resulting estimates were then adjusted based on other epidemiological evidence from specific disease studies. Methods used to estimate global all-cause and cause-specific mortality from these data are described elsewhere [6].

            In the GBD 1990 [5], deaths coded to ICD-9 195–199 (i.e., malignant neoplasm of other and unspecified sites including those whose point of origin cannot be determined, secondary and unspecified neoplasm) were redistributed pro-rata across all malignant neoplasm categories within each age-sex group, so that the category 'Other malignant neoplasms' includes only malignant neoplasms of other specified sites. Reviews of the cancer registry and methods of diagnosis suggest that four sites (month and pharynx, liver, breast and cervix uteri) where there did not appear to be any significant mis-coding of cancer deaths, since these can be diagnosed clinically without any further diagnostic tests even in developing regions [11]. Accordingly, the cancer garbage code redistribution algorithm was revised for the GBD 2000 to redistribute cancer deaths in ICD C76-C80 pro-rata across the sites other than the four sites above.

            Estimation of cancer mortality and incidence

            Given the regional cancer mortality envelope by age and sex, the site-specific distributions of cancer mortality are necessary to disagreggate the estimated total cancer deaths by age and sex for each region. The approaches to estimating mortality distributions were different depending on the availability and quality of data on detailed causes of death.

            Direct estimates of the site-specific distributions of cancer mortality were possible for the regions where established vital registration records with high coverage and ICD-coding are available, including countries in the A sub regions (AmrA, EurA and WprA) and countries in AmrB, EurB1, EurB2 and EurC [6]. For the other regions of the world (AfrD, AfrE, AmrD, EmrB, EmrD, SearB, SearD, WprB1, WprB2 and WprB3 sub regions), a site-specific model for relative interval survival adjusted for each region was developed and applied to the regional incidence estimated by International Agency for Research on Cancer (IARC) to calculate the mortality distribution by site for the year 2000 [7, 12]. The region-specific incidence estimates of the Globocan 2000 was adjusted to ensure the consistency with the GBD 2000 definitions [7]. Our survival model and adjusted incidence estimates of the Globocan 2000 were primarily used to estimate the distribution, but not the magnitude, of cancer by site, sex, and age group.

            The final site-specific cancer mortality was then estimated by multiplying age- and sex- specific regional cancer mortality envelope by estimated cancer mortality distribution by site. The cancer survival model is flexible enough to yield the survival estimates of various age, years and period as well as mean duration of time of cancer by site [7]. We estimated incidence-to-mortality rate ratios at each age group form the survival model and, by using the final cancer mortality, applied the ratios to back calculate the final incidence by age and sex for each cancer site in all regions of the world for the year 2000.

            Results

            Cancer mortality by region

            The GBD 2000 classifies the cause of deaths into three broad categories: communicable disease, non-communicable disease, and injuries. In 2000, approximately 56 million deaths occurred world wide and non-communicable disease accounted for 58% of total number of deaths, followed by communicable disease (33%) and injuries (9%) (Figure 2). Cancer was estimated to account for over 7 million deaths (13% of total mortality and 22% of non-communicable disease mortality) world wide in 2000, only preceded by cardiovascular diseases (29 % of total) and infectious and parasitic diseases (19%). Depending on the extent of health transition, cancer mortality as a proportion of total mortality differed substantially by region, from less than 5% in AfrE to approximately 30% in WprA sub region.
            http://static-content.springer.com/image/art%3A10.1186%2F1471-2407-2-37/MediaObjects/12885_2002_Article_57_Fig2_HTML.jpg
            Figure 2

            Regional distribution of mortality by cause, 2000

            Tables 2, 3, 4, 5 show the regional estimates of total number of deaths and age-specific mortality rates of all cancers for the GBD 2000. More than 60% of cancer deaths occurred in developing regions, particularly in SearD (mainly India) and WprB1(mainly China) sub regions due to their large population size. On average global cancer mortality rates among males and females were 128.2 and 104.6 per 100,000, respectively. Not surprisingly crude mortality rates from all cancers vary significantly and are much higher in developed regions (AmrA, EurA, and WprA). However, since age-specific mortality rate is generally higher in developing regions, regional mortality rates, age-standardised to the world population, showed less variations compared to crude mortality rates and higher mortality rates were observed in regions such as AfrD, AfrE, AmrB, EurC, and WprB (Figure 3).
            Table 2

            Mortality data sources (number of Member States with recent deaths coverage) by WHO sub region for the GBD2000

            Subregion

            Category I: Complete vital statistics (95%+ coverage)

            Category II: Incomplete vital statistics

            Category III: Sample registration and surveillance systems

            Category IV: Child mortality estimated from surveys and censuses

            Category V: No recent data on child or adult mortality

            Number of countries

            AfrD

            2

            2

            0

            19

            3

            26

            AfrE

            0

            2

            1

            14

            3

            20

            AmrA

            3

            0

            0

            0

            0

            3

            AmrB

            17

            9

            0

            0

            0

            26

            AmrD

            0

            4

            0

            2

            0

            6

            EmrB

            4

            3

            0

            6

            0

            13

            EmrD

            0

            2

            0

            5

            2

            9

            EurA

            26

            0

            0

            0

            0

            26

            EurB

            7

            9

            0

            0

            0

            16

            EurC

            8

            1

            0

            0

            0

            9

            SearB

            1

            1

            0

            1

            0

            3

            SearD

            0

            1

            2

            3

            1

            7

            WprA

            4

            1

            0

            0

            0

            5

            WprB

            3

            12

            1

            6

            0

            22

            World

            75

            47

            4

            56

            9

            191

            Table 3

            Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, both sexes, 2000

            Region

            Age-group

             

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of deaths (000s)

            World

            46.0

            49.4

            141.3

            462.1

            1,503.0

            1,852.4

            1,901.0

            1,078.7

            7,033.9

            AfrD

            5.0

            2.5

            10.7

            26.3

            59.2

            70.0

            66.5

            31.5

            271.6

            AfrE

            4.9

            2.6

            15.2

            33.1

            65.0

            76.4

            72.1

            31.5

            300.8

            AmrA

            0.6

            1.2

            3.9

            23.1

            102.4

            132.3

            194.5

            168.1

            626.2

            AmrB

            3.2

            4.4

            10.7

            31.7

            86.4

            94.3

            103.5

            66.6

            400.8

            AmrD

            1.0

            1.4

            2.7

            6.4

            14.8

            16.0

            18.9

            11.5

            72.9

            EmrB

            1.2

            2.0

            3.8

            8.0

            19.2

            18.2

            17.8

            7.7

            77.8

            EmrD

            1.9

            2.5

            4.3

            10.6

            17.8

            15.1

            13.2

            4.3

            69.7

            EurA

            0.7

            1.5

            5.3

            31.3

            154.1

            238.2

            350.9

            279.8

            1,061.7

            EurB1

            0.7

            1.1

            3.9

            16.6

            59.3

            76.6

            69.8

            26.5

            254.5

            EurB2

            0.2

            0.6

            1.4

            4.3

            7.9

            10.9

            7.5

            1.9

            34.8

            EurC

            0.8

            1.7

            5.8

            28.4

            114.2

            162.1

            146.1

            44.5

            503.7

            SearB

            2.9

            4.0

            7.9

            30.9

            90.0

            79.8

            59.1

            25.9

            300.6

            SearD

            12.9

            11.9

            32.7

            65.1

            189.0

            262.1

            192.2

            109.2

            875.1

            WprA

            0.2

            0.4

            1.6

            7.7

            49.6

            77.6

            104.2

            90.4

            331.6

            WprB1

            8.9

            10.6

            28.5

            128.2

            451.6

            503.1

            467.5

            165.6

            1,764.0

            WprB2

            0.9

            1.0

            3.0

            9.5

            21.4

            18.9

            16.7

            13.3

            84.8

            WprB3

            0.0

            0.1

            0.2

            0.6

            1.2

            0.7

            0.4

            0.2

            3.4

            Age-specific mortality rate per 100,000

            World

            7.6

            4.1

            9.0

            36.3

            186.8

            548.2

            965.1

            1,702.1

            116.5

            AfrD

            9.1

            2.8

            11.6

            49.5

            210.0

            667.6

            1,386.4

            2,799.0

            81.4

            AfrE

            8.5

            2.7

            16.3

            63.6

            243.8

            798.9

            1,612.8

            2,932.2

            89.1

            AmrA

            2.9

            2.6

            6.3

            31.5

            178.2

            581.8

            1,074.1

            1,901.0

            203.1

            AmrB

            7.0

            4.9

            8.6

            34.1

            159.9

            463.9

            895.3

            1,773.8

            90.7

            AmrD

            10.7

            8.2

            13.3

            51.0

            211.0

            593.4

            1,354.4

            2,827.8

            102.3

            EmrB

            7.3

            5.7

            9.1

            31.5

            144.0

            374.6

            688.6

            1,182.8

            55.8

            EmrD

            10.2

            7.5

            11.0

            41.5

            129.5

            305.6

            540.6

            716.3

            50.5

            EurA

            3.2

            3.1

            6.6

            33.1

            196.8

            570.4

            1,109.9

            2,089.7

            259.6

            EurB1

            5.7

            4.2

            9.0

            47.1

            226.3

            602.5

            874.0

            1,325.3

            153.5

            EurB2

            3.7

            4.8

            10.0

            41.5

            172.8

            450.4

            584.6

            550.4

            68.4

            EurC

            6.7

            5.1

            10.4

            51.3

            266.1

            656.0

            911.4

            1,012.8

            205.4

            SearB

            7.1

            5.0

            7.0

            36.7

            192.9

            442.1

            679.3

            1,109.6

            76.2

            SearD

            8.0

            3.9

            8.8

            24.9

            124.6

            448.9

            681.4

            1,499.2

            64.9

            WprA

            2.4

            2.3

            5.1

            25.9

            153.3

            471.8

            927.3

            1,907.7

            222.6

            WprB1

            8.6

            4.5

            8.4

            38.1

            218.2

            617.6

            1,080.7

            1,435.2

            130.0

            WprB2

            5.9

            3.3

            7.2

            31.7

            152.4

            312.2

            525.6

            1,540.4

            59.7

            WprB3

            4.3

            4.3

            8.2

            47.8

            173.4

            280.3

            378.4

            1,162.9

            49.1

            Table 4

            Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, males, 2000

            Region

            Age-group

             

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of deaths (000s)

            World

            22.6

            27.4

            79.9

            228.3

            844.8

            1,121.7

            1,074.6

            502.6

            3,901.9

            AfrD

            2.1

            1.3

            6.2

            14.3

            29.2

            34.2

            34.8

            17.1

            139.3

            AfrE

            2.6

            1.5

            9.6

            20.3

            33.3

            36.2

            36.1

            17.0

            156.8

            AmrA

            0.3

            0.6

            2.3

            10.5

            54.0

            74.5

            105.8

            77.1

            325.1

            AmrB

            1.7

            2.5

            6.0

            12.4

            41.4

            51.7

            57.6

            33.9

            207.1

            AmrD

            0.4

            0.8

            1.4

            2.2

            5.4

            7.5

            9.6

            5.9

            33.3

            EmrB

            0.7

            1.2

            1.9

            3.0

            10.0

            11.6

            11.6

            4.8

            44.9

            EmrD

            1.2

            1.5

            2.4

            5.1

            9.0

            8.8

            7.6

            2.7

            38.2

            EurA

            0.4

            0.9

            3.2

            15.2

            90.1

            151.1

            205.8

            127.8

            594.3

            EurB1

            0.4

            0.7

            2.1

            8.7

            37.2

            49.5

            39.9

            12.1

            150.5

            EurB2

            0.1

            0.3

            0.8

            2.0

            4.4

            6.6

            3.9

            0.7

            18.9

            EurC

            0.4

            1.0

            3.3

            13.8

            70.1

            101.2

            73.5

            15.9

            279.2

            SearB

            1.5

            2.0

            4.2

            11.8

            45.4

            48.4

            35.7

            12.8

            161.8

            SearD

            6.0

            6.0

            15.5

            31.0

            88.4

            148.3

            106.4

            48.7

            450.1

            WprA

            0.1

            0.2

            0.8

            3.4

            29.2

            52.8

            67.0

            44.9

            198.5

            WprB1

            4.1

            6.2

            18.7

            69.7

            285.7

            327.5

            268.6

            73.8

            1,054.3

            WprB2

            0.5

            0.6

            1.6

            4.6

            11.4

            11.7

            10.3

            7.2

            47.9

            WprB3

            0.0

            0.0

            0.1

            0.2

            0.6

            0.4

            0.2

            0.1

            1.6

            Age-specific mortality rate per 100,000

            World

            7.3

            4.5

            10.0

            35.3

            209.6

            694.5

            1,264.5

            2,095.6

            128.2

            AfrD

            7.6

            2.9

            13.5

            54.6

            214.0

            697.7

            1,607.5

            3,446.7

            83.9

            AfrE

            9.0

            3.3

            20.6

            78.4

            258.1

            824.4

            1,866.5

            4,078.5

            93.5

            AmrA

            3.0

            2.8

            7.2

            28.4

            190.0

            689.9

            1,353.3

            2,286.9

            213.1

            AmrB

            7.4

            5.4

            9.6

            27.1

            158.5

            546.5

            1,139.1

            2,145.2

            94.5

            AmrD

            9.0

            8.9

            13.5

            36.2

            158.0

            583.7

            1,505.9

            3,264.8

            93.6

            EmrB

            8.9

            6.6

            9.1

            22.2

            137.7

            461.9

            904.8

            1,444.8

            62.1

            EmrD

            12.9

            8.9

            11.8

            39.2

            134.5

            385.5

            704.1

            1,014.3

            54.8

            EurA

            3.4

            3.6

            7.7

            31.7

            230.9

            762.6

            1,576.8

            2,711.7

            295.6

            EurB1

            6.3

            5.0

            9.7

            48.8

            288.5

            847.1

            1,225.6

            1,657.4

            183.0

            EurB2

            4.8

            5.6

            10.9

            38.8

            197.1

            598.0

            772.0

            676.4

            75.0

            EurC

            7.0

            5.6

            11.6

            50.4

            351.0

            1,001.0

            1,453.4

            1,541.1

            242.3

            SearB

            7.0

            4.9

            7.3

            28.0

            199.0

            569.2

            905.5

            1,264.7

            82.0

            SearD

            7.1

            3.8

            8.0

            22.7

            113.7

            516.9

            792.8

            1,419.2

            64.8

            WprA

            2.9

            2.9

            5.4

            22.9

            181.1

            668.2

            1,387.3

            2,603.3

            270.5

            WprB1

            7.5

            5.1

            10.6

            40.3

            267.2

            796.0

            1,372.3

            1,729.7

            151.1

            WprB2

            5.9

            3.8

            7.6

            31.3

            175.1

            431.4

            784.9

            2,303.2

            68.1

            WprB3

            5.1

            5.5

            7.0

            29.3

            162.4

            329.5

            476.3

            1,404.1

            46.7

            Table 5

            Estimated global and regional number of total cancer deaths (thousands) and mortality rate (per 100,000) by age, females, 2000

            Region

            Age-group

             

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of deaths (000s)

            World

            23.4

            22.0

            61.4

            233.8

            658.2

            730.6

            826.4

            576.2

            3,132.0

            AfrD

            2.9

            1.2

            4.4

            12.0

            30.0

            35.8

            31.7

            14.4

            132.3

            AfrE

            2.3

            1.0

            5.6

            12.8

            31.7

            40.2

            35.9

            14.4

            144.0

            AmrA

            0.3

            0.5

            1.6

            12.6

            48.4

            57.8

            88.7

            91.1

            301.1

            AmrB

            1.5

            2.0

            4.7

            19.3

            45.0

            42.6

            45.9

            32.7

            193.8

            AmrD

            0.6

            0.6

            1.4

            4.2

            9.4

            8.5

            9.3

            5.6

            39.6

            EmrB

            0.4

            0.8

            1.8

            5.0

            9.2

            6.6

            6.2

            2.9

            32.9

            EmrD

            0.7

            1.0

            1.9

            5.5

            8.8

            6.4

            5.6

            1.6

            31.4

            EurA

            0.3

            0.6

            2.1

            16.2

            64.0

            87.1

            145.1

            152.0

            467.4

            EurB1

            0.3

            0.4

            1.8

            7.9

            22.1

            27.1

            29.9

            14.4

            104.0

            EurB2

            0.1

            0.2

            0.6

            2.3

            3.6

            4.3

            3.6

            1.1

            15.9

            EurC

            0.4

            0.7

            2.5

            14.6

            44.1

            60.9

            72.6

            28.7

            224.5

            SearB

            1.5

            2.0

            3.7

            19.1

            44.6

            31.4

            23.4

            13.1

            138.8

            SearD

            6.9

            5.9

            17.2

            34.2

            100.6

            113.8

            85.8

            60.5

            425.0

            WprA

            0.1

            0.1

            0.7

            4.3

            20.4

            24.9

            37.2

            45.5

            133.1

            WprB1

            4.8

            4.3

            9.8

            58.5

            165.9

            175.7

            198.8

            91.8

            709.7

            WprB2

            0.4

            0.4

            1.4

            5.0

            9.9

            7.2

            6.4

            6.2

            36.9

            WprB3

            0.0

            0.0

            0.1

            0.4

            0.6

            0.3

            0.2

            0.1

            1.7

            Age-specific mortality rate per 100,000

            World

            8.0

            3.8

            8.0

            37.3

            163.9

            414.3

            737.9

            1,462.6

            104.6

            AfrD

            10.6

            2.6

            9.6

            44.6

            206.1

            641.3

            1,204.5

            2,286.7

            78.9

            AfrE

            8.1

            2.2

            12.0

            48.9

            230.4

            777.2

            1,418.8

            2,202.6

            84.8

            AmrA

            2.7

            2.4

            5.3

            34.7

            166.6

            484.1

            862.1

            1,663.3

            193.4

            AmrB

            6.6

            4.4

            7.7

            40.9

            161.3

            392.0

            705.7

            1,504.1

            86.9

            AmrD

            12.5

            7.5

            13.2

            65.1

            260.9

            602.3

            1,226.6

            2,479.1

            110.8

            EmrB

            5.5

            4.8

            9.2

            42.1

            151.7

            280.7

            474.5

            909.5

            49.0

            EmrD

            7.4

            5.9

            10.1

            43.8

            124.7

            237.8

            411.1

            481.1

            46.1

            EurA

            2.9

            2.6

            5.4

            34.6

            162.9

            397.0

            781.7

            1,751.8

            224.7

            EurB1

            5.0

            3.4

            8.3

            45.3

            166.0

            394.8

            632.1

            1,134.8

            124.4

            EurB2

            2.5

            4.1

            9.1

            44.1

            150.2

            326.0

            463.3

            491.3

            61.9

            EurC

            6.4

            4.5

            9.1

            52.2

            192.2

            417.0

            661.6

            851.5

            172.7

            SearB

            7.3

            5.1

            6.6

            45.4

            187.2

            329.0

            491.8

            991.1

            70.5

            SearD

            8.8

            4.0

            9.7

            27.2

            136.1

            383.2

            580.4

            1,570.4

            65.1

            WprA

            2.0

            1.7

            4.7

            29.0

            125.6

            290.5

            580.5

            1,509.3

            176.2

            WprB1

            9.9

            3.9

            6.0

            35.7

            165.9

            435.6

            839.7

            1,262.3

            107.6

            WprB2

            6.0

            2.9

            6.8

            32.1

            132.6

            215.4

            342.3

            1,113.7

            51.5

            WprB3

            3.5

            3.0

            9.5

            68.4

            184.5

            233.3

            294.1

            960.7

            51.7

            http://static-content.springer.com/image/art%3A10.1186%2F1471-2407-2-37/MediaObjects/12885_2002_Article_57_Fig3_HTML.jpg
            Figure 3

            Age-standardised mortality rate from all cancers by region, 2000

            Cancer mortality envelope was disaggregated by applying the distribution of cancer mortality by site estimated from both the detailed analysis of vital records and the use of survival model and incidence data from the International Agency for Research on Cancer (IARC). Tables 6 and 7 show the estimated global and regional numbers of deaths and age-standardised mortality rates by sex for 17 cancer sites. Generally higher mortality rates were observed in developing regions except cancers of lung and pancreas which are more prevalent in developed regions and highly fatal.
            Table 6

            Estimated global and regional number of cancer deaths and age-standardised mortality rate by site, males, 2000

              

            WHO sub region

             

            World

            AFRO

            AMRO

            EMRO

            EURO

            SEARO

            WPRO

            Site

             

            D

            E

            A

            B

            D

            B

            D

            A

            B1

            B2

            C

            B

            D

            A

            B1

            B2

            B3

            Number of deaths (000s)

            Mouth and oropharynx cancers

            222.4

            10.7

            14.3

            6.6

            8.5

            0.7

            2.0

            1.5

            19.2

            6.0

            0.8

            14.7

            13.1

            88.9

            4.1

            25.5

            5.4

            0.4

            Oesophagus cancer

            273.6

            4.9

            13.8

            11.6

            10.5

            0.7

            1.8

            0.7

            21.4

            3.4

            1.7

            10.0

            3.3

            41.9

            9.4

            135.7

            2.9

            0.0

            Stomach cancer

            512.0

            12.0

            9.8

            10.0

            25.8

            7.6

            7.5

            2.3

            38.9

            14.9

            3.5

            42.2

            7.1

            28.1

            34.3

            261.1

            6.8

            0.1

            Colon and rectum cancers

            311.8

            7.4

            8.8

            36.1

            14.4

            1.6

            2.2

            2.3

            72.1

            14.3

            1.0

            28.7

            13.9

            19.6

            23.1

            63.3

            2.9

            0.1

            Liver cancer

            414.9

            20.6

            23.5

            8.7

            9.3

            2.8

            3.0

            2.3

            25.3

            5.8

            0.7

            7.8

            25.9

            17.3

            23.8

            231.5

            6.3

            0.2

            Pancreas cancer

            117.0

            1.5

            2.7

            16.0

            7.9

            1.1

            0.9

            1.0

            26.7

            5.8

            1.0

            11.2

            3.5

            7.6

            11.2

            18.4

            0.5

            0.0

            Trachea, bronchus, lung cancers

            877.3

            7.0

            9.4

            101.4

            36.1

            1.6

            8.7

            7.1

            158.0

            46.6

            3.8

            83.6

            40.8

            102.7

            43.2

            214.6

            12.4

            0.3

            Melanoma of the skin

            35.1

            2.4

            2.2

            7.7

            3.3

            0.6

            0.2

            0.1

            8.3

            2.0

            0.2

            2.5

            0.7

            1.4

            1.7

            1.6

            0.1

            0.0

            Breast cancer

            2.6

            0.0

            0.0

            0.5

            0.3

            0.0

            0.0

            0.0

            0.9

            0.2

            0.1

            0.5

            0.0

            0.0

            0.1

            0.0

            0.0

            0.0

            Cervix uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Corpus uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Ovary cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Prostate cancer

            263.6

            26.0

            19.2

            39.6

            30.4

            5.8

            2.1

            1.7

            70.2

            9.4

            0.5

            13.3

            8.1

            19.8

            10.4

            6.1

            0.9

            0.0

            Bladder cancer

            123.9

            6.9

            4.3

            10.3

            4.9

            0.5

            2.6

            7.7

            27.1

            7.1

            0.7

            10.4

            4.4

            15.9

            4.1

            15.9

            1.0

            0.0

            Lymphomas, multiple myeloma

            168.6

            15.9

            13.7

            23.1

            9.6

            2.1

            4.1

            3.6

            27.6

            5.6

            0.9

            5.4

            9.6

            26.1

            7.8

            11.2

            2.0

            0.1

            Leukaemia

            145.3

            5.2

            6.9

            14.5

            9.6

            2.0

            2.3

            3.7

            20.0

            5.4

            0.8

            7.8

            7.6

            21.0

            4.9

            31.9

            1.7

            0.1

            Other malignant neoplasms

            425.2

            18.7

            25.6

            39.0

            36.5

            6.0

            7.5

            4.2

            79.1

            24.0

            3.2

            41.3

            16.6

            60.5

            20.4

            37.4

            5.0

            0.2

            Age-standardized mortality rate per 100,000

            Mouth and oropharynx cancers

            7.3

            11.7

            16.6

            2.8

            4.5

            2.8

            4.0

            3.1

            5.5

            5.9

            4.0

            9.0

            8.0

            16.7

            2.8

            3.4

            10.7

            18.4

            Oesophagus cancer

            9.0

            5.5

            16.4

            4.8

            5.6

            3.0

            3.6

            1.6

            5.6

            3.2

            9.0

            5.9

            2.1

            7.9

            6.1

            18.3

            6.1

            1.9

            Stomach cancer

            16.8

            13.5

            11.7

            3.9

            13.7

            31.5

            15.1

            4.9

            9.3

            14.2

            18.7

            25.1

            4.5

            5.3

            21.5

            35.5

            14.2

            3.3

            Colon and rectum cancers

            10.2

            8.1

            11.0

            13.7

            7.6

            6.5

            4.2

            4.8

            17.0

            13.6

            5.2

            17.0

            8.9

            3.7

            14.6

            8.7

            6.0

            4.1

            Liver cancer

            13.6

            20.9

            25.6

            3.6

            4.9

            11.1

            6.2

            5.0

            6.2

            5.6

            3.6

            4.6

            15.9

            3.1

            15.7

            30.5

            12.2

            10.1

            Pancreas cancer

            3.8

            1.6

            3.4

            6.3

            4.2

            4.7

            1.8

            2.2

            6.6

            5.6

            5.3

            6.7

            2.2

            1.5

            7.1

            2.5

            1.0

            0.2

            Trachea, bronchus, lung cancers

            28.8

            7.9

            11.5

            40.1

            19.3

            6.5

            17.7

            15.9

            39.5

            44.2

            19.7

            48.9

            26.0

            19.4

            26.3

            29.1

            25.1

            13.8

            Melanoma of the skin

            1.2

            2.7

            2.6

            3.2

            1.7

            2.5

            0.4

            0.2

            2.2

            2.0

            1.1

            1.6

            0.5

            0.3

            1.1

            0.2

            0.2

            2.4

            Breast cancer

            0.1

            0.0

            0.0

            0.2

            0.2

            0.1

            0.0

            0.0

            0.2

            0.2

            0.3

            0.3

            0.0

            0.0

            0.1

            0.0

            0.0

            0.0

            Cervix uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Corpus uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Ovary cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Prostate cancer

            8.7

            33.3

            27.9

            12.7

            16.2

            24.9

            4.5

            4.3

            14.3

            8.8

            2.9

            7.8

            5.6

            4.1

            5.7

            0.9

            1.9

            1.5

            Bladder cancer

            4.1

            8.4

            5.8

            3.6

            2.6

            2.2

            5.6

            17.7

            6.0

            6.7

            4.0

            6.1

            2.9

            3.1

            2.3

            2.3

            2.3

            0.8

            Lymphomas, multiple myeloma

            5.5

            15.1

            13.5

            9.2

            4.9

            8.3

            7.3

            6.3

            7.1

            5.7

            4.4

            3.5

            5.8

            4.6

            5.1

            1.5

            3.6

            5.5

            Leukaemia

            4.8

            4.9

            6.7

            5.9

            4.7

            6.5

            3.7

            5.9

            5.4

            5.7

            3.4

            5.3

            4.2

            3.3

            3.9

            4.6

            2.6

            2.6

            Other malignant neoplasms

            14.0

            20.2

            31.0

            16.6

            18.9

            23.0

            14.6

            8.4

            21.4

            23.6

            16.0

            26.1

            10.2

            11.3

            13.6

            5.2

            10.3

            8.5

            Table 7

            Estimated global and regional number of cancer deaths and age-standardised mortality rate by site, females, 2000

              

            WHO sub region

             

            World

            AFRO

            AMRO

            EMRO

            EURO

            SEARO

            WPRO

            Site

             

            D

            E

            A

            B

            D

            B

            D

            A

            B1

            B2

            C

            B

            D

            A

            B1

            B2

            B3

            Number of deaths (000s)

            Mouth and oropharynx cancers

            97.2

            5.3

            7.1

            3.3

            2.7

            0.5

            1.1

            0.6

            5.7

            1.5

            0.3

            2.9

            5.5

            42.7

            1.7

            13.6

            2.6

            0.2

            Oesophagus cancer

            157.6

            4.0

            6.8

            3.7

            3.8

            0.3

            1.5

            0.5

            7.8

            1.0

            1.3

            3.5

            2.3

            33.6

            2.0

            83.6

            2.0

            0.0

            Stomach cancer

            324.2

            8.9

            7.2

            7.0

            16.5

            7.1

            3.7

            1.6

            27.9

            8.6

            2.2

            30.6

            5.5

            16.1

            19.0

            157.7

            4.6

            0.1

            Colon and rectum cancers

            295.5

            5.6

            5.3

            37.2

            16.1

            2.1

            2.2

            1.7

            69.7

            11.8

            1.1

            33.61

            3.6

            14.01

            9.4

            59.72

            2.2

            0.1

            Liver cancer

            191.0

            11.0

            9.8

            5.3

            9.1

            3.2

            1.2

            1.1

            13.3

            3.8

            0.5

            5.6

            10.6

            10.4

            10.5

            93.5

            2.2

            0.2

            Pancreas cancer

            105.6

            1.5

            2.5

            16.9

            8.7

            1.2

            0.7

            0.6

            26.9

            4.6

            0.7

            9.8

            3.3

            5.2

            9.4

            13.0

            0.5

            0.0

            Trachea, bronchus, lung cancers

            323.8

            2.9

            4.5

            70.5

            14.9

            0.9

            2.5

            2.3

            49.2

            9.8

            1.1

            16.2

            7.5

            23.2

            16.9

            97.6

            3.7

            0.2

            Melanoma of the skin

            30.1

            2.4

            3.0

            4.3

            2.7

            0.6

            0.2

            0.1

            7.2

            1.9

            0.2

            3.0

            1.0

            1.0

            1.1

            1.2

            0.1

            0.0

            Breast cancer

            466.3

            18.6

            23.0

            53.3

            30.7

            4.0

            5.1

            7.0

            91.8

            18.5

            2.5

            39.4

            29.0

            67.0

            12.4

            57.5

            6.3

            0.2

            Cervix uteri cancer

            259.6

            24.1

            36.8

            5.3

            19.3

            4.6

            3.5

            2.6

            8.3

            6.3

            1.0

            11.7

            15.4

            86.2

            2.6

            26.1

            5.4

            0.3

            Corpus uteri cancer

            72.9

            1.4

            1.7

            8.2

            10.4

            3.5

            0.4

            0.3

            16.0

            4.3

            0.8

            11.0

            4.0

            3.2

            3.3

            4.1

            0.2

            0.0

            Ovary cancer

            128.6

            3.9

            6.7

            15.5

            7.0

            1.1

            0.9

            0.9

            25.7

            5.7

            0.6

            12.9

            8.7

            18.5

            4.9

            13.8

            1.6

            0.1

            Prostate cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Bladder cancer

            53.5

            2.3

            2.0

            4.9

            2.1

            0.3

            0.5

            2.0

            10.5

            1.7

            0.2

            2.8

            1.4

            14.2

            1.9

            6.3

            0.6

            0.0

            Lymphomas, multiple myeloma

            163.7

            6.6

            5.2

            21.7

            8.0

            1.6

            2.8

            2.4

            27.4

            4.3

            0.5

            4.8

            6.1

            54.8

            6.2

            9.4

            1.8

            0.1

            Leukaemia

            114.7

            4.4

            4.9

            12.0

            8.4

            1.9

            1.7

            2.5

            17.2

            3.8

            0.7

            7.2

            7.2

            14.7

            3.6

            23.1

            1.4

            0.1

            Other malignant neoplasms

            344.5

            29.4

            14.8

            32.0

            33.2

            6.9

            5.1

            5.1

            63.0

            16.4

            2.4

            29.6

            15.5

            19.9

            18.3

            49.5

            3.4

            0.2

            Age-standardized mortality rate per 100,000

            Mouth and oropharynx cancers

            3.2

            6.6

            8.8

            1.3

            1.5

            2.2

            2.5

            1.3

            1.4

            1.4

            1.4

            1.3

            3.7

            9.9

            1.0

            2.0

            4.9

            10.8

            Oesophagus cancer

            5.3

            5.0

            8.8

            1.3

            2.1

            1.4

            3.8

            1.1

            1.6

            0.9

            6.1

            1.4

            1.6

            7.7

            1.2

            12.7

            3.8

            1.7

            Stomach cancer

            10.8

            11.3

            9.2

            2.5

            9.1

            32.2

            9.0

            3.6

            5.8

            7.9

            10.6

            13.0

            3.7

            3.8

            11.5

            24.1

            8.7

            2.6

            Colon and rectum cancers

            9.9

            7.0

            7.0

            13.0

            8.9

            9.4

            5.6

            3.7

            14.4

            10.7

            5.3

            13.9

            9.3

            3.3

            11.6

            9.1

            4.2

            2.6

            Liver cancer

            6.4

            12.4

            11.5

            2.0

            5.0

            13.9

            3.0

            2.4

            2.9

            3.4

            2.2

            2.4

            7.1

            2.1

            6.2

            13.9

            3.9

            6.9

            Pancreas cancer

            3.5

            1.7

            3.4

            6.1

            4.8

            5.6

            1.7

            1.5

            5.7

            4.1

            3.4

            4.1

            2.3

            1.2

            5.5

            2.0

            0.9

            0.3

            Trachea, bronchus, lung cancers

            10.8

            3.2

            5.3

            27.4

            8.0

            4.0

            6.0

            5.2

            11.6

            9.0

            5.1

            6.9

            4.9

            4.9

            10.1

            14.5

            6.8

            7.7

            Melanoma of the skin

            1.0

            3.1

            4.1

            1.7

            1.5

            2.6

            0.4

            0.3

            1.7

            1.8

            1.0

            1.5

            0.7

            0.2

            0.7

            0.2

            0.1

            1.5

            Breast cancer

            15.6

            21.4

            27.7

            21.1

            16.0

            16.1

            12.2

            14.4

            22.8

            17.4

            12.0

            18.7

            17.6

            14.5

            9.4

            8.1

            11.3

            12.0

            Cervix uteri cancer

            8.7

            27.4

            43.8

            2.4

            9.8

            18.7

            8.7

            5.5

            2.3

            6.1

            4.7

            5.9

            9.3

            18.0

            2.0

            3.9

            9.7

            15.5

            Corpus uteri cancer

            2.4

            1.9

            2.3

            3.1

            5.5

            1.5

            1.0

            0.8

            3.5

            3.9

            3.8

            4.7

            2.6

            0.8

            2.1

            0.6

            0.4

            1.2

            Ovary cancer

            4.3

            4.3

            8.1

            6.1

            3.7

            4.4

            2.2

            1.8

            6.3

            5.3

            3.0

            6.0

            5.3

            4.1

            3.5

            2.0

            2.9

            3.2

            Prostate cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Bladder cancer

            1.8

            2.9

            2.6

            1.6

            1.2

            1.2

            1.4

            4.6

            2.0

            1.5

            0.9

            1.1

            1.1

            3.1

            1.0

            1.0

            1.1

            0.2

            Lymphomas, multiple myeloma

            5.5

            6.7

            5.6

            7.9

            4.2

            6.5

            6.3

            4.8

            6.1

            4.1

            2.4

            2.3

            3.9

            11.7

            3.8

            1.4

            3.0

            3.1

            Leukaemia

            3.8

            4.7

            5.1

            4.6

            4.1

            6.5

            3.1

            4.3

            4.1

            3.8

            2.8

            3.8

            4.1

            2.6

            2.7

            3.6

            2.1

            2.2

            Other malignant neoplasms

            11.5

            34.3

            18.0

            12.5

            17.6

            28.6

            12.5

            10.9

            14.6

            15.3

            11.0

            14.1

            10.1

            4.9

            11.0

            7.7

            6.3

            8.2

            Tables 8 and 9 represent the ranking of the number of deaths by cancer site in the world and three selected sub regions: a high child and adult mortality/low income region (AfrE), a very low child and adult mortality/high income region (EurA), and a low child and adult mortality/middle income region (SearB). Lung cancer was the leading cause of cancer deaths in the world, accounting for 17% of total cancer mortality, followed by cancers of stomach (12% of total), liver (9%), colon and rectum (9%), and breast (7%). In males, lung, stomach, and liver cancers were the three most common cause of cancer deaths. The leading cause of cancer deaths among females was breast but lung cancer was already the second largest cause of cancer deaths.
            Table 8

            Ranking of the global cancer deaths by site, 2000

            site

            Number of death (000s)

            Proportion of total (%)

            Both sexes

              

            Trachea, bronchus, and lung

            1211.5

            17.2

            Stomach

            835.1

            11.9

            Liver

            611.4

            8.7

            Colon and rectum

            608.0

            8.6

            Breast

            473.8

            6.7

            Oesophagus

            430.4

            6.1

            Lymphomas and myeloma

            329.9

            4.7

            Mouth and oropharynx

            320.0

            4.5

            Prostate

            264.0

            3.8

            Leukaemia

            263.8

            3.8

            Cervix uteri

            254.2

            3.6

            Pancreas

            222.3

            3.2

            Bladder

            179.4

            2.6

            Ovary

            130.1

            1.8

            Corpus uteri

            73.5

            1.0

            Melanoma of the skin

            65.3

            0.9

            Males

              

            Trachea, bronchus, and lung

            877.2

            22.5

            Stomach

            511.3

            13.1

            Liver

            419.4

            10.7

            Colon and rectum

            312.3

            8.0

            Oesophagus

            272.8

            7.0

            Prostate

            264.0

            6.8

            Mouth and oropharynx

            222.0

            5.7

            Lymphomas and myeloma

            169.6

            4.3

            Leukaemia

            145.4

            3.7

            Bladder

            126.1

            3.2

            Pancreas

            116.8

            3.0

            Melanoma of the skin

            35.0

            0.9

            Females

              

            Breast

            471.2

            15.0

            Trachea, bronchus, and lung

            334.2

            10.7

            Stomach

            323.7

            10.3

            Colon and rectum

            295.7

            9.4

            Cervix uteri

            254.2

            8.1

            Liver

            192.1

            6.1

            Lymphomas and myeloma

            160.2

            5.1

            Oesophagus

            157.6

            5.0

            Ovary

            130.1

            4.2

            Leukaemia

            118.4

            3.8

            Pancreas

            105.5

            3.4

            Mouth and oropharynx

            98.0

            3.1

            Corpus uteri

            73.5

            2.3

            Bladder

            53.4

            1.7

            Melanoma of the skin

            30.3

            1.0

            Table 9

            Ranking of selected regional cancer deaths by site, 2000

            WHO sub region

            AfrE (high child and adult mortality)

            EurA (very low child and adult mortality)

            SearB (low child and adult mortality)

            site

            Number of death (000s)

            Proportion of total (%)

            site

            Number of death (000s)

            Proportion death of total (%)

            site

            Number of death (000s)

            Proportion death of total (%)

            Both sexes

                    

            Cervix uteri

            37.3

            12.4

            Trachea, bronchus, and lung

            207.1

            19.5

            Trachea, bronchus, and lung

            48.3

            16.1

            Liver

            35.3

            11.7

            Colon and rectum

            141.6

            13.3

            Liver

            39.4

            13.1

            Breast

            23.8

            7.9

            Breast

            92.7

            8.7

            Breast

            29.4

            9.8

            Mouth and oropharynx

            21.6

            7.2

            Prostate

            70.1

            6.6

            Colon and rectum

            28.5

            9.5

            Oesophagus

            20.7

            6.9

            Stomach

            66.7

            6.3

            Mouth and oropharynx

            19.4

            6.5

            Lymphomas and myeloma

            19.2

            6.4

            Lymphomas and myeloma

            55.0

            5.2

            Lymphomas and myeloma

            16.2

            5.4

            Prostate

            19.2

            6.4

            Pancreas

            53.6

            5.0

            Cervix uteri

            15.6

            5.2

            Stomach

            17.1

            5.7

            Liver

            38.5

            3.6

            Leukaemia

            15.1

            5.0

            Colon and rectum

            14.3

            4.8

            Bladder

            37.6

            3.5

            Stomach

            13.1

            4.3

            Trachea, bronchus, and lung

            14.0

            4.6

            Leukaemia

            37.2

            3.5

            Ovary

            8.8

            2.9

            Leukaemia

            12.4

            4.1

            Oesophagus

            29.2

            2.7

            Prostate

            8.5

            2.8

            Ovary

            6.9

            2.3

            Ovary

            25.7

            2.4

            Pancreas

            7.0

            2.3

            Bladder

            6.3

            2.1

            Mouth and oropharynx

            24.9

            2.3

            Bladder

            6.2

            2.1

            Melanoma of the skin

            5.3

            1.8

            Corpus uteri

            16.0

            1.5

            Oesophagus

            5.9

            2.0

            Pancreas

            5.3

            1.8

            Melanoma of the skin

            15.5

            1.5

            Corpus uteri

            4.1

            1.4

            Corpus uteri

            1.7

            0.6

            Cervix uteri

            8.3

            0.8

            Melanoma of the skin

            1.8

            0.6

            Males

                    

            Liver

            24.9

            15.9

            Trachea, bronchus, and lung

            158.0

            26.6

            Trachea, bronchus, and lung

            40.8

            25.2

            Prostate

            19.2

            12.2

            Colon and rectum

            72.0

            12.1

            Liver

            28.4

            17.6

            Mouth and oropharynx

            14.4

            9.2

            Prostate

            70.1

            11.8

            Colon and rectum

            14.6

            9.1

            Lymphomas and myeloma

            14.0

            8.9

            Stomach

            38.8

            6.5

            Mouth and oropharynx

            13.8

            8.5

            Oesophagus

            13.8

            8.8

            Lymphomas and myeloma

            27.6

            4.6

            Lymphomas and myeloma

            10.0

            6.2

            Stomach

            9.9

            6.3

            Bladder

            27.1

            4.6

            Prostate

            8.5

            5.3

            Trachea, bronchus, and lung

            9.4

            6.0

            Pancreas

            26.7

            4.5

            Leukaemia

            7.8

            4.8

            Colon and rectum

            9.0

            5.7

            Liver

            25.3

            4.3

            Stomach

            7.5

            4.6

            Leukaemia

            7.3

            4.7

            Oesophagus

            21.4

            3.6

            Bladder

            4.7

            2.9

            Bladder

            4.3

            2.7

            Leukaemia

            20.0

            3.4

            Pancreas

            3.6

            2.2

            Pancreas

            2.8

            1.8

            Mouth and oropharynx

            19.2

            3.2

            Oesophagus

            3.6

            2.2

            Melanoma of the skin

            2.3

            1.4

            Melanoma of the skin

            8.3

            1.4

            Melanoma of the skin

            0.7

            0.5

            Females

                    

            Cervix uteri

            37.3

            25.9

            Breast

            91.8

            19.6

            Breast

            29.3

            21.1

            Breast

            23.8

            16.5

            Colon and rectum

            69.6

            14.9

            Cervix uteri

            15.6

            11.3

            Liver

            10.3

            7.2

            Trachea, bronchus, and lung

            49.2

            10.5

            Colon and rectum

            13.9

            10.0

            Stomach

            7.2

            5.0

            Stomach

            27.8

            6.0

            Liver

            11.0

            7.9

            Mouth and oropharynx

            7.2

            5.0

            Lymphomas and myeloma

            27.4

            5.9

            Ovary

            8.8

            6.3

            Ovary

            6.9

            4.8

            Pancreas

            26.9

            5.8

            Trachea, bronchus, and lung

            7.5

            5.4

            Oesophagus

            6.8

            4.8

            Ovary

            25.7

            5.5

            Leukaemia

            7.2

            5.2

            Colon and rectum

            5.3

            3.7

            Leukaemia

            17.2

            3.7

            Lymphomas and myeloma

            6.2

            4.5

            Lymphomas and myeloma

            5.3

            3.7

            Corpus uteri

            16.0

            3.4

            Mouth and oropharynx

            5.6

            4.0

            Leukaemia

            5.1

            3.5

            Liver

            13.3

            2.8

            Stomach

            5.6

            4.0

            Trachea, bronchus, and lung

            4.5

            3.2

            Bladder

            10.5

            2.2

            Corpus uteri

            4.1

            2.9

            Melanoma of the skin

            3.0

            2.1

            Cervix uteri

            8.3

            1.8

            Pancreas

            3.4

            2.4

            Pancreas

            2.5

            1.8

            Oesophagus

            7.8

            1.7

            Oesophagus

            2.4

            1.7

            Bladder

            2.0

            1.4

            Melanoma of the skin

            7.2

            1.5

            Bladder

            1.5

            1.1

            Corpus uteri

            1.7

            1.2

            Mouth and oropharynx

            5.7

            1.2

            Melanoma of the skin

            1.0

            0.7

            There is a significant variation in the distribution of site-specific cancer mortality by region. In AfrE, the leading causes of cancer mortality in males and females were liver and cervix uteri cancers, respectively, both of which are primarily due to viral infections. Liver cancer accounted for approximately one quarter of all male cancer deaths and cervical cancer accounted for more than one-third of female cancer deaths. In EurA, the pattern of cancer mortality distribution is a typical one observed in industrialised countries: lung, colorectal, and prostate cancers accounted for a large proportion of male cancer mortality while breast, colorectal, and lung cancers were major causes among females. Site-specific cancer mortality distribution in SearB lay somewhere between the two sub regions, although lung and breast cancers were already leading causes of cancer deaths in males and females, respectively.

            Cancer incidence by site

            Regional incidence was back calculated from multiplying mortality by site-specific incidence-to-mortality rate ratios by age, sex, and region. As shown in Table 10, (age-standardised) incidence-to-mortality rate ratio was generally higher in cancers with relatively better prognosis including lymphoma, leukaemia, and cancers of colon and rectum, breast, uterus, and ovary. As a result, the new cases of such cancers as a proportion of total new cases were higher than the proportion of mortality from same cancers. Although this pattern was consistent across the regions, the ratios varied substantially by age, sex, and region (data not shown).
            Table 10

            Estimated global site-specific cancer incidence-to-mortality rate ratios by sex

            Site

            Male

            Female

            Mouth and oropharynx

            1.20

            1.57

            Oesophagus

            1.05

            1.05

            Stomach

            1.15

            1.19

            Colon and rectum

            1.69

            1.75

            Liver

            1.01

            1.06

            Pancreas

            1.02

            1.01

            Trachea, bronchus, and lung

            1.07

            1.10

            Melanoma of the skin

            3.37

            2.93

            Breast

             

            2.19

            Cervix uteri

             

            1.91

            Corpus uteri

             

            4.45

            Ovary

             

            1.70

            Prostate

            2.08

             

            Bladder

            2.21

            2.01

            Lymphomas and multiple myeloma

            1.40

            1.51

            Leukaemia

            1.35

            1.44

            Other malignant neoplasms

            1.49

            1.63

            Tables 11, 12, 13 show the regional estimates of total new cases and age-specific incidence rates of all cancers in 2000. More than 10 million new cancers cases occurred world wide. Due to the differences in survival by region, estimated incidence-to-mortality rate ratios were generally much higher in developed regions and the proportion of cancer incidence in developing regions was approximately 50% of total cancer incidence in the world. Despite their much smaller population size, the number of new cases in AmrA and EurA are comparable to those in SearD and WprB1. On average global cancer incidence rates among males and females were 169.7 and 171.1 per 100,000, respectively (Figure 4). Regional age-standardised incidence rates also suggest that female incidence was slightly higher than male incidence in developing regions, particularly in AmrD where the number of deaths female cancers was high. On the other hand, male and female incidence rates were almost the same in all A sub regions (AmrA, EurA, and WprA).
            http://static-content.springer.com/image/art%3A10.1186%2F1471-2407-2-37/MediaObjects/12885_2002_Article_57_Fig4_HTML.jpg
            Figure 4

            Age-standardised incidence rate from all cancers by region, 2000

            Table 11

            Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, both sexes, 2000

             

            Age group

            Region

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of new cases (000s)

            World

            136.8

            96.5

            360.1

            923.3

            2459.3

            2641.4

            2514.5

            1160.2

            10292.1

            AfrD

            12.5

            4.6

            24.7

            41.9

            87.6

            90.8

            74.5

            31.9

            368.6

            AfrE

            12.8

            4.9

            33.8

            49.1

            99.2

            102.4

            81.0

            31.9

            415.1

            AmrA

            3.0

            3.3

            22.7

            110.4

            306.3

            308.4

            404.2

            176.4

            1334.8

            AmrB

            10.0

            8.5

            31.5

            76.1

            150.8

            137.5

            127.6

            69.2

            611.1

            AmrD

            2.9

            2.6

            7.5

            15.6

            28.5

            23.8

            22.7

            11.9

            115.5

            EmrB

            3.5

            4.3

            8.8

            15.7

            28.4

            24.0

            20.5

            7.9

            113.2

            EmrD

            5.4

            4.7

            9.3

            20.0

            28.2

            19.9

            15.1

            4.4

            106.9

            EurA

            2.7

            3.6

            23.8

            96.6

            323.0

            421.1

            531.4

            322.2

            1724.3

            EurB1

            2.1

            2.2

            11.0

            33.8

            91.6

            105.0

            84.4

            27.1

            357.2

            EurB2

            0.6

            1.2

            3.7

            8.4

            11.7

            14.0

            8.7

            1.9

            50.2

            EurC

            2.6

            3.5

            18.0

            60.8

            172.9

            222.9

            180.5

            46.1

            707.3

            SearB

            8.8

            7.5

            18.9

            65.1

            138.9

            103.9

            67.6

            26.7

            437.5

            SearD

            39.6

            24.2

            85.1

            111.0

            277.0

            317.7

            208.4

            110.8

            1173.9

            WprA

            0.9

            0.9

            6.8

            25.7

            108.2

            133.0

            153.0

            107.7

            536.1

            WprB1

            26.9

            18.3

            47.7

            176.3

            575.8

            593.2

            516.0

            170.3

            2124.4

            WprB2

            2.5

            2.0

            6.6

            15.6

            29.5

            22.9

            18.2

            13.6

            110.8

            WprB3

            0.1

            0.1

            0.4

            1.2

            1.9

            0.9

            0.5

            0.2

            5.2

            Age-specific incidence rate per 100,000

            World

            22.6

            8.1

            23.0

            72.4

            305.6

            781.8

            1276.6

            1830.7

            170.4

            AfrD

            22.9

            5.2

            26.8

            78.9

            310.4

            866.4

            1554.9

            2834.8

            110.4

            AfrE

            22.3

            5.2

            36.3

            94.3

            371.8

            1070.3

            1812.2

            2975.0

            123.0

            AmrA

            14.4

            7.5

            36.4

            150.7

            532.9

            1356.3

            2232.0

            1994.7

            433.0

            AmrB

            21.9

            9.5

            25.4

            82.0

            279.1

            676.3

            1103.7

            1842.4

            138.2

            AmrD

            30.8

            15.1

            36.5

            123.3

            406.3

            881.5

            1623.0

            2921.2

            162.0

            EmrB

            21.4

            12.3

            21.4

            62.2

            213.6

            494.3

            793.5

            1206.4

            81.1

            EmrD

            28.9

            14.2

            23.8

            78.2

            205.5

            401.7

            619.9

            728.7

            77.5

            EurA

            12.4

            7.5

            29.6

            102.1

            412.5

            1008.3

            1681.0

            2406.4

            421.6

            EurB1

            17.0

            8.5

            25.3

            95.7

            349.8

            826.0

            1056.8

            1355.2

            215.4

            EurB2

            10.5

            9.7

            26.6

            81.0

            254.7

            577.3

            674.1

            560.0

            98.7

            EurC

            20.6

            10.3

            32.4

            109.7

            403.0

            901.9

            1125.9

            1048.5

            288.5

            SearB

            21.4

            9.3

            16.8

            77.4

            297.8

            575.8

            776.5

            1142.3

            110.9

            SearD

            24.4

            7.9

            22.9

            42.4

            182.7

            544.1

            738.9

            1521.0

            87.1

            WprA

            10.9

            5.8

            22.1

            86.1

            334.2

            808.6

            1361.9

            2273.3

            360.0

            WprB1

            26.1

            7.8

            14.0

            52.3

            278.2

            728.1

            1193.0

            1475.8

            156.5

            WprB2

            16.6

            6.3

            15.8

            51.7

            210.3

            378.2

            572.8

            1565.2

            78.0

            WprB3

            11.7

            7.7

            21.6

            93.3

            271.0

            364.6

            422.9

            1174.1

            76.4

            Table 12

            Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, males, 2000

             

            Age group

            Region

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of new cases (000s)

            World

            64.5

            50.9

            154.0

            257.7

            1174.2

            1528.4

            1380.8

            556.5

            5167.1

            AfrD

            5.2

            2.3

            10.4

            13.0

            37.9

            45.1

            39.0

            17.3

            170.2

            AfrE

            6.6

            2.8

            15.3

            18.3

            42.5

            47.2

            40.0

            17.2

            189.9

            AmrA

            1.6

            1.7

            11.0

            28.3

            134.7

            174.3

            226.6

            109.9

            688.2

            AmrB

            5.3

            4.4

            13.9

            15.7

            56.1

            70.5

            68.2

            34.6

            268.7

            AmrD

            1.2

            1.4

            2.8

            2.6

            7.2

            10.5

            11.2

            6.0

            42.9

            EmrB

            2.2

            2.5

            3.6

            3.4

            13.2

            14.7

            13.1

            4.9

            57.5

            EmrD

            3.4

            2.7

            4.3

            6.3

            13.3

            11.5

            8.5

            2.7

            52.8

            EurA

            1.5

            2.0

            11.5

            26.4

            153.8

            250.2

            291.4

            139.6

            876.3

            EurB1

            1.1

            1.3

            4.8

            10.8

            49.4

            63.2

            45.7

            12.2

            188.5

            EurB2

            0.4

            0.7

            1.6

            2.2

            5.3

            7.9

            4.3

            0.7

            23.1

            EurC

            1.4

            1.8

            8.1

            17.5

            90.3

            126.3

            84.3

            16.0

            345.6

            SearB

            4.3

            3.3

            7.0

            11.8

            57.2

            59.7

            39.5

            13.0

            195.8

            SearD

            16.2

            11.8

            27.0

            29.8

            110.2

            173.8

            113.7

            49.1

            531.6

            WprA

            0.5

            0.5

            3.0

            5.8

            51.0

            86.0

            94.3

            51.3

            292.3

            WprB1

            12.3

            10.5

            27.1

            61.4

            337.9

            373.6

            289.8

            74.8

            1187.5

            WprB2

            1.2

            1.0

            2.5

            4.2

            13.5

            13.5

            11.0

            7.2

            54.2

            WprB3

            0.1

            0.1

            0.1

            0.2

            0.7

            0.5

            0.3

            0.1

            2.0

            Age-specific incidence rate per 100,000

            World

            20.8

            8.3

            19.2

            39.8

            291.3

            946.2

            1624.8

            2320.5

            169.7

            AfrD

            18.7

            5.2

            22.6

            49.5

            277.5

            921.0

            1801.5

            3472.3

            102.4

            AfrE

            23.1

            5.9

            32.8

            70.5

            328.9

            1075.5

            2067.8

            4109.5

            113.2

            AmrA

            15.3

            7.6

            34.8

            76.6

            474.1

            1614.6

            2897.4

            3261.5

            451.0

            AmrB

            22.6

            9.6

            22.4

            34.4

            215.1

            745.8

            1347.6

            2190.5

            122.6

            AmrD

            25.6

            16.0

            27.0

            42.0

            212.4

            814.8

            1742.9

            3320.7

            120.7

            EmrB

            26.0

            13.8

            17.2

            25.2

            181.4

            584.4

            1018.0

            1464.3

            79.6

            EmrD

            36.1

            16.2

            21.6

            48.4

            199.2

            503.8

            791.2

            1024.4

            75.6

            EurA

            13.3

            8.2

            27.9

            55.2

            394.2

            1262.9

            2233.2

            2960.3

            435.9

            EurB1

            18.5

            9.5

            21.8

            60.5

            383.2

            1081.9

            1403.2

            1668.1

            229.1

            EurB2

            13.5

            10.6

            22.9

            43.2

            238.3

            710.9

            851.6

            678.2

            91.7

            EurC

            21.4

            10.7

            28.7

            63.8

            451.9

            1248.4

            1667.0

            1551.3

            299.9

            SearB

            20.3

            8.0

            12.3

            28.1

            250.5

            702.6

            1001.8

            1284.1

            99.2

            SearD

            19.4

            7.5

            14.0

            21.8

            141.7

            606.1

            847.2

            1430.6

            76.5

            WprA

            12.8

            6.7

            18.9

            38.6

            316.3

            1088.7

            1953.2

            2971.8

            398.4

            WprB1

            22.7

            8.6

            15.4

            35.5

            316.0

            908.2

            1480.4

            1753.4

            170.2

            WprB2

            15.4

            6.6

            11.6

            28.6

            207.3

            500.1

            835.9

            2327.7

            77.2

            WprB3

            13.5

            9.0

            10.5

            27.9

            214.4

            400.7

            515.2

            1412.7

            57.5

            Table 13

            Estimated global and regional number of new cases (thousands) and incidence rate (per 100,000) of all cancers by age, females, 2000

             

            Age group

            Region

            0–4

            5–14

            15–29

            30–44

            45–59

            60–69

            70–79

            80+

            Total

            Number of new cases (000s)

            World

            72.3

            45.6

            206.1

            665.6

            1285.1

            1112.9

            1133.6

            603.7

            5125.0

            AfrD

            7.4

            2.3

            14.2

            28.9

            49.6

            45.8

            35.6

            14.7

            198.4

            AfrE

            6.1

            2.1

            18.5

            30.8

            56.7

            55.1

            41.0

            14.8

            225.2

            AmrA

            1.4

            1.6

            11.7

            82.1

            171.6

            134.2

            177.7

            66.5

            646.7

            AmrB

            4.7

            4.1

            17.5

            60.4

            94.7

            66.9

            59.5

            34.6

            342.4

            AmrD

            1.7

            1.2

            4.7

            13.0

            21.3

            13.3

            11.5

            5.9

            72.6

            EmrB

            1.3

            1.8

            5.2

            12.4

            15.2

            9.3

            7.4

            3.0

            55.6

            EmrD

            1.9

            2.0

            5.0

            13.7

            14.9

            8.4

            6.6

            1.7

            54.1

            EurA

            1.2

            1.6

            12.3

            70.2

            169.2

            170.9

            240.0

            182.7

            848.0

            EurB1

            0.9

            0.9

            6.2

            23.0

            42.2

            41.8

            38.7

            14.9

            168.8

            EurB2

            0.2

            0.5

            2.1

            6.2

            6.4

            6.1

            4.4

            1.2

            27.1

            EurC

            1.2

            1.6

            9.9

            43.3

            82.7

            96.7

            96.2

            30.2

            361.7

            SearB

            4.5

            4.2

            11.9

            53.3

            81.7

            44.2

            28.1

            13.7

            241.7

            SearD

            23.4

            12.4

            58.1

            81.2

            166.8

            143.8

            94.7

            61.7

            642.2

            WprA

            0.3

            0.4

            3.8

            19.9

            57.2

            47.1

            58.7

            56.4

            243.8

            WprB1

            14.6

            7.8

            20.6

            114.8

            237.8

            219.6

            226.2

            95.5

            936.9

            WprB2

            1.3

            0.9

            4.1

            11.4

            15.9

            9.3

            7.2

            6.3

            56.5

            WprB3

            0.0

            0.1

            0.3

            1.0

            1.1

            0.4

            0.2

            0.1

            3.2

            Age-specific incidence rate per 100,000

            World

            24.6

            7.9

            27.0

            106.1

            320.0

            631.1

            1012.3

            1532.5

            171.1

            AfrD

            27.2

            5.1

            30.9

            107.8

            341.2

            818.6

            1352.1

            2330.7

            118.3

            AfrE

            21.6

            4.6

            39.8

            117.9

            412.0

            1065.8

            1616.9

            2253.0

            132.6

            AmrA

            13.5

            7.4

            38.1

            226.2

            590.3

            1123.0

            1726.5

            1214.7

            415.3

            AmrB

            21.2

            9.3

            28.4

            127.8

            339.0

            615.8

            914.1

            1589.7

            153.5

            AmrD

            36.2

            14.2

            46.1

            200.8

            588.6

            942.4

            1521.8

            2602.4

            203.0

            EmrB

            16.6

            10.7

            25.8

            104.3

            252.3

            397.3

            571.2

            937.3

            82.8

            EmrD

            21.5

            12.1

            26.1

            109.2

            211.4

            315.0

            484.3

            495.4

            79.3

            EurA

            11.5

            6.8

            31.5

            150.3

            430.7

            778.6

            1292.8

            2105.4

            407.8

            EurB1

            15.4

            7.4

            29.0

            131.6

            317.4

            608.6

            818.5

            1175.8

            202.0

            EurB2

            7.5

            8.8

            30.4

            117.2

            270.0

            464.6

            559.4

            504.5

            105.5

            EurC

            19.7

            9.9

            36.1

            154.6

            360.5

            661.9

            876.5

            895.0

            278.3

            SearB

            22.5

            10.8

            21.3

            126.4

            343.1

            463.0

            589.7

            1033.9

            122.7

            SearD

            29.8

            8.3

            32.6

            64.8

            225.9

            484.2

            640.6

            1601.5

            98.4

            WprA

            9.0

            4.9

            25.5

            134.4

            351.9

            550.0

            916.0

            1873.2

            322.7

            WprB1

            29.8

            7.0

            12.5

            70.1

            237.8

            544.5

            955.4

            1312.9

            142.1

            WprB2

            17.9

            6.1

            20.2

            73.7

            212.9

            279.2

            386.9

            1138.6

            78.8

            WprB3

            9.6

            6.3

            33.4

            166.5

            328.3

            330.2

            343.6

            973.9

            96.5

            Estimated global and regional numbers of new cases and age-standardised incidence rates for 17 cancer sites by sex are shown in Tables 14 and 15. As in mortality distribution, there is a significant variations in the distribution of site-specific cancer incidence by region (Tables 16 and 17). The distribution of cancer incidence was almost similar to that of mortality: lung cancer was the most common cancer in the world in 2000, accounting for 13% of total cancer mortality, followed by cancers of stomach (10% of total), liver (10%), colon and rectum (10%), and breast (6%). The variations in the distribution of site-specific new cases of cancer by region were also similar to those observed in mortality distribution. In all regions, compared to proportion of total mortality, the proportion of lung cancer decreased while that of colon and rectum, breast, uterus and prostate increased, suggesting the difference in survival by cancer site as suggested above.
            Table 14

            Estimated global and regional number of new cases and age-standardised incidence rate of cancer by site, males, 2000

              

            WHO sub region

             

            World

            AFRO

            AMRO

            EMRO

            EURO

            SEARO

            WPRO

            Site

             

            D

            E

            A

            B

            D

            B

            D

            A

            B1

            B2

            C

            B

            D

            A

            B1

            B2

            B3

            Number of new cases (000s)

            Mouth and oropharynx cancers

            267.1

            12.1

            16.5

            11.3

            10.4

            0.9

            2.6

            1.7

            28.7

            7.4

            0.9

            17.8

            16.0

            98.1

            6.5

            29.7

            6.1

            0.5

            Oesophagus cancer

            286.5

            5.1

            14.1

            12.4

            11.1

            0.7

            1.9

            0.8

            22.8

            3.6

            1.8

            10.7

            3.8

            42.0

            10.1

            142.7

            3.0

            0.0

            Stomach cancer

            589.3

            13.3

            10.9

            11.8

            29.7

            8.7

            8.6

            2.5

            45.6

            17.2

            4.0

            48.6

            8.6

            30.1

            40.6

            300.9

            7.6

            0.1

            Colon and rectum cancers

            527.8

            9.5

            12.0

            85.6

            21.2

            2.2

            3.2

            3.1

            133.8

            21.5

            1.4

            42.8

            21.4

            25.7

            49.2

            91.0

            3.8

            0.1

            Liver cancer

            422.0

            20.0

            23.6

            9.0

            9.5

            2.9

            3.1

            2.3

            26.1

            6.0

            0.7

            7.9

            28.6

            18.4

            24.6

            232.8

            6.2

            0.2

            Pancreas cancer

            119.3

            1.5

            2.8

            16.5

            8.1

            1.2

            0.9

            1.0

            27.4

            5.9

            1.0

            11.4

            3.7

            7.3

            11.5

            18.7

            0.5

            0.0

            Trachea, bronchus, lung cancers

            939.9

            7.4

            9.8

            112.1

            38.5

            1.7

            9.3

            7.4

            172.0

            49.5

            3.9

            89.3

            43.1

            107.8

            46.9

            227.8

            13.1

            0.3

            Melanoma of the skin

            118.2

            3.5

            3.4

            61.8

            5.3

            0.9

            0.3

            0.2

            22.6

            3.2

            0.3

            4.0

            1.2

            2.1

            6.7

            2.6

            0.1

            0.1

            Breast cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Cervix uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Corpus uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Ovary cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Prostate cancer

            550.2

            36.5

            28.2

            165.7

            46.0

            8.6

            3.2

            2.7

            139.1

            15.2

            0.8

            22.3

            13.4

            29.6

            28.1

            9.5

            1.2

            0.0

            Bladder cancer

            277.2

            10.6

            7.3

            60.3

            8.1

            0.8

            4.1

            14.4

            65.1

            12.1

            1.2

            17.8

            7.7

            27.8

            13.5

            24.8

            1.5

            0.0

            Lymphomas, multiple myeloma

            238.5

            20.3

            18.6

            36.2

            13.4

            2.8

            6.5

            5.2

            39.3

            7.8

            1.3

            7.4

            13.3

            36.5

            11.8

            15.2

            2.6

            0.2

            Leukaemia

            195.2

            6.3

            9.2

            20.6

            13.1

            2.9

            3.4

            5.3

            25.6

            6.6

            1.1

            9.3

            10.7

            28.2

            6.7

            44.0

            2.2

            0.1

            Other malignant neoplasms

            635.8

            24.2

            33.5

            84.8

            54.2

            8.6

            10.3

            6.2

            128.4

            32.5

            4.7

            56.3

            24.2

            77.8

            35.8

            47.7

            6.4

            0.3

            Age-standardised incidence rate per 100,000

            Mouth and oropharynx cancers

            8.8

            12.9

            18.4

            5.0

            5.5

            3.3

            4.9

            3.6

            8.6

            7.4

            4.5

            10.9

            9.3

            18.5

            4.7

            3.9

            12.0

            21.7

            Oesophagus cancer

            9.4

            5.7

            16.8

            5.1

            5.9

            3.1

            3.8

            1.7

            6.0

            3.4

            9.4

            6.3

            2.2

            8.2

            6.6

            19.2

            6.3

            2.0

            Stomach cancer

            19.4

            15.0

            13.0

            4.6

            15.8

            35.8

            17.4

            5.5

            11.0

            16.4

            21.3

            28.8

            5.2

            5.9

            25.6

            40.8

            15.9

            3.8

            Colon and rectum cancers

            17.3

            10.4

            14.6

            34.4

            11.3

            9.2

            6.3

            6.5

            33.0

            20.4

            7.1

            25.1

            12.9

            4.9

            32.4

            12.3

            7.8

            5.8

            Liver cancer

            13.7

            20.3

            24.7

            3.7

            5.0

            11.4

            6.4

            5.0

            6.4

            5.7

            3.6

            4.8

            16.0

            3.2

            16.2

            30.8

            12.1

            9.9

            Pancreas cancer

            3.9

            1.6

            3.5

            6.5

            4.3

            4.8

            1.8

            2.3

            6.8

            5.7

            5.3

            6.8

            2.2

            1.5

            7.3

            2.5

            1.0

            0.2

            Trachea, bronchus, lung cancers

            30.9

            8.3

            12.0

            44.8

            20.6

            6.9

            18.9

            16.6

            43.3

            47.1

            20.6

            52.2

            27.5

            20.3

            28.9

            30.8

            26.4

            14.7

            Melanoma of the skin

            3.9

            3.8

            3.7

            27.2

            2.8

            3.7

            0.6

            0.3

            6.6

            3.1

            1.6

            2.6

            0.7

            0.4

            4.9

            0.3

            0.3

            3.6

            Breast cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Cervix uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Corpus uteri cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Ovary cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Prostate cancer

            18.0

            45.0

            38.9

            63.7

            24.8

            36.3

            6.9

            6.5

            31.8

            14.1

            4.4

            12.8

            8.6

            5.8

            17.1

            1.3

            2.5

            2.3

            Bladder cancer

            9.0

            12.0

            8.8

            24.4

            4.3

            3.3

            8.5

            30.5

            16.1

            11.6

            6.4

            10.7

            4.6

            4.8

            8.7

            3.5

            3.1

            1.4

            Lymphomas, multiple myeloma

            7.8

            18.2

            17.0

            15.3

            6.8

            10.7

            10.6

            8.6

            10.9

            8.1

            6.2

            5.1

            7.6

            6.1

            8.2

            2.1

            4.5

            7.1

            Leukaemia

            6.4

            5.5

            7.7

            8.9

            6.3

            8.6

            5.1

            7.8

            7.5

            7.2

            4.3

            6.8

            5.7

            4.3

            5.8

            6.7

            3.3

            3.3

            Other malignant neoplasms

            20.8

            24.1

            37.1

            39.9

            27.2

            31.0

            19.1

            11.3

            39.1

            32.8

            22.4

            37.5

            13.5

            13.7

            27.0

            6.6

            12.4

            11.2

            Table 15

            Estimated global and regional number of new cases and age-standardised incidence rate of cancer by site, females, 2000

              

            WHO sub region

             

            World

            AFRO

            AMRO

            EMRO

            EURO

            SEARO

            WPRO

            Site

             

            D

            E

            A

            B

            D

            B

            D

            A

            B1

            B2

            C

            B

            D

            A

            B1

            B2

            B3

            Number of new cases (000s)

            Mouth and oropharynx cancers

            153.6

            8.2

            11.4

            5.9

            4.6

            0.8

            2.2

            1.1

            9.9

            2.5

            0.5

            4.6

            9.4

            63.6

            3.0

            21.2

            4.2

            0.4

            Oesophagus cancer

            166.2

            4.2

            7.2

            3.3

            4.0

            0.3

            1.6

            0.5

            8.4

            1.0

            1.3

            3.8

            2.5

            34.9

            2.1

            89.0

            2.0

            0.0

            Stomach cancer

            383.9

            10.3

            8.4

            7.1

            19.7

            8.4

            4.5

            2.0

            33.9

            10.2

            2.6

            36.3

            6.7

            18.1

            23.7

            186.7

            5.1

            0.1

            Colon and rectum cancers

            517.3

            8.5

            8.2

            73.8

            26.2

            3.3

            4.0

            2.8

            131.0

            19.0

            1.8

            54.1

            22.8

            21.1

            41.7

            95.5

            3.3

            0.1

            Liver cancer

            204.4

            11.9

            11.1

            4.7

            9.7

            3.4

            1.3

            1.2

            14.0

            4.0

            0.5

            5.9

            11.7

            12.0

            11.1

            99.6

            2.2

            0.2

            Pancreas cancer

            106.9

            1.6

            2.6

            14.3

            9.1

            1.3

            0.8

            0.7

            28.1

            4.8

            0.7

            10.2

            3.6

            5.3

            9.8

            13.6

            0.5

            0.0

            Trachea, bronchus, lung cancers

            365.7

            3.1

            5.0

            74.6

            16.4

            1.0

            3.0

            2.6

            55.3

            10.8

            1.1

            17.7

            8.3

            25.9

            18.9

            117.7

            4.0

            0.2

            Melanoma of the skin

            88.5

            3.3

            4.3

            26.5

            5.7

            0.9

            0.4

            0.3

            26.5

            3.5

            0.3

            5.9

            1.9

            1.7

            5.0

            2.2

            0.1

            0.1

            Breast cancer

            1031.9

            28.3

            39.8

            226.5

            59.3

            7.2

            10.2

            13.6

            221.8

            32.6

            4.5

            68.5

            53.9

            109.0

            43.7

            102.1

            10.2

            0.5

            Cervix uteri cancer

            487.5

            43.3

            67.9

            16.1

            40.6

            9.2

            6.7

            5.6

            18.8

            12.6

            1.9

            22.5

            32.8

            146.7

            6.6

            45.0

            10.2

            0.8

            Corpus uteri cancer

            326.3

            4.6

            6.0

            46.0

            48.8

            8.6

            1.6

            1.3

            68.3

            17.9

            3.8

            43.6

            19.9

            11.7

            17.3

            17.4

            0.8

            0.1

            Ovary cancer

            221.3

            7.1

            12.2

            22.4

            13.2

            2.1

            2.1

            2.0

            39.4

            10.0

            1.2

            21.6

            18.1

            31.9

            8.4

            26.6

            2.9

            0.2

            Prostate cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Bladder cancer

            105.7

            3.6

            3.4

            14.9

            3.5

            0.4

            0.8

            3.7

            21.4

            2.7

            0.3

            4.4

            2.4

            28.9

            4.6

            9.7

            1.0

            0.0

            Lymphomas, multiple myeloma

            242.6

            10.2

            8.0

            32.2

            12.4

            2.3

            5.0

            4.0

            40.9

            6.9

            1.0

            7.3

            9.6

            74.9

            9.7

            15.2

            2.7

            0.1

            Leukaemia

            169.5

            5.9

            7.0

            14.7

            12.4

            2.9

            2.6

            3.8

            23.0

            4.9

            0.9

            9.0

            10.8

            24.9

            5.2

            39.4

            1.9

            0.1

            Other malignant neoplasms

            553.9

            44.2

            22.7

            63.6

            56.7

            11.7

            8.9

            8.9

            107.3

            25.3

            4.4

            46.5

            27.3

            31.7

            32.7

            56.1

            5.3

            0.3

            Age-standardised incidence rate per 100,000

            Mouth and oropharynx cancers

            5.1

            9.2

            12.6

            2.6

            2.4

            3.4

            4.6

            2.2

            2.7

            2.5

            2.5

            2.2

            5.7

            13.5

            2.2

            3.1

            7.7

            18.6

            Oesophagus cancer

            5.6

            5.2

            9.2

            1.3

            2.2

            1.5

            4.0

            1.1

            1.8

            1.0

            6.5

            1.5

            1.7

            8.0

            1.3

            13.4

            3.9

            1.8

            Stomach cancer

            12.8

            12.7

            10.5

            2.9

            10.7

            37.4

            10.9

            4.3

            7.3

            9.4

            12.4

            15.6

            4.4

            4.3

            14.9

            28.2

            10.1

            3.1

            Colon and rectum cancers

            17.3

            9.9

            10.2

            29.8

            14.1

            14.4

            9.4

            5.9

            29.2

            17.2

            8.6

            23.0

            14.7

            4.7

            26.7

            14.2

            6.3

            4.2

            Liver cancer

            6.8

            13.0

            12.0

            1.9

            5.2

            14.6

            3.1

            2.5

            3.1

            3.6

            2.3

            2.5

            7.5

            2.3

            6.6

            14.8

            4.2

            7.6

            Pancreas cancer

            3.6

            1.8

            3.5

            5.6

            5.0

            5.8

            1.9

            1.6

            6.0

            4.3

            3.6

            4.3

            2.4

            1.3

            5.8

            2.1

            0.9

            0.4

            Trachea, bronchus, lung cancers

            11.9

            3.5

            5.8

            30.5

            8.8

            4.4

            6.7

            5.6

            13.4

            9.9

            5.5

            7.6

            5.4

            5.3

            11.6

            16.0

            7.4

            8.4

            Melanoma of the skin

            2.9

            3.9

            5.3

            12.6

            2.9

            4.0

            0.8

            0.6

            7.9

            3.4

            1.4

            3.2

            1.2

            0.3

            4.2

            0.3

            0.2

            2.8

            Breast cancer

            34.2

            29.9

            41.6

            103.5

            29.7

            27.6

            22.5

            26.2

            64.1

            32.0

            21.2

            35.4

            30.7

            20.9

            38.6

            14.1

            18.5

            21.9

            Cervix uteri cancer

            16.6

            43.3

            69.8

            8.2

            19.8

            34.9

            15.0

            10.7

            6.2

            12.8

            9.0

            12.7

            18.4

            30.2

            6.0

            6.6

            18.0

            33.1

            Corpus uteri cancer

            10.8

            5.2

            6.8

            20.3

            24.5

            32.8

            3.7

            2.8

            18.4

            17.1

            18.1

            21.2

            11.5

            2.1

            13.3

            2.4

            1.5

            5.2

            Ovary cancer

            7.3

            6.8

            12.1

            9.8

            6.6

            7.9

            4.3

            3.7

            10.8

            9.9

            5.6

            11.2

            10.2

            6.2

            6.8

            3.6

            5.0

            6.3

            Prostate cancer

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            0.0

            Bladder cancer

            3.6

            4.1

            3.9

            6.0

            1.9

            1.8

            2.2

            7.9

            4.6

            2.4

            1.5

            1.9

            1.6

            5.7

            2.7

            1.5

            1.8

            0.6

            Lymphomas, multiple myeloma

            8.3

            9.1

            7.7

            13.8

            6.3

            9.2

            9.9

            7.2

            10.6

            7.0

            4.4

            4.0

            5.8

            15.7

            6.7

            2.2

            4.4

            4.8

            Leukaemia

            5.5

            5.6

            6.1

            6.6

            6.0

            9.1

            4.3

            5.9

            6.0

            5.2

            3.8

            5.2

            6.0

            3.9

            4.4

            5.8

            3.0

            2.9

            Other malignant neoplasms

            18.8

            45.9

            24.0

            30.2

            28.6

            44.0

            20.0

            17.2

            29.6

            24.9

            19.6

            25.8

            16.1

            6.1

            23.3

            10.7

            9.4

            129

            Table 16

            Ranking of the global cancer incidence by site, 2000

            site

            Number of death (000s)

            Proportion of total (%)

            Both sexes

              

            Trachea, bronchus, and lung

            1305.6

            12.7

            Stomach

            1045.0

            10.2

            Liver

            1031.9

            10.0

            Colon and rectum

            973.1

            9.5

            Breast

            626.4

            6.1

            Oesophagus

            550.2

            5.3

            Lymphomas and myeloma

            487.5

            4.7

            Mouth and oropharynx

            481.1

            4.7

            Prostate

            452.7

            4.4

            Leukaemia

            420.7

            4.1

            Cervix uteri

            382.9

            3.7

            Pancreas

            364.7

            3.5

            Bladder

            326.3

            3.2

            Ovary

            226.2

            2.2

            Corpus uteri

            221.3

            2.2

            Melanoma of the skin

            206.7

            2.0

            Males

              

            Trachea, bronchus, and lung

            939.9

            18.2

            Stomach

            589.3

            11.4

            Liver

            550.2

            10.6

            Colon and rectum

            527.8

            10.2

            Oesophagus

            422.0

            8.2

            Prostate

            286.5

            5.5

            Mouth and oropharynx

            277.2

            5.4

            Lymphomas and myeloma

            267.1

            5.2

            Leukaemia

            238.5

            4.6

            Bladder

            195.2

            3.8

            Pancreas

            119.3

            2.3

            Melanoma of the skin

            118.2

            2.3

            Females

              

            Breast

            1031.9

            20.1

            Trachea, bronchus, and lung

            517.3

            10.1

            Stomach

            487.5

            9.5

            Colon and rectum

            383.9

            7.5

            Cervix uteri

            365.7

            7.1

            Liver

            326.3

            6.4

            Lymphomas and myeloma

            242.6

            4.7

            Oesophagus

            221.3

            4.3

            Ovary

            204.4

            4.0

            Leukaemia

            169.5

            3.3

            Pancreas

            166.2

            3.2

            Mouth and oropharynx

            153.6

            3.0

            Corpus uteri

            106.9

            2.1

            Bladder

            105.7

            2.1

            Melanoma of the skin

            88.5

            1.7

            Table 17

            Ranking of the selected regional cancer incidence by site, 2000

            WHO sub region

            AfrE (high child and adult mortality)

            EurA (very low child and adult mortality)

            SearB (low child and adult mortality)

            site

            Number of Proportion

            site

            Number of Proportion

            site

            Number of Proportion

             

            (000s)

            (%)

             

            (000s)

            (%)

             

            (000s)

            (%)

            Both sexes

                    

            Cervix uteri

            67.9

            16.4

            Trachea, bronchus, and lung

            264.7

            15.4

            Trachea, bronchus, and lung

            53.9

            12.3

            Liver

            39.8

            9.6

            Colon and rectum

            227.3

            13.2

            Liver

            51.4

            11.7

            Breast

            34.7

            8.3

            Breast

            221.8

            12.9

            Breast

            44.3

            10.1

            Mouth and oropharynx

            28.2

            6.8

            Prostate

            139.1

            8.1

            Colon and rectum

            40.3

            9.2

            Oesophagus

            27.9

            6.7

            Stomach

            86.5

            5.0

            Mouth and oropharynx

            32.8

            7.5

            Lymphomas and myeloma

            26.6

            6.4

            Lymphomas and myeloma

            80.2

            4.7

            Lymphomas and myeloma

            25.4

            5.8

            Prostate

            21.2

            5.1

            Pancreas

            79.6

            4.6

            Cervix uteri

            22.9

            5.2

            Stomach

            20.3

            4.9

            Liver

            68.3

            4.0

            Leukaemia

            21.5

            4.9

            Colon and rectum

            19.4

            4.7

            Bladder

            55.5

            3.2

            Stomach

            19.9

            4.5

            Trachea, bronchus, and lung

            16.2

            3.9

            Leukaemia

            49.1

            2.8

            Ovary

            18.1

            4.1

            Leukaemia

            14.8

            3.6

            Oesophagus

            48.6

            2.8

            Prostate

            15.3

            3.5

            Ovary

            12.2

            2.9

            Ovary

            40.1

            2.3

            Pancreas

            13.4

            3.1

            Bladder

            10.7

            2.6

            Mouth and oropharynx

            39.4

            2.3

            Bladder

            10.1

            2.3

            Melanoma of the skin

            7.7

            1.8

            Corpus uteri

            38.6

            2.2

            Oesophagus

            7.2

            1.7

            Pancreas

            6.0

            1.4

            Melanoma of the skin

            31.2

            1.8

            Corpus uteri

            6.2

            1.4

            Corpus uteri

            5.4

            1.3

            Cervix uteri

            18.8

            1.1

            Melanoma of the skin

            3.1

            0.7

            Males

                    

            Liver

            28.2

            14.8

            Trachea, bronchus, and lung

            172.0

            19.6

            Trachea, bronchus, and lung

            43.1

            22.0

            Prostate

            23.6

            12.4

            Colon and rectum

            139.1

            15.9

            Liver

            28.6

            14.6

            Mouth and oropharynx

            18.6

            9.8

            Prostate

            133.8

            15.3

            Colon and rectum

            21.4

            11.0

            Lymphomas and myeloma

            16.5

            8.7

            Stomach

            65.1

            7.4

            Mouth and oropharynx

            16.0

            8.2

            Oesophagus

            14.1

            7.4

            Lymphomas and myeloma

            45.6

            5.2

            Lymphomas and myeloma

            13.4

            6.9

            Stomach

            12.0

            6.3

            Bladder

            39.3

            4.5

            Prostate

            13.3

            6.8

            Trachea, bronchus, and lung

            10.9

            5.8

            Pancreas

            28.7

            3.3

            Leukaemia

            10.7

            5.5

            Colon and rectum

            9.8

            5.2

            Liver

            27.4

            3.1

            Stomach

            8.6

            4.4

            Leukaemia

            9.2

            4.9

            Oesophagus

            26.1

            3.0

            Bladder

            7.7

            3.9

            Bladder

            7.3

            3.8

            Leukaemia

            25.6

            2.9

            Pancreas

            3.8

            1.9

            Pancreas

            3.4

            1.8

            Mouth and oropharynx

            22.8

            2.6

            Oesophagus

            3.7

            1.9

            Melanoma of the skin

            2.8

            1.5

            Melanoma of the skin

            22.6

            2.6

            Melanoma of the skin

            1.2

            0.6

            Females

                    

            Cervix uteri

            67.9

            30.2

            Breast

            221.8

            26.2

            Breast

            53.9

            22.3

            Breast

            39.8

            17.7

            Colon and rectum

            131.0

            15.4

            Cervix uteri

            32.8

            13.6

            Liver

            12.2

            5.4

            Trachea, bronchus, and lung

            68.3

            8.1

            Colon and rectum

            22.8

            9.4

            Stomach

            11.4

            5.1

            Stomach

            55.3

            6.5

            Liver

            19.9

            8.2

            Mouth and oropharynx

            11.1

            4.9

            Lymphomas and myeloma

            40.9

            4.8

            Ovary

            18.1

            7.5

            Ovary

            8.4

            3.7

            Pancreas

            39.4

            4.6

            Trachea, bronchus, and lung

            11.7

            4.8

            Oesophagus

            8.2

            3.7

            Ovary

            33.9

            4.0

            Leukaemia

            10.8

            4.5

            Colon and rectum

            8.0

            3.6

            Leukaemia

            28.1

            3.3

            Lymphomas and myeloma

            9.6

            4.0

            Lymphomas and myeloma

            7.2

            3.2

            Corpus uteri

            26.5

            3.1

            Mouth and oropharynx

            9.4

            3.9

            Leukaemia

            7.0

            3.1

            Liver

            23.0

            2.7

            Stomach

            8.3

            3.4

            Trachea, bronchus, and lung

            6.0

            2.7

            Bladder

            21.4

            2.5

            Corpus uteri

            6.7

            2.8

            Melanoma of the skin

            5.0

            2.2

            Cervix uteri

            18.8

            2.2

            Pancreas

            3.6

            1.5

            Pancreas

            4.3

            1.9

            Oesophagus

            14.0

            1.7

            Oesophagus

            2.5

            1.0

            Bladder

            3.4

            1.5

            Melanoma of the skin

            9.9

            1.2

            Bladder

            2.4

            1.0

            Corpus uteri

            2.6

            1.2

            Mouth and oropharynx

            8.4

            1.0

            Melanoma of the skin

            1.9

            0.8

            Discussion

            Various attempts have been made to quantify the global burden of cancer and to estimate site-specific cancer mortality and morbidity [1, 1215]. More recently, the efforts made by the International Agency for Research on Cancer (IARC) have led to the Globocan 2000 estimates, which has also used information on incidence and survival to estimate cancer death for the year 2000 from various sources including cancer registries [12, 13]. The analyses reported here have built extensively on the IARC work to synthesis and estimate cancer mortality and incidence distributions by site for all regions of the world. Compared to the estimates of the Globocan 2000, the GBD 2000 estimates for global cancer mortality and incidence are 11% and 3% higher, respectively. Although the overall difference in terms of proportion is small, the absolute difference between the two estimates remains relatively large. This difference is predominantly due to a substantially large difference in the AFRO, EMRO, and SEARO regions.

            Some researchers suggest that model-based estimates of cancer mortality in GBD 1990 bear little relation to the actual profile of cancer recorded at the regional registries [1, 16]. The proposed approach here is substantially different from the previous estimates and, although broader cause of death to estimate cancer envelope is still based on cause of death models in some countries, majority of the data sources of cause of death is now vital registration and/or sampling data. The total number of mortality from cancer is not extrapolated by model alone and the survival model was used to estimate the distribution of death by site, not the actual magnitude of cancer mortality in regions where no or little data on detailed cause of death is available. The model estimates were consistent with mortality distribution of vital records and the Globocan 2000 [7]. Therefore, the major source of discrepancy is not the estimated cancer mortality distribution but the overall mortality envelope applied to each region.

            The Globocan 2000 estimates are based on either cancer incidence data from cancer registries in the region (with a survival model used to estimate deaths) or on mortality data collected by regional cancer registries or other sources. Both these sources of data are likely to be incomplete and to result in underestimation of cancer deaths. On the other hand, the GBD 2000 starts with data on the level of all-cause mortality, and uses all available data on cause of death and cause of death models where such data is not available, to estimate the distribution of major cause groups, including cancers. For regions with insufficient vital registration such as AFRO and SEARO regions, this process significantly increases the mortality envelope for these two broad cause categories. It is possible that these methods result in an overestimate of total cancer deaths in some regions, and continuos efforts are being made to obtain additional data from these regions in order to check the validity of these estimates, and where appropriate, to improve them.

            Although cancer is still a fatal disease in many developing countries[2], there is a growing evidence that cancer survival even in developing countries is continuously improving [3, 4]. The present study suggests that in all regions mortality was much higher in males while incidence were almost the same due to relatively good prognosis of breast and cervix cancers compared to common cancers among males such as liver and lung cancers. Due to the differences in survival by region, incidence-to-mortality rate ratios were higher in developed in which increasing disability among cancer survivors is warranted [1719]. It is suggested that data on incidence as well as mortality are necessary to understand the magnitude and trends of cancer problems and to evaluate the interventions against cancer in the context of prevention [1]. When setting priorities, interventions against cancers need to be compared with other health interventions which aims at reducing only morbidity [5, 20].

            GBD 2000 employs a composite measure of disease burden in terms of disability-adjusted life years (DALYs) which consist of years lived with disability (morbidity) and years of life lost (mortality) [5]. As a part of this exercise, we have estimated both mortality and incidence of cancers by site. We will further estimate the years lived with disability to derive cancer burden in DALYs once weights assigned to disabling conditions are revised based on the estimates from the on-going population-based surveys from more than 70 countries [21].

            The presents study also suggests that there is a significant variation in the distribution of cancer mortality and incidence by region depending on age and population structure, distribution of risk factors, and opportunity of detection and treatment [2, 22]. However, the frequent cancers such as lung, liver and cervical cancers are potentially preventable [23]. For example, Parkin has estimated that there would have been 23% fewer cases of cancers in the developing world in 1990, if infections such as hepatitis B and C virus and human papilloma virus had been prevented [24]. Another estimate suggests that 230,000 deaths (more than 4% of all cancer deaths) from liver cancer could have been avoided with only immunisations against hepatitis B [13]. Smoking was estimated to be responsible for another 20% of all cancer deaths, all of which are preventable [13].

            Given a high incidence of cancers which are potentially preventable in both developed and developing countries, the role of primary prevention, early detection as well as treatment should be evaluated more carefully [2]. Cost-effectiveness analysis plays a role for this purpose, which should be generalisable and comparable across various interventions including both currently delivered and potentially feasible ones [20]. Estimating the magnitude of cancer mortality and incidence is a key input for setting research and intervention priorities. Combined with costs of each intervention, mortality and incidence estimates provide a basis for effectiveness calculation in cost-effectiveness analysis of cancer control programmes.

            Conclusions

            Based on the algorithm to estimate region-specific overall cancer mortality, and site-specific survival, death distributions, and incidence as a part of GBD 2000 study, it is estimated that cancers accounted for over 7 million deaths (13% of total mortality) and more than 10 million new cases occurred world wide in 2000. Cancer mortality and incidence in developing countries already accounted for over 60% and about half of the global total, respectively. Although there was a significant variation in the distribution of cancer mortality and incidence by region, many of the common cancers are potentially preventable. Magnitude of cancer burden estimation by taking into account both mortality and morbidity is an essential information to set research priorities and policy formulation and can be used for setting cancer control priorities when combined with data on costs of interventions.

            Author's Contributions

            KS conceived of the study, analysed the data, and drafted the manuscript. CDM participated in the design of the study, and performed statistical analyses. CBP carried out the data compilation and drafted the manuscript. ADL participated in the design of the study and in the mortality analysis. CJLM conceived of the study and participated in its design and coordination. All authors read and approved the final manuscript.

            Declarations

            Acknowledgements

            Many people are contributing to the analysis of cancer incidence and mortality for the GBD 2000 both inside and outside WHO. We wish to particularly acknowledge the contributions of staff within the Global Program on Evidence for Health Policy who have contributed to the estimation of total cancer deaths for the year 2000: Majid Ezzati, Brodie Ferguson, Mie Inoue, Rafael Lozano, Doris Ma Fat, Chalapati Rao, Joshua Salomon, and Niels Tomijima. We also thank staff of the International Agency for Research on Cancer (IARC) for provision of data, advice on survival analyses carried out by IARC and methods used to estimate cancer incidence and mortality for GLOBOCAN 2000, particularly Max Parkin, Jacques Ferlay, Paola Pisani and Fred Bray.

            Authors’ Affiliations

            (1)
            Global Program on Evidence for Health Policy, World Health Organization
            (2)
            Family and Community Health/Child and Adolescent Health and Development, World Health Organization
            (3)
            Executive Director, Evidence and Information for Policy, World Health Organization

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            25. Pre-publication history

              1. The pre-publication history for this paper can be accessed here:http://​www.​biomedcentral.​com/​1471-2407/​2/​37/​prepub

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            © Shibuya et al 2002

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