In 2015, cancer caused over 8.7 million deaths globally and was the second leading cause of death behind cardiovascular diseases.¹ Even though these impressive numbers are testimony that the “war on cancer” has not been won, recent developments in personalized medicine and novel treatment approaches like immunotherapy have raised hope of significantly improving cancer survival.^2-4 These expectations for patients with cancer in high-income countries contrast with the challenge of making basic diagnostic and treatment options widely available in low-resource settings.⁵ Both the equity and affordability of cancer care from individual and societal perspectives are increasingly being questioned.⁶ Survival rates between and within high-income countries differ for reasons such as variation in education, access to specialized care, effective treatment, and insurance status.^7-9 The full potential of cancer prevention for reducing incidence and mortality is far from being realized, and efforts are especially lagging in low-income countries.¹⁰ Awareness of this “cancer divide,” with substantially worse outcomes and a high burden in socioeconomically disadvantaged populations, has led to a focus on global oncology by the international health community.^4,5,10 This is reflected in the third Sustainable Development Goal (SDG) to “by 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”¹¹ Estimates of the burden of cancer are produced annually as part of the Global Burden of Disease (GBD) study providing a unique means of tracking progress in closing this divide. Here, we present results of the GBD 2015 study for 32 cancer groups covering cancer incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for 195 countries or territories from 1990 to 2015 for both sexes across age groups.

Cancer is now widely recognized as a global problem that unfortunately lacks a global solution. The latest United Nations high-level meeting on noncommunicable diseases (NCDs) exemplified this conundrum.¹ Despite global commitment to reducing the risk of and disability from NCDs, including cancer, implementation of known solutions is inadequate to reach the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases^2,3 (25% reduction in premature mortality from NCDs by 2025) and the third Sustainable Development Goal (by 2030 reduce by one-third premature mortality from NCDs through prevention and treatment, and promote mental health and well-being).⁴ To reduce cancer burden, identifying the scope of the problem and mapping out implementation of solutions is best done in National Cancer Control Plans (NCCPs). However, a recent review showed that only 29% of low-income countries had a NCCP, and even if NCCPs existed, cost, financing, monitoring, and expansion of information systems was often inadequate. Many highly effective prevention and treatment strategies exist for cancer. However, they are often very specific (eg, vaccination for human papillomavirus and hepatitis B virus for prevention of cervical and liver cancer, or tyrosine kinase inhibitors for cancers with targetable mutations). Effective NCCPs therefore require detailed knowledge about the local burden of cancer and associated risk factors. We herein present results from the Global Burden of Disease (GBD) 2017 study describing cancer incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 195 countries from 1990 through 2017, which can inform cancer control through policy, resource allocation, and health system planning.

Liver cancer was the fourth leading cause of cancer death in 2015 after lung, colorectal, and stomach cancer.¹ The most common type of primary liver cancer globally is hepatocellular carcinoma, followed by cholangiocarcinoma.² Liver cancer burden varies markedly by sex and geographic region due to risk factor exposure.³ Major risk factors include infections (hepatitis B virus [HBV], hepatitis C virus [HCV], liver flukes in endemic areas), behavioral factors (alcohol, tobacco), metabolic factors (excess body fatness), and aflatoxins.^4,5

Multiple myeloma (MM) is a clonal plasma cell neoplasm with substantial morbidity and mortality, characterized by end organ damage—renal impairment, hypercalcemia, lytic bony lesions, and anemia. With the development of better therapies, myeloma has changed from an untreatable ailment to one that is still not curable but treatable with mostly outpatient therapy. Myeloma treatment has improved substantially over the past decade. The first major advance was the development of autologous stem cell transplant (ASCT) in the 1980s and 1990s.¹ So-called novel agents were first developed in the late 1990s and early 2000s—beginning with the “IMIDs” (thalidomide and lenalidomide) and followed by the proteasome inhibitors (PIs).² More recently, monoclonal antibodies, such as daratumumab and elotuzumab, and histone deacetylating agents, such as panobinostat, have also been approved by the US Food and Drug Administration (FDA).²

Brain and CNS cancers (collectively referred to as CNS cancers) are a source of mortality and morbidity for which diagnosis and treatment require extensive resource allocation and sophisticated diagnostic and therapeutic technology. Previous epidemiological studies are limited to specific geographical regions or time periods, making them difficult to compare on a global scale. In this analysis, we aimed to provide a comparable and comprehensive estimation of the global burden of brain cancer between 1990 and 2016. We report means and 95% uncertainty intervals (UIs) for incidence, mortality, and disability-adjusted life-years (DALYs) estimates for CNS cancers (according to the International Classification of Diseases tenth revision: malignant neoplasm of meninges, malignant neoplasm of brain, and malignant neoplasm of spinal cord, cranial nerves, and other parts of CNS) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. Data sources include vital registration and cancer registry data. Mortality was modelled using an ensemble model approach. Incidence was estimated by dividing the final mortality estimates by mortality to incidence ratios. DALYs were estimated by summing years of life lost and years lived with disability. Locations were grouped into quintiles based on the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. In 2016, there were 330 000 (95% UI 299 000 to 349 000) incident cases of CNS cancer and 227 000 (205 000 to 241 000) deaths globally, and age-standardised incidence rates of CNS cancer increased globally by 17·3% (95% UI 11·4 to 26·9) between 1990 and 2016 (2016 age-standardised incidence rate 4·63 per 100 000 person-years [4·17 to 4·90]). The highest age-standardised incidence rate was in the highest quintile of SDI (6·91 [5·71 to 7·53]). Age-standardised incidence rates increased with each SDI quintile. East Asia was the region with the most incident cases of CNS cancer for both sexes in 2016 (108 000 [95% UI 98 000 to 122 000]), followed by western Europe (49 000 [37 000 to 54 000]), and south Asia (31 000 [29 000 to 37 000]). The top three countries with the highest number of incident cases were China, the USA, and India. CNS cancer was responsible for 7·7 million (95% UI 6·9 to 8·3) DALYs globally, a non-significant change in age-standardised DALY rate of -10·0% (-16·4 to 2·6) between 1990 and 2016. The age-standardised DALY rate decreased in the high SDI quintile (-10·0% [-27·1 to -0·1]) and high-middle SDI quintile (-10·5% [-18·4 to -1·4]) over time but increased in the low SDI quintile (22·5% [11·2 to 50·5]). CNS cancer is responsible for substantial morbidity and mortality worldwide, and incidence increased between 1990 and 2016. Significant geographical and regional variation in the incidence of CNS cancer might be reflective of differences in diagnoses and reporting practices or unknown environmental and genetic risk factors. Future efforts are needed to analyse CNS cancer burden by subtype. Bill & Melinda Gates Foundation.