article · The Lancet Oncology
This study addressed the lack of comprehensive global estimates for cancer burden in adolescents and young adults (aged 15-39 years), a distinct subgroup with unique needs. Using the Global Burden of Disease Study 2019 methodology, researchers analysed international mortality data, cancer registries, and modelled survival to calculate incidence, prevalence, years lived with disability (YLDs), and years of life lost (YLLs), culminating in disability-adjusted life-years (DALYs). The findings revealed 1.19 million incident cancer cases and 396,000 deaths globally in this age group in 2019. Adolescent and young adult cancers contributed 23.5 million DALYs, predominantly from YLLs, making cancer the fourth leading cause of death and tenth leading cause of DALYs for this population worldwide.
This research highlights the significant global health impact of cancer on adolescents and young adults, a group often overlooked in cancer statistics. Understanding these patterns, especially across different economic settings, is crucial for developing targeted prevention, treatment, and support programmes to reduce premature deaths and long-term disability in this age group.
This research provides foundational data to inform global and country-level cancer control efforts, guiding public health organisations and policymakers in developing targeted prevention, treatment, and support programmes for adolescents and young adults. It is early-stage research contributing to strategic planning rather than a direct commercial application.
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BACKGROUND: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. METHODS: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. FINDINGS: There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. INTERPRETATION: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. FUNDING: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.
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DOI: 10.1016/s1470-2045(21)00581-7
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