Global, regional, and national lifetime probabilities of developing cancer in 2020

Graphical abstract

Abstract

The lifetime risk of cancer is a measure of the cumulative risk of cancer over a specific age range and has a clear, intuitive appeal. However, comparative assessments of cancer-specific risk across populations are limited. We used the adjusted for multiple primaries method to estimate the lifetime risk of cancer from the obtained data from GLOBOCAN for 185 countries/regions for the year 2020, alongside all-cause mortality and population data from the United Nations. The estimated global lifetime risk of cancer from birth to death was 25.10% (95% confidence interval (CI): 25.08%–25.11%) in 2020; the risk was 26.27% (95% CI: 26.24%–26.30%) in men and 23.96% (95% CI: 23.93%–23.98%) in women. Significant differences were observed in the risks between countries/regions within world areas and by the human development level. The lifetime risk of cancer was 38.48%, 25.38%, 11.36%, and 10.34% in countries/regions with very high, high, medium, and low Human Development Index, respectively. Globally, prostate and breast cancers were associated with the greatest lifetime risks among men and women (4.65% and 5.90%, respectively). The lifetime risk of cancer decreased with age, with a remaining risk of 12.61% (95% CI: 12.60%–12.63%) from the age of 70 years. The lifetime risk from birth to death translates to approximately one in four persons developing cancer, with men and women having similar risk levels. The identified age-specific variations in cancer risk at the population level can provide crucial information to support targeted cancer prevention and health system planning.

1. Introduction

Cancer is a leading cause of death globally, accounting for approximately 10 million deaths in 2020 and escalating public health and economic issue [1]. Having population-level indicators that are intuitive and instructive to the global cancer burden is crucial. The lifetime risk of developing cancer is a measure of the cumulative probability that a person has been diagnosed with cancer during his or her remaining lifespan (usually from birth to a defined upper age limit), assuming an absence of competing causes of death [2].

The lifetime risk of developing cancer, such as the index of incidence or mortality, is another measure of how widespread cancer is globally, and this index is useful for estimating the cumulative risk of developing cancer during an individual’s remaining lifespan. However, this index has been calculated in a limited number of populations. Thus, herein, we aimed to estimate the lifetime risk of developing cancer at the regional, national, and global levels.

In this paper, we quantify the prospects of developing cancer during a certain lifespan using a method that adjusts for competing causes of death, life expectancy, and multiple primaries to facilitate cancer planning globally [3]. We present and interpret the overall lifetime risk of developing cancer, as well as individual cancer types at the global, regional, and national level for the year 2020 using the GLOBOCAN cancer incidence and mortality estimates from the International Agency for Research on Cancer [4].

2. Methods

2.1. Data sources

The number of new cases and deaths of all cancers combined (excluding non-melanoma skin cancer (NMSC)) and that of 36 major cancer types were obtained from GLOBOCAN 2020, according to sex and age group (0–4, 5–9, …, 65–69, 70–84, and 85+) [4], [5]. The 36 cancer types were those classified using the tenth edition of the International Classification of Diseases (ICD-10), which formed the basis of the GLOBOCAN cancer-specific estimates. Table S1 (online) presents the cancer dictionary and ICD-10 codes. The population and all-cause mortality data were obtained from the United Nations (World Population Prospects 2019) [6]. We classified the world into 20 predefined geographic areas [4] and divided these areas into quartiles according to the Human Development Index (HDI) released by the United Nations Development Programme [7]. The HDI is a comprehensive indicator that captures human advancement and reflects the well-being of countries/regions by measuring three human development dimensions: health, education, and income. The Ethical Committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College waived the need for ethical approval or informed consent for this study.

2.2. Statistical methods

The “adjusted for multiple primaries (AMP)” method [3], [8] was used to calculate the lifetime risk, which considers deaths from other causes and corrects for the inclusion of multiple primary cancers in the incidence rates. Cancer incidence, cancer mortality, and all-cause mortality rates by 5-year age group were used to estimate the lifetime risk of cancer according to sex at different age spans, which represents the probability of being diagnosed with cancer from that age onwards:

$$S={\int }_0^{\infty }{\lambda }_{\mathrm{c}}\left(a\right)S_0\left(a\right)\mathrm{d}\mathrm{a}=\sum _{i=1}^f\frac{R_i}{R_i+M_i-D_i}{S}_0\left(a_i\right)\times \left(1-\mathrm{e}\mathrm{x}\mathrm{p}\left(-\frac{W_{\mathrm{i}}}{N_{\mathrm{i}}}\left(R_i+M_i-D_i\right)\right)\right),$$ (1)

where for age group i: S indicates the probability of being diagnosed with cancer; M_i indicates the annual number of deaths (all-cause mortality); D_i indicates the annual number of cancer-related deaths (cancer mortality); R_i indicates the annual number of cancer cases; N_i indicates the population; λ_c indicates the cancer incidence rate; $S_0^{}\left(a_i\right)$ denotes the probability of being alive and cancer free at age a_i; W_i denotes the width of the age group i.

The confidence interval (CI) of lifetime risk was estimated based on the binomial method. Supplementary materials provide more details on the methods and the derivation of variance for the lifetime risk of developing cancer.

We calculated the lifetime risks of developing cancer overall and by the major 36 cancer types and sex. Estimations were made on the global, regional, and national levels by HDI quartiles and different age intervals. Sensitivity analyses compared the lifetime risks of developing cancer with the cumulative risks for the age group of 0–74 years, which is a traditional indicator of cancer burden that can be calculated directly as a surrogate of the cumulative risk that remained unadjusted for competing risks from other causes and life expectancy (Supplementary materials provided the detailed methods). This study defined “lifetime” as a specific period and is not necessarily from birth and calculated the cumulative probability from some specific points in time, such as 40, 50, 60, and 70 years, to death. We performed all analyses with SAS software (version 9.4, SAS Institute, Cary, USA).

3. Results

3.1. Global, regional, and national lifetime risks of developing cancer

Table 1 shows the probability of developing cancer by world areas for the 36 cancer types, overall, and sex. The estimated global lifetime risk of being diagnosed with cancer (excluding NMSC) from birth to death was approximately 25.10% in 2020 (95% CI: 25.08%–25.11%), and the risk was 26.27% (95% CI: 26.24%–26.30%) in men and 23.96% (95% CI: 23.93%–23.98%) in women, which corresponds closely to 1 in 4 persons, with large regional and national differences. Among the 20 world areas, Australia/New Zealand had the highest lifetime risk of incidence (47.68%, 95% CI: 47.38%–47.98%), followed by Northern Europe (44.63%, 95% CI: 44.48%–44.77%) and Western Europe (44.08%, 95% CI: 43.98%–44.18%), while Western Africa had the lowest risk (8.59%, 95% CI: 8.49%–8.69%) (Table 1 and Table S2 online). Countries/regions with very high HDI had the greatest risk (38.48%, 95% CI: 38.44%–38.52%), followed by the high (25.38%, 95% CI: 25.35%–25.41%), medium (11.36%, 95% CI: 11.33%–11.39%), and low HDI countries/regions (10.34%, 95% CI: 10.27%–10.40%) when the risks were compared across the four-tier HDI groups. The highest estimated risk of developing cancer at the national level was observed in Ireland at 49.73% (95% CI: 48.90%–50.56%), with similarly high risks observed in Japan, Australia, the Netherlands, Norway, Denmark, France, New Zealand, Belgium, and the United Kingdom. The three countries with the lowest lifetime risk were the Central African Republic (<7%), Niger, and Lesotho (Table 1, Fig. 1, Table S3 online).

Table 1.

Lifetime risks (%) of developing cancer within selected age intervals by sex in 2020.^a

Population	Birth to death	40 years to death	50 years to death	60 years to death	70 years to death
Both sexes
World	25.10 (25.08–25.11)	23.95 (23.92–23.98)	22.27 (22.23–22.30)	18.68 (18.64–18.71)	12.61 (12.58–12.64)
Very high HDI	38.48 (38.44–38.52)	36.80 (36.73–36.87)	34.50 (34.43–34.56)	29.21 (29.14–29.28)	19.97 (19.91–20.04)
High HDI	25.38 (25.35–25.41)	24.11 (24.06–24.17)	22.25 (22.20–22.30)	18.39 (18.34–18.44)	12.13 (12.08–12.18)
Medium HDI	11.36 (11.33–11.39)	10.53 (10.48–10.58)	9.38 (9.32–9.43)	7.28 (7.23–7.33)	4.27 (4.22–4.31)
Low HDI	10.34 (10.27–10.40)	9.44 (9.34–9.55)	8.34 (8.23–8.44)	6.37 (6.27–6.47)	3.62 (3.53–3.72)
Eastern Africa	12.29 (12.19–12.39)	11.15 (10.98–11.32)	9.83 (9.66–10.00)	7.56 (7.40–7.73)	4.30 (4.14–4.45)
Middle Africa	9.52 (9.37–9.67)	8.70 (8.45–8.95)	7.65 (7.40–7.89)	5.92 (5.67–6.16)	3.39 (3.16–3.62)
Northern Africa	17.42 (17.31–17.53)	16.41 (16.22–16.61)	14.92 (14.73–15.11)	11.95 (11.76–12.13)	7.69 (7.51–7.86)
Southern Africa	16.64 (16.40–16.88)	15.33 (14.93–15.73)	13.71 (13.31–14.11)	10.71 (10.32–11.11)	6.32 (5.95–6.70)
Western Africa	8.59 (8.49–8.69)	7.84 (7.68–8.00)	6.86 (6.69–7.02)	5.08 (4.92–5.24)	2.68 (2.53–2.83)
Eastern Asia	32.35 (32.31–32.39)	30.98 (30.91–31.05)	28.84 (28.77–28.91)	24.41 (24.35–24.48)	16.96 (16.89–17.02)
South-Central Asia	11.35 (11.32–11.38)	10.54 (10.49–10.59)	9.42 (9.37–9.47)	7.35 (7.30–7.40)	4.34 (4.29–4.39)
South-Eastern Asia	18.73 (18.67–18.79)	17.62 (17.51–17.73)	15.98 (15.88–16.09)	12.88 (12.78–12.99)	8.40 (8.30–8.50)
Western Asia	24.19 (24.07–24.31)	23.08 (22.88–23.29)	21.61 (21.41–21.82)	18.31 (18.11–18.51)	12.31 (12.11–12.50)
Eastern Europe	27.86 (27.79–27.93)	26.34 (26.20–26.49)	24.18 (24.04–24.32)	19.27 (19.14–19.41)	11.27 (11.15–11.40)
Northern Europe	44.63 (44.48–44.77)	42.74 (42.46–43.03)	40.27 (39.99–40.55)	34.56 (34.29–34.83)	23.94 (23.69–24.19)
Southern Europe	40.61 (40.51–40.72)	38.64 (38.43–38.86)	36.13 (35.92–36.34)	30.37 (30.16–30.57)	20.73 (20.55–20.92)
Western Europe	44.08 (43.98–44.18)	42.02 (41.82–42.22)	39.30 (39.11–39.50)	33.20 (33.01–33.39)	22.54 (22.37–22.71)
Caribbean	25.96 (25.72–26.20)	24.92 (24.49–25.35)	23.44 (23.01–23.86)	20.01 (19.60–20.43)	14.05 (13.66–14.44)
Central America	18.53 (18.42–18.65)	17.28 (17.07–17.48)	16.00 (15.79–16.20)	13.56 (13.36–13.76)	9.47 (9.29–9.66)
South America	27.93 (27.85–28.01)	26.56 (26.41–26.70)	24.88 (24.74–25.02)	21.29 (21.15–21.43)	15.05 (14.92–15.19)
Northern America	39.78 (39.70–39.86)	37.83 (37.68–37.98)	35.10 (34.95–35.25)	29.08 (28.93–29.23)	19.27 (19.13–19.40)
Australia/New Zealand	47.68 (47.38–47.98)	45.63 (45.06–46.21)	42.73 (42.16–43.29)	36.44 (35.89–36.99)	25.52 (25.01–26.03)
Melanesia	17.20 (16.51–17.90)	15.82 (14.68–16.95)	14.05 (12.92–15.18)	10.75 (9.64–11.86)	5.76 (4.71–6.82)
Micronesia/Polynesia	32.48 (29.98–34.97)	31.46 (27.13–35.78)	29.55 (25.25–33.84)	25.04 (20.81–29.26)	16.69 (12.69–20.70)
Men
World	26.27 (26.24–26.30)	25.43 (25.37–25.48)	24.19 (24.14–24.24)	20.70 (20.64–20.75)	13.80 (13.75–13.85)
Very high HDI	41.10 (41.04–41.16)	39.87 (39.76–39.98)	38.29 (38.18–38.40)	33.09 (32.98–33.19)	22.23 (22.13–22.33)
High HDI	26.73 (26.68–26.78)	25.84 (25.75–25.92)	24.40 (24.32–24.49)	20.52 (20.44–20.60)	13.29 (13.21–13.37)
Medium HDI	11.05 (11.01–11.10)	10.36 (10.28–10.43)	9.47 (9.39–9.54)	7.58 (7.50–7.65)	4.49 (4.42–4.56)
Low HDI	9.15 (9.04–9.25)	8.55 (8.39–8.71)	7.89 (7.74–8.05)	6.40 (6.24–6.56)	3.79 (3.64–3.94)
Eastern Africa	10.46 (10.30–10.63)	9.67 (9.41–9.93)	8.96 (8.70–9.22)	7.45 (7.19–7.70)	4.58 (4.33–4.82)
Middle Africa	9.20 (8.93–9.47)	8.67 (8.26–9.08)	8.07 (7.66–8.48)	6.81 (6.41–7.22)	4.17 (3.78–4.56)
Northern Africa	17.78 (17.59–17.96)	17.08 (16.79–17.38)	15.99 (15.69–16.29)	13.16 (12.87–13.45)	8.55 (8.27–8.82)
Southern Africa	15.58 (15.13–16.03)	14.70 (14.01–15.39)	13.63 (12.94–14.32)	10.85 (10.17–11.54)	6.10 (5.45–6.76)
Western Africa	7.54 (7.38–7.70)	7.04 (6.80–7.29)	6.47 (6.23–6.72)	5.13 (4.89–5.38)	2.88 (2.64–3.11)
Eastern Asia	35.13 (35.06–35.20)	34.20 (34.09–34.31)	32.53 (32.43–32.64)	27.94 (27.83–28.05)	19.02 (18.92–19.12)
South-Central Asia	11.22 (11.18–11.27)	10.53 (10.46–10.61)	9.65 (9.57–9.72)	7.75 (7.67–7.82)	4.62 (4.55–4.70)
South-Eastern Asia	18.55 (18.45–18.66)	17.72 (17.55–17.90)	16.48 (16.30–16.65)	13.59 (13.42–13.76)	8.80 (8.64–8.96)
Western Asia	26.69 (26.48–26.91)	25.90 (25.56–26.25)	24.90 (24.56–25.24)	21.73 (21.39–22.07)	14.58 (14.25–14.91)
Eastern Europe	28.99 (28.85–29.12)	27.92 (27.67–28.17)	26.32 (26.07–26.57)	21.32 (21.08–21.57)	11.93 (11.70–12.15)
Northern Europe	47.19 (46.96–47.43)	45.80 (45.37–46.22)	44.10 (43.68–44.53)	38.61 (38.19–39.02)	26.50 (26.12–26.89)
Southern Europe	44.86 (44.69–45.04)	43.34 (43.01–43.68)	41.55 (41.22–41.88)	35.53 (35.21–35.85)	23.61 (23.31–23.90)
Western Europe	47.88 (47.71–48.04)	46.25 (45.94–46.56)	44.31 (44.00–44.61)	38.20 (37.91–38.50)	25.47 (25.19–25.74)
Caribbean	27.66 (27.27–28.05)	26.99 (26.31–27.67)	25.97 (25.30–26.65)	22.48 (21.82–23.14)	15.42 (14.79–16.05)
Central America	18.47 (18.28–18.66)	17.51 (17.19–17.83)	16.83 (16.52–17.15)	14.88 (14.57–15.19)	10.47 (10.18–10.77)
South America	28.35 (28.22–28.49)	27.37 (27.14–27.60)	26.33 (26.10–26.56)	23.07 (22.85–23.30)	16.04 (15.82–16.25)
Northern America	40.14 (40.02–40.27)	38.69 (38.46–38.92)	36.73 (36.50–36.95)	30.87 (30.65–31.09)	20.03 (19.82–20.23)
Australia/New Zealand	50.25 (49.78–50.73)	48.65 (47.79–49.51)	46.49 (45.64–47.35)	40.26 (39.42–41.09)	27.72 (26.94–28.49)
Melanesia	16.70 (15.59–17.80)	15.93 (14.18–17.69)	15.04 (13.29–16.79)	12.27 (10.54–14.01)	6.70 (5.04–8.37)
Micronesia/Polynesia	34.13 (29.99–38.27)	33.50 (26.73–40.26)	32.54 (25.79–39.29)	28.22 (21.54–34.90)	18.08 (11.68–24.48)
Women
World	23.96 (23.93–23.98)	22.49 (22.45–22.54)	20.35 (20.31–20.40)	16.66 (16.62–16.70)	11.44 (11.40–11.48)
Very high HDI	36.09 (36.04–36.13)	33.92 (33.83–34.01)	30.87 (30.78–30.96)	25.49 (25.41–25.58)	17.83 (17.75–17.90)
High HDI	24.00 (23.96–24.04)	22.34 (22.27–22.41)	20.03 (19.96–20.10)	16.19 (16.13–16.26)	10.93 (10.86–10.99)
Medium HDI	11.69 (11.65–11.73)	10.71 (10.64–10.78)	9.28 (9.21–9.35)	6.97 (6.90–7.03)	4.03 (3.97–4.09)
Low HDI	11.54 (11.47–11.62)	10.35 (10.21–10.50)	8.79 (8.65–8.93)	6.37 (6.23–6.50)	3.48 (3.35–3.61)
Eastern Africa	14.09 (13.97–14.21)	12.61 (12.39–12.84)	10.68 (10.46–10.91)	7.68 (7.46–7.90)	4.04 (3.84–4.25)
Middle Africa	9.90 (9.72–10.07)	8.77 (8.46–9.09)	7.27 (6.95–7.58)	5.07 (4.76–5.37)	2.65 (2.37–2.93)
Northern Africa	17.08 (16.95–17.22)	15.76 (15.51–16.01)	13.87 (13.62–14.12)	10.75 (10.51–11.00)	6.88 (6.65–7.10)
Southern Africa	17.65 (17.36–17.94)	15.90 (15.39–16.40)	13.72 (13.22–14.22)	10.50 (10.01–10.98)	6.46 (6.01–6.92)
Western Africa	9.66 (9.53–9.78)	8.64 (8.42–8.86)	7.24 (7.02–7.46)	5.04 (4.82–5.25)	2.49 (2.29–2.68)
Eastern Asia	29.45 (29.40–29.50)	27.61 (27.52–27.70)	24.98 (24.89–25.07)	20.73 (20.64–20.81)	14.77 (14.69–14.85)
South-Central Asia	11.46 (11.43–11.50)	10.53 (10.46–10.60)	9.16 (9.09–9.23)	6.92 (6.86–6.99)	4.03 (3.97–4.10)
South-Eastern Asia	18.96 (18.88–19.04)	17.56 (17.42–17.70)	15.53 (15.39–15.67)	12.22 (12.08–12.35)	8.05 (7.92–8.17)
Western Asia	21.94 (21.80–22.08)	20.45 (20.19–20.71)	18.41 (18.15–18.67)	14.95 (14.70–15.20)	10.05 (9.82–10.29)
Eastern Europe	27.17 (27.08–27.25)	25.18 (24.99–25.36)	22.45 (22.27–22.63)	17.61 (17.44–17.79)	10.84 (10.69–11.00)
Northern Europe	42.24 (42.05–42.42)	39.86 (39.48–40.24)	36.62 (36.24–36.99)	30.69 (30.33–31.05)	21.53 (21.21–21.86)
Southern Europe	36.60 (36.47–36.73)	34.17 (33.89–34.45)	30.93 (30.66–31.20)	25.42 (25.16–25.68)	18.00 (17.77–18.23)
Western Europe	40.48 (40.35–40.60)	37.97 (37.70–38.23)	34.49 (34.23–34.75)	28.39 (28.15–28.64)	19.76 (19.54–19.99)
Caribbean	24.16 (23.87–24.46)	22.76 (22.21–23.31)	20.81 (20.26–21.35)	17.45 (16.93–17.98)	12.58 (12.09–13.07)
Central America	18.44 (18.29–18.58)	16.90 (16.63–17.16)	15.05 (14.78–15.31)	12.16 (11.90–12.41)	8.38 (8.14–8.62)
South America	27.51 (27.41–27.61)	25.74 (25.56–25.93)	23.43 (23.25–23.62)	19.52 (19.34–19.70)	14.05 (13.88–14.22)
Northern America	39.50 (39.39–39.60)	37.03 (36.83–37.24)	33.53 (33.33–33.74)	27.34 (27.15–27.54)	18.56 (18.38–18.73)
Australia/New Zealand	45.01 (44.62–45.40)	42.53 (41.76–43.30)	38.89 (38.13–39.65)	32.55 (31.82–33.28)	23.23 (22.56–23.89)
Melanesia	17.80 (16.92–18.68)	15.76 (14.27–17.24)	13.07 (11.60–14.54)	9.23 (7.80–10.66)	4.83 (3.48–6.17)
Micronesia/Polynesia	30.66 (27.55–33.76)	29.24 (23.63–34.86)	26.34 (20.78–31.89)	21.61 (16.20–27.01)	15.20 (10.12–20.28)

^aAll sites exclude non-melanoma skin cancer.

Fig. 1.

Lifetime risks of developing cancer by geographic areas and sex. (a) Men. (b) Women. Green diamonds denote the average lifetime risk in each selected geographic areas; vertical lines denote the estimated lifetime risk in each selected countries/regions.

3.2. Lifetime risks of developing cancer according to sex

Globally, one in four persons developed cancer during their lifetime, as seen in both men and women. Risks varied across areas of the world, with the highest in Australia/New Zealand (close to 1 in 2) and the lowest in Western Africa (close to 1 in 10) for both sexes. We revealed significant sex differences in overall cancer risk in some areas, with over 10% higher risks in men compared with women in Southern Europe, Western Europe, Eastern Asia, Australia/New Zealand, Northern Europe, Western Asia, the Caribbean, and Micronesia/Polynesia. In contrast, women had a >10% higher risk compared with men in Eastern Africa, Western Africa, and Southern Africa (Table 1, Tables S4 and S5 online). Further, significant between-county differences were found in sex-specific cancer risks, with the greatest risk in Japan (54.79%, 95% CI: 54.59%–54.99%) and Ireland (46.52%, 95% CI: 45.46%–47.58%) and lowest risk in Lesotho (5.11%, 95% CI: 3.44%–6.78%) and the Central African Republic (7.61%, 95% CI: 6.76%–8.47%), for men and women, respectively (Tables S4 and S5 online).

3.3. Lifetime risks of developing cancer according to cancer type and age at diagnosis

The remaining risks of developing cancer at the age of 40, 50, 60, and 70 years onward varied by sex (Tables S4 and S5 online) and areas of the world in 2020 (Table S6, Figs. S1–S3 online). The risks remained reasonably stable until the age of 50 years, at 22.27% (95% CI: 22.25%–22.29%) in both sexes (24.19% (95% CI: 24.16%–24.22%) and 20.35% (95% CI: 20.33%–20.38%) in men and women, respectively) but gradually decreased with age thereafter, with a remaining risk of 12.61% (95% CI: 12.58%–12.64%) (13.80%, 95% CI: 13.75%–13.85% for men and 11.44%, 95% CI: 11.40%–11.48%) for women) from the age of 70 years onward (Table 1, Fig. 2).

Fig. 2.

Global lifetime risks of developing cancer in men and women by age at diagnosis in 2020. (a) Men. (b) Women. Curves are represented for baseline ages at birth, 40, 50, 60, and 70 years of cancer-free life. Risks until death represent lifetime risk from the baseline age.

The highest lifetime risk for men, in terms of specific cancers, was due to prostate cancer globally as well as in 119 countries/regions and many areas of the world, with a lifetime risk of 26.58% (95% CI: 23.80%–29.35%) in France Guadeloupe, and approximately one in ten in areas of Northern Europe, Western Europe, Southern Europe, Micronesia/Polynesia, Caribbean, and South America. The highest lifetime risk among women was due to breast cancer, ranking first in 148 countries/regions and most areas of the world, with lifetime risks ranging from 2.67% (95% CI: 2.60%–2.74%) in Middle Africa to 13.88% (95% CI: 13.67%–14.08%) in Australia/New Zealand (Table 1 and Tables S7–S9, Figs. S1–S12 online).

The lifetime risk of cancer decreased by age globally and across areas of the world, although substantial variation in age-conditional risks was observed for different cancer sites. Lung cancer, as well as gastrointestinal (GI) cancers (colorectum, stomach, liver, esophagus, and pancreas), demonstrated a high risk across different age intervals in both sexes (Table 2). High risk was observed even after the age of 70 years for some major sex-specific cancers, such as prostate (4.65, 95% CI: 4.63%–4.66%) in men. Diverse patterns were seen according to cancer site in women, with breast cancer exhibiting the highest cancer risk from the age of 70 years and onwards (2.15%, 95% CI: 2.13%–2.17%), but the risk of cervical, thyroid, and ovarian cancers among women decreased by 60%–70% from the age of 70 years and onwards, compared with those at the age of 40 years (Table 3).

Table 2.

Lifetime risks (%) of developing cancer for selected cancer types in 2020.^a

Population	All	Esophagus	Stomach	Colorectum	Liver	Lung	Breastb	Prostate
World	25.10 (25.08–25.11)	0.93 (0.93–0.93)	1.77 (1.76–1.77)	3.16 (3.15–3.17)	1.36 (1.35–1.36)	3.61 (3.60–3.62)	5.90 (5.89–5.91)	4.65 (4.63–4.66)
Very high HDI	38.48 (38.44–38.52)	0.65 (0.64–0.65)	2.23 (2.22–2.24)	5.53 (5.52–5.55)	1.28 (1.28–1.29)	5.69 (5.67–5.70)	10.31 (10.28–10.33)	9.89 (9.86–9.92)
High HDI	25.38 (25.35–25.41)	1.46 (1.45–1.46)	2.36 (2.35–2.37)	3.28 (3.27–3.29)	2.10 (2.09–2.10)	4.30 (4.29–4.31)	5.09 (5.07–5.10)	3.34 (3.32–3.36)
Medium HDI	11.36 (11.33–11.39)	0.66 (0.66–0.67)	0.62 (0.61–0.63)	0.65 (0.65–0.66)	0.41 (0.41–0.42)	0.81 (0.80–0.82)	2.99 (2.97–3.01)	1.11 (1.09–1.13)
Low HDI	10.34 (10.27–10.40)	0.37 (0.36–0.38)	0.53 (0.51–0.54)	0.80 (0.78–0.81)	0.65 (0.63–0.66)	0.59 (0.57–0.61)	3.10 (3.06–3.13)	2.55 (2.49–2.61)
Eastern Africa	12.29 (12.19–12.39)	0.78 (0.76–0.81)	0.49 (0.47–0.51)	0.83 (0.80–0.86)	0.52 (0.50–0.54)	0.39 (0.37–0.41)	3.12 (3.07–3.17)	3.08 (2.98–3.18)
Middle Africa	9.52 (9.37–9.67)	0.24 (0.21–0.26)	0.41 (0.37–0.44)	0.66 (0.62–0.70)	0.54 (0.50–0.57)	0.24 (0.21–0.27)	2.67 (2.60–2.74)	3.88 (3.69–4.08)
Northern Africa	17.42 (17.31–17.53)	0.21 (0.20–0.22)	0.63 (0.61–0.65)	1.31 (1.27–1.34)	1.98 (1.95–2.02)	1.57 (1.53–1.60)	5.55 (5.49–5.62)	2.79 (2.70–2.88)
Southern Africa	16.64 (16.40–16.88)	0.68 (0.63–0.74)	0.33 (0.30–0.37)	1.34 (1.27–1.41)	0.44 (0.40–0.48)	1.68 (1.60–1.76)	5.13 (4.98–5.28)	5.23 (4.95–5.51)
Western Africa	8.59 (8.49–8.69)	0.11 (0.09–0.12)	0.34 (0.32–0.37)	0.55 (0.53–0.58)	0.68 (0.65–0.71)	0.19 (0.17–0.21)	3.31 (3.25–3.38)	2.71 (2.60–2.82)
Eastern Asia	32.35 (32.31–32.39)	2.15 (2.14–2.16)	4.16 (4.14–4.17)	4.72 (4.71–4.74)	2.76 (2.75–2.77)	6.32 (6.30–6.33)	5.28 (5.26–5.30)	3.33 (3.31–3.35)
South-Central Asia	11.35 (11.32–11.38)	0.70 (0.69–0.71)	0.70 (0.69–0.71)	0.67 (0.67–0.68)	0.36 (0.36–0.37)	0.82 (0.82–0.83)	2.89 (2.88–2.91)	0.92 (0.90–0.93)
South-Eastern Asia	18.73 (18.67–18.79)	0.27 (0.27–0.28)	0.81 (0.80–0.82)	2.18 (2.16–2.21)	1.92 (1.90–1.94)	2.59 (2.57–2.62)	4.93 (4.90–4.97)	2.04 (2.00–2.08)
Western Asia	24.19 (24.07–24.31)	0.30 (0.28–0.31)	1.44 (1.41–1.47)	2.67 (2.63–2.71)	0.83 (0.81–0.86)	4.11 (4.06–4.16)	5.77 (5.71–5.84)	4.84 (4.74–4.93)
Eastern Europe	27.86 (27.79–27.93)	0.36 (0.36–0.37)	1.61 (1.60–1.63)	4.23 (4.20–4.26)	0.62 (0.61–0.63)	3.61 (3.59–3.64)	7.13 (7.09–7.17)	5.64 (5.57–5.70)
Northern Europe	44.63 (44.48–44.77)	1.14 (1.11–1.16)	1.03 (1.01–1.05)	6.99 (6.94–7.05)	1.05 (1.03–1.07)	6.53 (6.47–6.58)	12.45 (12.35–12.54)	14.84 (14.72–14.97)
Southern Europe	40.61 (40.51–40.72)	0.33 (0.32–0.34)	1.74 (1.71–1.76)	6.68 (6.64–6.72)	1.35 (1.33–1.37)	5.56 (5.52–5.59)	11.36 (11.29–11.43)	10.02 (9.95–10.10)
Western Europe	44.08 (43.98–44.18)	0.77 (0.76–0.78)	1.26 (1.24–1.28)	6.16 (6.13–6.20)	1.14 (1.13–1.16)	6.10 (6.07–6.14)	12.85 (12.79–12.92)	13.57 (13.49–13.65)
Caribbean	25.96 (25.72–26.20)	0.45 (0.42–0.48)	1.18 (1.12–1.23)	3.23 (3.15–3.32)	0.95 (0.90–1.00)	3.14 (3.05–3.22)	6.56 (6.42–6.71)	10.97 (10.73–11.21)
Central America	18.53 (18.42–18.65)	0.18 (0.16–0.19)	1.26 (1.23–1.29)	1.67 (1.64–1.71)	1.16 (1.13–1.19)	0.99 (0.96–1.02)	4.93 (4.86–4.99)	7.03 (6.91–7.15)
South America	27.93 (27.85–28.01)	0.50 (0.48–0.51)	1.66 (1.64–1.68)	3.36 (3.33–3.39)	0.83 (0.82–0.85)	2.55 (2.53–2.58)	7.64 (7.60–7.69)	9.76 (9.68–9.84)
Northern America	39.78 (39.70–39.86)	0.52 (0.51–0.53)	0.77 (0.76–0.78)	4.48 (4.45–4.50)	1.11 (1.10–1.12)	6.52 (6.49–6.55)	12.43 (12.38–12.49)	10.32 (10.26–10.37)
Australia/New Zealand	47.68 (47.38–47.98)	0.75 (0.71–0.79)	1.03 (0.98–1.07)	7.38 (7.27–7.50)	1.19 (1.15–1.24)	5.96 (5.86–6.07)	13.88 (13.67–14.08)	13.60 (13.37–13.83)
Melanesia	17.20 (16.51–17.90)	0.39 (0.27–0.51)	0.85 (0.67–1.04)	1.20 (0.99–1.42)	1.09 (0.93–1.26)	1.41 (1.19–1.62)	4.78 (4.38–5.17)	3.59 (3.05–4.13)
Micronesia/Polynesia	32.48 (29.98–34.97)	0.35 (0.12–0.58)	1.46 (0.92–2.01)	2.74 (2.01–3.46)	1.55 (1.04–2.07)	6.45 (5.36–7.55)	8.73 (7.19–10.26)	10.00 (7.56–12.43)

^aAll sites exclude non-melanoma skin cancer.

^bOnly for women.

Table 3.

Lifetime risks (%) of developing cancer within selected age intervals for the top 10 cancer types by sex in 2020.^a

Sites	Birth to death	40 years to death	50 years to death	60 years to death	70 years to death
Both sexes
All cancers	25.10 (25.08–25.11)	23.95 (23.92–23.98)	22.27 (22.23–22.30)	18.68 (18.64–18.71)	12.61 (12.58–12.64)
Breastb	5.90 (5.89–5.91)	5.49 (5.47–5.51)	4.69 (4.67–4.71)	3.50 (3.48–3.52)	2.15 (2.13–2.17)
Prostate	4.65 (4.63–4.66)	4.65 (4.62–4.67)	4.61 (4.59–4.63)	4.24 (4.22–4.26)	2.94 (2.91–2.96)
Lung	3.61 (3.60–3.62)	3.59 (3.58–3.60)	3.49 (3.48–3.50)	3.08 (3.06–3.09)	2.15 (2.13–2.16)
Colorectum	3.16 (3.15–3.17)	3.12 (3.11–3.13)	2.99 (2.98–3.00)	2.63 (2.62–2.65)	1.92 (1.91–1.93)
Stomach	1.77 (1.76–1.77)	1.75 (1.74–1.75)	1.68 (1.67–1.68)	1.46 (1.45–1.47)	1.04 (1.03–1.05)
Liver	1.36 (1.35–1.36)	1.32 (1.32–1.33)	1.24 (1.23–1.24)	1.02 (1.01–1.03)	0.68 (0.67–0.69)
Bladder	1.02 (1.02–1.02)	1.01 (1.01–1.02)	0.99 (0.99–1.00)	0.91 (0.90–0.92)	0.70 (0.69–0.71)
Esophagus	0.93 (0.93–0.93)	0.92 (0.91–0.93)	0.88 (0.88–0.89)	0.75 (0.74–0.75)	0.48 (0.47–0.49)
Pancreas	0.89 (0.88–0.89)	0.88 (0.88–0.89)	0.86 (0.86–0.87)	0.79 (0.78–0.79)	0.61 (0.60–0.61)
Non-Hodgkin lymphoma	0.81 (0.81–0.81)	0.75 (0.75–0.76)	0.70 (0.70–0.71)	0.60 (0.60–0.61)	0.43 (0.42–0.43)
Men
All cancers	26.27 (26.24–26.30)	25.43 (25.37–25.48)	24.19 (24.14–24.24)	20.70 (20.64–20.75)	13.80 (13.75–13.85)
Prostate	4.65 (4.63–4.66)	4.65 (4.62–4.67)	4.61 (4.59–4.63)	4.24 (4.22–4.26)	2.94 (2.91–2.96)
Lung	4.59 (4.58–4.60)	4.57 (4.55–4.59)	4.44 (4.42–4.47)	3.90 (3.88–3.92)	2.66 (2.64–2.68)
Colorectum	3.36 (3.35–3.37)	3.31 (3.30–3.33)	3.18 (3.16–3.20)	2.77 (2.76–2.79)	1.94 (1.92–1.95)
Stomach	2.27 (2.26–2.28)	2.25 (2.23–2.26)	2.17 (2.15–2.18)	1.88 (1.86–1.89)	1.29 (1.27–1.30)
Liver	1.79 (1.78–1.79)	1.74 (1.73–1.75)	1.60 (1.59–1.61)	1.28 (1.27–1.29)	0.80 (0.79–0.81)
Bladder	1.54 (1.54–1.55)	1.54 (1.52–1.55)	1.51 (1.49–1.52)	1.38 (1.37–1.39)	1.05 (1.04–1.07)
Esophagus	1.24 (1.24–1.25)	1.23 (1.22–1.25)	1.18 (1.17–1.19)	0.98 (0.97–0.99)	0.61 (0.60–0.62)
Pancreas	0.88 (0.87–0.88)	0.87 (0.86–0.88)	0.84 (0.83–0.85)	0.75 (0.74–0.76)	0.55 (0.54–0.56)
Non-Hodgkin lymphoma	0.87 (0.87–0.88)	0.81 (0.80–0.82)	0.75 (0.74–0.76)	0.64 (0.63–0.65)	0.44 (0.44–0.45)
Kidney	0.79 (0.78–0.79)	0.76 (0.75–0.77)	0.71 (0.70–0.72)	0.58 (0.57–0.59)	0.38 (0.37–0.39)
Women
All cancers	23.96 (23.93–23.98)	22.49 (22.45–22.54)	20.35 (20.31–20.40)	16.66 (16.62–16.70)	11.44 (11.40–11.48)
Breast	5.90 (5.89–5.91)	5.49 (5.47–5.51)	4.69 (4.67–4.71)	3.50 (3.48–3.52)	2.15 (2.13–2.17)
Colorectum	2.97 (2.96–2.97)	2.92 (2.91–2.94)	2.80 (2.79–2.82)	2.50 (2.48–2.51)	1.90 (1.89–1.92)
Lung	2.62 (2.61–2.63)	2.60 (2.59–2.62)	2.53 (2.51–2.54)	2.25 (2.24–2.27)	1.64 (1.63–1.65)
Cervix	1.44 (1.43–1.44)	1.25 (1.24–1.26)	0.97 (0.96–0.98)	0.65 (0.64–0.66)	0.35 (0.34–0.36)
Stomach	1.26 (1.25–1.26)	1.24 (1.23–1.25)	1.18 (1.17–1.19)	1.05 (1.04–1.06)	0.79 (0.78–0.80)
Uterus	1.17 (1.16–1.17)	1.14 (1.13–1.15)	1.03 (1.02–1.04)	0.79 (0.78–0.80)	0.46 (0.45–0.47)
Thyroid	1.01 (1.01–1.01)	0.81 (0.80–0.82)	0.62 (0.61–0.63)	0.40 (0.39–0.40)	0.20 (0.19–0.21)
Liver	0.92 (0.91–0.92)	0.90 (0.89–0.91)	0.86 (0.85–0.87)	0.76 (0.75–0.77)	0.56 (0.56–0.57)
Pancreas	0.90 (0.89–0.90)	0.89 (0.89–0.90)	0.88 (0.87–0.89)	0.82 (0.81–0.83)	0.67 (0.67–0.68)
Ovary	0.85 (0.85–0.86)	0.79 (0.78–0.80)	0.69 (0.68–0.70)	0.53 (0.52–0.54)	0.34 (0.33–0.34)

^aAll sites exclude non-melanoma skin cancer.

^bOnly for women.

3.4. Comparison between lifetime risk of developing cancer with cumulative risk for ages of 0–74 years

Fig. 3 presents the lifetime risk of developing cancer in comparison with the cumulative risk for age groups of 0–74 years. We revealed significant differences in the two indicators according to life expectancy variations, as the lifetime risk used the actual life expectancy in each country while the cumulative risk fixed the upper age limit as 74 years. Of 86 countries/regions with a life expectancy of <75 years, 51 presented a lower lifetime risk than the cumulative risk ages of 0–74 years. In contrast, we observed uniform higher lifetime risks of cancer compared with the cumulative risk of age span of 0–74 years in 100 countries/regions with a life expectancy of >75 years (Fig. S13 online).

Fig. 3.

Correlation between lifetime probability of developing cancer and traditional cumulative risk measure (ages 0–74 years) with both sexes combined. The red line indicates the fitted risks using quadratic regression with a 95% confidence interval; the short dash black line indicates the reference line where the risk estimations of two measures are equal; the color circles indicate the risks in different countries/regions with different life expectancy.

4. Discussion

The global lifetime risk of cancer was estimated to be one in four for both men and women in 2020. The risk of cancer increased with rising HDI levels, reaching 38% in very high HDI countries/regions, although the risks significantly differ between world areas and individual countries/regions. Prostate and breast were the cancer types associated with the greatest lifetime risks in men and women, respectively, across all examined age intervals. The lifetime risk of cancer decreases with age despite the substantial variations in age-conditional risks according to cancer type. The risks of lung cancer and the major GI cancers remained high in both sexes across different age spans, while lifetime risks of cervical, thyroid, and ovarian cancers decreased by 60%–70% in women aged 70 years and onwards, relative to those aged from 40 years.

Our estimates emphasized the importance of cancer as a disease threatening global health with significant variations across countries/regions, which was quite compatible with previous cancer burden assessments by incidence or mortality [9]. We revealed that approximately one in two persons in Australia/New Zealand but one in twelve persons in Western Africa would suffer from cancer across their lifespan. This huge variation highlights the unbalanced cancer burden distribution worldwide and indicates the importance of developing country-specific cancer prevention and control plans. The increased lifetime cancer risk with the HDI level indicates that people living in more developed countries/regions have a relatively longer life expectancy and increasing probabilities of developing cancer accordingly (Figs. S14 and S15 online), while people living in low HDI countries/regions usually have relatively high competing risks of death from other causes than cancer (e.g., acute infectious diseases). The lifetime risk calculated in this study was consistent with some previous national estimations [4], [10], such as the total cancer risk estimation in the United States (40.5% among women and 38.9% among men) [11] and the United Kingdom (53.5% among men and 47.5% among women) [8] and the prostate cancer risk in Australia (19.6%) [12] and the breast cancer risk in the Netherlands (13.6%) [13]. This study is the first to provide comparable estimates of the lifetime risk of developing cancer in different geographic areas, considering the increased life expectancy and competing risks of death from any cause other than cancer, unlike the individual country-level estimations. It provides an intuitive indicator that directly helps compare cancer burden across populations and aids in long-term health system planning and cancer control programs.

The globally prioritized cancer types and their national variations are instructive for risk factor control and cancer screening program. In general, the lifetime probability of developing major cancers, including lung, colorectum, prostate, and breast cancers, increased alongside the HDI level. Most notably, exceptions were observed in terms of prostate cancer, which presented a 2.3 times higher risk in low HDI countries/regions than that in medium HDI countries/regions. Men from Africa, including Zimbabwe, Liberia, Rwanda, Congo, Uganda, Tanzania, and Burundi, presented a high lifetime risk of >4% for prostate cancer (Table S8 online). The Western African ancestry, increased awareness, certain genetic mutations (e.g., BRCA1, BRCA2), broader prostate-specific antigen testing, and cancer screening system improvements were thought attributable to the high burden, although the etiology remains largely unknown [4]. Additionally, the lifetime risks of hepatic, gastric, and esophageal cancers in high HDI countries/regions were preceded by those in very high HDI countries/regions, with great contributions from Eastern Asian. Major risk factors, including tobacco, excessive alcohol consumption, H. Pylori, hepatitis B or C virus infection, aflatoxin-contaminated foods exposure, liver flukes, metabolic conditions, and nutritional status, should be considered when developing targeted national health system planning and cancer prevention and control program in these countries/regions [14], [15], [16], [17].

The lifetime and age-conditional probability estimates of developing specific cancer types provide important information for cancer prevention and control. In general, the total cancer risk before the age of 50 years was relatively low (12%) globally, indicating low cost-effectiveness of cancer screening at younger ages. Prostate and breast cancers contributed the greatest lifetime risks in men and women across all age intervals, which was partly related to the large-scale cancer screening programs [4]. This contributes to the evidence of current debates regarding the tailored screening guidelines for different cancer types, including indolent cancers (e.g., thyroid cancer) and more progressive cancers. The trade-offs of benefits and risks, including, but not limited to, mortality reduction and prospects of overdiagnosis, such as the potential negative impact on the psychosocial burden of patients and the possibilities of false positive results, should be comprehensively considered. Furthermore, we observed significant variations in lifetime risks across the age spectrum by different cancer types. Some highly-fatal cancers, such as lung and GI cancers, demonstrated sustained high risks across all age intervals, indicating the need for continued efforts in developing cancer prevention programs and screening from age 40 years onwards, where applicable [18], [19]. The risks of prostate, bladder, and breast cancers remained high, while the risks of cervical, thyroid, and ovarian cancer decreased by 60%–70% from the age of 70 years onwards compared with the risk from the age of 40 years onwards in women. Altogether, these age-conditional risks provide important data to help define the appropriate screening age interval for planning cancer screening programs, especially when competing for required health resources for other highly-fatal diseases [20], [21], [22].

This study has several strengths. First, we used the most updated and representative data systematic, including the GLOBOCAN 2020 estimates and the death data from the UN, thereby allowing a global lifetime risk estimation of developing cancer and comparable estimates in different geographic areas and countries [3], [8]. Secondly, we used the AMP method to estimate the lifetime risk of cancer, considering competing risks of death from any cause other than cancer, as well as life expectancy. Our results revealed that the traditional cumulative incidence risk indicator at ages of 0–74 years may underestimate the cancer risk in populations with relatively a high life expectancy or relatively low competing risks of other-cause mortality [23]. The lifetime risk reported in this study is an intuitive indicator that directly helps compare cancer burden across populations, considering the increasing trend of cancer incidence, the continued global developments of the social economy [16], [24], [25], the extent of population aging [6], and increasing life expectancy [26], [27], [28]. Thirdly, we reported the age-conditional probability of developing cancer across different age spans at the global and national levels and provided estimations on the potential risk reductions by different age groups and cancer types, all of which provide helpful information on cancer control strategy planning and evaluation, particularly preventive interventions to stop cancer [29].

Moreover, this study has some limitations. First, the GLOBOCAN estimates for 2020 rely on the best available local cancer registry data and national vital registration systems to calculate incidence and mortality rates at the country level. High-quality recorded incidence data remains lacking in some areas such as South America and Africa, while only approximately one-third of the world population is presently covered by official mortality statistics [30]. Second, this study provided lifetime estimates based on the current cross-sectional data, including age-specific cancer incidence and mortality rates and all-cause mortality rates, but subsequent trends in cancer-specific incidence rates are likely to alter in their direction and magnitude [31], [32], [33], [34], [35] with the shifting distributions of certain key lifestyle risk factors, and thus the lifetime risk of developing cancer is subject to future change. Third, the estimates provided in this study do not reflect the impact of coronavirus disease 2019, as they are based on extrapolations of cancer data collected in earlier years before the pandemic. Finally, cancer burdens significantly vary within countries/regions, particularly those with large populations, including China, the United States, Russia, and India; thus, the study results can only represent the average national risk.

5. Conclusion

Our study provides global, regional, and country-specific estimates of the lifetime risks of developing cancer following sex and age, adjusted for competing causes of death and multiple primaries. The global estimates in 2020 indicated that one in four persons were diagnosed with cancer during their life spans, in both men and women. Very large variations were found across countries or areas of the world, ranging from approximately one in three persons who would have developed cancer in their lifetimes in very high HDI countries/regions to one in ten persons in low HDI countries/regions. The lifetime risks of cancer decreased by age, with varying patterns by world region and cancer type. Altogether, this study revealed a comprehensive quantification of lifetime risks from cancer, which provides important information for global health system planning, as well as targeted cancer control interventions in different countries/regions.

Conflict of interest

The authors declare that they have no conflict of interest.

Biographies

Rongshou Zheng graduated from Peking University and received his master’s degree in Epidemiology and Biostatistics in 2010. Currently, he works at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College as an associate professor. His research interest includes descriptive cancer epidemiology and application of data in surveillance for public health.

Shaoming Wang received her Ph.D. degree in Epidemiology and Health Statistics from Peking Union Medical College. She is now an associate professor at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences. Her research interest focuses on burden assessment and etiology research of cancer.

Freddie Bray is head of the Cancer Surveillance Branch at the International Agency for Research on Cancer, in Lyon, France. In support of the overwhelming need for high-quality cancer surveillance systems, he leads the Global Initiative for Cancer Registration development. His areas of research revolve around the descriptive epidemiology of cancer. These include the estimation of the global cancer burden and the analysis of time trends of cancer, including predictions of the future scale and profile of cancer and linkages to human development transitions.

Wenqiang Wei received his M.D. and Ph.D. degrees in Epidemiology and Health Statistics from the Chinese Academy of Medical Science and Peking Union Medical College. He is currently a professor and the chief of the Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. His current research interest mainly focuses on cancer epidemiology and comprehensive prevention and control in high-risk areas.

Appendix A. Supplementary materials

The following are the Supplementary data to this article: