Abstract
Background:
Lung cancer is the most common cancer and a leading cause of cancer-related deaths globally. The aim of this study was to evaluate the incidence and mortality of lung cancer worldwide in 2022 and to project the number of new cases and deaths due to lung cancer in China and the United States in 2050.
Methods:
In this study, data from the GLOBCAN 2022 database were used to analyze lung cancer incidence and mortality. The current status of lung cancer incidence and deaths was described by country/region, sex, age, and the human development index (HDI), and future lung cancer incidence and deaths in China and the United States were projected for 2050.
Results:
Globally, an estimated 2,480,675 new lung cancer cases and 1,817,469 lung cancer-related deaths occurred in 2022, with age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) of 23.6/100,000 and 16.8/100,000, respectively. In China, the ASIR and ASMR for male lung cancer patients were approximately 1.7 times and 2.7 times greater than those for female lung cancer patients, respectively. The ASIR and ASMR in high-HDI countries were approximately 8.5 times and 6.5 times those in low-HDI countries, respectively. It is estimated that in 2050, there will be approximately 1120 thousand new cases and 960 thousand deaths among Chinese men, 680 thousand new cases and 450 thousand deaths among Chinese women, approximately 170 thousand new cases and 110 thousand deaths among American men, and 160 thousand new cases and 90 thousand deaths among American women.
Conclusions:
There are significant differences in the incidence and mortality of lung cancer among different regions and sexes. Therefore, sex factors need to be considered in the prevention, screening, and treatment strategies of lung cancer, and the implementation of tertiary prevention measures for lung cancer, especially primary and secondary prevention, needs to be actively promoted.
Keywords: Lung neoplasm, Incidence, Mortality, GLOBOCAN, Females, Early detection of cancer
Introduction
Lung cancer is the most common cancer and a leading cause of cancer-related deaths worldwide. According to GLOBOCAN 2020, there were an estimated 2.2 million new lung cancer cases in 2020, with an age-standardized incidence rate (ASIR) of 22.4/100,000, and approximately 1.8 million lung cancer deaths worldwide, with an age-standardized mortality rate (ASMR) of 18.0/100,000.[1] The data reflect the serious global burden of lung cancer, which remains the leading cause of cancer-related death,[2] even though female breast cancer had overtaken lung cancer as the most common cancer in 2020.[3] The incidence and mortality rates of lung cancer vary between males and females, with males generally having higher incidence and mortality rates than females.[4,5] Furthermore, the burden of lung cancer varies significantly between developed and developing countries.
In China, the number of new cases of lung cancer in 2020 reached 539,181, making it the country with the highest number of new lung cancer cases globally.[6] The incidence of lung cancer in China is relatively low, but the mortality rate and disability-adjusted life year (DALY) rate are high.[7] The incidence and mortality rates of lung cancer have been continuously increasing over the past few decades, with both rates showing an upward trend from 1990 to 2019.[8,9]
The aims of this study were to analyze the incidence and mortality of lung cancer globally in 2022, to explore the age trends of the ASIR and ASMR by sex in China, to predict the future burden of lung cancer in both China and the United States until 2050, to elucidate the current global epidemiological characteristics of lung cancer, and to provide a scientific basis and guidance for the formulation of lung cancer prevention and control strategies as well as increasing public health awareness.
Methods
Data source
Lung cancer incidence and mortality data for 2022 were obtained from the GLOBOCAN 2022 database of the International Agency for Research on Cancer (IARC). The GLOBOCAN 2022 database contains estimates of the incidence, mortality, and prevalence of 36 cancers by sex and age group in 185 countries or territories worldwide in the year 2022. For global cancer incidence and mortality data, it can be used to obtain a globalized visualization.[10]
Statistical analysis
We used data from the GLOBCAN 2022 database, which can be used to estimate the current status of lung cancer incidence and mortality globally and in China using Segi’s World Standard Population for incidence and mortality. Incidence and mortality can be obtained by country/region, sex, age, and the United Nations-defined human development index (HDI). The HDI consists of three components: a long and healthy life, access to knowledge, and standard of living. GLOBOCAN 2022 data can also be used to predict the number of lung cancer cases and deaths in China and the United States in 2050.
Data management was carried out using Excel 2016 (Microsoft, Seattle, USA) and R 4.3.3 software (The R Foundation for Statistical Computing, Vienna, Austria), and relevant graphs were generated using the ggplot2 package in R 4.3.3 software.
Results
Global incidence and mortality of lung cancer
In 2022, an estimated 2,480,675 new cases of lung cancer and 1,817,469 deaths from lung cancer occurred globally, with an ASIR of 23.6 per 100,000 and an ASMR of 16.8 per 100,000. The highest ASIR and ASMR globally were in Hungary, at 47.6 per 100,000 and 39.8 per 100,000, respectively, while the lowest ASIR and ASMR were in Niger, at 1.0 per 100,000 and 0.9 per 100,000, respectively [Table 1].
Table 1.
Estimated incidence and mortality, age-standardized incidence and mortality of lung cancer in selected countries and regions in 2022.
| Country | Incidence | Mortality | ||||
|---|---|---|---|---|---|---|
| N | ASR per 100,000 | Crude rate per 100,000 | N | ASR per 100,000 | Crude rate per 100,000 | |
| Asia | ||||||
| China | 1,060,584 | 40.8 | 75.1 | 733,291 | 26.7 | 51.9 |
| Japan | 136,723 | 30.5 | 108.9 | 83,243 | 14.2 | 66.3 |
| India | 81,748 | 5.8 | 5.8 | 75,031 | 5.3 | 5.3 |
| Türkiye | 41,032 | 37.9 | 48.0 | 38,505 | 35.1 | 45.0 |
| Africa | ||||||
| South Africa | 9446 | 18.1 | 15.6 | 8672 | 16.9 | 14.3 |
| Morocco | 8825 | 20.4 | 23.4 | 7970 | 18.5 | 21.1 |
| Egypt | 7643 | 8.8 | 7.2 | 6805 | 7.9 | 6.4 |
| Algeria | 5040 | 11.3 | 11.1 | 4599 | 10.4 | 10.1 |
| Niger | 102 | 1.0 | 0.4 | 101 | 0.9 | 0.4 |
| Europe | ||||||
| Russian Federation | 70,362 | 26.0 | 48.3 | 51,887 | 18.6 | 35.6 |
| Germany | 62,025 | 28.1 | 73.9 | 47,731 | 21.4 | 56.9 |
| United Kingdom | 50,700 | 30.1 | 74.0 | 35,394 | 19.4 | 51.7 |
| France (metropolitan) | 49,613 | 35.9 | 75.7 | 36,876 | 24.2 | 56.2 |
| Italy | 43,808 | 24.6 | 72.7 | 35,668 | 18.0 | 59.2 |
| Hungary | 9911 | 47.6 | 103.2 | 8462 | 39.8 | 88.1 |
| Latin America and the Caribbean | ||||||
| Brazil | 44,213 | 14.6 | 20.5 | 38,292 | 12.5 | 17.8 |
| Argentina | 13,016 | 19.9 | 28.3 | 10,673 | 16.1 | 23.2 |
| Mexico | 8257 | 5.4 | 6.3 | 7808 | 5.1 | 5.9 |
| Cuba | 7339 | 29.8 | 64.9 | 6066 | 24.3 | 53.7 |
| Northern America | ||||||
| Canada | 31,157 | 32.4 | 81.2 | 22,970 | 21.5 | 59.8 |
| United States of America | 226,033 | 31.9 | 67.5 | 127,653 | 16.6 | 38.1 |
| Oceania | ||||||
| Australia | 13,426 | 24.1 | 51.5 | 9191 | 15.6 | 35.3 |
| New Zealand | 2796 | 27.3 | 57.1 | 2122 | 19.4 | 43.3 |
| Papua New Guinea | 621 | 10.7 | 6.7 | 553 | 9.6 | 6.0 |
| New Caledonia | 170 | 41.8 | 58.4 | 127 | 31.0 | 43.7 |
ASR: Age-standardized rate.
A similar geographical distribution of ASIR and ASMR was observed in men worldwide. In men, the regions with higher ASIRs and ASMRs were East Asia, Micronesia/Polynesia, and Eastern Europe, with Turkey having the highest ASIR and ASMR among men worldwide. A similar geographical distribution of ASIR and ASMR was found in women; North America, Central Europe, East Asia, and Northern Europe had higher ASIRs and ASMRs, with Hungary having the highest ASIR and ASMR.
Incidence and mortality of lung cancer in China
In 2022, the number of new cases of lung cancer in China was 1,060,584, with a crude incidence rate of 75.1 per 100,000 and an ASIR of 40.8 per 100,000 [Table 1]; among them, the ASIR for men was 52.0 per 100,000, and for women, it was 30.3 per 100,000, with the ASIR for males being approximately 1.7 times greater than that for females [Table 2]. The number of deaths from lung cancer in China in 2022 was 733,291, with a crude mortality rate of 51.9 per 100,000, and an ASMR of 26.7 per 100,000 [Table 1]; among them, the ASMR for men was 39.5 per 100,000 and was 14.7 per 100,000 for women, with the ASMR for males being approximately 2.7 times higher than that of females [Table 2].
Table 2.
Estimated age-standardized incidence and mortality of lung cancer by age group in China in 2022.
| Age group (years) | Incidence (per 100,000) | Mortality (per 100,000) | ||||
|---|---|---|---|---|---|---|
| Males | Females | Overall | Males | Females | Overall | |
| All | 52.0 | 30.3 | 40.8 | 39.5 | 14.7 | 26.7 |
| 0–4 | 0.1 | 0.1 | 0.1 | 0 | 0 | 0 |
| 5–9 | 0.1 | 0.1 | 0.1 | 0 | 0 | 0 |
| 10–14 | 0.2 | 0.1 | 0.1 | 0.1 | 0 | 0.1 |
| 15–19 | 0.2 | 0.3 | 0.2 | 0.1 | 0.1 | 0.1 |
| 20–24 | 0.7 | 0.7 | 0.7 | 0.3 | 0.2 | 0.3 |
| 25–29 | 1.8 | 2.3 | 2.0 | 0.7 | 0.4 | 0.5 |
| 30–34 | 3.3 | 5.4 | 4.3 | 1.6 | 1.0 | 1.3 |
| 35–39 | 6.7 | 10.0 | 8.3 | 3.0 | 2.0 | 2.5 |
| 40–44 | 14.0 | 18.6 | 16.2 | 7.4 | 4.7 | 6.1 |
| 45–49 | 35.0 | 33.4 | 34.2 | 19.2 | 10.1 | 14.8 |
| 50–54 | 83.4 | 63.8 | 73.7 | 50.8 | 20.6 | 35.9 |
| 55–59 | 126.3 | 77.2 | 101.9 | 80.6 | 26.1 | 53.5 |
| 60–64 | 248.2 | 128.9 | 188.3 | 167.3 | 52.1 | 109.4 |
| 65–69 | 346.2 | 169.3 | 256.2 | 259.1 | 81.6 | 168.8 |
| 70–74 | 427.4 | 208.5 | 313.9 | 352.6 | 125.1 | 234.7 |
| 75–79 | 499.2 | 248.5 | 366.0 | 464.6 | 181.7 | 314.3 |
| 80–84 | 537.1 | 293.8 | 402.5 | 553.8 | 251.1 | 386.4 |
| ≥85 | 494.0 | 274.2 | 359.6 | 568.2 | 279.4 | 391.6 |
For numbers less than 0.05, they are rounded off to 0.
ASIRs were slightly greater in females than in males until the age of 45 years, and after the age of 40 years, ASIRs and ASMRs tended to increase significantly in both males and females. The ASIRs and ASMRs of lung cancer were greater in patients older than 60 years, with a slight decrease in the ASIR for patients aged 85 years and older [Figure 1].
Figure 1.
Age trends in standardized incidence and mortality rates of lung cancer for men and women in China by 2022.
Relationships between the HDI and lung cancer incidence and mortality
When countries were grouped according to HDI levels (low HDI, medium HDI, high HDI, and very high HDI), there was a positive relationship between the ASIR and ASMR of lung cancer and the HDI. That is, as the HDI increased, the ASIR and ASMR of lung cancer also exhibited an upward trend. However, the ASIRs and ASMRs of lung cancer in high-HDI countries are currently greater than those in very-high-HDI countries. The ASIR in high-HDI countries is approximately 8.5 times that in low-HDI countries, and the ASMR in high-HDI countries is approximately 6.5 times that in low-HDI countries [Figure 2].
Figure 2.
Age-standardized incidence and mortality of lung cancer in 2022 for countries with different HDI. ASR: Age-standardized rate; HDI: Human development index.
China is currently in the high human development group, while the United States is in the very high human development group. Compared with countries in the same HDI category, China has higher lung cancer incidence and mortality rates, and the United States has higher lung cancer incidence and intermediate mortality rates.
Prediction of lung cancer trends in China and the United States
Through a comprehensive analysis based on models and multiple data, it is estimated that by 2050, the number of male patients in China will increase from 660 thousand to 1120 thousand, and the number of female patients will increase from 400 thousand to 680 thousand, representing increases of 69.7% and 70.0%, respectively [Figure 3A]; additionally, it is estimated that the number of male patients in the United States will increase from 110 thousand to 170 thousand, and the number of female patients will increase from 110 thousand to 160 thousand, representing increases of 54.5% and 45.5%, respectively [Figure 3B].
Figure 3.
Estimated number of cases and deaths of lung cancer by sex in China (A) and the United States (B) from 2022 to 2050.
Through a comprehensive analysis based on models and multiple data, it is estimated that by 2050, the number of male deaths in China will increase from 520 thousand to 960 thousand, and the number of female deaths will increase from 220 thousand to 450 thousand, representing increases of 45.8% and 104.5%, respectively; additionally, it is estimated that the number of male deaths in the United States will increase from 70 thousand to 110 thousand, and the number of female deaths will increase from 60 thousand to 90 thousand, representing increases of 57.1% and 50.0%, respectively [Figure 3B].
Overall, from 2022 to 2050, the number of cases and deaths by sex in both China and the United States will increase, with a greater trend in China than in the United States. By 2050, the number of cases and deaths by sex in China will still be significantly greater than those in the United States.
Discussion
Lung cancer is a serious burden worldwide. Despite female breast cancer being the most common cancer at present,[3] lung cancer remains the leading cause of cancer death.[2] A number of risk factors for lung cancer have been identified, such as smoking, aging, air pollutants, secondhand smoke exposure, occupational hazards, a family history of lung cancer, and genetic variants.[11,12] Smoking is the main risk factor for lung cancer, with smokers having a risk of developing lung cancer approximately 10 to 40 times greater than that of non-smokers, and the amount of smoking is dose-dependently related to the risk of lung cancer.[13] Gredner et al[14] demonstrated that implementing the highest level of tobacco control policies in Europe can prevent more than 1.6 million cases of lung cancer over a 20-year period. Despite smoking being the primary risk factor for lung cancer, 10%–20% of lung cancer cases globally occur in non-smokers, and this proportion is increasing.[15]
Regional differences in the incidence and mortality of lung cancer are very clear globally, reflecting, to a large extent, differences in smoking patterns, which in turn vary by sex and economic development status. In developed countries, due to effective tobacco control policies and widespread public health education, the smoking rate is lower, leading to relatively lower rates of lung cancer incidence and mortality.[1] In contrast, in many underdeveloped countries, due to the lack of effective tobacco control measures, tobacco use remains widespread, resulting in increased rates of lung cancer incidence and mortality.[16] Additionally, in developed countries, greater healthcare spending and a more comprehensive healthcare system allow patients to be diagnosed earlier and receive appropriate treatment, thus increasing survival rates.[17,18] In underdeveloped countries, however, limited medical resources lead to many patients being diagnosed in the late stages of the disease,[16] thereby missing the optimal treatment window.[18] Therefore, it is necessary to improve screening programs and increase public awareness of early symptoms of lung cancer in low-income and less developed areas. Furthermore, given the clear causal relationship between smoking and lung cancer,[16] ongoing global tobacco reforms are needed to reduce the international burden of lung cancer.
In China, the lung cancer burden clearly differs by sex, with the ASIR and ASMR of male lung cancer being approximately 1.7 times and 2.7 times those of female lung cancer, respectively. Sex differences in lung cancer are common globally, and in some countries in Europe and North America, the incidence rates of lung cancer in young or middle-aged women are approaching or exceeding those in men,[19–21] indicating a greater overall burden of lung cancer in women in the coming decades. The reasons for this difference may be related to sex hormones, genetic factors, exposure to environmental risk factors, immune responses, and differences in response to treatment.[5,22] The results of a national stratified multistage cluster probability sampling study showed that the smoking rate among men was 50.5%, while among women, the smoking rate was only 2.1%.[23] The much higher smoking rate among men than among women may be one of the significant reasons for the marked sex differences in the incidence and mortality rates of lung cancer in China. A multicenter prospective study revealed that among non-smokers, men had a significantly greater risk of lung cancer than women did, suggesting that factors other than smoking,[24] the main risk factor, contribute to the difference in lung cancer risk between the sexes. Therefore, while continuing to strengthen tobacco control measures, we should also pay attention to other factors that exacerbate the burden of lung cancer, such as indoor and outdoor air pollution, smoke from heating and cooking, and secondhand smoke.[11,25] Furthermore, the existence of these sex differences also indicates the need to consider sex differences in the prevention, screening, and treatment strategies for lung cancer to achieve more effective personalized medical care.
As the HDI increases, the ASIR and ASMR of lung cancer also show an upward trend. In countries with low and very low HDI values, the ASIR and ASMR of lung cancer are generally lower, which may be due to lower smoking rates, shorter life expectancies, higher competing risks from other diseases, poor access to healthcare services, etc., leading to a large number of patients in high-risk groups for lung cancer dying prematurely from causes other than lung cancer, resulting in a lower incidence of lung cancer.[13] In countries with high and very high HDI values, which have more developed economic and social conditions, this may be related to the increase in the incidence and mortality rates of lung cancer. On the one hand, with economic development, people’s lifestyles have changed, leading to, for example, an increase in smoking rates; on the other hand, environmental pollution in industrialized areas is an important factor leading to an increase in the incidence and mortality rates of lung cancer, with some environmental pollutant substances, such as polycyclic aromatic hydrocarbons, being confirmed carcinogens.[26] In addition, a longer life expectancy provides the possibility for the occurrence and development of lung cancer, and abundant medical resources have increased the screening and diagnostic rates for lung cancer, resulting in a higher incidence of lung cancer in countries with high and very high HDI values.
From 2022 to 2050, the number of cases and deaths by sex in both China and the United States will increase. By 2050, the incidence of morbidity and mortality by sex in China will still be significantly greater than that in the United States. The reasons for this difference may be related to factors such as smoking, population aging, and economic development level. China is a major tobacco-consuming country,[27] with a high smoking rate being an important factor leading to high incidence and mortality rates of lung cancer.[28,29] The country also faces serious population aging issues,[30,31] which increase the incidence and mortality rates of lung cancer.[32] In contrast, countries with higher economic development levels, such as the United States, often have better public health systems and more effective tobacco control policies, which help reduce the incidence and mortality rates of lung cancer.[33] Therefore, China should take effective tobacco control measures, increase public health awareness, encourage early screening for high-risk groups, and develop new treatment for lung cancer. At the same time, China can strengthen cooperation and exchanges with other countries in the field of lung cancer prevention and treatment.
In short, the global burden of lung cancer in terms of incidence and mortality remains heavy, with significant regional differences. The ASIR and ASMR of lung cancer are high in countries with high and very high HDI values. In China, there is a clear sex difference in the burden of lung cancer, with the ASIR and ASMR for males being significantly greater than those for females. The number of cases and deaths for different sexes in China and the United States will increase by 2050. Therefore, to reduce the global burden of lung cancer, efforts should be made to promote the implementation of tertiary prevention measures for lung cancer, especially primary and secondary prevention measures; improve lung cancer screening strategies, and increase the effectiveness of lung cancer screening.
Funding
This study was supported by grants from the China Postdoctoral Science Foundation (No. 2023M731010), the Training Project for Young and Middle-aged Excellent Talents in Health Science and Technology Innovation of Henan Province (No. YXKC2022045) and the Henan Province key research and development project (No. 221111310200).
Conflicts of interest
None.
Footnotes
Lanwei Guo and Chenxin Zhu contributed equally to this work.
How to cite this article: Guo LW, Zhu CX, Cai L, Zhang XL, Fang Y, Chen HD, Yang HY. Global burden of lung cancer in 2022 and projected burden in 2050. Chin Med J 2024;137:2577–2582. doi: 10.1097/CM9.0000000000003268
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