Unveiling the cancer epidemic in India: a glimpse into GLOBOCAN 2022 and past patterns

Summary

Background

The Global Cancer Observatory (GLOBOCAN) 2022 estimates highlight cancer as a significant global health problem. In the South-East Asia-region, India ranks third in terms of cancer incidence, second for mortality, and 121 in terms of crude rates globally. As cancer risks increase with age, particularly affecting older individuals, this study explores the current cancer burden in India by analyzing the cancer landscape across different age groups, determining the population's risk of cancer diagnosis and death, and projecting the future cancer burden aligned with past mortality patterns.

Methods

This is a comprehensive-retrospective, cross-sectional study examining 36 cancer types, by gender, and across four-distinct age groups (childhood, reproductive, middle age, geriatric) in India, using the GLOBOCAN 2022 database. The study further analyzes the past mortality patterns (2000–2022) and future cancer landscape of India by determining annual percent change (APC), through Multijoinpoint regression analysis.

Findings

The five most prevalent cancers affecting both genders collectively account for 44% of cancer burden in India. Notably, females exhibit higher crude incidence (104.5) and crude mortality (64.2) rates compared to males (91.5 and 62.2), based on 0.676 billion females and 0.731 billion males’ populations in 2022. The middle-aged and geriatric-cohorts account the heaviest (70%) cancer burden with higher crude rates (315.9–543.1 incidents, 215.6–407.8 mortalities). Alarmingly, cancer-related mortalities have increased faster among females (1.2–4.4% APC) than males (1.2–2.4% APC) over the past decade, and are expected to continue rising over coming two decades.

Interpretation

Approximately three out of every five individuals in India succumb to death following a cancer diagnosis, as per the GLOBOCAN 2022 incidence (1,413,316) to mortality (916,827) ratio. Childhood and reproductive age-group individuals bear the lowest risk of developing (0.12–2.4%) and dying (0.08–1.3%) from cancer compared to their middle-aged and geriatric counterparts, having highest risks of developing (8.3–10.3%) and dying (5.5–7.7%) from cancer. As the population of India transitions from the reproductive age group to the middle age and geriatric age group, the India is anticipated to witness the highest cancer burden of all-time in near future, potentially exacerbated by the looming epidemic.

Funding

No funding received.

Research in context.

Evidence before this study

India, as the fastest-growing economy and one of the most populous countries on planet Earth, has witnessed an increase in life expectancy by 5.6 years over the past two decades, with the present life expectancy standing at 67.7 years. The latest GLOBOCAN 2022 report has highlighted cancer as a major public health problem globally, and India currently ranks 121th in terms of age-standardized rates worldwide. Although cancer incidences and mortalities are more prevalent in the elderly population (aged 60 and above) worldwide and India has almost 60% of its population in the working/young (14–59 years) age group. Despite this, India is among the top three countries globally for both cancer incidence and mortality numbers, highlighting a huge cancer burden on India's healthcare system.

Added value of this study

To our knowledge, our study provides the first comprehensive evaluation of the current and future landscape of cancer in India, focusing on different age groups and gender disparities. By analyzing past cancer mortality patterns and leveraging datasets like the Global Health Observatory and Globocan 2022, the study sheds light on the cancer burden in different genders and age groups (Childhood, Reproductive, Middle-age, and Geriatric). The study reveals the disproportionate burden borne by females in India and identifies the most prevalent cancer types contributing to the majority of incidences and mortalities in both genders (60% in females and 44% in males). In both males and females, respiratory and esophagus cancers exhibited mortality rates of 92.9 per 100 new diagnoses. Approximately three out of five individuals would be expected to succumb to mortality if diagnosed with cancer in India. The data show that children and reproductive-age individuals have a 0.12%–2.38% chance of developing cancer and a 0.08%–1.3% chance of dying from it. However, middle-aged and geriatric individuals have a higher 8.34%–10.31% chance of developing cancer with a 5.53%–7.68% chance of dying from it. In the coming two decades, India will face a formidable challenge in managing cancer incidence-related mortalities, which will increase with an Annual Percent Change (APC) of 2% as the population of India gets older.

Implications of all the available evidence

The findings of this study underscore the pressing need for targeted interventions and strategies to address the escalating cancer burden in India. With a significant portion (70%) of cancer incidences and mortalities concentrated in the middle-aged and geriatric age groups, the country is poised to face a formidable challenge in the coming years due to the transition of the current reproductive-age population to the middle-aged and geriatric groups. The projected increase in cancer mortalities, as indicated by Joinpoint trend analysis, necessitates proactive measures to enhance early detection, access to quality care, and public health initiatives. At the core of these initiatives must be tailored specifically to the specific needs of diverse populations, different age groups, genetic predispositions, socio-economic disparities, and cultural influences.

Introduction

In the last two decades, the life expectancy in India has increased by 5.6 years (9%) from 62.1 years in 2000 to 67.7 years in 2024.¹ Historically, communicable diseases were the leading contributors to mortalities in India. However, with socio-economic development and a concomitant increase in life expectancy, non-communicable diseases such as cardiovascular disease, stroke, diabetes-mellitus, and cancer have emerged as significant public health problems in India.² Between 2012 and 2022, the population of India grew by 11.2%.³ During this same period, the cancer incidence increased by 36%, rising from 1.01 million in 2012 to 1.38 million in 2022.^4,5 Similarly, cancer-related mortality also exhibited a rise of 30.3%, increasing from 0.68 million in 2012 to 0.89 million in 2022.^4,5 Furthermore, age-standardized incidence rates (ASRs), demonstrated a modest increase of 2.21%, while the mortality ASRs demonstrated a decrease of 3.47% over the last decade.^4,5 The human lifespan transits through distinct age groups: 0–14 (Childhood), 15–49 (reproductive age), 50–69 (middle-aged), and 70+ (Geriatric). In each age group, the leading causes of mortalities and underlying diseases differ significantly, however, different cancers originating at different sites contribute to a significant proportion of deaths across all age-groups.⁶

In this article, we investigate the cancer burden in India based on the latest GLOBOCAN 2022 estimates, aligning it with the past 20 years of cancer-related mortalities based on estimates from the Global Health Observatory (GHO).^5,7 This article aims to investigate four key areas: the global cancer trends and cancer burden in India, cancer landscape across different age groups, and projects future cancer landscape of India in alignment with past mortality patterns.

Methods

Data source

Global Cancer Observatory (GLOBOCAN) provides estimates of incidence, mortality, and prevalence for 36 cancer types, including non-melanoma skin cancer (NMSC), for 185 countries or territories worldwide.⁵ Data is categorized by sex and age group and presented in a tabular form with Age-Standardized Rates (ASRs) and Crude Rates (CR) per 100,000 people. The sources and methodologies for the global estimates rely heavily on cancer registries from various countries, including India, and are detailed on the GLOBOCAN website.^1,5 For this study, data on new cancer incidences and mortalities for all 36 cancer types, including non-melanoma skin cancer, was sourced from the GLOBOCAN 2022 database for global cancer burden, different world regions, and India.

To determine past mortality patterns and annual percent change (APC), Joinpoint regression analysis was conducted using India nationwide cancer mortality data sourced from the Global Health Observatory (GHO) for India from 2000 to 2019.⁷ The dataset included cancer-related mortalities for the overall population, and for males and females separately within the 0–70 years' age group, along with the corresponding population for each year. To project the future incidence and mortality patterns in terms of APC, we retrieved the estimated cancer incidence and mortality absolute numbers for India from 2025 to 2050, based on 2022 case data, from the GLOBOCAN 2022 Cancer Tomorrow database and the estimated population for corresponding years was referred from Worldometer.^3,8,9

Data categorization

We have categorized lip and oral cavity cancer (C00-C06) as oral cancer, liver and intrahepatic bile-duct cancer (C22) as liver cancer, colon, rectum, and anus cancer (ICD-10 codes C18-C21) as colorectal cancer, lung, trachea, and bronchus cancer (C33-C34) as respiratory cancer, cervix uteri (C53) as cervical cancer, brain and central nervous system cancer (C70-C72) as brain cancer, and kidney and renal pelvis cancer (C64-C65) as kidney cancer.

Data analysis

To gain a comprehensive understanding of the global cancer burden, ASRs from the GLOBOCAN 2022 data were used to compare the cancer incidence and mortality across countries with different population structures. All the equation used for data analysis are defined in Supplementary File 1. To examine India's cancer burden within a regional context, the World Health Organization (WHO) region classification was used. Further to address the cancer burden across different age groups in India, ASRs, CR, and absolute numbers for cancer incidence and mortality data were categorized into four groups: Childhood (0–14), reproductive age (15–49), middle age (50–69), and geriatric (70+). For each cancer type, the percentage contribution by each age group was calculated as described in Supplementary File 1. The risk of developing and dying from cancer was determined per 100,000 individuals from each age-group using ASRs values for each cancer using the following equation:

$$\mathit{C}\mathit{a}\mathit{n}\mathit{c}\mathit{e}\mathit{r}\mathit{I}\mathit{n}\mathit{c}\mathit{i}\mathit{d}\mathit{e}\mathit{n}\mathit{c}\mathit{e}\mathit{R}\mathit{i}\mathit{s}\mathit{k}=\left(\frac{\left(\text{ASRs}\text{for}\mathrm{a}\mathrm{C}\text{ancer}\times \text{Year}\text{Spent}\text{in}\text{Age}\text{Group}\right)}{100,000}\right)\times 100$$

$$\mathit{C}\mathit{a}\mathit{n}\mathit{c}\mathit{e}\mathit{r}\mathit{M}\mathit{o}\mathit{r}\mathit{t}\mathit{a}\mathit{l}\mathit{i}\mathit{t}\mathit{y}\mathit{R}\mathit{i}\mathit{s}\mathit{k}=\left(\frac{\left(\text{AS}\mathrm{M}\text{Rs}\text{for}\mathrm{a}\mathrm{C}\text{ancer}\times \text{Year}\text{Spent}\text{in}\text{Age}\text{Group}\right)}{100,000}\right)\times 100$$

To project cancer mortality patterns in India from 2000 to 2022 (with data sourced from the GHO for 2000 to 2019 and from GLOBOCAN 2022 for 2022), crude mortality rates (CMR) per 100,000 individuals were calculated using absolute cancer mortality numbers and the population (differently for male and female population) using the following equation:

$$\mathit{C}\mathit{r}\mathit{u}\mathit{d}\mathit{e}\mathit{M}\mathit{o}\mathit{r}\mathit{t}\mathit{a}\mathit{l}\mathit{i}\mathit{t}\mathit{y}\mathit{o}\mathit{r}\mathit{I}\mathit{n}\mathit{c}\mathit{i}\mathit{d}\mathit{e}\mathit{n}\mathit{c}\mathit{e}\mathit{R}\mathit{a}\mathit{t}\mathit{e}=\left(\frac{\text{Number}\text{of}\text{Cancer}\text{Mortalities}\text{or}\text{Incidence}}{\text{Total}\text{Male}\text{and}/\text{or}\text{Female}\text{Population})}\right)\times 100,000$$

Further to estimate future cancer incidence and mortality patterns in India from 2024 to 2050, predicted absolute numbers of cancer incidence and mortality (and differently for males and females) were sourced from GLOBOCAN 2022, and the forecasted population was sourced from Worldometer. Furthermore, to estimate the male and female populations for determining Crude Rates, the sex ratio of 106.453 males per 100 females (from the National Health and Family Survey Round 5) was used to estimate male and female populations using the following equations:

$$\mathbf{E}\mathbf{s}\mathbf{t}\mathbf{i}\mathbf{m}\mathbf{a}\mathbf{t}\mathbf{e}\mathbf{d}\mathbf{M}\mathbf{a}\mathbf{l}\mathbf{e}\mathbf{P}\mathbf{o}\mathbf{l}\mathbf{u}\mathbf{l}\mathbf{a}\mathbf{t}\mathbf{i}\mathbf{o}\mathbf{n}=\frac{\text{Total}\text{Population}\times \left(\frac{\text{Indian}’\text{Sex}\text{ratio}}{100}\right)}{\left(\frac{\text{Indian}’\text{Sex}\text{ratio}}{100}\right)+1}or\mathbf{E}\mathbf{s}\mathbf{t}\mathbf{i}\mathbf{m}\mathbf{a}\mathbf{t}\mathbf{e}\mathbf{d}\mathbf{M}\mathbf{a}\mathbf{l}\mathbf{e}\mathbf{P}\mathbf{o}\mathbf{l}\mathbf{u}\mathbf{l}\mathbf{a}\mathbf{t}\mathbf{i}\mathbf{o}\mathbf{n}=TP\frac{SR}{SR+100}$$

$$\mathbf{E}\mathbf{s}\mathbf{t}\mathbf{i}\mathbf{m}\mathbf{a}\mathbf{t}\mathbf{e}\mathbf{d}\mathbf{\text{Female}}\mathbf{P}\mathbf{o}\mathbf{l}\mathbf{u}\mathbf{l}\mathbf{a}\mathbf{t}\mathbf{i}\mathbf{o}\mathbf{n}=\left[\text{Estimated}\text{total}\text{Polulation}-\text{Estimated}\text{Male}\text{Polulation}\right]$$

The Crude incidence rate (CIR) and Crude mortality rates (CMR) were calculated using the same equations as above. The estimated Crude rates were then used for Joinpoint trend analysis to estimate the average annual percent change (AAPC) values using Joinpoint Regression software (version 4.9.1.0).^10,11 The Joinpoint program used a best-fit piecewise continuous log-linear model to examine the mortality trend, determining the optimal number of Joinpoint through a sufficient number of permutations.^10,11 The AAPC values were selected to ensure a comparison of male and female mortality trends without inflection points. A total of 4499 permutations were performed with a significance level of 0.05 and a 95% Confidence Interval (CI) for the dataset.^10,11 The analysis generated estimated mortality trends with APC for each Joinpoint, along with lower and upper confidence intervals, P values, and AAPC values for all cancer types.^10,11 Graphical representations were created to visually depict the mortality trends for men, women, and both sexes using GraphPad Prism 8.0.2.

Results

Global cancer landscape and India's sobering reality

As shown in Fig. 1a, an estimated 19.97 million new cancer incidences and 9.74 million mortalities were reported globally in 2022. Respiratory cancers (including trachea, bronchus, and lung) rank first in terms of incidence, accounting for 12.42% of all new cases, followed by breast (11.5%), colorectum (9.6%), prostate (7.35%), and stomach cancer (4.85%), collectively accounting more than 45% of all new incidences. Moreover, respiratory cancers remain the leading cause of cancer-related mortalities (18.7%), followed by colorectum (9.3%), liver (7.8%), breast (6.9%), and stomach cancer (6.8%), together, contributing to nearly 50% of all cancer-related mortalities globally across genders (Fig. 1a).

Fig. 1.

(a). Bar graph illustrating the global distribution of overall incidence and mortality for the top nine most prevalent cancer types in 2022, (b). Sunburst chart depicting the global distribution of incidence and mortality percentages for the top five most prevalent cancer types among both genders, (c). Chart presenting the distribution of cancer incidence and mortality percentages across different WHO regions, (d). Chart showing the contribution of cancer incidence and mortality percentages by country within the South-East Asia Region (SEARO). Note: In each Sunburst chart, the area of the segments represents the proportion of the total number of incidences and mortalities.

Distinct disparities in cancer incidence and mortality rate were reported at the gender level (Fig. 1b, Supplementary Table S1). Among females, breast cancer was the most commonly diagnosed cancer (24%) and leading cause of mortality (15.4%), followed by respiratory (9.4%), colorectum (8.9%), and cervical cancers (6.9%). These cancers collectively accounted for approximately 49% of new cases and 46.5% of cancer mortalities in females, respectively. In contrast, males reported higher burden of respiratory cancers, accounting for 15.3% of new cases and 23% of mortalities, followed by prostate (14.2%) and colorectum cancers (10.37%) at rank second and third for new cases. However, in terms of mortalities, liver cancer (9.61%) surpassing prostate cancer (7.31%) as the second leading cause of death, followed by colorectal (9.20%) cancer.

The World Health Organization (WHO) categorizes countries primarily into six regions. As shown in Fig. 1c, approximately 12% of all new cancer incidences were reported in the WHO South-East Asia-region (SEARO), accounting for 15.7% of all mortalities. Within the SEARO region, India accounted for approximately 1.41 million new cancer incidences and 0.92 million cancer mortalities, which translates to 60% for both (Fig. 1d), highlighting the significant cancer burden in India.

India's current cancer burden and silent killers in numbers

Worldwide in terms of absolute incidence number, following China and the United States (rank first and second), India ranks third, contributing 7.5% (1.38 million) of all new cancer incidences. Furthermore, India ranked second following China for cancer-related mortalities, accounting for 10.3% (0.89 million) of all cancer-related mortalities (Supplementary File S2). As shown in Table 1, the five most prevalent cancer types in India affecting both genders account for over 44% of all newly incidences and cancer-related mortalities. With a 5-year prevalence of 16.5 per 100,000 people, female breast cancer remains the most prevalent cancer among females, contributing to 13.8% of all new cases (Table 1). Followed by oral (10.3%), cervical (9.2%), respiratory (5.8%), and esophagus (5%) cancers, with 5-year prevalence of 11.4, 10.4, 3.5, and 3.4 per 100,000 people. Furthermore, all of these cancers were also leading cause of cancer-related mortalities with breast cancer accounting for more than 10% of all cancer-related mortalities (Table 1). Alarmingly, respiratory and oesophagus cancers exhibited exceptionally high mortality rates of 92.9 per 100 new diagnoses.

Table 1.

Presents the overall and gender-wise cancer incidence and mortality pattern in India by cancer type, rank, and percent contribution, and five-year prevalence.

Cancer type (ICD)	Over All					Male		Female
	Incidence		Mortality		Prevalence	Number (%)		Number (%)
	Rank	Number (%)	Rank	Number (%)	5-year	Incidence	Mortality	Incidence	Mortality
Breast (C50)	1	192,020 (13.6)	1	98,337 (10.7)	16.2	–	–	192,020 (26.6)	98,337 (22.0)
Oral (C04.0-C06.9)	2	143,759 (10.2)	2	79,979 (8.7)	11.4	107,812 (15.6)	59,656 (12.7)	35,947 (5.0)	20,323 (4.5)
Cervical (C53)	3	127,526 (9.0)	3	79,906 (8.7)	10.4	–	–	127,526 (17.7)	79,906 (17.9)
Respiratory (C34)	4	81,748 (5.8)	4	75,031 (8.2)	3.5	58,970 (8.5)	54,220 (11.5)	22,778 (3.2)	20,811 (4.7)
Oesophagus (C15)	5	70,637 (5.0)	5	66,410 (7.2)	3.4	45,608 (6.6)	43,082 (9.2)	25,029 (3.5)	23,328 (5.2)
Colorectum (C18-C20)	6	70,038 (5.0)	7	40,993 (4.5)	5.4	43,360 (6.3)	25,447 (5.4)	26,678 (3.7)	15,546 (3.5)
Stomach (C16)	7	64,611 (4.6)	6	57,727 (6.3)	3.2	43,060 (6.2)	38,702 (8.2)	21,551 (3.0)	19,025 (4.3)
Leukaemia (C91)	8	49,883 (3.5)	9	36,871 (4.0)	4.2	29,487 (4.3)	21,549 (4.6)	20,396 (2.8)	15,322 (3.4)
Ovary (C56)	9	47,333 (3.3)	10	32,978 (3.6)	3.7	–	–	47,333 (6.6)	32,978 (7.4)
Non-Hodgkin lymphoma (C82-C85)	10	39,736 (2.8)	12	22,972 (2.5)	3.3	25,061 (3.6)	14,451 (3.1)	14,675 (2.0)	8521 (1.9)
Liver (C22)	11	38,703 (2.7)	8	36,953 (4.0)	1.6	27,334 (4.0)	26,137 (5.6)	11,369 (1.6)	10,816 (2.4)
Prostate (C61)	12	37,948 (2.7)	14	18,386 (2.0)	2.4	37,948 (5.5)	18,386 (3.9)	–	–
Larynx (C32)	13	35,855 (2.5)	13	22,467 (2.5)	3	31,486 (4.6)	19,787 (4.2)	4369 (0.6)	2680 (0.6)
Brain (C71)	14	32,574 (2.3)	11	27,990 (3.1)	3.2	20,401 (3.0)	17,504 (3.7)	12,173 (1.7)	10,486 (2.3)
Hypopharynx (C14.2)	15	30,510 (2.2)	20	11,618 (1.3)	1.6	24,033 (3.5)	9147 (1.9)	6477 (0.9)	2471 (0.6)
Oropharynx (C10)	16	23,174 (1.6)	17	14,202 (1.5)	1.7	19,549 (2.8)	12,021 (2.6)	3625 (0.5)	2181 (0.5)
Bladder (C67)	17	22,548 (1.6)	19	12,353 (1.3)	1.8	17,668 (2.6)	9754 (2.1)	4880 (0.7)	2599 (0.6)
Thyroid (C73)	18	21,873 (1.5)	23	5455 (0.6)	1.9	6030 (0.9)	2584 (0.5)	15,843 (2.2)	2871 (0.6)
Gallbladder (C23)	19	21,780 (1.5)	15	16,407 (1.8)	1.1	6844 (1.0)	5161 (1.1)	14,936 (2.1)	11,246 (2.5)
Kidney (C64)	20	17,480 (1.2)	21	10,464 (1.1)	1.4	11,094 (1.6)	6686 (1.4)	6386 (0.9)	3778 (0.8)
Corpus uteri (C54)	21	17,420 (1.2)	22	6845 (0.7)	1.6	–	–	17,420 (2.4)	6845 (1.5)
Multiple myeloma (C88.0)	22	16,526 (1.2)	16	14,216 (1.6)	1.2	10,002 (1.4)	8603 (1.8)	6524 (0.9)	5613 (1.3)
Pancreas (C25)	23	13,661 (1.0)	18	12,759 (1.4)	0.49	8712 (1.3)	8136 (1.7)	4949 (0.7)	4623 (1.0)
Penis (C60)	24	10,443 (0.7)	26	4450 (0.5)	0.87	10,443 (1.5)	4450 (0.9)	–	–
Hodgkin lymphoma (C81)	25	9611 (0.7)	27	3522 (0.4)	0.88	5880 (0.9)	2163 (0.5)	3731 (0.5)	1359 (0.3)
Salivary glands (C07-C08)	26	8107 (0.6)	24	4879 (0.5)	0.7	3773 (0.5)	2319 (0.5)	4334 (0.6)	2560 (0.6)
Nasopharynx (C11)	27	6519 (0.5)	25	4780 (0.5)	0.54	4275 (0.6)	3136 (0.7)	2244 (0.3)	1644 (0.4)
Vagina (C52)	28	5000 (0.4)	28	2465 (0.3)	0.35	–	–	5000 (0.7)	2465 (0.6)
Testis (C62)	29	4456 (0.3)	32	1050 (0.1)	0.44	4456 (0.6)	1050 (0.2)	–	–
Skin (Melanoma) (C43)	30	3689 (0.3)	29	2197 (0.2)	0.33	1914 (0.3)	1149 (0.2)	1775 (0.2)	1048 (0.2)
Vulva (C51)	31	3112 (0.2)	30	1539 (0.2)	0.25	–	–	3112 (0.4)	1539 (0.3)
Mesothelioma (C45)	32	1613 (0.1)	31	1432 (0.2)	0.08	820 (0.1)	739 (0.2)	793 (0.1)	693 (0.2)
Kaposi sarcoma (C46)	33	66 (0.0)	33	41 (0.0)	–	41 (0.0)	24 (0.0)	25 (0.0)	17 (0.0)
Unspecified sites (C80)	34	79,903 (5.7)	34	43,548 (4.7)	–	46,417 (6.7)	25,518 (5.4)	33,486 (4.6)	18,030 (4.0)
Other specified (C76.8)	35	63,454 (4.5)	35	45,605 (5.0)	–	38,700 (5.6)	28,494 (6.1)	24,754 (3.4)	17,111 (3.8)
All Cancers (C00–C97)	–	1,413,316	–	916,827	–	691,178 (48.90)	470,055 (51.26)	722,138 (51.09)	446,772 (48.73)

ICD: International Classification of Diseases.

As evident from Supplementary Table S2, overall CIR for all cancers combined is higher in females (104.5 per 100,000) than males (91.5 per 100,000). Furthermore, this trend is mirrored by a higher CMR in females (64.2 per 100,000) than in males (62.2 per 100,000). In females, breast cancer (16.2 5-Year Prevalence) was the most commonly diagnosed cancer, accounting for 29% of all new incidences with an ASR of 26.25, followed by cervical (19.2%), Ovary (7%), oral (5.4%), and esophagus (3.7%) cancer (Table 1). A similar trend was observed for mortalities, with breast cancer, accounting for 24.2% of all cancer-related mortalities in females, followed by cervical (19.8%), ovary (8.1%), oral (5.8%), and esophagus (4.7%) cancer. Together these top-five cancers accounted for more than 64% of incidences and 62% of mortalities in females.

In contrast, the pattern of cancer incidence and mortality differed in males (Table 1). Oral cancer was the most commonly diagnosed cancer (11.4 5-Year Prevalence), with an ASR of 14.45 and 16% contribution of all new incidences, followed by the respiratory (8.6%), oesophagus (6.7%), Colorectum (6.3%), and Stomach (6.3%) cancer. Similarly, oral cancer also accounted for more than 13% of all cancer-related mortalities, with an ASR of 8.08, followed by the respiratory (11.6%), oesophagus (8.3%), colorectum (5.6%), and stomach (5.5%) cancer. These top five cancers accounted for 44% of incidences and mortality in males.

Cancer's shifting landscape

The human lifespan transitions through distinct stages, and the prevalence of certain cancers demonstrably rises and falls in different age groups (Fig. 2a). As shown in Fig. 2b, in India, 50% of new cancer incidences and mortality were reported in the middle-age group (50–69 years) with 313.6 CIR and 245.6 CMR (Fig. 2c). While the reproductive age group (15–49 years) demonstrated the second-highest incidences numbers (26.1% with 48.1 CIR) and concerning 20.2% of cancer-related mortalities with 24.1 CMR. In addition, the geriatric age group (70+ years) exhibited the highest cancer burden in terms of CIR (543.1) and CMR (407.8), with 22.16% of new incidences and 25.6% mortalities. In comparison to all, the childhood age group (0–14 years) accounted the lowest (1.8%) incidences and cancer-related mortalities (1.3%) along with the lower 7.3 CIR and 3.4 CMR (Fig. 2b and c).

Fig. 2.

(a). Sankey diagram presenting cancer prevalence in terms of Crude Incidence rate in four different age groups 0–14 (Childhood), 15–49 (reproductive-age), 50–69 (Middle-aged), and 70+ (Geriatric), Bar diagram presenting absolute number and crude rate (Incidence and Mortality) for all cancers in different age groups (b–c). Overall population, (d–e). Male Population, (f–g). Female Population.

With an estimated 0.12% chance of developing cancer and a 0.08% chance of dying from it, approximately 26,016 new incidences of childhood cancer were reported, resulting in 12,059 mortalities (Table 2). Leukemia was the most commonly diagnosed childhood cancer (41.3%) with a CIR of 3.01, followed by brain cancer (13.6%) and Non-Hodgkin lymphoma (6.4%) with CIR of 0.99 and 0.47, respectively (Table 2). A similar trend was observed for mortalities, with Leukemia ranking first (41%), followed by brain cancer (16.1%) and Non-Hodgkin lymphoma (6.7%) with CMR of 1.4, 0.5, and 0.2. As evident from Table 2 and Fig. 2d–g, with a higher overall incidence in male children (59.8% with CIR 8.3) compared to female children (40.1% with CIR 6.2), leukemia emerged as the most prevalent childhood cancer across both genders, accounting for 43.6% and 38.0% of all new diagnoses in male and female children. Brain cancer held the second spot in both males (13.4%) and female (13.8%) childhood cancer diagnoses as shown in Table 2. Following closely, Non-Hodgkin lymphoma (7.5% incidence) ranked third for male children, while ovarian (5.8% incidence) cancer ranked third for female children. Mortality rates followed a similar pattern as shown in Table 2, with female children demonstrating a lower mortality burden (39.6% with CMR 2.8) compared to male children (60.5% with CMR 3.9). Leukemia being the leading cause of death accounted for 43% and 38% mortalities in male and female children, followed by brain cancer was the second leading cause of mortality for both male (16%) and female (17%). While Non-Hodgkin lymphoma ranked third for males (8%), and females (5%) children.

Table 2.

The prevalence of different cancer types in terms of absolute numbers (incidence and mortality), percent contribution, age-standardized ratio, and lifetime risk for cancer incidence and mortality of the five leading cancer types in different age groups and by different genders.

Age group	Cancer type	Over All						Male		Female
		Incidence			Mortality			Number (%)		Number (%)
		Number (%)	ASRs	Risk	Number (%)	ASRs	Risk	Incidence	Mortality	Incidence	Mortality
Childhood Age Group (0–14 Year)	Leukaemia	10,752 (41.3)	3.08	0.04	4955 (41.1)	1.4	0.02	6786 (43.6)	3138 (43.1)	3966 (38.0)	1817 (38.1)
	Brain	3528 (13.6)	1	0.01	1946 (16.1)	0.55	0.01	2090 (13.4)	1146 (15.7)	1438 (13.8)	800 (16.8)
	NHL	1674 (6.4)	0.45	0.01	811 (6.7)	0.22	0.00	1171 (7.5)	568 (7.8)	503 (4.8)	243 (5.1)
	HL	1233 (4.7)	0.33	0.00	593 (4.9)	0.16	0.00	919 (5.9)	445 (6.1)	486 (4.7)	182 (3.8)
	Kidney	988 (3.8)	0.31	0.00	373 (3.1)	0.12	0.00	502 (3.2)	191 (2.6)	314 (3.0)	148 (3.1)
	All Other	7841 (30.1)	3.64	0.05	3381 (28.0)	3.48	0.05	4100 (26.3)	1798 (24.7)	3741 (35.8)	1583 (33.2)
Reproductive Age Group (15–49 Year)	Breast	68,306 (18.5)	18.53	0.65	24,073 (13.0)	6.61	0.23	–	–	68,306 (31.2)	24,073 (23.8)
	Oral	44,546 (12.1)	5.82	0.20	22,308 (12.1)	2.94	0.10	36,483 (24.3)	18,192 (21.7)	8063 (3.7)	4116 (4.1)
	Cervix uteri	42,903 (11.6)	11.67	0.41	20,832 (11.3)	5.72	0.20	–	–	42,903 (19.6)	20,832 (20.6)
	Leukaemia	18,470 (5.0)	2.42	0.08	14,718 (8.0)	1.92	0.07	10,718 (7.1)	8429 (10.0)	7752 (3.5)	6289 (6.2)
	Ovary	15,556 (4.2)	4.24	0.15	6243 (3.4)	1.75	0.06	–	–	15,556 (7.1)	6243 (6.2)
	All Other	179,514 (48.6)	25.27	0.88	96,787 (52.3)	13.33	0.47	102,834 (68.5)	57,382 (68.3)	76,680 (35.0)	39,405 (39.0)
Middle Age Group (50–69 Year)	Breast	94,034 (13.3)	85.08	1.70	50,615 (10.4)	46.01	0.92	–	–	94,034 (26.6)	50,615 (21.8)
	Oral	73,769 (10.5)	33.09	0.66	44,091 (9.1)	19.78	0.40	54,288 (15.5)	32,328 (12.8)	19,481 (5.5)	11,763 (5.1)
	Cervix uteri	65,064 (9.2)	58.88	1.18	42,370 (8.7)	38.45	0.77	–	–	65,064 (18.4)	42,370 (18.2)
	Respiratory	46,577 (6.6)	21.12	0.42	43,839 (9.0)	19.84	0.40	34,599 (9.9)	32,573 (12.9)	11,978 (3.4)	11,266 (4.8)
	Oesophagus	39,874 (5.7)	17.94	0.36	38,559 (8.0)	17.32	0.35	26,303 (7.5)	25,432 (10.1)	13,571 (3.8)	13,127 (5.6)
	All Other	385,538 (54.7)	201.09	4.02	265,216 (54.7)	135.56	2.71	235,763 (67.2)	161,926 (64.2)	148,141 (41.9)	106,583 (45.9)
Geriatric Age Group (70+ Year)	Breast	29,633 (9.5)	97.48	1.46	23,628 (10.0)	77.45	1.16	–	–	29,633 (21.4)	23,628 (21.8)
	Respiratory	26,167 (8.4)	45.26	0.68	23,405 (10.0)	40.52	0.61	19,032 (0.0)	17,028 (0.0)	7135 (5.2)	6377 (5.9)
	Oral	25,289 (8.1)	43.8	0.66	13,513 (5.7)	23.39	0.35	16,934 (0.0)	9090 (0.0)	8355 (6.0)	4423 (4.1)
	Prostate	21,213 (6.8)	77.73	1.17	11,087 (4.7)	40.97	0.61	21,213 (12.1)	11,087 (8.8)	–	–
	Cervix uteri	19,540 (6.2)	64.34	0.97	16,696 (7.1)	54.82	0.82	–	–	19,540 (14.1)	16,696 (15.4)
	All Other	191,307 (61.1)	359.23	5.39	146,788 (62.4)	274.65	4.12	117,443 (67.3)	89,302 (70.6)	73,864 (53.3)	57,486 (52.9)

Note: Risk (Risk of cancer incidence or cancer-related mortality in particular age group), NHL (Non-Hodgkin lymphoma), HL (Hodgkin lymphoma), All other (other cancer types).

With an estimated 2.38% chance of developing cancer and a 1.13% chance of dying from it, a staggering 370,000 new cancer incidence and 185,000 mortalities were reported in the reproductive age group (Table 2). Breast cancer ranked first, representing 18.5% of all cases, with CIR of 18.7 per 100,000 people. Oral cancer at rank second, contributed 12% of all cases, with CRI of 5.8, while cervical cancer accounting for 11.6% of cases, with CIR of 11.8 at rank third (Table 2). For mortalities similar pattern was reported, with contribution of 13%, 12% and 11.3% of all cancer-related deaths in reproductive age group, breast, oral and cervix cancer were among most lethal cancers with CMR of 6.6, 2.9 and 5.7, respectively. In reproductive age group, the females contributed to higher cancer burden, with 60% of incidence and 55% of mortalities compared to 40% and 45%, in males, respectively (Table 2 and Fig. 2d and f). In females, breast cancer was the most prevalent cancer with 31.1% of new cases, followed by cervical (19.6%) and ovarian (7%) cancer (Table 2). Furthermore, breast (24%) and cervical cancer (20.6%) were also the leading causes of cancer-related mortalities in females, followed by leukemia (6.2%) and ovarian (6.2%) cancer. Among males, oral cancer was the most commonly diagnosed cancer (24.3%), followed by leukemia (7.1%) and colorectal cancer (5.6%) (Table 2). While oral cancer (21.6%) was the leading cause of cancer-related mortality in males, oesophagus cancer (10.1%) ranked second, followed by leukemia (10%).

With an estimated 8.34% chance of developing cancer and a 5.53% chance of dying from it, middle-aged individuals accounted for nearly half of all cancer incidences (704,000) and mortalities (484,000) in India (Table 2). Similar to young-adult breast (13.3%), oral (10.5%) and cervical (9.2%) cancer were most commonly diagnosed cancers in middle-aged people with CIR of 84.8, 32.8 and 58.7. Similarly, breast (10.4%) and oral (9%) cancer were leading cause of mortalities followed by respiratory (9%) cancers among middle-aged people with CMR of 45.6, 19.6 and 19.5. As shown in Table 2 and Fig. 2d and f at the gender level, middle-aged individuals contribute equal cancer burden. Among middle-aged males, oral (15.5%), respiratory (9.9%), and esophagus (7.5%) cancer were the most prevalent cancers in addition to contributing the highest number of mortalities, with respiratory cancer (13%) ranking first, followed by oral (12.8%) and esophagus cancer (10%). In middle-aged females, breast cancer (26.6%) was the most commonly diagnosed cancer, followed by cervical (18.4%) and ovarian cancer (6.3%) (Table 2). Similarly, breast (21.8%), cervical (18.2%), and ovarian cancer (8%) were also the leading causes of mortality among middle-aged females.

With the highest (10.31%) estimated chance of developing cancer and 7.68% chance of dying from it, the geriatric age group reported 313,000 new cancer incidences and 235,000 cancer-related mortalities, translating to 75 deaths per 100 newly diagnosed cases (Table 2). With a contribution of 9.5% of all new incidences, breast cancer ranked first with a CIR of 97.5 per 100,000 people, followed by respiratory system cancer (8.3%) and oral cancers (8%) with CIR of 45.38 and 43.9, respectively. Additionally, with a contribution of 10% of mortalities each, breast and respiratory system cancers were the leading causes of cancer-related mortalities in the geriatric age group, with CMR of 77.8 and 40.6, respectively, followed by cervical cancer (7.1%) at rank third with a CMR of 55. At the gender level, as shown in Table 2 and Fig. 2d and f, a higher burden of cancer was reported in geriatric males, with 56% of cancer incidence and 54% of mortalities compared to 44% and 46% in geriatric females, respectively. In the geriatric age group, prostate cancer was the most prevalent cancer, accounting for 12.1% of new cases, followed by respiratory system cancer (11%) and oral cancer (10%). However, respiratory system cancer (13.5%) and prostate cancer (9%) were the leading causes of cancer-related mortalities in geriatric males, followed by stomach cancer (8.4%) (Table 2). In contrast, among geriatric females, breast cancer (21.4%), cervical cancer (14.1%), and ovarian cancer (6.4%) remained the most commonly diagnosed cancers as well as causes of mortality, contributing to 21.8%, 15.4%, and 7.4% of mortalities, respectively.

Past patterns and future magnitude of cancer mortalities in India

In the year 2000, an estimated 0.49 million new cancer-related mortalities were reported, with a CMR of 46.7 per 100,000 people which increased to 0.917 million, in the year 2022, with a CMR of 65.18. The multijoinpoint regression analysis conducted to examine the past trends in CMR and APC from the year 2000–2022 for 23 cancers identified significant Joinpoint, revealing a substantial increase in mortalities over time. As shown in Fig. 3a and Supplementary Table S3, for the last 15 years, cancer-related mortalities in India have been increasing with an annual change of 1.6–2.9%. Among both genders, the APC in CMR is higher in females (1.16–4.45%) than in males (1.2–2.4%). Additionally, the analysis shows that post-2013 (until 2022), the mortalities in females have increased by 2.4% more than in males (from 54 to 66 in females and from 55 to 64 in males). The top five cancers among both genders attributes to more than 50% (0.33 million) of all cancer mortalities annually (Fig. 3b, Supplementary Table S4). With a contribution 15.3–15.6% of mortalities and an APC of 1.83–2.63%, oral cancer has emerged as the leading cause of cancer-related deaths among both genders, followed by stomach cancers (9.9–10.2% with 2.5% annual change in the last 5-years), respiratory-system cancers (8.8–10.1% with 2.18% annual change), breast cancers (8.3–9.7% with 2.8–4.3% annual change), and colorectal cancers (7.1–9% with 0.8–4.5% annual change).

Fig. 3.

Multi-joinpoint trend analysis for Annual Percent Change (APC) in crude rates across India, (a). Mortality trends for 23 cancer types (2000–2022) among the total population and both genders, (b). Mortality trends for the five most prevalent cancer types (2000–2019) among the total population and both genders, (c–d). Mortality trends for the five most prevalent cancer types in females and males, respectively (2000–2019), (e–f). Estimated APC in future incidences and mortality crude rates of all cancer types across India (2025–2050) among the total population and both sexes. ∗Indicates that the APC is significantly different from zero at the alpha = 0.05 level.

In contrast, to overall trends, the top five cancers in females’ accounts for over 61% of all cancer deaths each year. With a significant 2.4–2.6% increase in annual mortalities (from 16.8% in 2000 to 19.2% in 2019), breast cancer has emerged as a major contributor to cancer-related mortalities in females. Additionally, with a 3.9%, 4.05%, and 6.7% annual mortality increases the cervical, oral, and colorectal cancers have contributed significantly to cancer-related mortalities in females. However, the stomach cancer-related mortalities in females have slowed down with a 1.05% annual increase (from 4.05% annually) in previous years as shown in Fig. 3c and Supplementary Table S5. In contrast to females, the top five cancers in males account for over 58% of all cancer deaths each year. With a 2.6% annual increase in mortalities, oral cancer consistently ranks first as the leading cause of cancer-related mortalities among males, accounting for almost 20.9% each year (Fig. 3d, Supplementary Table S6). Following closely, the respiratory system remains the second-highest contributor, accounting for almost 14.2% of mortalities with a 3% annual increase each year (last 5-years). However, the stomach and prostate cancer-related mortalities in males have not changed significantly and have increased by 1% annually in recent years. In contrast, colorectal-related mortalities have seen a significant increase of 3.4% in the past years.

Complementing the past patterns, the future incidences and mortality estimates by GLOBOCAN 2022, shows that India will witness a significant increase in cancer incidence (1.5–2.7 million) and mortality (0.99–1.832 million) in the coming years (Supplementary Tables S7 and S8). The multijoint point regression analysis, conducted for future (2025–2050) crude rate estimates from GLOBOCAN 2022 and the predicted population of India from Worldometer, shows that the overall CIR in India will increase from 100 to 126, with an annual APC of 1.86% over the next two decades (Fig. 3e, Supplementary Table S7). In addition to the increased incidence, India will face a formidable challenge in managing cancer-related mortalities, which will increase with an APC of 2% during the same period. Furthermore, the analysis reveals that the CIR will slowdown from 50.9 to 43.1 in females with APC from 1.8% to 1.5%, but the CMR will continue to increase (from 65 to 109), with APC of 1.7–2% between 2040 and 2050. In contrast to females, the incidence and mortalities will continue to increase in males, with an APC of 2%, as depicted in Fig. 3f, Supplementary Table S8.

Discussion

Our study reveals that the cancer burden exhibits significant disparities across WHO regions, with the AFRO-region and SEARO-Region bearing the highest incidence and mortality rates of cancer. With high absolute numbers, respiratory, colorectal, breast, and stomach cancers remain the most commonly diagnosed cancers among both genders globally. Gender disparities in cancer burden are evident, with breast cancer dominating in females and respiratory cancers being the leading cause of cancer mortalities in both genders. This underscores the need for tailored interventions and public health campaigns to address the specific needs of each gender.

India in the SEARO region is not only the most populous country on the planet, but also one of the fastest-growing economies in the world. Besides these superlatives, India stands out as one of the largest contributors to the global cancer burden, ranking third in terms of new incidences and second in mortalities, which significantly burdens its healthcare system. With an Incidence to Mortality Percentage of approximately 64.8%, it can be inferred that, approximately three out of five individuals would be expected to succumb to mortality if diagnosed with cancer. However, the crude rates, paint a different picture, ranking India at 121 for incidence and mortality. The high population of India overshadows the crude rates, skewing the overall statistics and making it appear as if the incidence and mortality rates are lower than they actually are. Even a small increase in crude-rates can result in a high absolute number, eventually increasing the cancer burden on the healthcare system.

Another reason for India's low crude rates is the relatively large proportion (55–60%) of the population aged 15–59 years.⁸ The analysis shows that individuals in the children and reproductive age group have a 0.12%–2.38% chance of developing cancer and a 0.08%–1.3% chance of dying from it. In contrast, middle-aged and geriatric individuals have a higher 8.3%–10.3% chance of developing cancer with 5.5%–7.7% chance of dying from it. This trend is further supported by the fact that more than 70% of cancer incidences with markedly higher crude rates are in the middle age and geriatric age groups compared to the combined crude rates in children and reproductive age group. This data demonstrates that in the coming years, India may face a formidable cancer burden. Multijoinpoint trend analysis for past mortality patterns indicates that cancer mortality rates in India are on the rise for last two decades. Alarmingly, cancer deaths are increasing faster among females (1.2–4.4% per year) than males (1.2–2.4% per year). Furthermore, future projections show that cancer incidence and mortality will continue to rise in the coming years, with mortality rates expected to increase from 64.7 to 109.6% between 2022 and 2050. The main reason would be the transition of the current reproductive-age population to the middle age and geriatric groups, reflecting the shifting demographics influencing cancer outcomes in the country.

In conclusion, the current analysis underscores the global burden of cancer, particularly in India within the SEARO-region. The anticipated rise in cancer incidence and mortality is expected to be further exacerbated by an impending epidemic, which could overwhelm the country's healthcare system. These findings emphasize the importance of developing and implementing a resilient framework for targeted interventions aimed at managing gender-specific and prevalent common cancers through comprehensive strategies. The establishment of a robust system for targeted interventions in cancer management in India demands a holistic strategy that integrates cutting-edge medical advancements with a patient-centered approach, fostering a culture of early detection, timely intervention, and equitable access to high-quality cancer care services across diverse demographic groups at different levels of the healthcare system. At the core of these initiatives, it is essential to develop targeted strategies that cater to the specific needs of diverse populations, of different age groups, socio-economic backgrounds, and cultural influences. A nationwide approach, encompassing public health campaigns, population-wide screening programs, and collaborative efforts between governments, healthcare providers, and communities, is essential to overcome coming cancer epidemic in India.

Contributors

The manuscript writing and data analysis were done by Dr. Khushwant Singh and Dr. Kavitha Dhanasekaran. Manuscript corrections were done by Dr. Khushwant Singh, Dr. Kavitha Dhanasekaran, and Dr. Ashoo Grover. Dr. Ashoo Grover also provided valuable suggestions during the study. All authors have reviewed and approved the final version of the manuscript.

Data sharing statement

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Declaration of interests

Authors do not have any competing interests.