ABSTRACT
Objective
To summarize the latest cancer burden among Chinese adults aged 60 years and older and compare it with the global average and four regions classified by Human Development Index (HDI).
Methods
Cancer incidence and mortality data were extracted from the GLOBOCAN 2022 database. The estimated numbers of new cases and deaths, age‐standardized incidence rates (ASIRs), and age‐standardized mortality rates (ASMRs) were analyzed for the top ten cancer types in Chinese older adults, categorized by sex and age groups (60–69, 70–84, and 85+ years). Descriptive analyses were conducted to compare ASIRs and ASMRs for all cancer sites combined and major cancer types among adults aged 60 and older across China, the global average, and four HDI‐classified regions.
Results
In 2022, there were an estimated 2884.2 thousand new cancer cases and 1963.9 thousand cancer deaths among Chinese adults aged 60 and older. The ASIR (1211.8 per 100,000) and ASMR (857.2 per 100,000) for all cancers combined were 1.6 and 2.0 times higher in males than in females, respectively. Nearly half of new cancer cases and deaths occurred in the 70–84 age group, accounting for 48.4% of all cases (1395.9 thousand) and 53.3% of all deaths (1046.4 thousand). Lung, colorectal, stomach, liver, esophageal, prostate, and female breast cancers were the most prevalent cancer types. Compared with the global average and four HDI‐classified regions, Chinese older adults had higher ASIRs and ASMRs for lung, stomach, liver, and esophageal cancers but lower rates for prostate and female breast cancers. The ASIR and ASMR for prostate cancer were comparable to those in countries with medium HDI. For female breast cancer, the ASIR was similar to that in countries with low and medium HDI, with a lower ASMR. For colorectal cancer, the ASIR and ASMR were close to the global average but lower than those in countries with very high HDI.
Conclusion
Chinese adults aged 60 and older face a heavy burden of lung and digestive cancers, with incidence and mortality patterns reflecting characteristics of both developed and developing regions. Given the rapid population aging and limited healthcare resources, tailored, evidence‐based strategies are urgently needed to improve cancer prevention and control in China.
Keywords: cancer burden, China, epidemiology, GLOBOCAN 2022, older adults
Compared with the global average and four HDI‐classified regions, Chinese older adults had higher ASIRs and ASMRs for lung, stomach, liver, and esophageal cancers but lower rates for prostate and female breast cancers. For colorectal cancer, the ASIR and ASMR were close to the global average but lower than those in countries with very high HDI.
1. Introduction
Global aging is becoming an increasingly serious issue. It is estimated that the proportion of people aged 60 and older worldwide will nearly double from 12% in 2015 to 22% by 2050 [1]. Cancer is one of the most prevalent health problems in older people, with both incidence and mortality rates increasing with age. According to the International Agency for Research on Cancer (IARC), adults aged 60 and older accounted for nearly 65% of global cancer cases and over 72% of cancer deaths in 2022 [2]. China, which is now classified as an aging society, is experiencing rapid population aging, as the proportion of people over 60 years has increased from 13.3% in 2010 to 18.7% in 2020, and is projected to reach 28% by 2040 [3, 4]. The growing elderly population implies that cancer cases and deaths in China will continue to increase. Moreover, cancer in older individuals presents unique characteristics, such as greater heterogeneity in comorbidities, functional status, health conditions, and life expectancy, making prevention and control more complex compared to younger populations [5, 6, 7]. Therefore, timely updates on the cancer burden in Chinese older people are crucial to inform adjustments in cancer management strategies and optimize healthcare resource allocation.
Cancer burden varies significantly across regions with different levels of socioeconomic development, partly influenced by factors such as healthcare access, lifestyle transitions, and population aging [8]. The Human Development Index (HDI), which integrates life expectancy, education, and gross national income per capita, provides a valuable framework for analyzing these disparities [9]. Countries with very high HDI often experience higher incidences of prostate, breast, colorectal, and lung cancers, while upper gastrointestinal cancers, liver cancer, and cervical cancer are more common in countries with lower HDI [8, 10]. In the context of rapid socioeconomic growth, the cancer profile in China is shifting from patterns characteristic of developing countries to those more typical of developed countries [11, 12]. This dynamic transition underscores the necessity of applying the HDI framework to understand how socioeconomic development intersects with the cancer burden among Chinese older adults, providing practical insights for targeted prevention and control strategies.
Given the recent updates in cancer burden estimates by GLOBOCAN 2022, this study provides a comprehensive overview of cancer incidence and mortality among Chinese older adults aged 60 and older in 2022, using the latest available data. Previous studies on cancer burden among Chinese older adults have predominantly focused on comparisons with specific developed countries or regions, such as the United States, Japan, and Western Europe, where advanced healthcare systems and aging populations significantly influence cancer patterns [6, 13]. While these studies have provided valuable insights, comparisons within the broader HDI framework, which encompasses global, regional, and developmental perspectives, remain limited. We, therefore, sought to position the cancer burden of Chinese older adults within this framework by comparing their major cancer types with the global average and four distinct HDI‐classified regions. These findings aim to inform cancer prevention and control strategies tailored to the challenges of China's rapidly aging population and contribute to the global understanding of cancer burden in aging societies facing similar transitions.
2. Methods
2.1. Data Sources
We utilized data from the GLOBOCAN 2022 database, published by the IARC, which provides comprehensive incidence and mortality data of 36 specific cancer types in 185 countries or territories in 2022 [14]. The country‐specific data for China in the GLOBOCAN 2022 were based on high‐quality data from 700 population‐based cancer registries across China in 2018, covering 523 million people (about 37.22% of the national population) [12]. These data were sourced from the CANCER TODAY platform, accessible through the official website of the GLOBOCAN project at https://gco.iarc.who.int/today [2]. We extracted statistics on estimated numbers of new cancer cases and deaths, as well as age‐standardized incidence rates (ASIRs) and age‐standardized mortality rates (ASMRs). The ASIRs and ASMRs were calculated in the GLOBOCAN using the world standard population proposed by Segi and later revised by Doll et al. [2] A total of 33 cancer types (combining cancers of the colon, rectum, and anus and excluding non‐melanoma skin cancer, ICD‐10 codes C00‐97/C44) and all cancer sites combined were considered. The selected 33 cancer types align with previous research [14].
2.2. Data Analysis
First, we described the estimated numbers of new cases and deaths, as well as ASIRs and ASMRs for the top ten cancer types in Chinese older adults in 2022, categorized by sex and age groups (60–69, 70–84, and 85+ years), ranking each group based on the number of new cases or deaths. For each group, we calculated the percentages of new cases or deaths for each cancer type relative to the total cases or deaths in the group. Second, we grouped countries into four HDI categories: low, medium, high (excluding China), and very high HDI, based on the Human Development Report criteria: low (< 0.550), medium (0.550–0.699), high (0.700–0.799), and very high (≥ 0.800) [9]. We compared ASIRs and ASMRs for all cancer sites combined and major cancer types among Chinese adults aged 60 and older with those in the global average and four HDI‐classified regions. All analyses and graphing were conducted using R version 4.3.3.
3. Results
3.1. Estimated New Cases and Incidence of Leading Cancers in Chinese Older Adults, 2022
Table 1 shows the estimated new cases and ASIRs for the top ten cancers among Chinese older adults, categorized by sex and age group, in 2022. An estimated 2884.2 thousand new cancer cases (1710.7 thousand in males and 1173.5 thousand in females) occurred in 2022. The majority of new cases were observed in the 70–84 age group, with 1395.9 thousand cases, accounting for 48.4% of all new cancer cases in older adults. The ASIR for all cancers combined was 979.5 per 100,000, with the rate in males (1211.8 per 100,000) approximately 1.6 times higher than that in females (769.8 per 100,000). The overall cancer ASIR increased with age, from 836.5 per 100,000 in the 60–69 age group to 1310.1 per 100,000 in the 85+ age group.
TABLE 1.
Estimated new cases (thousands) and age‐standardized incidence rates (per 100,000) of the top 10 cancer sites by sex and age group in Chinese adults aged 60 and older, 2022 a .
| Rank b | All (60+ years) | 60–69 years | 70–84 years | 85+ years | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sites | Cases (%) | ASIR | Sites | Cases (%) | ASIR | Sites | Cases (%) | ASIR | Sites | Cases (%) | ASIR | |
| Both | All sites | 2884.2 | 979.5 | All sites | 1259.0 | 836.5 | All sites | 1395.9 | 1218.3 | All sites | 229.3 | 1310.1 |
| Male | All sites | 1710.7 (100.0) | 1211.8 | All sites | 740.4 (100.0) | 989.1 | All sites | 847.3 (100.0) | 1571.9 | All sites | 123.0 (100.0) | 1809.2 |
| 1 | Lung | 500.9 (29.3) | 354.6 | Lung | 217.9 (29.4) | 290.2 | Lung | 249.4 (29.4) | 463.6 | Lung | 33.6 (27.3) | 494.0 |
| 2 | Colorectum | 218.7 (12.8) | 155.2 | Colorectum | 95.9 (13.0) | 128.2 | Colorectum | 106.5 (12.6) | 197.2 | Colorectum | 16.2 (13.2) | 238.6 |
| 3 | Stomach | 189.0 (11.0) | 133.4 | Stomach | 81.3 (11.0) | 108.0 | Stomach | 95.7 (11.3) | 178.3 | Prostate | 14.6 (11.8) | 214.2 |
| 4 | Liver | 149.9 (8.8) | 109.8 | Liver | 74.2 (10.0) | 100.8 | Prostate | 77.7 (9.2) | 141.5 | Stomach | 12.0 (9.7) | 176.2 |
| 5 | Esophagus | 131.8 (7.7) | 93.4 | Esophagus | 57.7 (7.8) | 76.7 | Liver | 66.2 (7.8) | 123.5 | Liver | 9.4 (7.7) | 138.9 |
| 6 | Prostate | 126.4 (7.4) | 82.6 | Prostate | 34.1 (4.6) | 43.7 | Esophagus | 65.4 (7.7) | 122.0 | Esophagus | 8.7 (7.1) | 127.6 |
| 7 | Bladder | 57.4 (3.4) | 39.2 | Bladder | 20.3 (2.7) | 27.0 | Bladder | 30.7 (3.6) | 55.9 | Bladder | 6.3 (5.2) | 93.3 |
| 8 | Pancreas | 49.8 (2.9) | 34.8 | Pancreas | 19.9 (2.7) | 26.7 | Pancreas | 25.4 (3.0) | 46.8 | Pancreas | 4.5 (3.6) | 65.9 |
| 9 | NHL | 27.2 (1.6) | 19.5 | Thyroid | 14.3 (1.9) | 20.3 | NHL | 13.3 (1.6) | 24.8 | Leukemia | 1.7 (1.3) | 24.3 |
| 10 | Kidney | 25.8 (1.5) | 19.0 | Kidney | 13.6 (1.8) | 18.3 | Leukemia | 11.8 (1.4) | 22.0 | NHL | 1.6 (1.3) | 22.9 |
| Female | All sites | 1173.5 (100.0) | 769.8 | All sites | 518.6 (100.0) | 687.5 | All sites | 548.6 (100.0) | 902.6 | All sites | 106.3 (100.0) | 993.0 |
| 1 | Lung | 283.2 (24.1) | 179.4 | Lung | 111.8 (21.6) | 146.2 | Lung | 142.0 (25.9) | 232.1 | Lung | 29.4 (27.6) | 274.2 |
| 2 | Colorectum | 150.2 (12.8) | 93.8 | Breast | 76.7 (14.8) | 105.2 | Colorectum | 77.2 (14.1) | 125.6 | Colorectum | 16.1 (15.2) | 150.4 |
| 3 | Breast | 124.1 (10.6) | 92.0 | Colorectum | 56.9 (11.0) | 73.9 | Stomach | 43.4 (7.9) | 70.3 | Stomach | 10.2 (9.6) | 95.7 |
| 4 | Stomach | 82.4 (7.0) | 50.4 | Thyroid | 42.4 (8.2) | 59.3 | Breast | 42.4 (7.7) | 72.4 | Liver | 9.0 (8.5) | 84.3 |
| 5 | Liver | 73.6 (6.3) | 45.3 | Cervix | 28.9 (5.6) | 39.4 | Liver | 38.0 (6.9) | 61.9 | Esophagus | 6.6 (6.2) | 62.0 |
| 6 | Thyroid | 56.1 (4.8) | 45.2 | Stomach | 28.8 (5.6) | 37.2 | Esophagus | 28.7 (5.2) | 46.6 | Pancreas | 5.4 (5.1) | 50.8 |
| 7 | Esophagus | 50.4 (4.3) | 29.6 | Liver | 26.5 (5.1) | 34.3 | Pancreas | 22.7 (4.1) | 36.7 | Breast | 4.9 (4.6) | 46.0 |
| 8 | Cervix | 48.8 (4.2) | 35.6 | Corpus uteri | 17.4 (3.4) | 23.8 | Cervix | 17.9 (3.3) | 30.6 | Bladder | 2.3 (2.2) | 21.8 |
| 9 | Pancreas | 41.8 (3.6) | 25.1 | Esophagus | 15.0 (2.9) | 18.8 | Thyroid | 12.7 (2.3) | 22.3 | Gallbladder | 2.0 (1.9) | 18.7 |
| 10 | Corpus uteri | 27.0 (2.3) | 20.3 | Ovary | 13.9 (2.7) | 18.7 | Brain, CNS | 11.4 (2.1) | 19.0 | Brain, CNS | 1.9 (1.8) | 18.0 |
Abbreviations: ASIR, age‐standardized incidence rate; CNS, central nervous system; NHL, non‐Hodgkin lymphoma.
Excluding non‐melanoma skin cancer.
Ranked by the number of new cases.
The most common cancer in older men was lung cancer (500.9 thousand), followed by colorectal cancer (218.7 thousand), stomach cancer (189.0 thousand), liver cancer (149.9 thousand), esophageal cancer (131.8 thousand), and prostate cancer (126.4 thousand), accounting for 77.0% of total new cancer cases in older males. For older women, the top five cancers were lung cancer (283.2 thousand), colorectal cancer (150.2 thousand), breast cancer (124.1 thousand), stomach cancer (82.4 thousand), and liver cancer (73.6 thousand), accounting for 60.8% of total new cancer cases in older females. In addition, the ASIR of prostate cancer in males rose with age, from 43.7 per 100,000 (6th) in the 60–69 age group to 214.2 per 100,000 (3rd) in the 85+ age group. In contrast, breast cancer ASIR was highest in females aged 60–69 years (105.2 per 100,000, ranked 2nd).
3.2. Estimated Deaths and Mortality of Leading Cancers in Chinese Older Adults, 2022
Table 2 shows the estimated deaths and ASMRs for the top ten cancers among Chinese older adults, categorized by sex and age group, in 2022. It was estimated that the number of deaths was 1963.9 thousand (1250.7 thousand males and 713.2 thousand females). The majority of cancer deaths were observed in the 70–84 age group, with 1046.4 thousand deaths, accounting for 53.3% of all cancer deaths among older adults. The ASMR of all cancers combined was 627.2 per 100,000, with the rate in males (857.2 per 100,000) approximately 2.0 times higher than that in females (419.9 per 100,000). The ASMRs increased with age, from 436.6 per 100,000 in the 60–69 age group to 1425.5 per 100,000 in the 85+ age group.
TABLE 2.
Estimated deaths (thousands) and age‐standardized mortality rates (per 100,000) of the top 10 cancer sites by sex and age group in Chinese adults aged 60 and older, 2022 a .
| Rank b | All (60+ years) | 60–69 years | 70–84 years | 85+ years | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sites | Deaths (%) | ASMR | Sites | Deaths (%) | ASMR | Sites | Deaths (%) | ASMR | Sites | Deaths (%) | ASMR | |
| Both | All sites | 1963.9 | 627.2 | All sites | 668.0 | 436.6 | All sites | 1046.4 | 894.4 | All sites | 249.6 | 1425.5 |
| Male | All sites | 1250.7 (100.0) | 857.2 | All sites | 452.9 (100.0) | 599.4 | All sites | 662.5 (100.0) | 1211.1 | All sites | 135.3 (100.0) | 1989.1 |
| 1 | Lung | 420.4 (33.6) | 288.8 | Lung | 156.7 (34.6) | 206.6 | Lung | 225.1 (34.0) | 413.3 | Lung | 38.6 (28.6) | 568.2 |
| 2 | Stomach | 151.0 (12.1) | 102.1 | Liver | 63.5 (14.0) | 85.7 | Stomach | 84.8 (12.8) | 155.2 | Colorectum | 17.1 (12.6) | 250.7 |
| 3 | Liver | 137.4 (11.0) | 99.0 | Stomach | 51.6 (11.4) | 67.5 | Liver | 63.2 (9.5) | 117.2 | Stomach | 14.7 (10.8) | 215.6 |
| 4 | Esophagus | 116.0 (9.3) | 79.8 | Esophagus | 43.1 (9.5) | 57.0 | Colorectum | 62.6 (9.4) | 112.6 | Prostate | 12.7 (9.4) | 186.1 |
| 5 | Colorectum | 115.5 (9.2) | 77.4 | Colorectum | 35.9 (7.9) | 47.4 | Esophagus | 62.5 (9.4) | 115.1 | Liver | 10.7 (7.9) | 157.3 |
| 6 | Pancreas | 47.0 (3.8) | 32.4 | Pancreas | 17.6 (3.9) | 23.3 | Prostate | 27.3 (4.1) | 47.4 | Esophagus | 10.4 (7.7) | 153.1 |
| 7 | Prostate | 46.1 (3.7) | 28.5 | Brain, CNS | 8.1 (1.8) | 10.7 | Pancreas | 24.7 (3.7) | 45.3 | Bladder | 7.4 (5.5) | 108.9 |
| 8 | Bladder | 29.8 (2.4) | 19.0 | Leukemia | 6.6 (1.5) | 8.8 | Bladder | 16.7 (2.5) | 29.3 | Pancreas | 4.7 (3.5) | 69.4 |
| 9 | Brain, CNS | 18.6 (1.5) | 13.2 | Nasopharynx | 6.2 (1.4) | 8.4 | Leukemia | 9.6 (1.4) | 17.7 | NHL | 1.8 (1.3) | 26.6 |
| 10 | Leukemia | 17.9 (1.4) | 12.3 | NHL | 6.2 (1.4) | 8.2 | Brain, CNS | 9.2 (1.4) | 17.0 | Leukemia | 1.7 (1.2) | 24.5 |
| Female | All sites | 713.2 (100.0) | 419.9 | All sites | 215.0 (100.0) | 277.5 | All sites | 383.9 (100.0) | 612.2 | All sites | 114.3 (100.0) | 1067.5 |
| 1 | Lung | 180.5 (25.3) | 104.6 | Lung | 50.4 (23.4) | 64.7 | Lung | 100.2 (26.1) | 159.3 | Lung | 29.9 (26.2) | 279.4 |
| 2 | Colorectum | 80.5 (11.3) | 45.0 | Liver | 21.2 (9.9) | 27.3 | Colorectum | 43.8 (11.4) | 68.3 | Colorectum | 16.9 (14.8) | 158.1 |
| 3 | Liver | 68.0 (9.5) | 40.4 | Colorectum | 19.8 (9.2) | 25.3 | Liver | 36.5 (9.5) | 58.8 | Stomach | 11.7 (10.3) | 109.7 |
| 4 | Stomach | 64.8 (9.1) | 36.8 | Breast | 17.6 (8.2) | 23.7 | Stomach | 36.2 (9.4) | 57.0 | Liver | 10.2 (9.0) | 95.6 |
| 5 | Esophagus | 43.8 (6.1) | 24.0 | Stomach | 16.9 (7.9) | 21.5 | Esophagus | 26.3 (6.9) | 41.5 | Esophagus | 8.3 (7.2) | 77.2 |
| 6 | Breast | 40.5 (5.7) | 26.4 | Cervix | 12.6 (5.9) | 16.5 | Pancreas | 21.1 (5.5) | 33.7 | Pancreas | 5.8 (5.1) | 54.3 |
| 7 | Pancreas | 38.0 (5.3) | 22.2 | Pancreas | 11.1 (5.2) | 14.2 | Breast | 17.6 (4.6) | 28.4 | Breast | 5.3 (4.6) | 49.6 |
| 8 | Cervix | 29.2 (4.1) | 18.9 | Esophagus | 9.3 (4.3) | 11.5 | Cervix | 14.1 (3.7) | 23.2 | Cervix | 2.5 (2.2) | 23.5 |
| 9 | Ovary | 19.2 (2.7) | 12.9 | Ovary | 9.0 (4.2) | 12.0 | Ovary | 8.8 (2.3) | 14.8 | Bladder | 2.4 (2.1) | 22.6 |
| 10 | Brain, CNS | 16.2 (2.3) | 10.0 | Brain, CNS | 5.8 (2.7) | 7.6 | Brain, CNS | 8.4 (2.2) | 13.7 | Brain, CNS | 2.0 (1.7) | 18.5 |
Abbreviations: ASMR, age‐standardized mortality rate; CNS, central nervous system; NHL, non‐Hodgkin lymphoma.
Excluding non‐melanoma skin cancer.
Ranked by the number of deaths.
For older males, lung cancer (420.4 thousand) was the leading cause of cancer death, followed by stomach cancer (151.0 thousand), liver cancer (137.4 thousand), esophageal cancer (116.0 thousand), and colorectal cancer (115.5 thousand), accounting for 75.2% of total cancer deaths in older men. The top five causes of cancer deaths in older females were lung cancer (180.5 thousand), colorectal cancer (80.5 thousand), liver cancer (68.0 thousand), stomach cancer (64.8 thousand), and esophageal cancer (43.8 thousand), accounting for 61.3% of total cancer deaths in older females.
3.3. Comparison With Global and Four HDI‐Classified Regions
Figure 1 presents the estimated ASIRs and ASMRs for all cancer sites combined and selected major cancer types among adults aged 60 and older in 2022. The data include China, the global average, and four HDI‐classified regions. The ASIR for all cancers combined in Chinese older adults was comparable to the global average, higher than those in countries with low to high HDI (excluding China), but lower than in countries with very high HDI. Conversely, the ASMR of all cancers combined in older Chinese males slightly exceeded the global average and countries with very high HDI.
FIGURE 1.
Estimated age‐standardized incidence and mortality rates for all cancer sites combined and major cancer types among adults aged 60 and older across China, the global average, and four HDI‐classified regions, 2022. ASR, age‐standardized rate; HDI, human development index. The high HDI group in this context excluded China.
For specific cancer types, the ASIRs and ASMRs of lung, stomach, liver, and esophageal cancers were much higher in China than the global averages and those of four HDI‐classified regions for both sexes. In contrast, China exhibited much lower ASIRs and ASMRs of prostate and female breast cancers. Specifically, the ASIR and ASMR of prostate cancer in China were similar to those in countries with medium HDI but much lower than the global averages and countries with low, high (excluding China), and very high HDI. For female breast cancer, China had a comparable ASIR to countries with low and medium HDI, with a lower ASMR. The ASIR and ASMR of colorectal cancer in China were comparable to the global average, higher than countries with low to high HDI (excluding China), but lower than in countries with very high HDI. Moreover, the ASIRs and ASMRs of lung and colorectal cancers increased with higher HDI for both sexes, whereas the ASMR for female breast cancer showed minimal variation across countries with varying HDIs.
4. Discussion
We reported the estimated numbers of new cancer cases and deaths, as well as ASIRs and ASMRs for the top ten cancer types in Chinese adults aged 60 and older, using the latest available data from GLOBOCAN 2022, and made comparisons with global and four distinct HDI‐classified regions. In 2022, there were an estimated 2884.2 thousand new cancer cases and 1963.9 thousand cancer deaths among Chinese adults aged 60 and older. Lung, colorectal, stomach, liver, esophageal, prostate, and female breast cancers were the most prevalent cancer types. Compared with the global average and four HDI‐classified regions, Chinese older adults had higher ASIRs and ASMRs for lung, stomach, liver, and esophageal cancers but lower rates for prostate and female breast cancers. The ASIR and ASMR for prostate cancer were comparable to those in countries with medium HDI. For female breast cancer, the ASIR was similar to that in countries with low and medium HDI, with a lower ASMR. For colorectal cancer, the ASIR and ASMR were close to the global average but lower than those in countries with very high HDI. The cancer incidence and mortality patterns among Chinese older adults, reflecting characteristics of both developed and developing regions, present significant challenges to cancer prevention and control.
The ASIR for all cancer sites combined among Chinese older adults is comparable to the global average and lower than in countries with very high HDI, while the ASMR in Chinese older males was slightly higher than both. The following reasons may explain this disparity. First, the ASIRs of lung, stomach, liver, and esophageal cancers were higher in Chinese older adults than those in countries with very high HDI, and these cancer types generally have poorer survival outcomes for most patients [15]. In contrast, the ASIRs of prostate and female breast cancers were significantly higher in countries with very high HDI than those in China for older people, and these cancers tend to have a better prognosis [6]. Second, due to insufficient awareness of early screening, early cancer detection rates among Chinese older adults are low, which adversely affects patient outcomes [11]. In countries with very high HDI, the majority of cancer cases are identified through screening and early diagnosis, resulting in a higher proportion of patients with improved prognoses [11, 16]. Furthermore, gender disparities may also contribute to this disparity, as Chinese older males face about 1.6–2.0 times higher cancer incidence and mortality burden compared to females, which could be attributed to biological differences and varying environmental and lifestyle factors such as smoking and alcohol consumption [13]. Therefore, cancer prevention strategies tailored to gender‐specific risks, combined with efforts to enhance public cancer awareness and access to cancer screening services, may help mitigate the cancer burden and improve outcomes in the older population in China.
Lung cancer was the most common cancer type and the leading cause of cancer death among Chinese older adults for both sexes. Previous research suggested that the majority of the lung cancer burden in China could be attributed to smoking [17]. In 2019, the smoking rate among Chinese individuals aged 15 and above was estimated at 49.7% for males and 3.54% for females, compared to global rates of 32.7% and 6.62%, respectively [18]. The high prevalence of smoking in men explains their elevated ASIR of lung cancer, while the low smoking rates in women suggest that other contributing factors, such as potential exposure to secondhand smoke, indoor air pollution from solid fuel use, and outdoor particulate matter pollution, may contribute to the lung cancer epidemic in females [19, 20, 21]. To address this challenge, strengthening tobacco control measures, including smoking cessation programs and public health campaigns, is critical for reducing cancer risk in men and minimizing secondhand smoke exposure for women. Furthermore, more research is needed to investigate the etiology of lung cancer in non‐smoking women and to develop effective targeted prevention strategies. These combined efforts could help reduce the overall lung cancer burden in Chinese older adults.
Compared with global and four HDI‐classified regions, Chinese older adults face a disproportionately higher burden of stomach, liver, and esophageal cancers, which may be partly attributed to a high‐salt diet, smoking, alcohol consumption, infectious agents, and geographical conditions [6, 22, 23, 24]. While previous studies have reported a decline in the burden of upper gastrointestinal and liver cancers in recent decades [6, 13], significant challenges persist in their prevention and control among older adults in China. One notable example is the hepatitis B virus (HBV) vaccination program, which has contributed to reducing the liver cancer burden in younger generations [25]. However, its impact on older adults remains limited, as the program was initiated in 1992, with free routine infant immunization beginning in 2005 [26]. Consequently, individuals aged 60 and above, the primary focus of this study, have not fully benefited from this preventive measure, potentially contributing to their increased risk for liver cancer. This underscores the urgent need for effective secondary prevention strategies, particularly cancer screening, to mitigate the cancer burden in older adults. Despite efforts to promote screening for upper gastrointestinal and liver cancers since 2005, the population‐level coverage for the five leading cancers (lung, liver, stomach, colorectal, and esophageal) remains below 1% [27]. Furthermore, cancer screening guidelines in China primarily target high‐risk individuals aged 40–74, with limited evidence‐based recommendations for those aged 75 and older [5]. This is particularly concerning given that, in our study, nearly half of the new cancer cases and deaths among older adults occurred in the 70–84 age group. To address these gaps, emphasis should be placed on expanding opportunistic screening access and developing individualized screening strategies for those aged 75 and older [5, 28]. These approaches may help reduce disparities in cancer prevention and improve outcomes for older adults.
The cancer burden demonstrates significant heterogeneity across countries with varying HDIs and is strongly influenced by socioeconomic transitions. Our findings revealed that the burden of colorectal cancer increases with rising HDI for both sexes, while the ASMR of female breast cancer varies minimally across HDIs. In China, colorectal cancer ranks as the second most common cancer among older adults, with ASIR and ASMR close to global averages, reflecting shifts in dietary habits and lifestyles driven by rapid economic development [29]. Similarly, breast cancer is the third most common cancer among older Chinese females, attributed to factors including obesity from high‐energy diets, reduced physical activity, delayed childbirth, and shorter durations of breastfeeding—risks linked to urbanization and economic growth [30]. These results underscore the importance of targeted public health interventions to mitigate cancer risks arising from socioeconomic changes. For populations with lower socioeconomic status, addressing barriers to healthcare access and ensuring widespread availability of cancer prevention programs are essential, particularly through community‐based education and low‐cost early detection initiatives suited to resource‐constrained environments [31]. Meanwhile, populations with high socioeconomic status would benefit from tailored interventions focused on sustainable healthy lifestyles, such as dietary modifications and regular physical activity, alongside advanced, personalized screening strategies to detect cancers at earlier stages. Evidence‐driven measures are essential to ensure these strategies effectively address diverse cancer burdens and reduce associated disparities, thereby improving cancer outcomes across all socioeconomic groups.
Several potential limitations should be considered when interpreting our findings. First, we defined older adults as those aged 60 years and older, in line with the United Nations definition. This differs from the definition commonly used in countries with very high HDI, which defines older adults as 65 years and older. Second, variations in cancer registry coverage and data quality could underestimate the cancer burden among older populations in countries with lower HDI. Finally, due to data limitations, we were unable to analyze provincial‐level cancer burden or rural–urban disparities in China.
5. Conclusion
Chinese adults aged 60 and older face a heavy burden of lung and digestive cancers, with incidence and mortality patterns reflecting characteristics of both developed and developing regions. Given the rapid population aging and limited healthcare resources, tailored, evidence‐based strategies—such as raising public cancer awareness, promoting healthy lifestyles, enforcing robust tobacco control policies, and encouraging opportunistic cancer screening—are urgently needed to improve cancer prevention and control in China.
Author Contributions
Yuanjie Zheng: conceptualization, data curation, formal analysis, writing original draft. Wanqing Chen: conceptualization, supervision, reviewed and edited the manuscript. He Li, Qianru Li, Siyi He, Yi Teng, Mengdi Cao, Nuopei Tan, Jiachen Wang, Tingting Zuo, and Tianyi Li: reviewed and edited the manuscript. All authors contributed to the article and approved the submitted version.
Ethics Statement
The authors have nothing to report.
Consent
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
The authors would like to thank the staff of the International Agency for Research on Cancer and their collaborators for compiling and making these valuable data publicly available. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.
Funding: This study was supported by Capital's Funds for Health Improvement and Research (Grant No. 2024‐1G‐4023).
References
- 1. World Health Organization (WHO) , “Ageing and Health,” accessed September 19, 2024, https://www.who.int/news‐room/fact‐sheets/detail/ageing‐and‐health.
- 2. Ferlay J., Ervik M., Lam F., et al., “Global Cancer Observatory: Cancer Today (Version 1.1),” (International Agency for Research on Cancer), accessed October 15, 2024, https://gco.iarc.who.int/today.
- 3. Shi Z., Lin J., Wu Y., Fu S., Wan Y., and Fang Y., “Burden of Cancer and Changing Cancer Spectrum Among Older Adults in China: Trends and Projections to 2030,” Cancer Epidemiology 76 (2022): 102068, 10.1016/j.canep.2021.102068. [DOI] [PubMed] [Google Scholar]
- 4. World Health Organization (WHO) , “Ageing and Health in China,” accessed December 15, 2024, https://www.who.int/china/health‐topics/ageing.
- 5. Cao W. and Chen W., “Cancer Screening in the Aging Population: Where Do We Stand and What Can We Do?,” Journal of the National Cancer Center 2, no. 3 (2022): 127–129, 10.1016/j.jncc.2022.08.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Ju W., Zheng R., Zhang S., et al., “Cancer Statistics in Chinese Older People, 2022: Current Burden, Time Trends, and Comparisons With the US, Japan, and the Republic of Korea,” Science China. Life Sciences 66, no. 5 (2023): 1079–1091, 10.1007/s11427-022-2218-x. [DOI] [PubMed] [Google Scholar]
- 7. Xiang D., Hu S., Mai T., et al., “Worldwide Cancer Statistics of Adults Over 75 Years Old in 2019: A Systematic Analysis of the Global Burden of Disease Study 2019,” BMC Public Health 22, no. 1 (2022): 1979, 10.1186/s12889-022-14412-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Cao W., Qin K., Li F., and Chen W., “Socioeconomic Inequalities in Cancer Incidence and Mortality: An Analysis of GLOBOCAN 2022,” Chinese Medical Journal 137, no. 12 (2024): 1407–1413, 10.1097/CM9.0000000000003140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. United Nations Development Programme , “Human Development Reports,” accessed October 17, 2024, https://hdr.undp.org/data‐center/human‐development‐index.
- 10. Bray F., Jemal A., Grey N., Ferlay J., and Forman D., “Global Cancer Transitions According to the Human Development Index (2008–2030): A Population‐Based Study,” Lancet Oncology 13, no. 8 (2012): 790–801, 10.1016/S1470-2045(12)70211-5. [DOI] [PubMed] [Google Scholar]
- 11. Qiu H., Cao S., and Xu R., “Cancer Incidence, Mortality, and Burden in China: A Time‐Trend Analysis and Comparison With the United States and United Kingdom Based on the Global Epidemiological Data Released in 2020,” Cancer Communications 41, no. 10 (2021): 1037–1048, 10.1002/cac2.12197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Han B., Zheng R., Zeng H., et al., “Cancer Incidence and Mortality in China, 2022,” Journal of the National Cancer Center 4, no. 1 (2024): 47–53, 10.1016/j.jncc.2024.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Gao T. Y., Tao Y. T., Li H. Y., et al., “Cancer Burden and Risk in the Chinese Population Aged 55 Years and Above: A Systematic Analysis and Comparison With the USA and Western Europe,” Journal of Global Health 14 (2024): 04014, 10.7189/jogh.14.04014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Bray F., Laversanne M., Sung H., et al., “Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: A Cancer Journal for Clinicians 74, no. 3 (2024): 229–263, 10.3322/caac.21834. [DOI] [PubMed] [Google Scholar]
- 15. Arnold M., Rutherford M. J., Bardot A., et al., “Progress in Cancer Survival, Mortality, and Incidence in Seven High‐Income Countries 1995–2014 (ICBP SURVMARK‐2): A Population‐Based Study,” Lancet Oncology 20, no. 11 (2019): 1493–1505, 10.1016/S1470-2045(19)30456-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Smith R. A., Andrews K. S., Brooks D., et al., “Cancer Screening in the United States, 2019: A Review of Current American Cancer Society Guidelines and Current Issues in Cancer Screening,” CA: A Cancer Journal for Clinicians 69, no. 3 (2019): 184–210, 10.3322/caac.21557. [DOI] [PubMed] [Google Scholar]
- 17. Chen W., Xia C., Zheng R., et al., “Disparities by Province, Age, and Sex in Site‐Specific Cancer Burden Attributable to 23 Potentially Modifiable Risk Factors in China: A Comparative Risk Assessment,” Lancet Global Health 7, no. 2 (2019): e257–e269, 10.1016/S2214-109X(18)30488-1. [DOI] [PubMed] [Google Scholar]
- 18. Reitsma M. B., Kendrick P. J., Ababneh E., et al., “Spatial, Temporal, and Demographic Patterns in Prevalence of Smoking Tobacco Use and Attributable Disease Burden in 204 Countries and Territories, 1990–2019: A Systematic Analysis From the Global Burden of Disease Study 2019,” Lancet 397, no. 10292 (2021): 2337–2360, 10.1016/S0140-6736(21)01169-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Guan W. J., Zheng X. Y., Chung K. F., and Zhong N. S., “Impact of Air Pollution on the Burden of Chronic Respiratory Diseases in China: Time for Urgent Action,” Lancet 388, no. 10054 (2016): 1939–1951, 10.1016/S0140-6736(16)31597-5. [DOI] [PubMed] [Google Scholar]
- 20. Pilleron S., Gnangnon F., Noronha V., and Soto‐Perez‐de‐Celis E., “Cancer Incidence Estimates in Adults Aged 60 Years and Older Living in Low‐And‐Middle‐Income Countries for the Years 2020 and 2040,” Ecancermedicalscience 17 (2023): 1594, 10.3332/ecancer.2023.1594. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Zhang M., Yang L., Wang L., et al., “Trends in Smoking Prevalence in Urban and Rural China, 2007 to 2018: Findings From 5 Consecutive Nationally Representative Cross‐Sectional Surveys,” PLoS Medicine 19, no. 8 (2022): e1004064, 10.1371/journal.pmed.1004064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Liang H., Fan J. H., and Qiao Y. L., “Epidemiology, Etiology, and Prevention of Esophageal Squamous Cell Carcinoma in China,” Cancer Biology & Medicine 14, no. 1 (2017): 33–41, 10.20892/j.issn.2095-3941.2016.0093. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Wang H., Men P., Xiao Y., et al., “Hepatitis B Infection in the General Population of China: A Systematic Review and Meta‐Analysis,” BMC Infectious Diseases 19, no. 1 (2019): 811, 10.1186/s12879-019-4428-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Kim Y., Park J., Nam B. H., and Ki M., “Stomach Cancer Incidence Rates Among Americans, Asian Americans and Native Asians From 1988 to 2011,” Epidemiology and Health 37 (2015): e2015006, 10.4178/epih/e2015006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Sun D., Cao M., Li H., He S., and Chen W., “Cancer Burden and Trends in China: A Review and Comparison With Japan and South Korea,” Chinese Journal of Cancer Research = Chung‐Kuo Yen Cheng Yen Chiu 32, no. 2 (2020): 129–139, 10.21147/j.issn.1000-9604.2020.02.01. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Xu Y., Xia C., Li H., et al., “Survey of Hepatitis B Virus Infection for Liver Cancer Screening in China: A Population‐Based, Cross‐Sectional Study,” Chinese Medical Journal 137, no. 12 (2024): 1414–1420, 10.1097/CM9.0000000000003171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Xia C., Basu P., Kramer B. S., et al., “Cancer Screening in China: A Steep Road From Evidence to Implementation,” Lancet Public Health 8, no. 12 (2023): e996–e1005, 10.1016/S2468-2667(23)00186-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Kotwal A. A. and Walter L. C., “Cancer Screening in Older Adults: Individualized Decision‐Making and Communication Strategies,” Medical Clinics of North America 104, no. 6 (2020): 989–1006, 10.1016/j.mcna.2020.08.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Zhou Y., Song K., Chen Y., et al., “Burden of Six Major Types of Digestive System Cancers Globally and in China,” Chinese Medical Journal 137, no. 16 (2024): 1957–1964, 10.1097/CM9.0000000000003225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Lei S., Zheng R., Zhang S., et al., “Global Patterns of Breast Cancer Incidence and Mortality: A Population‐Based Cancer Registry Data Analysis From 2000 to 2020,” Cancer Communications 41, no. 11 (2021): 1183–1194, 10.1002/cac2.12207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Jiang D., Niu Z., Tan X., et al., “The Mortalities of Female‐Specific Cancers in China and Other Countries With Distinct Socioeconomic Statuses: A Longitudinal Study,” Journal of Advanced Research 49 (2023): 127–139, 10.1016/j.jare.2022.09.002. [DOI] [PMC free article] [PubMed] [Google Scholar]