Noncommunicable diseases (NCDs), particularly cancer, cardiovascular diseases, chronic respiratory diseases, and diabetes, are among the leading causes of death globally, accounting for approximately 74% of all deaths worldwide (1). Cancer is the second leading cause of death, with an estimated global mortality of over 9.3 million people annually due to noncommunicable diseases. Cancer is a major contributor to the global disease burden, and it is projected that the global cancer burden will continue to rise for at least the next 20 years (2–4). The United Nations Sustainable Development Goals highlight the importance of addressing the cancer burden under Target 3.4. This target aims to reduce premature mortality from noncommunicable diseases (NCDs), including cancer, by one-third by 2030 through prevention and treatment (5, 6). Additionally, it emphasizes the promotion of mental health and well-being as part of a broader strategy to combat NCDs. Despite growing awareness of the threat NCDs pose to human development, progress in controlling NCDs remains slow in most countries (7). Unlike other health threats, such as tuberculosis, human immunodeficiency virus, or malaria, cancer encompasses many distinct diseases requiring unique approaches for prevention, diagnosis, and treatment. Few countries have successfully addressed this challenge.

Monitoring the severity and demographic, spatial, and temporal variations of cancer burden is crucial for adjusting health planning and setting priorities for clinical care and research (8). Policy-makers need localized data to evaluate cancer control programs, establish progress benchmarks, and allocate resources effectively, although some countries lack cancer surveillance systems. Given that cancer is recognized as a national health priority by the World Health Organization and many governments, detailed epidemiological data on different cancer types are particularly important in lower- and middle-income countries (LMICs) and low-income countries (LICs), where health priorities often compete.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) framework facilitates the comparative evaluation of cancer burdens across different regions and time periods by examining cancer incidence, mortality, and disability-adjusted life years (DALYs). The aim of this study was to compare the incidence and mortality of 34 cancers across 204 countries or regions from 1990 to 2021, providing guidance for global cancer prevention and control. The presented results offer up-to-date information to better understand the evolution and trends of cancer burden across countries with different levels of development.

Data on annual incidence, mortality, and age-standardized rates for these 34 cancer types were collected from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, covering various demographic categories, including sex, region, country, and age. The dataset comprehensively evaluates the impact of 371 diseases and 88 risk factors across 204 countries and 811 subnational locations (9, 10). The Global Health Data Exchange (GHDx) query tool, an online health data resource provided by the Institute for Health Metrics and Evaluation (IHME), is used to collect annual frequencies and age-standardized rates (ASRs) of cancer-related incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for 34 types of cancer. All statistical analyses and data visualizations were performed using R (version 4.4.2) and JD_GBDR (V2.37, Jingding Medical Technology Co., Ltd.). In this study, the R software package (version4.2.3) and JD_GBDR (V2.22, Jingding Medical Technology Co., Ltd.) was used for the drawing of the figures. The detailed methodology is provided in the Supplementary Materials .

This study assessed the burden of 34 major cancers across 204 countries and territories from 1990 to 2021. In 2021, there were 23.57 million new cancer cases and 9.83 million deaths, largely driven by population growth and aging. While ASIR increased slightly, ASMR declined, reflecting improvements in early detection and treatment. Men had higher rates than women, and most cases occurred in individuals aged 50 and older. High-income regions had the highest ASIRs, whereas low-SDI regions, especially East Africa, had the highest ASMRs due to limited healthcare access. By 2050, cancer incidence is projected to rise by 19.9% and prevalence by 36.7%, while mortality and DALYs are expected to decline. These findings highlight progress in reducing cancer mortality but emphasize the need for equitable healthcare strategies to address disparities across regions, sex, and socioeconomic groups.

From 1990 to 2021, the global cancer burden significantly increased, with new cases increasing 2.3-fold and deaths increasing 1.7-fold. However, the ASIR increased by only 8.8%, whereas the ASMR decreased by 21.5%. Similar results have been confirmed in previous studies (11, 12). The global increase in the ASIR for cancer is largely due to population ageing, as older populations are more susceptible to cancer (13–15). Improvements in diagnostic technologies and screening programs have also led to more cancers being detected (16, 17). Additionally, lifestyle factors, such as smoking, poor diet, and physical inactivity, contribute to the increasing incidence (18–20). On the other hand, advancements in diagnostic and therapeutic technologies, including advanced imaging, molecular diagnostics, targeted therapies, and immunotherapies, have significantly reduced cancer mortality, improved cure rates, and extended survival for advanced-stage patients (21–23). These technological improvements, combined with progress in early detection, public health interventions, and enhanced healthcare systems, are key drivers of the declining ASMR (24–26). There are notable sex differences in cancer burden, with men experiencing higher incidence and mortality rates than women. These disparities may be linked to factors such as higher smoking prevalence among men, greater occupational exposure to carcinogens, differences in genetic and epigenetic factors, and hormone levels that influence cancer susceptibility (27–30). A significant portion of cancer cases occur in individuals aged 50 years and above, and the growing proportion of high-risk groups due to ageing, coupled with population growth, has greatly contributed to the increase in absolute cancer cases, particularly in low- and middle-income countries (31). Furthermore, there are significant differences in the contributions of various cancer types. Nonmelanoma skin cancer, TBL cancer, colon and rectum cancer, and breast cancer are the most common types of cancer globally, while TBL cancer, stomach cancer, breast cancer, and liver cancer account for the highest mortality rates. This highlights the need to tailor prevention, diagnosis, and treatment strategies by cancer type. In addition, cancer burden patterns vary by income level. High-income countries report higher incidence rates due to ageing populations and widespread screening, whereas low-income countries face higher mortality rates due to limited healthcare resources and late-stage diagnoses. However, emerging risk factors, including obesity, sedentary behavior, and environmental pollution, are gaining prominence and may drive future cancer burdens, underscoring the complex interplay of ageing, medical progress, and lifestyle changes in shaping global cancer trends. Similar to trends predicted by previous research (32–34), global cancer incidence and prevalence are projected to rise significantly by 2050, primarily among individuals aged 60 years and older, underscoring a substantial burden.

Significant geographical disparities exist in the global cancer burden (32, 35), highlighting the diverse impacts of socioeconomic development, healthcare infrastructure, and exposure to environmental and behavioral risk factors. High-income countries typically exhibit higher ASIRs and ASPRs, reflecting widespread access to cancer screening, early diagnosis, and longer survival among patients. For example, the ASIRs for breast and prostate cancer in High-income North America rank among the highest in the world. However, these regions have relatively low ASMRs and ASDRs, highlighting the effectiveness of advanced cancer management and treatment strategies that reduce mortality and improve patient outcomes. In contrast, low- and middle-income countries face disproportionately higher cancer mortality rates and disease burdens, as evidenced by their elevated ASMRs and ASDRs. This disparity is particularly pronounced in Sub-Saharan Africa, where liver and cervical cancer burdens remain high owing to the prevalence of HBV and HPV infections, compounded by limited access to vaccination programs and insufficient healthcare resources. Moreover, disparities exist even within the same regions, reflecting localized variations in risk factors and healthcare access. For example, High-income Asia Pacific, Japan, and South Korea report significantly higher gastric cancer burdens than neighboring nations, driven by dietary patterns and higher rates of Helicobacter pylori infection (36). These regional and national differences underscore the need for tailored cancer prevention and control strategies that address specific risk factors and healthcare challenges in each context.

Sex and age are critical determinants of the global cancer burden. In 2021, men experienced a 1.2-fold higher cancer incidence and 1.3-fold higher mortality than women did, with significantly higher rates of cancers such as TBL cancer, stomach cancer, and colon and rectum cancer among men (32, 37–39). This disparity is driven by multiple factors. Men are more likely to engage in high-risk behaviors such as smoking, excessive alcohol consumption, and occupational exposure to carcinogens, all of which increase their cancer risk (40–42). Additionally, men’s lower health awareness and reduced participation in routine screenings often lead to later-stage diagnoses, resulting in poorer outcomes. Biological differences, including variations in hormone levels, may further influence susceptibility to certain cancers and their progression rates, adding complexity to the observed disparities (43, 44). Age also plays a crucial role in shaping the global cancer burden, as the disease is closely associated with the human life cycle. In children and adolescents, leukemia is the primary contributor to the cancer burden, highlighting the importance of early diagnosis and specialized pediatric care (45). While leukemia is more common among children and adolescents, the greatest cancer burden is borne by individuals aged 50 years and above, who account for the majority of new cases and deaths worldwide. Notably, individuals aged 70 years and above have the highest incidence and mortality rates for several cancers, including TBL cancer, colon and rectum cancer, stomach cancer, and prostate cancer, underscoring the profound impact of cancer on the older adult population. This age-related pattern reflects the cumulative effects of prolonged exposure to carcinogens, biological ageing, and reduced immune surveillance, highlighting the importance of targeted prevention and care strategies for ageing populations (46, 47). Understanding the interplay between sex and age in cancer epidemiology is essential for developing comprehensive approaches to reduce disparities and address the unique challenges faced by different demographic groups.

The relationship between socioeconomic development and cancer burden, as analyzed through SDI stratification, reveals complex and contrasting patterns. Studies have revealed that countries with high SDIs have significantly higher cancer incidence and prevalence rates, whereas those with low SDIs have greater burdens on cancer mortality and DALYs (9, 48–50). In addition, in the past decade, low- and low-middle-SDI regions have experienced faster increases in cancer cases and deaths than high-SDI regions. Projections align with this trend, indicating that by 2040, over two-thirds of global cancer cases are expected to occur in low- and middle-income countries, highlighting the shifting global burden of cancer (2). High-SDI countries demonstrate the highest ASIRs and ASPRs, reflecting widespread access to advanced healthcare systems, early diagnostic technologies, and effective treatment options. These nations benefit from well-established cancer management programs, resulting in relatively low ASMRs and ASDRs. For example, prostate and breast cancers have the highest ASPRs in high-SDI countries, yet their mortality rates remain comparatively low, highlighting the effectiveness of prevention and treatment strategies in these settings. Conversely, low-SDI countries face substantial challenges, including the highest mortality and DALYs, which stem from limited healthcare infrastructure, delays in diagnosis, and a lack of comprehensive preventive measures. Liver cancer and cervical cancer, in particular, exhibit significantly higher mortality rates in low-SDI countries than in their high-SDI counterparts, underscoring the impact of inadequate vaccination coverage, insufficient access to screening programs, and limited treatment options (51, 52). These disparities reflect the pressing need for targeted interventions and equitable healthcare resource allocation to address the disproportionate burden borne by low-SDI nations. Understanding these contrasting patterns is essential for tailoring global cancer prevention and control efforts to the specific needs and capacities of countries at different levels of socioeconomic development.

Despite being based on high-quality GBD data and advanced modelling methods and providing a systematic analysis of global cancer burden trends from 1990 to 2021, this study has several limitations that may affect the interpretation and application of its results. First, the data quality and sources are limited in low-income countries and regions with insufficient data, especially in areas with low cancer registry coverage, leading to increased uncertainty in some estimates. Additionally, differences in data collection standards and reporting practices across countries may impact the accuracy of cross-country comparisons. Second, while the modelling methods and time series analysis used in this study are efficient, they may not fully capture the nonlinear changes in cancer burden and their complex driving factors, such as short-term fluctuations caused by the introduction of screening policies or treatment technologies. Moreover, the study provides limited discussion on the role of specific risk factors (e.g., smoking, alcohol consumption, and obesity) and social policies (e.g., tobacco control and vaccination) and does not sufficiently assess the impact of treatment advances on patient survival and quality of life. Furthermore, external factors such as the disruption of cancer screening and treatment due to the COVID-19 pandemic, environmental risks due to climate change, and the influence of cultural and behavioral differences on cancer patterns have not been fully incorporated into the analysis framework (53, 54). Non-melanoma skin cancer (NMSC) contributes substantially to incident cases in several regions. Nevertheless, its ascertainment varies considerably across cancer registries, with some providing comprehensive reporting while others underreport or exclude NMSC altogether. Such heterogeneity may introduce bias into incidence estimates and complicate cross-country comparisons. Accordingly, while our analysis offers valuable insights into the global and regional cancer burden, trends involving NMSC should be interpreted with caution. Although our analysis does not show marked deviations in cancer incidence growth rates following the onset of the COVID-19 pandemic, this observation should be interpreted cautiously. The pandemic likely affected cancer detection and reporting through multiple mechanisms, including disruptions in routine screening programs, delays in diagnostic services, changes in health-seeking behavior, and potential lag in registry reporting. These factors could mask short-term fluctuations or temporarily reduce observed incidence, particularly in regions where healthcare systems were heavily impacted. Therefore, while the observed post-2019 trends appear broadly consistent with pre-pandemic patterns, we refrain from concluding that COVID-19 had no substantial impact on cancer incidence growth, and emphasize that ongoing monitoring and further analyses will be necessary to fully understand the pandemic’s effects. Nevertheless, these limitations do not diminish the value of this study in revealing the spatiotemporal patterns of the global cancer burden but rather provide direction for future research to optimize data sources, explore driving factors in greater depth, and strengthen cross-disciplinary discussions.

On the basis of the findings of this study, several key strategies are recommended to advance global cancer prevention and control efforts. First, expanding vaccination programs targeting HBV and HPV is crucial, as these initiatives have the potential to substantially lower the incidence and mortality of related cancers, including liver and cervical cancer. Second, enhancing screening and early diagnostic capabilities is essential, particularly for breast, cervical, pancreatic, and colorectal cancers (55, 56). This effort is especially important in resource-limited settings, where access to timely and effective diagnostic tools remains a significant challenge. Third, optimizing cancer treatment and improving resource allocation are vital. Expanding access to advanced therapies, such as targeted treatments and immunotherapies, in low-SDI countries, along with bolstering international support to enhance healthcare infrastructure, can help reduce disparities in cancer outcomes. In addition to these medical interventions, raising public health awareness through education campaigns is necessary to address modifiable risk factors. These campaigns should focus on reducing smoking, alcohol consumption, and unhealthy diets while promoting physical activity to mitigate cancer risk. Finally, the establishment and enhancement of cancer registries in underrepresented regions are imperative for generating reliable data to inform policy decisions and resource distributions. Recent advancements in the Internet of Things (IoT) have demonstrated considerable potential in the field of cancer prevention. Through the integration of wearable sensors, mobile health platforms, and real-time data analytics, IoT technologies enable continuous monitoring of lifestyle behaviors, facilitate the early detection of warning signals, and enhance adherence to cancer screening and follow-up programs. Moreover, the emerging concept of the Internet of Surgical Things (IoST) highlights how IoT can be embedded in surgical practice, supporting telesurgery, surgical telementoring, image-guided procedures, and telemonitoring of patients (57). While IoST has primarily been applied to improve surgical precision and perioperative care, these advances also illustrate the broader capacity of IoT-based systems to enhance early detection, optimize treatment pathways, and strengthen long-term surveillance in oncology. Collectively, these strategies emphasize the need for a multifaceted and equitable approach to cancer prevention and control, addressing both systemic healthcare barriers and individual-level behaviors to reduce the global burden of cancer.

Future research on global cancer trends should prioritize improving data quality, especially in low-SDI countries, to strengthen cancer registry systems and ensure more accurate and comprehensive data. This would facilitate better tracking of incidence and mortality rates over time, enabling targeted interventions. Understanding the complex interplay between behavioral, genetic, and environmental risk factors is also crucial for identifying modifiable risks and developing effective prevention strategies. Furthermore, evaluating existing healthcare interventions—such as HPV vaccination, smoking cessation, and cancer screening programs—can offer insights into their effectiveness in reducing the cancer burden, particularly in resource-limited settings. Merging strategies such as liquid biopsies, including circulating tumor DNA, with polygenic risk scores (PRS) for risk stratification offers promising avenues for the early detection of deadly cancers (55, 56). Nonetheless, their clinical implementation entails important ethical and practical considerations, including informed consent, data privacy, equitable access, and potential psychosocial impacts (58). Rigorous validation and careful evaluation will be essential to fully realize the potential of these approaches in personalized cancer prevention and early detection. As cancer trends evolve, focusing on emerging cancers with increasing incidence rates, such as pancreatic and thyroid cancers, is essential. Research should investigate the underlying causes of these trends and develop targeted therapies for early detection and treatment. A multidisciplinary approach combining epidemiology, genomics, and health economics is necessary to create comprehensive cancer control strategies. Finally, the COVID-19 pandemic may continue to affect estimates of cancer burden trends in the coming years, with reporting delays and the ongoing impact of the pandemic. Future research should focus on gaining a comprehensive understanding of the effects of the 2022 pandemic on cancer burden and its long-term implications. These research directions are critical for addressing disparities, improving prevention, and tailoring treatment approaches, ultimately enhancing cancer outcomes and quality of life for patients worldwide.

Cancer is a complex group of diseases with diverse risk factors, mechanisms, and treatment strategies, making it a challenge to understand and manage. The GBD 2021 study provides updated global cancer burden estimates, revealing significant disparities by sex, age, region, country, and SDI. By 2050, global cancer incidence is expected to exceed 26 million, with prevalence surpassing 100 million. However, cancer mortality is projected to decrease by 14.8%, and DALYs by 15.8%. These findings underscore the need for personalized cancer control strategies based on regional and socioeconomic contexts. Policymakers can use this data to guide resource allocation and implement targeted prevention efforts. Addressing sex- and age-related disparities is crucial for improving cancer care. However, reducing the global cancer burden requires coordinated efforts across policy, research, and international collaboration. The long-term effects of the COVID-19 pandemic on cancer remain uncertain, highlighting the need for further research to refine cancer control strategies in the post-pandemic era.