Cancer burden and the contributions of risk factors in China: A systematic analysis for the Global Burden of Disease Study 2021

Abstract Background: As a populous country in the world, China ranks among the top in terms of new cancer cases and deaths worldwide. This study aims to provide a detailed evaluation of the cancer burden in China, considering the evolving social, economic, and environmental factors that may have influenced cancer incidence and mortality rates. Methods: The cancer incidence, mortality, and the contributions of risk factors were estimated using data from the Global Burden of Disease Study (GBD) 2021. The number of new cases and deaths with their 95% uncertainty intervals (UIs) were analyzed. The trends of cancer age-standardized incidence rates (ASIR) from 1990 to 2021 and age-standardized death rates (ASDR) from 1980 to 2021 were estimated. Besides, risk factor contributions were also assessed. Results: In 2021, the total burden of cancer in China comprised 13.66 million new cases (95% UI: 11.79 to 15.85 million) and 2.82 million deaths (95% UI: 2.35 to 3.36 million). In 2021, ASIR and ASDR of cancers were 790.2 (95% UI: 676.8–926.3) per 100,000 population and 137.5 (95% UI: 115.1–163.4) per 100,000 population, respectively. In 2021, tracheal, bronchus, and lung cancer showed the highest ASIR of 44.0 (95% UI: 35.4–53.3) per 100,000 population among site-specific tumors, followed by non-melanoma skin cancer (37.5 [95% UI: 32.4–42.7] per 100,000 population), colon and rectum cancer (31.4 [95% UI: 25.5–38.0] per 100,000 population), stomach cancer (29.1 [95% UI: 22.4–36.2] per 100,000 population), breast cancer (19.4 [95% UI: 15.0–24.3] per 100,000 population), esophageal cancer (15.0 [95% UI: 12–18.4] per 100,000 population), and liver cancer (9.5 [95% UI: 7.7–11.8] per 100,000 population). Besides, the ASDR of cancers decreased about 29.78% in males and 42.00% in females in the past forty years in China. Tracheal, bronchus, and lung cancer showed the highest ASIR (62.63 per 100,000 population) and ASDR (56.45 per 100,000 population) in males. Of note, 31.73% of all cancer deaths in China were digestive cancers in 2021. For level 1 risks in 2021, behavioral risks were linked to 73.57% of cancer deaths. Conclusions: The disease burden of cancers remains a major public health concern in China. The ASIR increased from 1990 to 2021 and the ASDR decreased from 1980 to 2021 in cancers. Tracheal, bronchus, and lung cancer remain the most common types of cancer in China.