Commentary on “Global statistics and risk factors of neoplasms in the elderly, and the impact of aging on neoplasms from 1990 to 2021”

Dear Editor, We read with great interest the work of Wang et al, who used GBD 2021 data to characterize long-term trends in incidence, mortality, and disability-adjusted life-years (DALYs) for overall neoplasms and 34 subtypes among adults aged 55 years and older from 1990 to 2021[1]. Their synthesis highlights both the magnitude of the burden and its marked geographic variation, and offers a useful evidence base for prevention and service planning in aging societies[1]. First, because the GBD framework aggregates malignant, benign, and borderline entities under the single label of “neoplasms,” a more explicit separation of malignant versus non-malignant categories could improve clinical interpretability[2]. For instance, reporting parallel trends and leading contributors within each category may help readers distinguish genuine changes in cancer burden from shifts in detection, coding practice, or surveillance intensity for benign diseases. Second, cross-location comparisons may benefit from age standardization within populations aged 55 years. The proportion of “oldest-old” adults varies substantially across settings and over time; thus, crude rates among those aged 55 years and older may partly reflect the demographic structure rather than underlying risk. Using age-standardized rates based on an established standard population (e.g., the WHO World Standard) or presenting consistent age bands (55–64, 65–74, 75–84, and ≥85 years) could support more like-for-like comparisons and improve transparency for decomposition analyses using the Das Gupta approach[3,4]. Finally, the reported risk factor patterns are highly relevant, particularly the prominence of smoking and the rapid rise in drug use as increasingly important contributors to the attributed neoplasm burden in high SDI regions[1]. Given the long latency and cohort effects typical of many cancers, it would be helpful to clarify how GBD comparative risk assessment estimates were mapped to “overall neoplasms” in this older cohort and whether the observed increases are concentrated in a small set of sites with established causal pathways[2,5]. Presenting a brief site-level attribution summary for the leading risks might keep the message focused while supporting the translation into targeted prevention strategies. In conclusion, this study makes a valuable contribution to the understanding of neoplasm burden in older populations. With clearer stratification by neoplasm type and age structure, future analyses may further improve comparability and strengthen the link between global estimates and actionable site-specific prevention and service planning[1].