Changing Global and Chinese Cancer Burden: Insights from GLOBOCAN 2020

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Changing Global and Chinese Cancer Burden: Insights from GLOBOCAN 2020

In 2020, a landmark shift occurred in global cancer trends: breast cancer overtook lung cancer as the world’s most commonly diagnosed cancer. This milestone—along with rising mortality from liver cancer and persistent disparities in cancer burden—highlights how cancer patterns are evolving worldwide. A 2021 study by researchers at China’s National Cancer Center, analyzing data from the International Agency for Research on Cancer (IARC)’s GLOBOCAN 2020, offers critical insights into these changes—especially for China, which bears a third of the world’s cancer deaths.

Global Cancer Trends: Breast Cancer Takes the Lead

GLOBOCAN 2020 estimates 19.3 million new cancer cases and 9.96 million deaths worldwide in 2020. The top five most common cancers were:

  1. Breast (2.3 million cases)
  2. Lung (2.2 million cases)
  3. Prostate (1.4 million cases)
  4. Non-melanoma skin (1.2 million cases)
  5. Colorectal (1.1 million cases)

For the first time, breast cancer displaced lung cancer as the #1 diagnosed cancer—a shift driven by rising incidence in both high- and low-income countries. Meanwhile, liver cancer jumped from the 3rd to 2nd leading cause of cancer death (after lung cancer), with 830,000 deaths in 2020. Stomach, breast, and colorectal cancers rounded out the top five mortality causes.

Continental differences are stark:

  • Asia accounted for 50% of new cases and 58% of deaths—largely due to China’s size.
  • Oceania had the highest age-standardized incidence rate (ASIR: 404.6 per 100,000), thanks to high rates of skin and prostate cancer.
  • Europe had the highest age-standardized mortality rate (ASMR: 108.7 per 100,000), driven by lung and colorectal cancers.

China’s Cancer Burden: A Mix of Old and New Challenges

China’s cancer statistics are striking:

  • 24% of global new cases (4.57 million) and 30% of global deaths (3 million) in 2020.
  • ASIR: 204.8 per 100,000 (65th globally) and ASMR: 129.4 per 100,000 (13th globally)—both above the global average.

While lung cancer remains China’s most common and deadly cancer (820,000 new cases, 720,000 deaths in 2020), two key shifts are underway:

  1. Breast cancer is now the #1 cancer in women: 416,000 new cases in 2020—up from 300,000 in 2015.
  2. Western-style cancers are rising: Colorectal cancer (555,000 cases) and thyroid cancer (221,000 cases) are surging, linked to diets high in processed foods, obesity, and reduced physical activity.

Yet gastrointestinal cancers (stomach, liver, esophageal, colorectal) still dominate mortality, accounting for 45% of all cancer deaths in China. This is far higher than in developed countries (e.g., 15% in the U.S.), where early detection and treatment improve survival. In China, late-stage diagnosis and limited access to care contribute to poorer outcomes for these cancers.

Future Projections: A Growing Crisis

By 2040, the global cancer burden is expected to grow by 49% in new cases and 62% in deaths. For China, the numbers are even more alarming:

  • 6.85 million new cases (up from 4.57 million in 2020)
  • 5.07 million deaths (up from 3 million in 2020)

These increases are driven by two factors:

  1. Aging population: China’s over-60 population is projected to reach 400 million by 2050—cancer risk rises sharply with age.
  2. Lifestyle changes: Urbanization, Western diets, and reduced physical activity are fueling cancers linked to “Westernization.”

What This Means for Cancer Control

China’s cancer crisis reflects a “cancer transition”—a shift from infection-related cancers (e.g., liver from hepatitis B, stomach from H. pylori) to lifestyle-related cancers (e.g., breast, colorectal). To address this, the study’s authors emphasize tailored, evidence-based strategies:

  1. Prevention first: Target modifiable risks like tobacco use (responsible for 25% of Chinese cancer deaths), air pollution, and obesity.
  2. Early detection: Expand national screening programs for lung, breast, and colorectal cancers—currently limited in rural areas.
  3. Vaccination: Scale up hepatitis B (for liver cancer) and HPV (for cervical cancer) vaccines.
  4. Health education: Improve cancer awareness in rural China, where low knowledge is linked to higher risk.

The study also highlights gaps in data quality: while China’s cancer registries have expanded (covering 598 million people in 2020), inconsistencies remain. Better data will help refine prevention efforts and track progress.

Conclusion

The 2020 GLOBOCAN data paints a clear picture: global cancer patterns are changing, and China is at the center of this shift. While breast cancer now leads globally, China faces a unique challenge—balancing rising lifestyle-related cancers with persistent gastrointestinal and infection-linked diseases.

For China, the path forward lies in precision public health: combining universal screening, targeted education, and policy changes (e.g., stricter tobacco controls) to address both old and new cancer threats. As the study’s authors note, “Comprehensive strategies are urgently needed to target China’s changing profiles of the cancer burden.”

This research—led by Wei Cao, Hong-Da Chen, Yi-Wen Yu, Ni Li, and Wan-Qing Chen of the National Cancer Center/National Clinical Research Center for Cancer in Beijing—was published in the Chinese Medical Journal (2021).

doi.org/10.1097/CM9.0000000000001474

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