Global, regional, and national lifetime risks of developing and dying from gastrointestinal cancers in 185 countries: a population-based systematic analysis of GLOBOCAN

Background Gastrointestinal cancers account for a quarter of the global cancer incidence and a third of cancer-related deaths. We sought to estimate the lifetime risks of developing and dying from gastrointestinal cancers at the country, world region, and global levels in 2020. Methods For this population-based systematic analysis, we obtained estimates of gastrointestinal cancer incidence and mortality rates from GLOBOCAN for 185 countries, alongside all-cause mortality and population data from the UN. Countries were categorised into quartiles of the Human Development Index (HDI). The lifetime risk of gastrointestinal cancers was estimated with a standard method that adjusts for multiple primaries, taking into account competing risks of death from causes other than cancer and life expectancy. Findings The global lifetime risks of developing and dying from gastrointestinal cancers from birth to death was 8 center dot 20% (95% CI 8 center dot 18-8 center dot 21) and 6 center dot 17% (6 center dot 16-6 center dot 18) in 2020. For men, the risk of developing gastrointestinal cancers was 9 center dot 53% (95% CI 9 center dot 51-9 center dot 55) and of dying from them 7 center dot 23% (7 center dot 22-7 center dot 25); for women, the risk of developing gastrointestinal cancers was 6 center dot 84% (6 center dot 82-6 center dot 85) and of dying from them 5 center dot 09% (5 center dot 08-5 center dot 10). Colorectal cancer presented the highest risk, accounting for 38 center dot 5% of the total lifetime risk of developing, and 28 center dot 2% of dying from, gastrointestinal cancers, followed by cancers of the stomach, liver, oesophagus, pancreas, and gallbladder. Eastern Asia has the highest lifetime risks for cancers of the stomach, liver, oesophagus, and gallbladder, Australia and New Zealand for colorectal cancer, and Western Europe for pancreatic cancer. The lifetime risk of gastrointestinal cancers increased consistently with increasing level of HDI; however, high HDI countries (the third HDI quartile) had the highest death risk. Interpretation The global lifetime risk of gastrointestinal cancers translates to one in 12 people developing, and one in 16 people dying from, gastrointestinal cancers. The identified high risk and observed disparities across countries warrants context-specific targeted gastrointestinal cancer control and health systems planning.