A new report examines national and regional cancer incidence and mortality patterns in the Latin America and the Caribbean region using the most recent GLOBOCAN estimates for the year 2020, alongside recent national mortality trends from the World Health Organization mortality database. The study team provides an updated overview of estimates for cancer incidence and mortality in the year 2020 for 32 countries in the region reflecting important sociodemographic changes that occurred over the last decades, including urbanisation and the progressive adoption of more westernised lifestyles at the population level. While this reflects the leading cancers in terms of prostate, breast and colorectum, infection-related stomach and cervical cancers remain relatively common in the region. The findings are published by Marion Piñeros of the Cancer Surveillance Branch, International Agency for Research on Cancer (IARC) in Lyon, France and colleagues on 17 June 2022 in The Lancet Regional Health Americas.
The authors wrote in the background that the Latin America and the Caribbean region has doubled in population size over the last half century. Concurrently, life expectancy has increased among the 32 constituent countries reaching 76 years at the regional level, although national averages vary from 65 in Guyana to 83 years in Martinique.
Cancer is already the leading cause of premature death in almost half of the Latin America and the Caribbean countries, and the cancer burden is predicted to rise over the next decades. There are major challenges ahead in planning rational cancer care and preventive services in the region where a third of inhabitants are living in poverty.
Contemporary data on the cancer burden aims to inform effective cancer policies. The current report provides an update and benchmarking of national cancer incidence and mortality estimates for the year 2020, alongside recent mortality trends in the Latin America and the Caribbean region. The number of new cancer cases and deaths were extracted from the GLOBOCAN 2020 database developed by the IARC, and mortality data over time from IARC's cancer mortality database.
New cancer cases, deaths and corresponding age-standardised rates per 100,000 person-years were presented. Random fluctuations in mortality trends by country, sex and cancer site were smoothed using LOWESS regression. To enable benchmarking in the region and to facilitate comparisons with their previous report, the authors additionally provided comparisons with corresponding estimates in the US and Spain for the same year using the same sources.
An estimated total of 1.5 million new cancer cases and 700,000 deaths occured annually in the Latin America and the Caribbean region, with corresponding incidence and mortality rates of 186.5 and 86.6 per 100,000. The most common cancers in 2020 were prostate (15%), breast (14%), colorectal (9%), lung (7%) and stomach (5%). Within the region, South America exhibited the highest incidence rates for all cancers combined, changing the relative regional position of the 2012 estimates, when the Caribbean ranked first.
Lung cancer remained the leading cause of cancer death (12%), for both sexes combined, although rates varied substantially between countries. The mortality trends of infectious-related cancers tended to decline in most countries, while rates of cancer types linked to westernisation were mainly increasing.
The authors commented that as a marker of progress in cancer control, there are marked variations in the temporal patterns of cancer-specific mortality, with the broad successes seen in terms of declining trends in stomach, prostate and male lung cancer mortality, tempered by concerns regarding the clear increasing trends in many countries in the region of breast and colorectal cancer mortality; for the latter two cancers, the decreases seen in Argentina and Uruguay are the only exceptions.
The authors discussed the findings in terms of current available evidence on the underlying determinants and the prospects of effective cancer control. Countries like the US have experienced significant decreases in cancer mortality over the past three decades, attributable to reductions in overall cancer incidence, to advances in early detection, and to improvements in treatment. A recent IARC modelling study advocated a greater focus on prevention strategies, given policies that tackle tobacco smoking and obesity and the implementation of HPV immunisation. Although important advances have occurred in tobacco control in the Latin America and the Caribbean region, preventive measures such as those targeting physical activity and diet are slow to advance. With respect to early detection, screening and cancer care, a recent report provides evidence of both progress as well as barriers that persist in the region.
This study also fosters international collaborative research with local partners in the Latin America and the Caribbean region that are actively supporting the Global Initiative for Cancer Registry Development. Despite the existence of estimates, countries need to do an effort to improve the generation of data by population-based cancer registries.
Assuming the rates remain unchanged, the cancer burden in the Latin America and the Caribbean region will increase by 67%, reaching 2.4 million new cases annually by 2040. The authors concluded that with an increasing burden anticipated over the next decades in this region, there is a need to plan oncological care services and the human health force accordingly.
Reference
Piñeros M, Laversanne M, Barrios E, et al. An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. The Lancet Regional Health Americas; Published online 17 June 2022. DOI: https://doi.org/10.1016/j.lana.2022.100294