The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Authors: Elysia Alvarez, Lisa M Force, Rixing Xu, Kelly Compton, Dan Lu, Hannah Henrikson, Jonathan Kocarnik, James Harvey, Alyssa Pennini, Frances Dean, Weijia Fu, Martina T Vargas, Theresa H.M. Keegan, Hany Ariffin, Ronald D. Barr, Yana Arturovna Erdomaeva, Sanjeeva Gunasekera, Yetunde O. John-Akinola, Tyler G. Ketterl, Tezer Kutluk, Marcio H. Malogolowkin, Prashant Mathur, Venkatraman Radhakrishnan, Lynn A. G. Ries, Carlos Rodríguez‐Galindo, G. B. Sagoyan, Iyad Sultan, Behzad Abbasi, Mohsen Abbasi‐Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd‐Elsalam, Amir Abdoli, Haimanot Abebe, Aidin Abedi, Hassan Abidi, Hassan Abolhassani, Hiwa Abubaker Ali, Eman Abu‐Gharbieh, Basavaprabhu Achappa, Juan Acuña, Isaac Akinkunmi Adedeji, Oyelola A. Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad U. Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, Sepideh Ahmadi, Muktar Beshir Ahmed, Tarik A. Rashid, Yusra Ahmed Salih, Wajeeha Aiman, Gizachew Taddesse Akalu, Hanadi Al Hamad, Fares Alahdab, Abdulhadi A. AlAmodi, Fahad Alanezi, Turki M Alanzi, Adugnaw Zeleke Alem, Dejene Tsegaye Alem, Yosef Alemayehu, Fadwa Alhalaiqa, Robert Kaba Alhassan, Saqib Ali, Gianfranco Alicandro, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sunitha Alluri, Nihad A. Almasri, Sadeq Ali Al‐Maweri, Sami Almustanyir, Rajaa Al‐Raddadi, Nelson Alvis‐Guzmán, Edward Kwabena Ameyaw, Saeed Amini, Hubert Amu, Robert Ancuceanu, Cătălina Liliana Andrei, Tudorel Andrei, Fereshteh Ansari, Alireza Ansari‐Moghaddam, Davood Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab‐Zozani, Ayele Mamo Argaw, Muhammad Arshad, Judie Arulappan, Armin Aryannejad, Zatollah Asemi, Mohammad Asghari Jafarabadi, Mohammad Reza Atashzar, Prince Atorkey, Alok Atreya, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Ávila‐Burgos, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Alemu Degu Ayele, Solomon Shitu Ayen, Mohammed A. Azab, Sina Azadnajafabad, Hiva Azami, Mohammadreza Azangou‐Khyavy, Amirhossein Azari Jafari, Ghasem Azarian, Ahmed Y. Azzam, Saeed Bahadory, Jianjun Bai, Atif Amin Baig, Jennifer L. Baker, Maciej Banach, Till Bärnighausen, Francesco Barone‐Adesi, Fabio Barra, Amadou Barrow, Huda Basaleem, Abdul‐Monim Batiha, Masoud Behzadifar, Niguss Cherie Bekele, Rebuma Belete, Uzma Belgaumi, Arielle Wilder Bell, Alemshet Yirga Berhie, Devidas S. Bhagat, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Sadia Bibi, Ali Bijani, Antonio Biondi, Setognal Birara, Tone Bjørge, Obasanjo Afolabi Bolarinwa, Srinivasa Rao Bolla, Archith Boloor, Dejana Braithwaite, Hermann Brenner, Norma B. Bulamu, Katrin Burkart, Maria Teresa Bustamante-Teixeira, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Chao Cao, Yin Cao, Giulia Carreras, Ferrán Catalá-López, Francieli Cembranel, Ester Cerin, Raja Chandra Chakinala, Promit Ananyo Chakraborty, Vijay Kumar Chattu, Pankaj Chaturvedi, Akhilanand Chaurasia, Prachi P. Chavan, Odgerel Chimed‐Ochir, Jee-Young Jasmine Choi, Devasahayam J Christopher, Dinh‐Toi Chu, Michael T. Chung, João Conde, Vera Marisa Costa, Omar B. Da’ar, Omid Dadras, Saad M A Dahlawi, Xiaochen Dai, Giovanni Damiani, Emanuele D’Amico, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Amira Hamed Darwish, Ahmad Daryani, Fernando de la Hoz, Sisay Abebe Debela, Takele Gezahegn Demie, Getu Debalkie Demissie, Zeleke Geto Demissie, Edgar Denova‐Gutiérrez, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Samath Dhamminda Dharmaratne, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mostafa Dianatinasab, Mojtaba Didehdar, Mengistie Diress, Shirin Djalalinia, Huyen Phuc, Saeid Doaei, Fariba Dorostkar, Wendel Mombaque dos Santos, Thomas M Drake, Michael Ekholuenetale, Iman El Sayed, Maysaa El Sayed Zaki, Maha El Tantawi, Hassan El‐Abid, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hala Rashad Elhabashy, Muhammed Elhadi, Shaimaa I El-Jaafary, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Babak Eshrati, Sharareh Eskandarieh, Mohammed Faisaluddin, Jawad Fares, Umar Farooque, Abidemi Omolara Fasanmi, Wafa Fatima, José Miguel P. Ferreira de Oliveira, Simone Ferrero, Lorenzo Ferro Desideri, Getahun Fetensa, Irina Filip, Florian Fischer, James L. Fisher, Masoud Foroutan, Takeshi Fukumoto, Péter Gaál, Mohamed M. Gad, Piyada Gaewkhiew, Silvano Gallus, Tushar Garg, Teferi Gebru Gebremeskel, Belete Negese, Tamiru Getachew, Mansour Ghafourifard, Seyyed‐Hadi Ghamari, Ahmad Ghashghaee, Fariba Ghassemi, Nermin Ghith, Ali Gholami, Jamshid Gholizadeh Navashenaq, Syed Amir Gilani, Themba G. Ginindza, Abraham Tamirat Gizaw, James Glasbey, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Sameer Vali Gopalani, Giuseppe Gorini, Houman Goudarzi, Bárbara Niegia Garcia de Goulart, Ayman Grada, Mohammed Ibrahim Mohialdeen Gubari, Maximiliano Ribeiro Guerra, Avirup Guha, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Gupta, Rasool Haddadi, Nima Hafezi‐Nejad, Alemayehu Hailu, Arvin Haj‐Mirzaian, Rabih Halwani, Randah R Hamadeh, Mitiku Teshome Hambisa, Sajid Hameed, Samer Hamidi, Shafiul Haque, Sanam Hariri, Josep María Haro, Ahmed I Hasaballah, S M Mahmudul Hasan, Seyedeh Melika Hashemi, Treska S Hassan, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Sultan Hussen Hebo, Golnaz Heidari, Mohammad Heidari, Brenda Yuliana Herrera-Serna, Claudiu Herţeliu, Demisu Zenbaba Heyi, Kamal Hezam, Michael K. Hole, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Bellal Hossain, Mohammad‐Salar Hosseini, Mostafa Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Mohamed Hsaïri, Junjie Huang, Nawfal R Hussein, Bing‐Fang Hwang, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena Ilić, Milena Ilić, Kaire Innos, Lalu Muhammad Irham, Rakibul Islam, Sheikh Mohammed Shariful Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Louis Jacob, Farhad Jadidi‐Niaragh, Vardhmaan Jain, Mihajlo Jakovljević, Roksana Janghorban, Amirreza Javadi Mamaghani, Shubha Jayaram, Ranil Jayawardena, Seyed Behzad Jazayeri, Rime Jebai, Ravi Prakash Jha, Tamás Joó, Nitin Joseph, Farahnaz Joukar, Mikk Jürisson, Billingsley Kaambwa, Ali Kabir, Leila R Kalankesh, Feroze Kaliyadan, Zul Kamal, Ashwin Kamath, Himal Kandel, Sitanshu Sekhar Kar, Ibraheem M. Karaye, Amirali Karimi, Bekalu Getnet Kassa, Joonas H. Kauppila, Phillip M. Kemp Bohan, André Pascal Kengne, Amene Abebe Kerbo, Mohammad Keykhaei, Yousef Khader, Himanshu Khajuria, Nastaran Khalili, Neda Khalili, Ejaz Ahmad Khan, Gulfaraz Khan, Maseer Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Maryam Khayamzadeh, Omid Khosravizadeh, Jagdish Khubchandani, Roba Khundkar, Min Seo Kim, Yun Jin Kim, Adnan Kısa, Sezer Kısa, Katarzyna Kissimova‐Skarbek, Ali‐Asghar Kolahi, Jacek A Kopec, Rajasekaran Koteeswaran, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Nuworza Kugbey, G Anil Kumar, Nithin Kumar, Alexander Kwarteng, Carlo La Vecchia, Qing Lan, Iván Landires, Savita Lasrado, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Wei‐Chen Lee, Yeong Yeh Lee, Yo Han Lee, James Leigh, Elvynna Leong, Bingyu Li, Jiarui Li, Ming‐Chieh Li, Stephen S Lim, Xuefeng Liu, Stany W. Lobo, Joana A. Loureiro, Alessandra Lugo, Raimundas Lunevičius, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Morteza Mahmoudi, Azeem Majeed, Alaa Makki, Shilpa Male, Mohammad‐Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Mohammed A. Mamun, Navid Manafi, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Alì Mansournia, Santi Martini, Seyedeh Zahra Masoumi, Clara N Matei, Manu Raj Mathur, Colm McAlinden, Ravi Mehrotra, Walter Mendoza, Ritesh G. Menezes, Alexios‐Fotios A. Mentis, Tuomo J Meretoja, Amanual Getnet Mersha, Mohamed Kamal Mesregah, Tomislav Meštrović, Junmei Miao Jonasson, Bartosz Miazgowski, Irmina Maria Michałek, Ted R. Miller, Alemu Basazin Mingude, Seyyedmohammadsadeq Mirmoeeni, Hamed Mirzaei, Sanjeev Misra, Prasanna Mithra, Karzan Abdulmuhsin Mohammad, Mokhtar Mohammadi, Seyyede Momeneh Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Ahmed Mohammed, Shafiu Mohammed, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H. Mokdad, Mariam Molokhia, Sara Momtazmanesh, Lorenzo Monasta, Mohammad Ali Moni, Ghobad Moradi, Yousef Moradi, Maliheh Moradzadeh, Rahmatollah Moradzadeh, Paula Moraga, Shane D. Morrison, Ebrahim Mostafavi, Amin Mousavi Khaneghah, Christine Mpundu‐Kaambwa, Sumaira Mubarik, Lillian Mwanri, Ashraf Nabhan, Shankar Prasad Nagaraju, Chie Nagata, Mohsen Naghavi, Mukhammad David Naimzada, Luigi Naldi, Vinay Nangia, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Biswa Prakash Nayak, Vinod C Nayak, Javad Nazari, Sabina O. Nduaguba, Ionuţ Negoi, Șerban Negru, Seyed Aria Nejadghaderi, Samata Nepal, Sandhya Neupane Kandel, Haruna Asura Nggada, Cuong Tat Nguyen, Chukwudi A Nnaji, Hamed Nosrati, Hasti Nouraei, Ali Nowroozi, Virginia Núñez-Samudio, Vincent Ebuka Nwatah, Chimezie Igwegbe Nzoputam, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, In‐Hwan Oh, Andrew T Olagunju, Tinuke O Olagunju, Babayemi O. 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BACKGROUND: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. METHODS: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. FINDINGS: There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. INTERPRETATION: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. FUNDING: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.