Global and regional cancer burden attributable to modifiable risk factors to inform prevention

Bray, F. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 74, 229–263 (2024).
Google Scholar
Tran, K. B. et al. The global burden of cancer attributable to risk factors, 2010−19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 400, 563–591 (2022).
Google Scholar
Stein, C. J. & Colditz, G. A. Modifiable risk factors for cancer. Br. J. Cancer 90, 299–303 (2004).
Google Scholar
Goddard, K. A. B. et al. Estimation of cancer deaths averted from prevention, screening, and treatment efforts, 1975−2020. JAMA Oncol. 11, 162–167 (2025).
Google Scholar
GBD 2023 Cancer Collaborators. The global, regional, and national burden of cancer, 1990−2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023. Lancet 406, 1565−1586 (2025).
de Martel, C., Georges, D., Bray, F., Ferlay, J. & Clifford, G. M. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob. Health 8, e180–e190 (2020).
Google Scholar
Plummer, M. et al. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob. Health 4, e609–e616 (2016).
Google Scholar
Whiteman, D. C. & Wilson, L. F. The fractions of cancer attributable to modifiable factors: a global review. Cancer Epidemiol. 44, 203–221 (2016).
Google Scholar
Azevedo, E. S. G. et al. The fraction of cancer attributable to ways of life, infections, occupation, and environmental agents in Brazil in 2020. PLoS ONE 11, e0148761 (2016).
Google Scholar
Brown, K. F. et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br. J. Cancer 118, 1130–1141 (2018).
Google Scholar
Islami, F. et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann. Oncol. 28, 2567–2574 (2017).
Google Scholar
Islami, F. et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA Cancer J. Clin. 74, 405–432 (2024).
Google Scholar
Kulhánová, I. et al. Proportion of cancers attributable to major lifestyle and environmental risk factors in the Eastern Mediterranean region. Int. J. Cancer 146, 646–656 (2020).
Google Scholar
Nemati, S. et al. Population attributable proportion and number of cancer cases attributed to potentially modifiable risk factors in Iran in 2020. Int. J. Cancer 153, 1758–1765 (2023).
Google Scholar
Soerjomataram, I. et al. Cancers related to lifestyle and environmental factors in France in 2015. Eur. J. Cancer 105, 103–113 (2018).
Google Scholar
Teh, H. S. & Woon, Y. L. Burden of cancers attributable to modifiable risk factors in Malaysia. BMC Public Health 21, 410 (2021).
Google Scholar
Arnold, M. et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995−2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol. 20, 1493–1505 (2019).
Google Scholar
Shelton, J. et al. 25 year trends in cancer incidence and mortality among adults aged 35−69 years in the UK, 1993−2018: retrospective secondary analysis. BMJ 384, e076962 (2024).
Google Scholar
WHO global report on trends in prevalence of tobacco use 2000–2030. https://www.who.int/publications/i/item/9789240088283 (World Health Organization, 2024).
Manthey, J. et al. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet 393, 2493–2502 (2019).
Google Scholar
Arndt, M. B. et al. Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 404, 2543–2583 (2024).
Google Scholar
WHO Report on the Global Tobacco Epidemic, 2023: Protect People From Tobacco Smoke (World Health Organization, 2023); https://www.who.int/publications/i/item/9789240077164
Bauman, A. et al. Impact of the first year of the ‘This girl can’ physical activity and sport mass media campaign in Australia. BMC Public Health 23, 333 (2023).
Google Scholar
Ginsburg, O. & Horton, R. A Lancet Commission on women and cancer. Lancet 396, 11–13 (2020).
Google Scholar
WHO Framework Convention on Tobacco Control. Gender-responsive Tobacco Control: Evidence and Options for Policies and Programmes (World Health Organization, 2018); https://fctc.who.int/resources/publications/m/item/gender-responsive-tobacco-control-evidence-and-options-for-policies-and-programmes
Forman, D. et al. Global burden of human papillomavirus and related diseases. Vaccine 30, F12–F23 (2012).
Google Scholar
Lei, J. et al. HPV vaccination and the risk of invasive cervical cancer. N. Engl. J. Med. 383, 1340–1348 (2020).
Google Scholar
Chen, Y. C. et al. Global prevalence of Helicobacter pylori Infection and incidence of gastric cancer between 1980 and 2022. Gastroenterology 166, 605–619 (2024).
Google Scholar
Malaty, H. M. et al. Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood. Lancet 359, 931–935 (2002).
Google Scholar
Bellack, N. R., Koehoorn, M. W., MacNab, Y. C. & Morshed, M. G. A conceptual model of water’s role as a reservoir in Helicobacter pylori transmission: a review of the evidence. Epidemiol. Infect. 134, 439–449 (2006).
Google Scholar
Malfertheiner, P. et al. Helicobacter pylori infection. Nat. Rev. Dis. Primers 9, 19 (2023).
Google Scholar
Chiang, T. H. et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut 70, 243–250 (2021).
Google Scholar
Dorji, T. et al. Population-level cancer screening and cancer care in Bhutan, 2020−2023: a review. Lancet Reg. Health Southeast Asia 24, 100370 (2024).
Google Scholar
Tsuda, M. et al. Effect on Helicobacter pylori eradication therapy against gastric cancer in Japan. Helicobacter 22, e12415 (2017).
Google Scholar
Maucort-Boulch, D., de Martel, C., Franceschi, S. & Plummer, M. Fraction and incidence of liver cancer attributable to hepatitis B and C viruses worldwide. Int. J. Cancer 142, 2471–2477 (2018).
Google Scholar
Schweitzer, A., Horn, J., Mikolajczyk, R. T., Krause, G. & Ott, J. J. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386, 1546–1555 (2015).
Google Scholar
Kandeel, A. et al. Evidence for the elimination of viral hepatitis B and C in Egypt: results of a nationwide survey in 2022. Liver Int. 44, 955–965 (2024).
Google Scholar
Salama, I. I. et al. Effectiveness of hepatitis B virus vaccination program in Egypt: multicenter national project. World J. Hepatol. 7, 2418–2426 (2015).
Google Scholar
Thursz, M., Njie, R. & Lemoine, M. Global eradication of hepatitis B—feasible or fallacy? Nat. Rev. Gastroenterol. Hepatol. 9, 492–494 (2012).
Google Scholar
Clougherty, J. E. A growing role for gender analysis in air pollution epidemiology. Environ. Health Perspect. 118, 167–176 (2010).
Google Scholar
Okello, G., Devereux, G. & Semple, S. Women and girls in resource poor countries experience much greater exposure to household air pollutants than men: results from Uganda and Ethiopia. Environ. Int. 119, 429–437 (2018).
Google Scholar
Shupler, M. et al. Global estimation of exposure to fine particulate matter (PM2.5) from household air pollution. Environ. Int. 120, 354–363 (2018).
Google Scholar
Raimondi, S., Suppa, M. & Gandini, S. Melanoma epidemiology and sun exposure. Acta Derm. Venereol. 100, adv00136 (2020).
Google Scholar
Iannacone, M. R. & Green, A. C. Towards skin cancer prevention and early detection: evolution of skin cancer awareness campaigns in Australia. Melanoma Manag. 1, 75–84 (2014).
Google Scholar
Cumberbatch, M. G., Cox, A., Teare, D. & Catto, J. W. Contemporary occupational carcinogen exposure and bladder cancer: a systematic review and meta-analysis. JAMA Oncol. 1, 1282–1290 (2015).
Google Scholar
Cislaghi, B. et al. Gender norms and gender equality in full-time employment and health: a 97-country analysis of the world values survey. Front. Psychol. 13, 689815 (2022).
Google Scholar
Santana, V. S. & Ribeiro, F. S. Occupational cancer burden in developing countries and the problem of informal workers. Environ. Health 10 Suppl 1, S10 (2011).
Google Scholar
Bray, F., Soerjomataram, I., Mery, L. & Ferlay, J. Improving the quality and coverage of cancer registries globally. Lancet 386, 1035–1036 (2015).
Google Scholar
Bray, F. et al. Cancer Incidence in Five Continents: inclusion criteria, highlights from Volume X and the global status of cancer registration. Int. J. Cancer 137, 2060–2071 (2015).
Google Scholar
Moore, S. C. et al. Endogenous estrogens, estrogen metabolites, and breast cancer risk in postmenopausal Chinese women. J. Natl Cancer Inst. 108, djw103 (2016).
Google Scholar
Freedman, N. D. et al. Impact of changing US cigarette smoking patterns on incident cancer: risks of 20 smoking-related cancers among the women and men of the NIH-AARP cohort. Int. J. Epidemiol. 45, 846–856 (2015).
Google Scholar
Lee, C. H. et al. Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan. Int. J. Cancer 113, 475–482 (2005).
Google Scholar
Ferlay, J. et al. Global Cancer Observatory: Cancer Today (version 1.1). International Agency for Research on Cancer https://gco.iarc.fr/today/en (2024).
International Statistical Classification of Diseases and Related Health Problems, 10th revision, Fifth edition, 2016 (World Health Organization, 2015); https://iris.who.int/handle/10665/246208
Fritz, A. et al. International Classification of Diseases for Oncology 3rd edn (World Health Organization, 2000); https://www.who.int/standards/classifications/other-classifications/international-classification-of-diseases-for-oncology
Bray, F. et al. Cancer Incidence in Five Continents, Vol. XII (IARC CancerBase No. 19). International Agency for Research on Cancer https://ci5.iarc.fr/ci5-xii/ (2023).
Crump, K. S. Risk of benzene-induced leukemia: a sensitivity analysis of the pliofilm cohort with additional follow-up and new exposure estimates. J. Toxicol. Environ. Health 42, 219–242 (1994).
Google Scholar
Elliott, A. M., Aucott, L. S., Hannaford, P. C. & Smith, W. C. Weight change in adult life and health outcomes. Obes. Res. 13, 1784–1792 (2005).
Google Scholar
Grundy, A. et al. Cancer incidence attributable to alcohol consumption in Alberta in 2012. CMAJ Open 4, E507–E514 (2016).
Google Scholar
Lanphear, B. P. & Buncher, C. R. Latent period for malignant mesothelioma of occupational origin. J. Occup. Med. 34, 718–721 (1992).
Google Scholar
O’Reilly, K. M., McLaughlin, A. M., Beckett, W. S. & Sime, P. J. Asbestos-related lung disease. Am. Fam. Physician 75, 683–688 (2007).
Google Scholar
Parker, E. D. & Folsom, A. R. Intentional weight loss and incidence of obesity-related cancers: the Iowa Women’s Health Study. Int. J. Obes. Relat. Metab. Disord. 27, 1447–1452 (2003).
Google Scholar
Steenland, K., Stayner, L. & Deddens, J. Mortality analyses in a cohort of 18 235 ethylene oxide exposed workers: follow up extended from 1987 to 1998. Occup. Environ. Med. 61, 2–7 (2004).
Google Scholar
Weiss, W. Cigarette smoking and lung cancer trends. A light at the end of the tunnel? Chest 111, 1414–1416 (1997).
Google Scholar
GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990−2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet 397, 2337−2360 (2021).
World Health Organization. Global Information System on Alcohol and Health. https://www.who.int/data/gho/data/themes/global-information-system-on-alcohol-and-health
NCD Risk Factor Collaboration. National Adult Body-Mass Index – Data Downloads. https://www.ncdrisc.org/data-downloads-adiposity.html (2024).
World Health Organization. Insufficient physical activity – indicator group. https://www.who.int/data/gho/data/themes/topics/indicator-groups/insufficient-physical-activity-indicator-group (2024).
Rumgay, H. et al. Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption: a population attributable fraction analysis. Lancet Oncol. 25, 1413–1423 (2024).
Google Scholar
United Nations Children’s Fund (UNICEF). Breastfeeding. https://data.unicef.org/topic/nutrition/breastfeeding/ (UNICEF Data, 2025).
Air pollution: concentrations of fine particulate matter (PM2.5), SDG 11.6.2. World Health Organization https://www.who.int/data/gho/data/indicators/indicator-details/GHO/concentrations-of-fine-particulate-matter-(pm2-5) (2025).
Langselius, O. et al. Global burden of cutaneous melanoma incidence attributable to ultraviolet radiation in 2022. Int. J. Cancer 157, 1110–1119 (2025).
Google Scholar
WHO/ILO joint estimates of the work-related burden of disease and injury. World Health Organization https://www.who.int/teams/environment-climate-change-and-health/monitoring/who-ilo-joint-estimates (2021).
Kehoe, T., Gmel, G., Shield, K. D., Gmel, G. & Rehm, J. Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms. Popul. Health Metr. 10, 6 (2012).
Google Scholar
Rehm, J. et al. Statistical modeling of volume of alcohol exposure for epidemiological studies of population health: the US example. Popul. Health Metr. 8, 3 (2010).
Google Scholar
Shield, K. D. & Rehm, J. Difficulties with telephone-based surveys on alcohol consumption in high-income countries: the Canadian example. Int. J. Methods Psychiatr. Res. 21, 17–28 (2012).
Google Scholar
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 403, 1027−1050 (2024).
Arnold, M. et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 16, 36–46 (2015).
Google Scholar
Prevalence of insufficient physical activity among adults. World Health Organization https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-insufficient-physical-activity-among-adults-aged-18-years-(age-standardized-estimate)-(-) (2017).
WHO/ILO joint estimates of the work-related burden of disease and injury, 2000−2016: global monitoring report (World Health Organization, 2021); https://www.who.int/publications/i/item/9789240034945
Pega, F., Hamzaoui, H., Náfrádi, B. & Momen, N. C. Global, regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000−2016: a systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Scand. J. Work Environ. Health 48, 158–168 (2022).
Google Scholar
Reitsma, M. B. et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990–2019. Lancet Public Health 6, e472–e481 (2021).
Google Scholar
Jordan, S. J., Whiteman, D. C., Purdie, D. M., Green, A. C. & Webb, P. M. Does smoking increase risk of ovarian cancer? A systematic review. Gynecol. Oncol. 103, 1122–1129 (2006).
Google Scholar
World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective (World Cancer Research Fund, 2018); https://www.wcrf.org/wp-content/uploads/2024/11/Summary-of-Third-Expert-Report-2018.pdf
Shield, K. et al. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health 5, e51–e61 (2020).
Google Scholar
Bagnardi, V. et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose−response meta-analysis. Br. J. Cancer 112, 580–593 (2015).
Google Scholar
Abar, L. et al. Body size and obesity during adulthood, and risk of lympho-haematopoietic cancers: an update of the WCRF-AICR systematic review of published prospective studies. Ann. Oncol. 30, 528–541 (2019).
Google Scholar
Wolin, K. Y., Yan, Y., Colditz, G. A. & Lee, I. M. Physical activity and colon cancer prevention: a meta-analysis. Br. J. Cancer 100, 611–616 (2009).
Google Scholar
Friedenreich, C. M. & Cust, A. E. Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br. J. Sports Med. 42, 636–647 (2008).
Google Scholar
Schmid, D. et al. A systematic review and meta-analysis of physical activity and endometrial cancer risk. Eur. J. Epidemiol. 30, 397–412 (2015).
Google Scholar
Renfrew, M. J., McCormick, F. M., Wade, A., Quinn, B. & Dowswell, T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst. Rev. 5, CD001141 (2012).
Google Scholar
Hamra, G. B. et al. Outdoor particulate matter exposure and lung cancer: a systematic review and meta-analysis. Environ. Health Perspect. 122, 906–911 (2014).
Google Scholar
Plummer, M., Franceschi, S., Vignat, J., Forman, D. & de Martel, C. Global burden of gastric cancer attributable to Helicobacter pylori. Int. J. Cancer 136, 487–490 (2015).
Google Scholar
de Martel, C., Plummer, M., Vignat, J. & Franceschi, S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int. J. Cancer 141, 664–670 (2017).
Google Scholar
GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990−2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1923−1994 (2018).
Levin, M. L. The occurrence of lung cancer in man. Acta Unio Int. Contra Cancrum 9, 531–541 (1953).
Google Scholar
Rumgay, H. et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 22, 1071–1080 (2021).
Google Scholar
Victora, C. G. et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 387, 475–490 (2016).
Google Scholar
WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide (World Health Organization, 2021); https://www.who.int/publications/i/item/9789240034228
Arnold, M. et al. Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012. Int. J. Cancer 143, 1305–1314 (2018).
Google Scholar




