Cancer death rates declined globally between 1990 and 2023. India was an exception

Analysis by network of thousands of researchers and academics from around the world relied on cancer incidence & mortality rates for 204 countries and territories for 47 cancer types.

Illustration: Ramandeep Kaur | ThePrint

New Delhi: In sharp contrast to declining cancer death rates around the world, when adjusted for age, India saw an alarming rise in the corresponding mortality rate, over 21 percentage points in the two decades leading up to 2023, according to a new analysis. 

In China, the only other country comparable to India in terms of population, both cancer incidence rates and mortality rates went down during this period—in line with trends in the majority of ‘high- and upper-middle-income countries’. In this case, incidence rate and mortality rate, or death rate, are expressed in cases or deaths per lakh population per year.

Top oncologists and researchers ThePrint spoke to pointed to late diagnosis, limited access to oncological services and widespread exposure to known risks as possible factors behind this surge in India.

The analysis from the Global Burden of Disease Study Cancer Collaborators, published Thursday in The Lancet, showed that the age-standardised death rate for cancer declined globally by 24 percentage points between 1990 and 2023.

In India, however, it went up by 21.2 percentage points during the same period.

The analysis was carried out by an extensive network of thousands of researchers and academics from around the world, led by US-based Institute for Health Metrics and Evaluation (IHME). The analysis relies on cancer incidence and mortality rates for 204 countries and territories for 47 cancer types or groupings and 44 attributable risk factors.

According to it, 107.2 cancer cases were detected per lakh population in India in 2023, up from 84.8 per lakh population in 1990, a rise of 26.4 percent. In 2023, India registered 86.9 age-standardised cancer deaths per lakh population. This number was 71.7 in 1990.

Age standardisation allowed for fair comparison of disease incidence and deaths among populations with different age structures by applying the observed age-specific rates to a standard population’s age distribution. 

According to the analysis, globally, new cancer cases detected each year more than doubled since 1990 to 18.5 million in 2023. 

Cancer-related deaths increased by 74% during the same period, to 10.4 million—with the majority of those affected living in ‘low- and middle-income countries’.

In 2023, breast cancer was the most diagnosed cancer worldwide for both sexes combined, with tracheal, bronchus, and lung (TBL) cancer being the leading cause of cancer-related deaths.

Also, according to the analysis, the number of new cancer cases detected worldwide each year is predicted to rise by 61 percent over the next 25 years, to 30.5 million in 2050; and the global annual cancer-related death toll is expected to increase by nearly 75 percent to 18.6 million. This surge in absolute growth in cancer-related mortality is mostly driven by population growth and increasingly ageing populations.

“Cancer remains an important contributor to disease burden globally and our study highlights how it is anticipated to grow substantially over the coming decades, with disproportionate growth in countries with limited resources,” said lead author Dr Lisa Force from IHME, University of Washington. 

For India, malignancies of breast, lungs, oesophagus, stomach and lip and oral cavity were associated with the highest cancer death rates.

India’s cancer burden 

Cancer care in India is largely marked by patchy screening facilities, delay in diagnosis, lack of affordability and disparities in availability of quality care, explained a senior scientist from the Indian Council of Medical Research-National Institute of Cancer Prevention and Research (ICMR-NICPR) who did not wish to be named.

Independent oncologists ThePrint spoke to concurred.

“This trend reflects a high mortality-to-incidence ratio, shaped by late-stage presentation, weak screening systems, limited oncology services, and widespread risk exposures,” Dr Sewanti Limaye, director, medical and precision oncology at Sir H.N. Reliance Hospital in Mumbai told ThePrint.

Mortality-to-incidence ratio is the ratio of a disease’s crude mortality rate and crude incidence rate. The crude mortality rate is the total number of deaths during a specific year, per 1,000 population estimated at midyear.

Dr Pritam Kalaskar, director, co-founder and consultant medical oncologist with MOC Cancer Care and Research Centre, a community-based cancer care center, said expansion of population-based cancer registries and more accurate death certification could also be revealing deaths that were previously missed, creating the appearance of a sharper rise.

Every year, data from the ICMR- National Centre for Disease Informatics and Research (ICMR- NCDIR) shows, nearly 15 lakh cancer cases are diagnosed in India with malignancies of breast, lung and oral cavity being the most common cancers in the country.

Also, in 2022, more than 9 lakh Indians succumbed to cancer and this number is rising every year. 

An Indian, currently, has an 11 percent risk of developing malignancy during their life-span, a study by ICMR researchers published last month said.

Cancer researcher Dr Ravi Mehrotra, who has previously headed the ICMR- NICPR, told ThePrint that while India and China have comparable ageing populations, what describes the striking difference in mortality rates due to malignancies in both countries is access to care and time of diagnosis. 

“The factors driving India’s incidence rate are understandable and they largely include ageing population, high tobacco use, high pollution rates, changing l lifestyles and metabolic syndromes which are risk factors for cancers but the reasons why a high number of people are dying following diagnosis include lack of timely treatment and issues around affordability and access,” he explained.

The figure of cancer incidence rate of 107 per 100,000 people represents risk of developing malignancy at the population level, while the 11 percent risk of developing cancer for an Indian during the lifespan represents the chance at an individual level, added Dr Mehrotra, who is also associated with the WHO-International Agency for Research in Cancer.

Different risk factors for men, women 

For the analysis, GBD researchers used data from population-based cancer registries, vital registration systems, and interviews with family members or caregivers of cancer patients who died.

Researchers estimated that 42 percent (4.3 million) of the estimated 10.4 million cancer deaths in 2023 were attributable to 44 potentially modifiable risk factors—presenting an opportunity for action. 

Behavioral risk factors contributed to most of the cancer deaths globally in 2023, irrespective of ‘upper-, middle-, or low-income’ countries. Tobacco use alone contributed to 21 percent of cancer deaths globally, the analysis noted. It was the leading risk factor globally, except in ‘low-income countries’, where the leading risk factor was unsafe sex.

Researchers observed that a greater proportion of global cancer deaths in men (46 percent) in 2023 were linked to potentially modifiable risk factors—tobacco use, unhealthy diet, high alcohol use, occupational risks, and air pollution—than in women (36 percent).

For women, the leading risk factors were tobacco, unsafe sex, unhealthy diet, obesity, and high blood sugar.

Dr Kalaskar underlined that China achieved declining age-standardised mortality through aggressive tobacco control, organised screening and rapid growth in oncology infrastructure—strategies India can adapt. The Indian healthcare landscape, he stressed, needs sustained tobacco control, nationwide early-detection drives, access to equitable treatment and continued investment in cancer registries and workforce training.

(Edited by Amrtansh Arora)