Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017 : A Systematic Analysis for the Global Burden of Disease Study

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017 A Systematic Analysis for the Global Burden of Disease Study Global Burden of Disease Cancer Collaboration IMPORTANCE Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. OBJECTIVE To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. EVIDENCE REVIEW We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. FINDINGS In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). CONCLUSIONS AND RELEVANCE The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. JAMA Oncol. 2019;5(12):1749-1768. doi:10.1001/jamaoncol.2019.2996 Published online September 27, 2019. Supplemental content CME Quiz at jamanetwork.com/learning and CME Questions page 1816 Group Information: The members of the Global Burden of Disease Cancer Collaboration appear at the end of the article. Corresponding Author: Christina Fitzmaurice, MD, MPH, Division of Hematology, Department of Medicine, Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Ste 600, Seattle, WA 98121 ([email protected]). Research JAMA Oncology | Original Investigation (Reprinted) 1749 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 Cancer is now widely recognized as a global problem that unfortunately lacks a global solution. The latest United Nations high-level meeting on noncommunicable diseases (NCDs) exemplified this conundrum. 1 Despite global commitment to reducing the risk of and disability from NCDs, including cancer, implementation of known solutions is inadequate to reach the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases 2,3 (25% reduction in premature mortality from NCDs by 2025) and the third Sustainable Development Goal (by 2030 reduce by onethird premature mortality from NCDs through prevention and treatment, and promote mental health and well-being). 4 To reduce cancer burden, identifying the scope of the problem and mapping out implementation of solutions is best done in National Cancer Control Plans (NCCPs). However, a recent review showed that only 29% of low-income countries had a NCCP, and even if NCCPs existed, cost, financing, monitoring, and expansion of information systems was often inadequate. Many highly effective prevention and treatment strategies exist for cancer. However, they are often very specific (eg, vaccination for human papillomavirus and hepatitis B virus for prevention of cervical and liver cancer, or tyrosine kinase inhibitors for cancers with targetable mutations). Effective NCCPs therefore require detailed knowledge about the local burden of cancer and associated risk factors. We herein present results from the Global Burden of Disease (GBD) 2017 study describing cancer incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted lifeyears (DALYs) for 195 countries from 1990 through 2017, which can inform cancer control through policy, resource allocation, and health system planning. Methods Methods have remained similar to the GBD 2016 study. 5 Detailed descriptions of the methods can be found in the GBD 2017 publications 6-9 as well as in the eAppendix, eFigures, and eTables in the Supplement. For each GBD study, the entire time series is re-estimated. This study therefore supersedes prior GBD iterations. The GBD study is compliant with the Guidelines for Accurate and Transparent Health Estimates Reporting statement (eTable 1 in the Supplement). Compared with the prior GBD study (GBD 2016), the neoplasms category for GBD 2017 also includes benign and in situ neoplasms (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes D00-D49). Because disability associated with benign neoplasms is most often very small, we only estimated disability for the new cause: myelodysplastic, myeloproliferative, and other hematopoietic neoplasms. The terms malignant neoplasms or cancer in this article only include ICD-10 codes C00 through C96. Other changes since GBD 2016 are the addition of new data sources (eTable 3 in the Supplement) for GBD 2017 and improvements in the way we estimated cancer survival by using the mortality-to-incidence ratio (MIR). In this study, estimates are presented for 29 cancer categories and 195 countries and territories. Estimates for benign neoplasms as well as selected subnational estimates are available online (https://vizhub. healthdata.org/gbd-compare/ and http://ghdx.healthdata.org/ gbd-results-tool). All rates are reported per 100 000 personyears. The GBD world population standard was used for the calculation of age-standardized rates. 9 We report 95% uncertainty intervals for all estimates. Estimation Framework The GBD cancer estimation process starts with mortality. Mortality estimates are made based on vital registration system (83% of data), cancer registry (16% of data) (eTable 3 in the Supplement), and verbal autopsy data (1% of data) using an ensemble model approach. 9,10 Predictive covariates used in the model can be found in the eAppendix (eTable 8 in the Supplement). Single-cause mortality estimates are scaled into the separately estimated all-cause estimate. 9 To estimate cancer incidence, mortality estimates are divided by a separately estimated MIR for each cancer type, sex, 5-year age group, location, and year; additional information regarding incidence and MIR estimation can be found in the eAppendix and eFigure 2 in the Supplement. Data sources used for estimating MIRs are described in eTable 2 in the Supplement. MIRs allow for a uniform method to estimate incidence. Other cancer estimation frameworks 11,12 have set a precedent for using MIRs for decades and have detailed its benefits, including greater representativeness, especially in settings that lack quality or complete population-based cancer registry systems. By determining incidence using mortality, we are able to account for uncaptured incident cases and, if mortality and incidence are determined correctly, estimating incidence based on MIRs should result in the similar results if using incidence directly. The correlation between survival data and the MIR is used to estimate 10-year cancer prevalence. Total prevalence is partitioned into 4 sequelae: (1) diagnosis/treatment, (2) remission, (3) metastatic/disseminated, and (4) terminal phase. Each sequela prevalence is multiplied by a disability weight to estimate YLDs. Lifetime prevalence of procedure-related disability is estimated for larynx, breast, colorectal, bladder, and Key Points Question What is the cancer burden over time at the global and national levels, measured in incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs), and how does it compare with other diseases? Findings Results of this systematic analysis show that in 2017 there were 24.5 million incident cases (16.8 million without nonmelanoma skin cancer), 9.6 million deaths, and 233.5 million DALYs due to cancer; between 2007 and 2017, incident cases increased by 33%, with the lowest increase in the most developed countries, and between 1990 and 2017 neoplasms increased among the top causes of DALYs from the sixth to the second place. Fifty-one percent of cancer cases occurred in countries of high Socio-demographic Index, but only 30% of cancer deaths and 24% of cancer DALYs. Meaning To ensure sustainable global development, increased efforts are needed in cancer prevention and in ensuring universal access to cancer care. Research Original Investigation Global Burden of Cancer, 1990 to 2017 1750 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 prostate cancers. A standard life expectancy is used to estimate years of life lost (YLLs). 9 DALYs are the sum of YLDs and YLLs. To determine the contribution of population aging, population growth, and change in age-specific rates on the change in incident cases between 2007 and 2017, we use hypothetical demographic scenarios holding 2 of these 3 components constant. Results are stratified by quintiles of Sociodemographic Index (SDI), which is a composite indicator including fertility, education, and income. 7 Results Global Incidence, Mortality, and DALYs In 2017, there were 24.5 million (95% UI, 22.0-27.4 million) incident cancer cases worldwide and 9.6 million (95% UI, 9.4-9.7 million) cancer deaths (Table). Cancer caused 233.5 million (95% UI, 228.8-238.0 million) DALYs in 2017, of which 97% came from YLLs and 3% came from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, the odds of developing cancer during a lifetime (ages 0-79 years) were 1 in 3 for men and 1 in 4 for women (eTable 16 in the Supplement). These odds differ substantially among SDI quintiles, ranging from 1 in 7 at the lowest SDI quintile to 1 in 2 at the highest SDI quintile for both sexes. In 2017, skin; tracheal, bronchus, and lung (TBL); and prostate cancers were the most common incident cancers in men, accounting for 54% of all cancer cases. The most common causes of cancer deaths and DALYs for men were TBL, liver, and stomach cancers (Table). For women in 2017, the most common incident cancers were nonmelanoma skin cancer (NMSC), breast cancer, and colorectal cancer, accounting for 54% of all incident cases. The leading causes of cancer deaths and DALYs for women were breast, TBL, and colorectal cancers. Between 2007 and 2017, the average annual agestandardized incidence rates (ASIRs) for all cancers combined increased in 123 of 195 countries (Figure 1 and eFigure 5 in the Supplement). In contrast, the average annual agestandardized death rates for all cancers combined decreased within that timeframe in 145 of 195 countries (Figure 2 and eFigure 6 in the Supplement). Incident cases for both sexes combined increased in all SDI quintiles between 2007 and 2017 for nearly all cancers (eTable 14 in the Supplement). The largest increase in cancer incident cases between 2007 and 2017 occurred in middle SDI countries, with a 52% increase, of which changing age structure contributed 24%, population growth 10%, and changing age-specific incidence rates 18%. The drivers behind increasing cancer incidence differ substantially by SDI. Whereas in the lowest SDI quintile, population growth is the major contributor to the increase in total cancer incidence, in low-middle SDI countries aging and changes in incidence rates contribute equally (each 12%), and in highmiddle and high SDI countries, increased incidence is mainly driven by population aging (eTable 14 in the Supplement). Global Top 10 Cancers in 2017 The global top 10 cancers were ranked by the highest number of incident cases, excluding “other malignant neoplasms.” 1. Nonmelanoma Skin Cancer In 2017, there were 7.7 million (95% UI, 5.3-10.6 million) incident cases of NMSC, of which 5.9 million (95% UI, 3.7-8.7 million) were due to basal cell carcinoma and 1.8 million (95% UI, 1.1-2.6 million) due to squamous cell carcinoma. There were 65 000 (95% UI, 63000-66 000) deaths due to NMSC (Table) and 1.3 million (95% UI, 1.3-1.4 million) DALYs, of which 97% came from YLLs (Figure 3) and 3% from YLDs (eTable 15 and eFigure 4 in the Supplement). Over a lifetime, the odds of developing NMSC were 1 in 7 for men and 1 in 10 for women globally. For men, the odds ranged from 1 in 71 in low SDI countries to 1 in 2 in high SDI countries, and for women from 1 in 104 in low SDI countries to 1 in 4 in high SDI countries (eTable 16 in the Supplement). An aging and growing population has led to a 33% (95% UI, 29%-36%) increase in NMSC cancer cases, from 5.8 million (95% UI, 4.1-7.8 million) in 2007 to 7.7 million (95% UI, 5.3-10.6 million) in 2017. The majority of this increase (20%) can be attributed to a change in the population age structure, and 13% can be attributed to population growth (eTable 14 and eFigure 11 in the Supplement). 2. Tracheal, Bronchus, and Lung Cancer In 2017, there were 2.2 million (95% UI, 2.1-2.2 million) incident cases of TBL cancer and 1.9 million (95% UI, 1.8-1.9 million) deaths. Tracheal, bronchus, and lung cancer caused 40.9 million (95% UI, 40.0-41.9 million) DALYs in 2017, of which 99% came from YLLs and 1% from YLDs (eTable 15 and eFigure 4 in the Supplement). Men were more likely to develop TBL cancer over a lifetime than women (1 in 17 men vs 1 in 43 women) (eTable 16 in the Supplement). The odds were the highest in high-middle SDI countries for men (1 in 13) and in high SDI countries for women (1 in 28). In low SDI countries, the odds were the lowest (1 in 45 for men and 1 in 142 for women). Tracheal, bronchus, and lung cancer was the leading cause of cancer in high-middle SDI countries (eFigure 5 in the Supplement). It was the most common cause of cancer deaths by absolute cases globally, as well as in all SDI quintiles (eFigure 6 in the Supplement). For men, TBL cancer was the most common incident cancer in 48 countries and the most common cause for cancer deaths in 110 countries (eFigures 7 and 9intheSupplement). For women, TBL cancer was the most common incident cancer in Greenland and the most common cause of cancer deaths in 22 countries (eFigures 8 and 10 in the Supplement). Between 2007 and 2017, TBL cancer cases increased by 37% (95% UI, 33%-40%). Changing age structure contributed 19%, population growth 13%, and changes in age-specific incidence rates 5% (eTable 14 and eFigure 11 in the Supplement). The ASIRs between 1990 and 2017 show diverging results between men and women globally and in high SDI countries, with ASIRs decreasing in men but increasing in women (eFigure 12 in the Supplement). In high-middle SDI countries, ASIRs remained stable for men but increased for women, whereas rates increased for both sexes in middle SDI countries (eFigures 13 and 14 in the Supplement). 3. Breast Cancer Breast cancer was the third most common incident cancer overall with an estimated 2.0 million (95% UI, 1.9-2.0 million) Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1751 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 Table. 2017 Global Incidence and Deaths for All Cancers and 29 Cancer Groups a Cancer Type b Incident Cases, Thousands c ASIR (per 100 000) Deaths, Thousands ASDR (per 100 000) Total Male Female Male Female Total Male Female Male Female All malignant neoplasms 24 491 (22 041-27 441) 13 294 (11 932-15 035) 11 197 (10 129-12 450) 365 (327-415) 265 (240-295) 9556 (9396-9692) 5442 (5325-5554) 4114 (4016-4201) 151.5 (148.2-154.6) 96.9 (94.5-98.9) Lip and oral cavity 390 (374-404) 239 (226-249) 151 (144-159) 6.2 (5.9-6.5) 3.6 (3.4-3.8) 194 (185-202) 125 (117-131) 69 (65-72) 3.3 (3.1-3.5) 1.6 (1.5-1.7) Nasopharynx 110 (104-116) 81 (76-87) 29 (27-30) 2.0 (1.9-2.2) 0.7 (0.7-0.7) 70 (67-72) 51 (48-54) 19 (18-19) 1.3 (1.3-1.4) 0.4 (0.4-0.5) Other pharynx 179 (160-189) 131 (114-141) 48 (45-51) 3.3 (2.9-3.6) 1.1 (1.1-1.2) 117 (102-124) 84 (70-91) 33 (31-36) 2.2 (1.8-2.4) 0.8 (0.7-0.8) Esophageal 473 (459-485) 331 (319-342) 142 (135-148) 8.9 (8.6-9.2) 3.3 (3.2-3.5) 436 (425-448) 311 (300-321) 125 (120-130) 8.4 (8.1-8.7) 2.9 (2.8-3.1) Stomach 1221 (1189-1255) 799 (771-830) 421 (408-434) 21.7 (21.0-22.6) 9.9 (9.6-10.2) 865 (848-885) 546 (531-564) 319 (310-328) 15.2 (14.8-15.7) 7.5 (7.3-7.7) Colon and rectum 1833 (1792-1873) 1015 (977-1047) 819 (795-839) 28.0 (27.0-28.9) 19.2 (18.6-19.6) 896 (876-916) 482 (465-498) 414 (401-423) 13.8 (13.3-14.2) 9.6 (9.4-9.9) Liver 953 (917-997) 690 (654-734) 264 (254-275) 17.9 (17.0-19.1) 6.2 (6.0-6.5) 819 (790-856) 572 (543-610) 247 (239-257) 15.1 (14.4-16.1) 5.8 (5.6-6.0) Gallbladder and biliary tract 211 (186-225) 90 (77-100) 120 (104-131) 2.6 (2.2-2.9) 2.8 (2.4-3.1) 174 (154-185) 72 (60-79) 102 (89-110) 2.1 (1.8-2.3) 2.4 (2.1-2.6) Pancreatic 448 (439-456) 232 (225-239) 215 (210-221) 6.4 (6.2-6.6) 5.0 (4.9-5.2) 441 (433-449) 226 (219-233) 215 (211-220) 6.3 (6.1-6.5) 5.0 (4.9-5.1) Larynx 211 (206-216) 178 (174-183) 33 (32-34) 4.6 (4.5-4.7) 0.8 (0.7-0.8) 126 (123-130) 106 (103-109) 21 (20-22) 2.8 (2.7-2.9) 0.5 (0.5-0.5) Tracheal, bronchus, and lung 2163 (2117-2213) 1468 (1424-1514) 695 (674-715) 39.9 (38.7-41.1) 16.3 (15.8-16.7) 1883 (1844-1923) 1287 (1250-1322) 596 (579-614) 35.4 (34.4-36.3) 13.9 (13.5-14.4) Malignant skin melanoma 309 (238-366) 157 (91-194) 152 (113-207) 4.2 (2.4-5.1) 3.6 (2.7-5.0) 62 (48-70) 33 (20-39) 29 (22-36) 0.9 (0.6-1.1) 0.7 (0.5-0.9) Nonmelanoma skin cancer 7664 (5251-10 570) 4350 (2974-6035) 3314 (2276-4558) 122.1 (83.9-170.3) 77.9 (53.6-107.0) 65 (63-66) 43 (41-45) 22 (21-22) 1.3 (1.2-1.3) 0.5 (0.5-0.5) Breast 1961 (1891-2023) 23 (22-24) 1938 (1868-2000) 0.6 (0.6-0.6) 45.9 (44.2-47.4) 612 (589-641) 11 (10-11) 601 (579-630) 0.3 (0.3-0.3) 14.1 (13.6-14.8) Cervical 601 (554-625) NA 601 (554-625) NA 14.5 (13.4-15.1) 260 (241-269) NA 260 (241-269) NA 6.1 (5.7-6.4) Uterine 407 (397-418) NA 407 (397-418) NA 9.6 (9.3-9.8) 85 (83-87) NA 85 (83-87) NA 2.0 (1.9-2.0) Ovarian 286 (278-295) NA 286 (278-295) NA 6.8 (6.6-7.1) 176 (171-181) NA 176 (171-181) NA 4.1 (4.0-4.3) Prostate 1334 (1171-1698) 1334 (1171-1698) NA 37.9 (33.0-48.0) NA 416 (357-490) 416 (357-490) NA 13.1 (11.2-15.3) NA Testicular 71 (69-74) 71 (69-74) NA 1.8 (1.7-1.9) NA 8 (7-8) 8 (7-8) NA 0.2 (0.2-0.2) NA Kidney 393 (371-405) 241 (226-249) 152 (141-158) 6.4 (6.0-6.6) 3.7 (3.4-3.8) 139 (129-143) 90 (85-93) 49 (43-51) 2.5 (2.4-2.6) 1.2 (1.0-1.2) Bladder 474 (462-492) 362 (350-380) 111 (108-115) 10.3 (10.0-10.8) 2.6 (2.5-2.7) 197 (192-206) 145 (140-154) 52 (50-53) 4.4 (4.2-4.7) 1.2 (1.2-1.2) Brain and nervous system 405 (351-443) 221 (189-251) 184 (132-213) 5.8 (4.9-6.5) 4.6 (3.3-5.3) 247 (213-265) 140 (118-158) 107 (76-119) 3.7 (3.1-4.1) 2.6 (1.9-2.9) Thyroid 255 (246-272) 76 (73-79) 179 (170-196) 1.9 (1.9-2.0) 4.3 (4.1-4.7) 41 (40-44) 17 (16-18) 24 (23-27) 0.5 (0.5-0.5) 0.6 (0.5-0.6) Mesothelioma 35 (34-36) 25 (24-26) 10 (10-11) 0.7 (0.7-0.7) 0.2 (0.2-0.3) 30 (29-31) 22 (21-22) 8 (8-9) 0.6 (0.6-0.6) 0.2 (0.2-0.2) Hodgkin lymphoma 101 (88-119) 61 (50-75) 40 (34-48) 1.6 (1.3-1.9) 1.0 (0.9-1.2) 33 (28-38) 21 (17-26) 12 (10-14) 0.5 (0.4-0.7) 0.3 (0.2-0.3) (continued) Research Original Investigation Global Burden of Cancer, 1990 to 2017 1752 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 incident cases in 2017. The majority occurred in women (1.9 million [95% UI, 1.9 -2.0 million]) (Table). Breast cancer was among the top 3 leading causes of cancer in all SDI quintiles except for the high and high-middle SDI quintiles, where it was the fourth most common cancer (eFigure 5 in the Supplement). It caused 601 000 (95% UI, 579 000-630 000) deaths in women and 11 000 (95% UI, 10 000-11 000) deaths in men, making it the fifth leading cause of cancer deaths for both sexes combined in 2017 globally (eFigure 6 in the Supplement). For women, breast cancer was the leading cause of cancer death in 2017 (Table). Breast cancer caused 17.7 million (95% UI, 16.918.7 million) DALYs for both sexes, of which 93% came from YLLs and 7% from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, 1 in 18 women developed breast cancer over a lifetime (eTable 16 in the Supplement). For women, the odds of developing breast cancer were the highest in high SDI countries (1 in 11), and the lowest in low SDI countries (1 in 38). For women, breast cancer was the most common cancer in 143 countries and the most common cause of cancer deaths in 112 countries (eFigures 8 and 10 in the Supplement). Overall, incident cases increased by 35% (95% UI, 30%-39%) because of a change in the population age structure (contributing 15%), population growth (contributing 13%), and an increase in agespecific incidence rates (contributing 7%) (eFigure 11 in the Supplement). Between 2007 and 2017, ASIRs for women decreased in high SDI countries but increased in the other SDI quintiles (eFigures 12-16 in the Supplement). 4. Colon and Rectum Cancer In 2017, there were 1.8 million (95% UI, 1.8-1.9 million) incident cases of colon and rectum cancer, and 896 000 (95% UI, 876 000-916 000) deaths (Table). Colon and rectum cancer caused 19.0 million (95% UI, 18.5-19.5 million) DALYs in 2017, of which 95% came from YLLs and 5% from YLDs (eTable 15 and eFigure 4 in the Supplement). The odds of developing colon and rectum cancer globally were higher for men than for women (1 in 26 for men vs 1 in 40 for women) (eTable 16 in the Supplement). The highest odds were in the high SDI quintile (1 in 15 for men and 1 in 25 for women) and the lowest in the low SDI quintile (1 in 81 for men and 1 in 98 for women). Between 2007 and 2017, incidence increased by 38% (95% UI, 34%-41%), from 1.3 million (95% UI, 1.3-1.3 million) to 1.8 million (95% UI, 1.8-1.9 million) cases (eTable 14 in the Supplement). Most of this increase can be explained by an aging and growing population (20% and 13%, respectively); however, even with the same population size and age structure, colorectal cancer cases would have increased by 5% between 2007 and 2017 owing to changing age-specific incidence rates. The ASIRs between 1990 and 2017 are similar for men and women at the global level and for all SDI quintiles (eFigures 12-16 in the Supplement). 5. Prostate Cancer In 2017, there were 1.3 million (95% UI, 1.2-1.7 million) incident cases of prostate cancer and 416 000 (95% UI, 357 000490000) deaths. Prostate cancer caused 7.1 million (95% UI, 6.1 million-8.4 million) DALYs globally in 2017, with 88% coming from YLLs and 12% from YLDs (eTable 15 and eFigure 4 in Table. 2017 Global Incidence and Deaths for All Cancers and 29 Cancer Groups a (continued) Cancer Type b Incident Cases, Thousands c ASIR (per 100 000) Deaths, Thousands ASDR (per 100 000) Total Male Female Male Female Total Male Female Male Female Non-Hodgkin lymphoma 488 (479-497) 279 (271-286) 209 (203-214) 7.5 (7.3-7.7) 5.0 (4.9-5.1) 249 (243-253) 144 (140-148) 104 (102-107) 4.0 (3.9-4.1) 2.5 (2.4-2.6) Multiple myeloma 153 (141-173) 82 (70-98) 70 (67-82) 2.3 (1.9-2.7) 1.6 (1.6-1.9) 107 (99-119) 55 (46-64) 52 (49-58) 1.6 (1.3-1.8) 1.2 (1.1-1.4) Other 716 (656-740) 383 (340-401) 333 (303-353) 10.3 (9.1-10.8) 8.2 (7.5-8.7) 360 (331-371) 187 (167-194) 173 (156-182) 5.1 (4.6-5.3) 4.2 (3.8-4.4) Leukemia Acute lymphoid 108 (91-117) 64 (54-71) 43 (34-49) 1.7 (1.5-1.9) 0.7 (0.6-0.8) 52 (46-57) 31 (27-34) 22 (18-24) 0.8 (0.7-0.9) 0.6 (0.5-0.6) Chronic lymphoid 114 (108-121) 66 (62-72) 48 (44-52) 1.8 (1.7-2.0) 1.1 (1.0-1.2) 35 (34-37) 21 (20-22) 14 (13-15) 0.6 (0.6-0.7) 0.3 (0.3-0.4) Acute myeloid 140 (127-147) 79 (69-84) 61 (54-67) 2.1 (1.9-2.3) 1.5 (1.3-1.7) 100 (91-105) 57 (51-61) 42 (38-46) 1.6 (1.4-1.7) 1.0 (0.9-1.1) Chronic myeloid 40 (37-43) 23 (20-24) 17 (15-20) 0.6 (0.6-0.7) 0.4 (0.4-0.5) 24 (22-26) 13 (12-14) 11 (10-13) 0.4 (0.3-0.4) 0.3 (0.2-0.3) Other 246 (212-267) 142 (121-157) 104 (85-113) 3.9 (3.3-4.3) 2.6 (2.1-2.9) 136 (121-147) 76 (65-84) 61 (51-65) 2.1 (1.8-2.3) 1.5 (1.2-1.6) Abbreviations: ASDR, age-standardized death rate; ASIR, age-standardized incidence rate; NA, not applicable. a All data reported as number or rate (95% uncertainty interval). b Cancer groups are defined based on International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes and include all codes pertaining to malignant neoplasms (ICD-9 140-208 and ICD-10 C00-C96) except for Kaposi sarcoma (C46). eTables 4 and 5 in the Supplement detail how the original ICD codes were mapped to the standardized Global Burden of Disease cause list. c Detailed results for incidence, mortality, and disability-adjusted life-years for the global level, by Socio-demographic Index quintile, region, and country can be accessed in eTables 14 and 18 in the Supplement, as well as at https://vizhub.healthdata.org/gbd-compare/. Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1753 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 the Supplement). Globally, the odds of developing prostate cancer were 1 in 18, ranging from 1 in 52 for low SDI countries to 1 in 9 in high SDI countries (eTable 16 in the Supplement). In 2017, prostate cancer was the cancer with the highest incidence for men in 114 countries and the leading cause of cancer-related deaths for men in 56 countries (eFigures 7 and 9 in the Supplement). The increasing incidence rates, together with an aging and growing population, have led to a 42% (95% UI, 37%- 52%) increase in prostate cancer cases since 2007 (940 000 [95% UI, 774 000-1.2 million] in 2007 and 1.3 million [95% UI, 1.2-1.7 million] in 2017). Twenty-one percent of this increase can be attributed to a change in the population age structure, 13% to a change in the population size, and 8% to a change in the age-specific incidence rates (eTable 14 and eFigure 11 in the Supplement). 6. Stomach Cancer In 2017, there were 1.2 million (95% UI, 1.2-1.3 million) incident cases of stomach cancer and 865 000 (95% UI, 848 000885 000) deaths worldwide. Stomach cancer caused 19.1 million (95% UI, 18.7-19.6 million) DALYs in 2017, with 98% coming from YLLs and 2% coming from YLDs (eTable 15 and eFigure 4 in the Supplement). One in 33 men and 1 in 78 women developed stomach cancer over a lifetime. The highest odds for men and women were in high-middle SDI countries (1 in 21 and 1 in 57, respectively), and the lowest odds were for men in low SDI countries (1 in 78) and for women in low-middle SDI countries (1 in 104) (eTable 16 in the Supplement). Between 2007 and 2017, stomach cancer moved from the second leading cause of crude cancer YLLs to the third place with a 5% (95% UI, 2%-7%) increase in absolute YLLs (Figure 3). Overall, incidence between 2007 and 2017 increased by 25% (95% UI, 22%-29%), of which a change in the population age structure contributed 19%, population growth 13%, and falling agespecific rates −6% (eTable 14 and eFigure 11 in the Supplement).TheASIRs havedroppedsubstantiallysince 1990 globally and for all SDI quintiles (eFigures 12-16 in the Supplement). 7. Liver Cancer In 2017, there were 953 000 (95% UI, 917 000-997 000) incident cases of liver cancer globally and 819 000 (95% UI, 790 000-856 000) deaths. Liver cancer caused 20.8 million (95% UI, 19.9-21.8 million) DALYs in 2017, with 99% coming from YLLs and 1% coming from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, liver cancer was more common in men, with 1 in 42 men developing liver cancer compared with 1 in 118 women. The highest odds of developing liver cancer were in high-middle SDI countries for men (1 in 31) and in middle SDI countries for women (1 in 94), whereas the lowest were seen in low SDI countries (1 in 98 men and 1 in 177 womFigure 1. Average Annual Percentage Change in Age-Standardized Incidence Rate in Both Sexes for All Cancers From 2007 to 2017 –2.9 to –2.0 –1.9 to –1.0 –0.9 to 0 0.1 to 1.0 1.1 to 2.0 >2.0 ≤–3.0 Annual percentage age change, % ATG DMA LCA VCT GRD TTO BRB MDV W Africa E Med. TLS COM MUS Persian Gulf MLT Balkan Peninsula MHL SLB VUT FJI KIR FSM WSM TONSGPSYC Caribbean ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; E Med., Eastern Mediterranean; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MLT, Malta; MUS, Mauritius; MHL, Marshall Islands; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; W Africa, West Africa; WSM, Samoa. Research Original Investigation Global Burden of Cancer, 1990 to 2017 1754 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 en) (eTable 16 in the Supplement). Population aging and population growth were the drivers of the increase from 705 000 (95% UI, 690 000-734 000) cases in 2007 to 953 000 (95% UI, 917 000-997 000) cases in 2017 (eTable 14 and eFigure 11 in the Supplement). Of the 35% increase in cases between 2007 and 2017, 17% was due to population aging, 13% due to population growth, and 6% due to an increase in age-specific incidence rates. 8. Cervical Cancer In 2017, 601 000 (95% UI, 554 000-625 000) women developed cervical cancer worldwide, and it caused 260 000 (95% UI, 241 000-269 000) deaths (Table). Cervical cancer caused 8.1 million (95% UI, 7.5-8.4 million) DALYs, with 96% coming from YLLs and 4% from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, 1 in 65 women developed cervical cancer during a lifetime (eTable 16 in the Supplement). The odds were the highest in low SDI countries (1 in 40) and the lowest in high SDI countries (1 in 106). In 2017, cervical cancer was the most common incident cancer for women in 50 countries (eFigure 8 in the Supplement) and the most common cause of cancer deaths in 39 countries (eFigure 10 in the Supplement). Between 2007 and 2017, incident cases increased by 19% (95% UI, 13%-23%) globally. Population growth contributed 13% and population aging 9%, while falling age-specific incidence rates offset this increase by −3% (eFigure 11 and eTable 14 in the Supplement). Deaths increased by 19% (95% UI, 13%-23%) between 2007 and 2017, and DALYs by 15% (95% UI, 10%-19%). The ASIRs decreased globally and for all SDI quintiles (eFigures 12-16 in the Supplement). 9. Non-Hodgkin Lymphoma In 2017, there were 488 000 (95% UI, 479 000-497 000) incident cases of non-Hodgkin lymphoma and 249 000 (95% UI, 243 000-253 000) deaths. Non-Hodgkin lymphoma caused 7.0 million (95% UI, 6.8-7.2 million) DALYs in 2017, with 97% coming from YLLs and 3% from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, 1 in 108 men and 1 in 162 women developed non-Hodgkin lymphoma over a lifetime. The highest odds were in high SDI countries (1 in 54 for men and 1 in 80 for women) and the lowest in low SDI countries (1 in 221 for men and 1 in 322 for women) (eTable 16 in the Supplement). Globally, incident cases between 2007 and 2017 increased by 39% (95% UI, 35%-42%), of which 15% was due to changing population age structure, 13% due to population growth, and 11% due to change in incidence rates (eTable 14 and eFigure 11 in the Supplement). 10. Bladder Cancer In 2017, there were 474 000 (95% UI, 462 000-492 000) incident cases of bladder cancer and 197 000 (95% UI, 192 000206 000) deaths. Bladder cancer caused 3.6 million (95% UI, Figure 2. Average Annual Percentage Change in Age-Standardized Mortality Rate in Both Sexes for All Cancers From 2007 to 2017 –2.9 to –2.0 –1.9 to –1.0 –0.9 to 0 0.1 to 1.0 1.1 to 2.0 >2.0 ≤–3.0 Annual percentage age change, % ATG DMA LCA VCT GRD TTO BRB MDV W Africa E Med. TLS COM MUS Persian Gulf MLT Balkan Peninsula MHL SLB VUT FJI KIR FSM WSM TONSGPSYCCaribbean ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; E Med., Eastern Mediterranean; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MLT, Malta; MUS, Mauritius; MHL, Marshall Islands; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; W Africa, West Africa; WSM, Samoa. Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1755 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 3.5-3.8 million) DALYs in 2017, with 93% coming from YLLs and 7% from YLDs (eTable 15 and eFigure 4 in the Supplement). Globally, 1 in 74 men and 1 in 301 women developed bladder cancer over a lifetime. The highest odds were in high SDI countries (1 in 42 for men and 1 in 185 for women) and the lowest in low SDI countries (1 in 198 for men and 1 in 489 for women) (eTable 16 in the Supplement). Globally, incident cases between 2007 and 2017 increased by 32% (95% UI, 30%-35%), of which 20% was due to changing population age structure and 13% to population growth (eTable 14 and eFigure 11 in the Supplement). Cancer in Comparison to Other Diseases Within the 22 mutually exclusive and collectively exhaustive GBD level 2 disease categories (eTable 17 in the Supplement), neoplasms ranked last for incidence in 1990 and 2017 (eTable 18 in the Supplement). For prevalence, neoplasms ranked last in 1990 but surpassed enteric infections in 2017. The YLDs ranking for neoplasms also increased between 1990 and 2017 from the 21st to the 19th position. Mortality due to neoplasms remained at the second place between 1990 and 2017. The largest increase was seen for neoplasm YLLs and DALYs, which increased from the sixth place in 1990 to the second place in 2017 aftercardiovasculardiseases (Figure4). The4 causes withhigher DALYs in 1990 that had been surpassed by neoplasms in 2017 are respiratory infections and tuberculosis, maternal and neonatal disorders, enteric infections, and other infections. Discussion The GBD study results are updated on an annual basis. In this article we focus on changes over the past decade and present the most recent results from the GBD 2017 study using cancer registry, vital registration, and verbal autopsy data to estimate the burden of cancer for 195 countries and territories from 1990 through 2017. 13,14 All results presented can also be found online at https://vizhub.healthdata.org/gbd-compare/ and http://ghdx.healthdata.org/gbd-results-tool. For this article, we also compare cancer burden with other diseases. Figure 3. Cancers Ranked by Absolute Years of Life Lost (YLLs) Among Both Sexes Between 2007 and 2017 a Rank Cancer 2007 Cancer 2017 Rank Tracheal, bronchus, and lung cancer Tracheal, bronchus, and lung cancer 1 Stomach cancer Liver cancer 2 Liver cancer Stomach cancer 3 Colon and rectum cancer Colon and rectum cancer 4 Breast cancer Breast cancer 5 Esophageal cancer Esophageal cancer 6 Brain and nervous system cancer Pancreatic cancer 7 Cervical cancer Brain and nervous system cancer 8 Pancreatic cancer Cervical cancer 9 Non–Hodgkin lymphoma Non–Hodgkin lymphoma 10 Other leukemia Prostate cancer 11 Prostate cancer Lip and oral cavity cancer 12 Lip and oral cavity cancer Other leukemia 13 Ovarian cancer Ovarian cancer 14 Gallbladder and biliary tract cancer Gallbladder and biliary tract cancer 15 Acute myeloid leukemia Bladder cancer 16 Bladder cancer Other pharynx cancer 17 Larynx cancer Acute myeloid leukemia 18 Kidney cancer Larynx cancer 19 Acute lymphoid leukemia Kidney cancer 20 Other pharynx cancer Acute lymphoid leukemia 21 Nasopharynx cancer Multiple myeloma 22 Multiple myeloma Nasopharynx cancer 23 Uterine cancer Uterine cancer 24 Hodgkin lymphoma Malignant skin melanoma 25 Malignant skin melanoma Hodgkin lymphoma 26 Nonmelanoma skin cancer Nonmelanoma skin cancer 27 Thyroid cancer Thyroid cancer 28 Chronic myeloid leukemia Mesothelioma 29 Mesothelioma Chronic myeloid leukemia 30 Chronic lymphoid leukemia Chronic lymphoid leukemia 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Testicular cancer Testicular cancer 32 Change in Absolute YLLs, % (UI) 24.8 (21.7 to 27.6) 21.2 (17.0 to 27.4) 4.8 (2.4 to 7.4) 23.8 (19.2 to 27.6) 23.9 (17.3 to 28.7) 8.9 (5.8 to 12.2) 35.8 (32.5 to 38.6) 18.4 (11.9 to 24.6) 15.1 (9.4 to 19.1) 22.1 (15.6 to 26.9) 28.3 (24.9 to 34.5) 30.5 (23.8 to 36.4) –8.1 (–14.6 to –1.8) 29.1 (24.8 to 33.1) 21.8 (17.8 to 26.3) 22.6 (19.9 to 25.3) 36.0 (25.4 to 44.2) 16.2 (4.4 to 24.6) 17.3 (13.9 to 20.9) 23.1 (18.5 to 27.3) 5.3 (–8.6 to 15.4) 30.4 (25.6 to 34.4) 18.3 (13.9 to 23.1) 14.8 (11.6 to 19.0) 16.1 (12.7 to 20.0) –5.2 (–8.6 to –1.8) 30.0 (26.2 to 32.7) 22.1 (16.7 to 28.0) 21.0 (13.8 to 27.3) –1.7 (–5.2 to 1.5) 18.3 (14.2 to 22.4) 0.9 (–3.3 to 6.3) Change in Age-Standardized YLL Rate, % (UI) –4.1 (–6.5 to –2.0) –4.6 (–8.0 to 0.1) –18.6 (–20.5 to –16.6) –4.5 (–8.0 to –1.7) –1.7 (–6.8 to 2.1) –16.2 (–18.6 to –13.7) 4.0 (1.5 to 6.1) 0 (–5.6 to 5.3) –7.2 (–11.8 to –3.9) 0.2 (–5.2 to 4.3) –3.6 (–6.2 to 1.2) 3.0 (–2.3 to 7.6) –20.8 (–26.5 to –15.4) 1.1 (–2.2 to 4.2) –6.8 (–9.9 to –3.5) –6.9 (–8.9 to –4.8) 6.5 (–1.7 to 12.8) –1.4 (–11.3 to 5.8) –9.1 (–11.7 to –6.4) –3.3 (–6.9 to 0) –4.7 (–17.6 to 4.7) 0.3 (–3.3 to 3.4) –5.0 (–8.5 to –1.3) –11.2 (–13.7 to –8.0) –7.2 (–9.8 to –3.8) –17.1 (–20.1 to –13.9) 0.5 (–2.3 to 2.6) –2.3 (–6.6 to 2.4) –5.4 (–10.8 to –0.8) –19.7 (–22.4 to –17.1) –9.2 (–12.3 to –6.1) –10.8 (–14.5 to –6.1) Rank increased No change Rank decreased UI indicates uncertainty interval. a Excluding other cancer. Research Original Investigation Global Burden of Cancer, 1990 to 2017 1756 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 The GBD 2017 results show that there are 24.5 million incident cancer cases worldwide (16.8 million without NMSC) and 9.6 million deaths, which is similar to the latest GLOBOCAN estimates for 2018 that estimate 17.0 million cases (without NMSC) and 9.4 million deaths. 15 The largest change in our estimates compared with the last iteration of the GBD study (GBD 2016) are the incidence estimates for NMSC, which have substantially increased. Despite being the most common incident cancer in many populations, cancer registry data to inform incidence estimates are often unreliable or nonexistent. For GBD 2017 we have therefore used Marketscan data for the United States, which has led to substantially higher estimates for NMSC. 16 A key strength of the GBD study is the comparative health assessment. Our analysis shows how cancer has increased in importance as a global health problem. Although it ranked sixth in 1990 among the top causes for DALYs worldwide, it has risen to the second place in 2017 behind cardiovascular diseases. Cancer now occupies the second place in the ranking of global deaths, YLLs, and DALYs, and is among the top 2 leading causes of deaths, YLLs, and DALYs in the highest 3 SDI quintiles. This shift in disease burden owing to the demographic and epidemiological transitions has important implications on health policy: ensuring access to universal health coverage and protection against catastrophic health expenditure directly related to the cancer treatment, but also against the long-term costs associated with a cancer diagnosis for a household, has to be prioritized. 17 Fifty percent of cancer cases occur in high SDI countries, but only 30% of cancer deaths, 25% of cancer DALYs, and 23% of cancer YLLs. To ensure sustainable global development, increased efforts are needed to reduce these health inequalities. Recognizing the strong interdependencies between socioeconomic status and health and the large contribution of cancer to the overall disease burden is a first step in making investments in cancer prevention and treatment a priority. 18 Cervical cancer is likely the best example of inequalities in cancer with vast differences in burden by SDI. As a completely preventable cancer where cost-effective vaccination 3 and screening approaches are available, cervical cancer has recently gained global attention through the World Health Organization’s call for elimination. 19 Falling incidence rates in all SDI quintiles are encouraging, but countries with the least resources are still facing the largest burden because of lack of screening programs. Immunization against human papillomavirus, screening, and treatment of cervical cancer is therefore of utmost importance in all socioeconomic settings. Deaths due to cancer contribute the majority of total health loss measured in DALYs, with disability contributing less than 12% for all cancers. As access to cancer care increases and treatments improve, cancer mortality decreases, but prevalence and disability in the survivor population increase, which is already the case in some highincome countries. 20 The World Health Organization Global Action Plan for the Prevention and Control of NCDs and the United Nations Sustainable Development Goals focus on the reduction of premature mortality as the first goal. At the same time, infrastructure should be planned that can address the growing survivor population’s need. Figure 4. Change in the Absolute Number of Disability-Adjusted Life-Years (DALYs) Between 1990 and 2017 for Both Sexes at the Global Level for Global Burden of Disease Level 2 Causes a Rank Cancer 2007 Respiratory infections and tuberculosis Maternal and neonatal diseases Cardiovascular diseases Enteric infections Other infections diseases Neoplasms Other noncommunicable diseases Unintentional injury Chronic respiratory disease Neglected tropical diseases and malaria Nutritional deficiencies Musculoskeletal disorders Mental disorders Transport injuries Neurological disorders Self-harm and violence Digestive diseases Diabetes and chronic kidney disease Sense organ diseases HIV/AIDS and sexually transmitted infections Skin diseases Substance use 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Rank 2017 Cardiovascular diseases Neoplasms Maternal and neonatal disease Respiratory infections and tuberculosis Musculoskeletal disorders Mental disorders Other noncommunicable diseases Chronic respiratory disease Neurological disorders Unintentional injury Diabetes and chronic kidney disease Enteric infections Digestive diseases Transport injuries Self-harm and violence Sense organ diseases HIV/AIDS and sexually transmitted infections Neglected tropical diseases and malaria Nutritional deficiency Other infectious diseases Substance use Skin diseases Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Communicable, maternal, neonatal, and nutritional diseases Noncommunicable diseases Injuries The cause neoplasms includes all cancers as defined under International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) causes C00 through C96, as well as myelodysplastic, myeloproliferative, and other hematopoietic neoplasms (ICD-10 codes D45-D47.9). a All diseases are grouped into 22 mutually exclusive and collectively exhaustive causes. Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1757 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 and Evaluation, Calverton, Maryland (Miller); School of Public Health, Curtin University, Perth, Western Australia, Australia (Miller); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Mills); Golestan University of Medical Sciences, Golestan, Iran (Mir); Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran (H. Mirzaei, Tamtaji); Department of Medical Immunology, Tehran University of Medical Sciences, Tehran, Iran (H. R. Mirzaei); Department of Oral Medicine, University of Washington, Seattle, (Mishra); Institute of Public Health, Heidelberg University, Heidelberg, Germany (Moazen, S. Mohammed); Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany (Moazen); Department of Biology, Salahaddin University, Erbil, Iraq (D. K. Mohammad, K. A. Mohammad); Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden (D. K. Mohammad); ISHIK University, Erbil, Iraq (K. A. Mohammad); Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia (Y. Mohammad); Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq (Darwesh); Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran (H. Mohammadi); Department of Physiology and Pharmacology, Mazandaran University of Medical Sciences, Sari, Iran (M. Mohammadi); Department of Epidemiology and Biostatistics, Bushehr University of Medical Sciences, Bushehr, Iran (Mohammadian); Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran (Mohammadian-Hafshejani); Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran (Mohammadoo-Khorasani, Mosapour); Department of Nursing, Shahroud University of Medical Sciences, Shahroud, Iran (Mohammadpourhodki); Department of Public Health, Samara University, Samera, Ethiopia (J. A. Mohammed); Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria (S. Mohammed); Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran (Mohebi); Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy (Monasta, Ronfani, Traini); Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran (Moossavi); Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran (Moradi, Moradpour); Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran (Moradi); Department of Economics and Management Sciences for Health, Tehran University of Medical Sciences, Tehran, Iran (Moradi-Joo); International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia (Morawska); Hospital de Santo António, Hospital Center of Porto, Porto, Portugal (Morgado-da-Costa); Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan (Morisaki); Department of Surgery, University of Washington, Seattle, (Morrison); Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran (Mousavi); Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia (Muhammed, Wondafrash); Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria (Musa); Center for Global Health, Northwestern University, Chicago, Illinois (Musa); Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Nabhan); Knowledge Translation and Utilization, Egyptian Center for Evidence Based Medicine, Cairo, Egypt (Nabhan); School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran (Naderi); Department of Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India (Nagarajan); Department of Research and Analytics, Bioinsilico Technologies, Chennai, India (Nagarajan); Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany (Nagel); Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran (Nahvijou, Shirkoohi, Zendehdel); O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham (Naik); Department of Epidemiology and Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran (Najafi); Department of Dermatology, San Bortolo Hospital, Vicenza, Italy (Naldi); GISED Study Center, Bergamo, Italy (Naldi); Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, South Korea (Nam); Daejeon Regional Cancer Center, Chungnam National University Hospital, Daejeon, South Korea (Nam); Department of Public Health, School of Public Health, Jiroft University of Medical Sciences, Jiroft, Iran (Nasiri); Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran (Nazari); Ministry of Health and Medical Education, Tehran, Iran (Nazari); Faculty of Health Sciences, University of Tampere, Tampere, Finland (Neupane); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (Newcomb); Department of Epidemiology, University of Washington, Seattle, (Newcomb, Oren); Department of Histopathology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria (Nggada); Department of Human Pathology, University of Maiduguri, Maiduguri, Nigeria (Nggada); Department of Biological Sciences, University of Embu, Embu, Kenya (Ngunjiri); Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam (Nguyen); Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (Nikniaz); Department of Public Health Sciences, State University of Semarang, Semarang, Indonesia (Ningrum); Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan (Ningrum); Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa (Nnaji); School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa (Nnaji); Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran (Nojomi); Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran (Nosratnejad); Mazandaran University of Medical Sciences, Sari, Iran (Shiadeh); Department of Anesthesia, Wolaita Sodo University, Sodo, Ethiopia (Obsa); Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia (Ofori-Asenso); Independent consultant, Accra, Ghana (Ofori-Asenso); Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia (Ogbo); Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea (Oh); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (A. T. Olagunju); Department of Psychiatry, University of Lagos, Lagos, Nigeria (A. T. Olagunju); Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (T. O. Olagunju); Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria (Oluwasanu); Department of Anatomic Pathology, Ekiti State University, AdoEkiti, Nigeria (Omonisi); Department of Anatomic Pathology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria (Omonisi); Department of Pharmacology and Therapeutics, University of Nigeria, Nsukka, Enugu, Nigeria (Onwujekwe); Department of Community Health, Christian Medical College, Vellore, India (Oommen); Graduate School of Public Health, San Diego State University, San Diego, California (Oren); Department of Global Health Nursing, St. Luke’s International University, Chuo-ku, Japan (Ota); Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia (Otstavnov); Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria (Owolabi); Department of TB & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India (P A); Department of Forensic Medicine and Toxicology, Manipal University, Mangaluru, India (Padubidri); Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Pakhale); Department of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran (Pakpour); Department of Nursing, Jönköping University, Jönköping, Sweden (Pakpour); Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea (Park); Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran (Pashaei); Department of Medicine, Maimonides Medical Center, Brooklyn, New York (Patel); Krishna Institute of Medical Sciences, Deemed University, Karad, India (Patil); University of Cartagena, Cartagena, Colombia (Pereira); Reference Center for Epidemiology and Cancer Prevention, CPO Piedmont, Torino, Italy (Piccinelli); Basic Medical Sciences Department, Durban University of Technology, Durban, South Africa (Pillay); Departments of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran (Pirestani); Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran (Pishgar); University Medical Center Groningen, University of Groningen, Groningen, Netherlands (Postma); Faculty of Economics and Business, University of Groningen, Groningen, Netherlands (Postma); Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran (Pourjafar); Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran (Pourjafar); Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prakash, Prasad); Non-communicable Diseases Research Center, Research Original Investigation Global Burden of Cancer, 1990 to 2017 1764 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 Alborz University of Medical Sciences, Karaj, Iran (Qorbani); Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran (M. Rabiee); Divisions of Chemistry and Diseases, Advanced Technologies Research Group, Tehran, Iran (N. Rabiee); A.T. Still University, Mesa, Arizona (Radfar); Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran (Rafiei); Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran (Rafiei); Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Rahim); Austin Health Clinical School of Nursing, La Trobe University, Heidelberg, Victoria, Australia (Rahman); National Centre for Farmer Health, Deakin University, Waurn Ponds, Victoria, Australia (Rahman); Department of Health Education and Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran (Rajati); Department of Public Health, Contech School of Public Health, Lahore, Pakistan (Rana); Public Health Department, University of Health Sciences, Lahore, Pakistan (Rana); Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India (Rath); WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, England, United Kingdom (D. L. Rawaf); University College London Hospitals, London, England, United Kingdom (D. L. Rawaf); Academic Public Health, Public Health England, London, England, United Kingdom (S. Rawaf); School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia (Renzaho); Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (Rezaei); Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network, Tehran, Iran (Rezaei); Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran (Rezapour, Moghadam); Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal (A. I. Ribeiro); Department of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal (D. Ribeiro); Department of Public Health, Wollega University, Nekemte, Ethiopia (Roro); Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran (Roshandel); Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran (Rostami, Sabbagh); Clinical Operations, Doctor Evidence, Santa Monica, California (Saad); Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sabour); Medical Department, University of Sharjah, Sharjah, United Arab Emirates (Saddik); Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran (Safiri); Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (Sahebkar); Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (Sahebkar); A.C.S. Medical College and Hospital, Tehran, Iran (Salahshoor); Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran (Salehi); Department of Urology, Cairo University, Cairo, Egypt (H. Salem); Public Health and Community Medicine Department, Cairo University, Giza, Egypt (M. R. Salem); Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (Salomon); Department of Entomology, Ain Shams University, Cairo, Egypt (Samy); Department of Surgery, Marshall University, Huntington, West Virginia (Sanabria); Departments of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio (Sanabria); School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia (Santric Milicevic); Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England, United Kingdom (Sartorius); Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran (Sarveazad); Surgery Department, Hamad Medical Corporation, Doha, Qatar (Sathian); Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, England, United Kingdom (Sathian); UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India (Satpathy); Udyam-Global Association for Sustainable Development, Bhubaneswar, India (Satpathy); GSK Biologicals, Wavre, Belgium (Savic); Department of Public Health Sciences, University of North Carolina at Charlotte (Sawhney); Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Sayyah); School of Health Sciences, Federal University of Santa Catarina, Ararangua, Brazil (Schneider); Department of Medical Statistics, Epidemiology and Medical Informatics, University of Zagreb, Zagreb, Croatia (Sekerija); Division of Epidemiology and Prevention of Chronic Noncommunicable Diseases, Croatian Institute of Public Health, Zagreb, Croatia (Sekerija); Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran (Sepehrimanesh); Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran (Seyedmousavi); Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran (Seyedmousavi); Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran (Shaahmadi); Department of Health Policy, Iran University of Medical Sciences, Tehran, Iran (Shabaninejad); Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Shahbaz); Independent consultant, Karachi, Pakistan (Shaikh); Department of Medical Laboratory Sciences, Mazandaran University of Medical Sciences, Sari, Iran (Shamshirian); Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran (Shamsizadeh); Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, Iran (H. Sharafi); Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran (Z. Sharafi); Department of Basic Sciences, Islamic Azad University, Sari, Iran (Sharif); Department of Laboratory Sciences, Islamic Azad University, Sari, Iran (Sharif); Department of Ophthalmology, Kerman University of Medical Sciences, Kerman, Iran (A. Sharifi); HIV/STI Surveillance Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran (H. Sharifi); University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India (Sharma); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom (Sheikh); Division of General Internal Medicine and Primary Care, Harvard University, Boston, Massachusetts (Sheikh); Cancer Biology Research Center, Tehran University of Medical Sciences, Tehran, Iran (Shirkoohi); Symbiosis Institute of Health Sciences, Symbiosis International University, Pune, Maharashtra, India (Shukla); School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (Si); Imam Ali Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran (Siabani); Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia (Siabani); School of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil (Silva); University of Brasília, Brasília, Brazil (Silveira); Department of the Health Industrial Complex and Innovation in Health, Ministry of Health, Brasília, Brazil (Silveira); Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia (A. Singh); Global Patient Outcome and Real World Evidence, Eli Lilly and Company, Indianapolis, Indiana (A. Singh); Department of Medicine, University of Alabama at Birmingham (J. A. Singh); Department of Epidemiology, University of Alabama at Birmingham (J. A. Singh); Medical Department, German Leprosy and TB Relief Association, Addis Ababa, Ethiopia (Sisay); Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (Sitas); Department of Internal Medicine and Specialties, University of Yaoundé I, Yaoundé, Cameroon (Sobngwi); Department of Endocrinology and Diabetes, Central Hospital of Yaoundé, Yaoundé, Cameroon (Sobngwi); Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran (Soofi, Zangeneh); Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain (Soriano); Centro de Investigación en Red de Enfermedades Respiratorias, Institute of Health Carlos III, Madrid, Spain (Soriano); Department of Occupational Therapy, Athens University of Applied Sciences, Athens, Greece (Stathopoulou); Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria (Sufiyan); Department of Medicine, University of Valencia, Valencia, Spain (Tabarés-Seisdedos); Biomedical Research Networking Center for Mental Health Network, Carlos III Health Institute, Madrid, Spain (Tabarés-Seisdedos); Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan (Tabuchi); University of Sydney, Sydney, New South Wales, Australia (Takahashi); Jordan University of Science and Technology, Ramtha, Jordan (Tarawneh); Department of Public Health, Kurdistan University of Medical Sciences, Sanandaj, Iran (Taymoori); Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran (Tehrani-Banihashemi); Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia (M. Temsah); Department of Public Health, Adigrat University, Adigrat, Ethiopia (B. E. Tesfay); Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia (F. H. Tesfay); Department of Public Health, Arba Minch University, Arba Minch, Ethiopia (Teshale); School of Public Health, University of Adelaide, Adelaide, South Australia, Australia (Tessema); Department of Public Health, University of Southern Denmark, Odense, Denmark (Thapa); Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1765 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland (Topor-Madry); The Agency for Health Technology Assessment and Tariff System, Warsaw, Poland (Topor-Madry); Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil (Tovani-Palone); Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam (B. X. Tran); Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand (K. B. Tran); Department of Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam (K. B. Tran); Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan (Ullah); Division of Health Sciences, University of Warwick, Coventry, England, United Kingdom (Uthman); Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy (Vacante); Women’s Reproductive Health Research Center, A.C.S. Medical College and Hospital, Tabriz, Iran (Vaezi); Alzahra Teaching Hospital, Tabriz, Iran (Vaezi); Department for International Development, Health Network of Cuba, Havana, Cuba (Varona Pérez); Centre of Research in Environmental Epidemiology, Barcelona Institute for Global Health, Barcelona, Spain (Varona Pérez); Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran (Veisani); Department of Neurology & Stroke Unit, Sant’Anna Hospital, Como, Italy (Vidale); Occupational Health Unit, Sant’Orsola Malpighi Hospital, Bologna, Italy (Violante); Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia (Vlassov); Department of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland (Vosoughi); Department of Pathology, Makerere University, Kampala, Uganda (Wabinga); Department of Public Health, Woldia University, Woldia, Ethiopia (Wachamo, Yimam); Foundation University Medical College, Foundation University, Rawalpindi, Pakistan (Waheed); Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia (Wijeratne); Department of Medicine, University of Melbourne, St Albans, Victoria, Australia (Wijeratne); Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia (Wondafrash); Department of Nursing, Wollo University, Dessie, Ethiopia (Wondmieneh); Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia (Wondmieneh); Department of Neonatal and Pediatric Health Nursing, Bahir Dar University, Bahirdar, Ethiopia (Workie); Department of Population Studies, International Institute for Population Sciences, Mumbai, India (Yadav); Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Yadegar); Department of Medical Physics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Yadollahpour); Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Yaseri); Department of Health Management, Policy, and Economics, Kerman University of Medical Sciences, Kerman, Iran (Yazdi-Feyzabadi); Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran (Yazdi-Feyzabadi); Wolkite University, Wolkite, Ethiopia (Yeshaneh); School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia (Yisma); Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan (Yonemoto); Health Economics & Finance, Global Health, Jackson State University, Jackson, Mississippi (Younis); Department of Public Health, Tsinghua University, Beijing, China (Younis); Department of Clinical Biochemistry, Tabriz University of Medical Sciences, Tabriz, Iran (Yousefi); Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran (Yousefifard); Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China (Yu); Global Health Institute, Wuhan University, Wuhan, China (Yu); Department of Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran (Zabeh); Department of Electrical Engineering, Bioelectric Group, Sharif University of Technology, Tehran, Iran (Zabeh); Epidemiology and Cancer Registry Sector, Institute of Oncology, Ljubljana, Slovenia (Zadnik); Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran (Moghadam, Zandian); Department of Epidemiology, University Hospital of Setif, Setif, Algeria (Zaidi); Student Research Committee, Babol University of Medical Sciences, Babol, Iran (Zamani); Department of Parasitology, Tarbiat Modares University, Tehran, Iran (L. Zaki); Department of Midwifery, Mekelle University, Mekelle, Ethiopia (Zenebe); Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia (Zewale); Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran (Ziapour). Author Contributions: Dr Fitzmaurice had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors had access to the data in the study and the final responsibility to submit for publication. Study concept and design: Fitzmaurice, Abbastabar, Abd-Allah, Abdelalim, Abdollahpour, Abualhasan, Alene, E. Amini, Anbari, Andrei, Ansariadi, Ataeinia, Ausloos, Babaee, Bagherzadeh, Bärnighausen, Belayneh, Bogale, Chanie, Chaturvedi, Constantin, Derakhshani, Deribe, Desta, Dinberu, Djalalinia, El Sayed, Endalew, Fentahun, Geta, Gezae, Ghashghaee, S. Hay, Herteliu, Hidru, Hosseinzadeh, Househ, James, Jee, Jenabi, Joo, Karimian, Khalilarjmandi, Khater, Kianipour, A. Kisa, S. Kisa, Lasrado, Leigh, Madadin, Maleki, N. Manafi, Manamo, Mansournia, Maroufizadeh, Mehrotra, Melaku, Menezes, Merat, Mills, Mir, Mohammad Darwesh, Mohammadoo-Khorasani, Mohammadpourhodki, A. Mohammed, Najafi, Nazari, Nggada, Omonisi, Postma, M. Rabiee, N. Rabiee, Rahim, Rana, Raoofi, Rath, D. Rawaf, Rezaei, Sabbagh, Salomon, Samy, Sanabria, Satpathy, Sayyah, Shahbaz, Shamshirian, Siabani, Sisay, Sitas, Tamtaji, Tarawneh, Tassew, B. Tesfay, Topor-Madry, Tovani-Palone, Varona Pérez, Wachamo, Yeshaneh, Zangeneh, Zewale, Murray. Acquisition, analysis, or interpretation of data: Fitzmaurice, Abate, Abbasi, Abdel-Rahman, Abdoli, Abdulle, Abebe, Abraha, Abu-Raddad, Adedeji, Advani, Afarideh, Afshari, Aghaali, Agius, Agrawal, Ahmadi, Ahmadian, Ahmadpour, Ahmed, Akbari, Akinyemiju, Al-Aly, AlAbdulKader, Alahdab, Alam, Alamene, Alemnew, Alinia, Alipour, Aljunid, Allah Bakeshei, Almadi, Almasi-Hashiani, Alsharif, Alsowaidi, Alvis-Guzman, S. Amini, Amoako, Anber, Anjomshoa, Ansari, Appiah, Arab-Zozani, Arabloo, Arefi, Aremu, Areri, Artaman, Asayesh, Asfaw, Ashagre, Assadi, Atalay, Ataro, Atique, Avila-Burgos, Avokpaho, Awasthi, Awoke, Ayala Quintanilla, Ayanore, Ayele, Bacha, Badawi, Bagherzadeh, Bagli, Balakrishnan, Balouchi, Bärnighausen, Battista, Masoud Behzadifar, Meysam Behzadifar, Bekele, Belay, Berfield, Berhane, Bernabé, Beuran, Bhakta, Bhattacharyya, Biadgo, Bijani, Bin Sayeed, Birungi, Bisignano, Bitew, Bjørge, Bleyer, Bogale, Bojia, Borzì, Bosetti, Bou-Orm, Brenner, Brewer, A. Briko, N. Briko, Bustamante-Teixeira, Butt, Carreras, Carrero, Carvalho, C. Castro, F. Castro, Catalá-López, Cerin, Chaiah, Chattu, Chauhan, Chehrazi, Chiang, Chichiabellu, Chido-Amajuoyi, Chimed-Ochir, Choi, Christopher, Chu, Costa, Crocetti, Crowe, Curado, Dahlwai, Damiani, Darwish, Daryani, das Neves, Demeke, Demis, Demissie, Demoz, Denova-Gutiérrez, Deribe, Desai, Desalegn, Dey, Dharmaratne, Dhimal, Diaz, Doku, Drake, Dubey, Dubljanin, Duken, Ebrahimi, Effiong, Eftekhari, El Razek, El Sayed, El Sayed Zaki, Elemineh, El-Jaafary, El-Khatib, Elkout, Ellenbogen, Elsharkawy, Emamian, Endries, Eshrati, Fadhil, Fallah Omrani, Faramarzi, Farhangi, Farioli, Farzadfar, Fernandes, Feyissa, Filip, Fischer, Fisher, Force, Foroutan, Freitas, Fukumoto, Futran, Gallus, Gankpe, Gayesa, Gebrehiwot, Gebremeskel, Gedefaw, Gelaw, Getachew, Ghafourifard, Ghajar, Gholamian, Gill, Ginindza, Girmay, Gizaw, Gomez, Gopalani, Gorini, Goulart, Grada, Guerra, Guimaraes, P. Gupta, R. Gupta, Hadkhale, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Hamadeh, Hamidi, Hanfore, Haro, Hasankhani, Hasanzadeh, Hassen, R. Hay, S. Hay, Henok, Henry, Hidru, Hoang, Hole, Hoogar, Horita, Hosgood, Hosseini, M. Hostiuc, S. Hostiuc, Hussen, Ileanu, Ilic, Innos, Irvani, Iseh, Islam, Islami, Jafari Balalami, Jafarinia, Jahangiry, Jahani, Jahanmehr, Jakovljevic, James, Javanbakht, Jayaraman, Jha, Jonas, Jonnagaddala, Jungari, Jürisson, Kabir, Kamangar, Karch, Karimi, Kasaeian, Kasahun, B. Kassa, T. Kassa, Kassaw, Kaul, Keiyoro, Kelbore, Kerbo, Khader, E. Khan, G. Khan, Khang, Khatab, Khater, Khayamzadeh, Khazaee-Pool, Khazaei, Khoja, Khosravi, Khubchandani, D. Kim, Y. Kim, A. Kisa, S. Kisa, Kissimova-Skarbek, Komaki, Koyanagi, Krohn, Kucuk Bicer, Kugbey, Kumar, Kuupiel, La Vecchia, Lad, Lake, Lakew, Lal, Lami, Lan, Lauriola, Lazarus, Leigh, Leshargie, Liao, Limenih, Listl, Lopez, Lopukhov, Lunevicius, Magdeldin, Majeed, Malekzadeh, A. Manafi, N. Manafi, Manamo, Mansourian, Mantovani, Martini, Mashamba-Thompson, Massenburg, Maswabi, Mathur, McAlinden, McKee, Meheretu, Mehta, Meier, G. Meles, H. Meles, Melese, Melku, Memiah, Mendoza, Merat, Meretoja, Mestrovic, B. Miazgowski, T. Miazgowski, Mihretie, Miller, Hamed Mirzaei, Hamid Reza Mirzaei, Mishra, Moazen, D. Mohammad, K. Mohammad, Y. Mohammad, Mohammadbeigi, H. Mohammadi, M. Mohammadi, Mohammadian, Mohammadian-Hafshejani, Mohammadoo-Khorasani, A. Mohammed, J. Mohammed, S. Mohammed, Mohebi, Mokdad, Monasta, Moodley, Moosazadeh, Moossavi, Moradi, Moradi-Joo, Moradi-Lakeh, Moradpour, Morawska, Morgado-da-Costa, Morisaki, Morrison, Mosapour, Mousavi, Muche, Muhammed, Musa, Nabhan, Naderi, Nagarajan, Nagel, Nahvijou, Naik, Naldi, Nam, Nasiri, Negoi, Neupane, Newcomb, Ngunjiri, Nguyen, Nikniaz, Ningrum, Nirayo, Nixon, Nnaji, Nojomi, Nosratnejad, Nourollahpour Shiadeh, Obsa, Ofori-Asenso, Ogbo, Oh, A. Olagunju, T. Olagunju, Oluwasanu, Onwujekwe, Oommen, Oren, Ortega-Altamirano, Ota, Otstavnov, Owolabi, Research Original Investigation Global Burden of Cancer, 1990 to 2017 1766 JAMA Oncology December 2019 Volume 5, Number 12 (Reprinted) jamaoncology.com Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 P A, Padubidri, Pakhale, Pakpour, Pana, Park, Parsian, Pashaei, Patel, Patil, Pennini, Pereira, Piccinelli, Pillay, Pirestani, Pishgar, Pourjafar, Pourmalek, Pourshams, Prakash, Prasad, Qorbani, M. Rabiee, N. Rabiee, Radfar, Rafiei, Rahimi, Rahman, Rajati, Raoofi, S. Rawaf, Reiner, Renzaho, Rezapour, A. Ribeiro, D. Ribeiro, Ronfani, Roro, Roshandel, Rostami, Saad, Sabbagh, Sabour, Saddik, Safiri, Sahebkar, Salehi, H. Salem, M. Salem, Salimzadeh, Samy, Santric Milicevic, Sartorius, Sarveazad, Sathian, Savic, Sawhney, Schneider, Schöttker, Sekerija, Sepanlou, Sepehrimanesh, Seyedmousavi, Shaahmadi, Shabaninejad, Shaikh, Shamsizadeh, H. Sharafi, Z. Sharafi, Sharif, A. Sharifi, H. Sharifi, Sharma, Sheikh, Shirkoohi, Shukla, Si, Siabani, Silva, Silveira, A. Singh, J. Singh, Sisay, Sobngwi, Soofi, Soriano, Stathopoulou, Sufiyan, Tabarés-Seisdedos, Tabuchi, Takahashi, Taymoori, Tehrani-Banihashemi, M. Temsah, O. Temsah, B. Tesfay, F. Tesfay, Teshale, Tessema, Thapa, Tlaye, Tovani-Palone, Traini, B. Tran, K. Tran, Tsadik, Ullah, Uthman, Vacante, Vaezi, Veisani, Vidale, Violante, Vlassov, Vollset, Vos, Vosoughi, Vu, Vujcic, Wabinga, Wachamo, Wagnew, Waheed, Weldegebreal, Weldesamuel, Wijeratne, Wondafrash, Wonde, Wondmieneh, Workie, Yadav, Yadegar, Yadollahpour, Yaseri, Yazdi-Feyzabadi, Yimam, Yimer, Yisma, Yonemoto, Younis, Yousefi, Yousefifard, Yu, Zabeh, Zadnik, Zahirian Moghadam, Zaidi, Zamani, Zandian, Zaki, Zendehdel, Zenebe, Zewale, Ziapour, Zodpey. Drafting of the manuscript: Fitzmaurice, Abu-Raddad, Alam, Aljunid, E. Amini, Anbari, Anber, Bagherzadeh, Bogale, Borzì, Chaturvedi, Deribe, Drake, El Razek, El Sayed, El Sayed Zaki, Fallah Omrani, Farhangi, Gelaw, Girmay, Arvin Haj-Mirzaian, Hasankhani, Househ, Jahanmehr, Jenabi, Khalilarjmandi, Khater, Khazaee-Pool, Komaki, Krohn, Kucuk Bicer, Massenburg, Maswabi, Mills, K. Mohammad, Mohammadpourhodki, Mokdad, Nagarajan, Omonisi, Pashaei, Pillay, M. Rabiee, N. Rabiee, Raoofi, Sabbagh, Salehi, Samy, Sanabria, Satpathy, Sayyah, Tassew, F. Tesfay, Uthman, Veisani, Wabinga, Wachamo, Yousefi, Zangeneh. Critical revision of the manuscript for important intellectual content: Abate, Abbasi, Abbastabar, Abd-Allah, Abdel-Rahman, Abdelalim, Abdoli, Abdollahpour, Abdulle, Abebe, Abraha, Abualhasan, Adedeji, Advani, Afarideh, Afshari, Aghaali, Agius, Agrawal, Ahmadi, Ahmadian, Ahmadpour, Ahmed, Akbari, Akinyemiju, Al-Aly, AlAbdulKader, Alahdab, Alamene, Alemnew, Alene, Alinia, Alipour, Aljunid, Allah Bakeshei, Almadi, Almasi-Hashiani, Alsharif, Alsowaidi, Alvis-Guzman, S. Amini, Amoako, Anbari, Andrei, Anjomshoa, Ansari, Ansariadi, Appiah, Arab-Zozani, Arabloo, Arefi, Aremu, Areri, Artaman, Asayesh, Asfaw, Ashagre, Assadi, Ataeinia, Atalay, Ataro, Atique, Ausloos, Avila-Burgos, Avokpaho, Awasthi, Awoke, Ayala Quintanilla, Ayanore, Ayele, Babaee, Bacha, Badawi, Bagherzadeh, Bagli, Balakrishnan, Balouchi, Bärnighausen, Battista, Masoud Behzadifar, Meysam Behzadifar, Bekele, Belay, Belayneh, Berfield, Berhane, Bernabé, Beuran, Bhakta, Bhattacharyya, Biadgo, Bijani, Bin Sayeed, Birungi, Bisignano, Bitew, Bjørge, Bleyer, Bojia, Borzì, Bosetti, Bou-Orm, Brenner, Brewer, A. Briko, N. Briko, Bustamante-Teixeira, Butt, Carreras, Carrero, Carvalho, C. Castro, F. Castro, Catalá-López, Cerin, Chaiah, Chanie, Chattu, Chauhan, Chehrazi, Chiang, Chichiabellu, Chido-Amajuoyi, Chimed-Ochir, Choi, Christopher, Chu, Constantin, Costa, Crocetti, Crowe, Curado, Dahlwai, Damiani, Darwish, Daryani, das Neves, Demeke, Demis, Demissie, Demoz, Denova-Gutiérrez, Derakhshani, Deribe, Desai, Desalegn, Desta, Dey, Dharmaratne, Dhimal, Diaz, Dinberu, Djalalinia, Doku, Drake, Dubey, Dubljanin, Duken, Ebrahimi, Effiong, Eftekhari, El Razek, El Sayed, El Sayed Zaki, Elemineh, El-Jaafary, El-Khatib, Elkout, Ellenbogen, Elsharkawy, Emamian, Endalew, Endries, Eshrati, Fadhil, Faramarzi, Farioli, Farzadfar, Fentahun, Fernandes, Feyissa, Filip, Fischer, Fisher, Force, Foroutan, Freitas, Fukumoto, Futran, Gallus, Gankpe, Gayesa, Gebrehiwot, Gebremeskel, Gedefaw, Geta, Getachew, Gezae, Ghafourifard, Ghajar, Ghashghaee, Gholamian, Gill, Ginindza, Gizaw, Gomez, Gopalani, Gorini, Goulart, Grada, Guerra, Guimaraes, P. Gupta, R. Gupta, Hadkhale, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Hamadeh, Hamidi, Hanfore, Haro, Hasankhani, Hasanzadeh, Hassen, R. Hay, S. Hay, Henok, Henry, Herteliu, Hidru, Hoang, Hole, Hoogar, Horita, Hosgood, Hosseini, Hosseinzadeh, M. Hostiuc, S. Hostiuc, Househ, Hussen, Ileanu, Ilic, Innos, Irvani, Iseh, Islam, Islami, Jafari Balalami, Jafarinia, Jahangiry, Jahani, Jakovljevic, James, Javanbakht, Jayaraman, Jee, Jenabi, Jha, Jonas, Jonnagaddala, Joo, Jungari, Jürisson, Kabir, Kamangar, Karch, Karimi, Karimian, Kasaeian, Kasahun, B. Kassa, T. Kassa, Kassaw, Kaul, Keiyoro, Kelbore, Kerbo, Khader, E. Khan, G. Khan, Khang, Khatab, Khater, Khayamzadeh, Khazaee-Pool, Khazaei, Khoja, Khosravi, Khubchandani, Kianipour, D. Kim, Y. Kim, A. Kisa, S. Kisa, Kissimova-Skarbek, Komaki, Koyanagi, Krohn, Kugbey, Kumar, Kuupiel, La Vecchia, Lad, Lake, Lakew, Lal, Lami, Lan, Lasrado, Lauriola, Lazarus, Leigh, Leshargie, Liao, Limenih, Listl, Lopez, Lopukhov, Lunevicius, Madadin, Magdeldin, Majeed, Maleki, Malekzadeh, A. Manafi, N. Manafi, Manamo, Mansourian, Mansournia, Mantovani, Maroufizadeh, Martini, Mashamba-Thompson, Massenburg, Maswabi, Mathur, McAlinden, McKee, Meheretu, Mehrotra, Mehta, Meier, Melaku, G. Meles, H. Meles, Melese, Melku, Memiah, Mendoza, Menezes, Merat, Meretoja, Mestrovic, B. Miazgowski, T. Miazgowski, Mihretie, Miller, Mills, Mir, Hamed Mirzaei, Hamid Reza Mirzaei, Mishra, Moazen, D. Mohammad, Y. Mohammad, Mohammad Darwesh, Mohammadbeigi, H. Mohammadi, M. Mohammadi, Mohammadian, Mohammadian-Hafshejani, Mohammadoo-Khorasani, Mohammadpourhodki, A. Mohammed, J. Mohammed, S. Mohammed, Mohebi, Mokdad, Monasta, Moodley, Moosazadeh, Moossavi, Moradi, Moradi-Joo, Moradi-Lakeh, Moradpour, Morawska, Morgado-da-Costa, Morisaki, Morrison, Mosapour, Mousavi, Muche, Muhammed, Musa, Nabhan, Naderi, Nagarajan, Nagel, Nahvijou, Naik, Najafi, Naldi, Nam, Nasiri, Nazari, Negoi, Neupane, Newcomb, Nggada, Ngunjiri, Nguyen, Nikniaz, Ningrum, Nirayo, Nixon, Nnaji, Nojomi, Nosratnejad, Nourollahpour Shiadeh, Obsa, Ofori-Asenso, Ogbo, Oh, A. Olagunju, T. Olagunju, Oluwasanu, Onwujekwe, Oommen, Oren, Ortega-Altamirano, Ota, Otstavnov, Owolabi, P A, Padubidri, Pakhale, Pakpour, Pana, Park, Parsian, Pashaei, Patel, Patil, Pennini, Pereira, Piccinelli, Pillay, Pirestani, Pishgar, Postma, Pourjafar, Pourmalek, Pourshams, Prakash, Prasad, Qorbani, M. Rabiee, N. Rabiee, Radfar, Rafiei, Rahim, Rahimi, Rahman, Rajati, Rana, Raoofi, Rath, D. Rawaf, S. Rawaf, Reiner, Renzaho, Rezaei, Rezapour, A. Ribeiro, D. Ribeiro, Ronfani, Roro, Roshandel, Rostami, Saad, Sabour, Saddik, Safiri, Sahebkar, H. Salem, M. Salem, Salimzadeh, Salomon, Samy, Sanabria, Santric Milicevic, Sartorius, Sarveazad, Sathian, Satpathy, Savic, Sawhney, Sayyah, Schneider, Schöttker, Sekerija, Sepanlou, Sepehrimanesh, Seyedmousavi, Shaahmadi, Shabaninejad, Shahbaz, Shaikh, Shamshirian, Shamsizadeh, H. Sharafi, Z. Sharafi, Sharif, A. Sharifi, H. Sharifi, Sharma, Sheikh, Shirkoohi, Shukla, Si, Siabani, Silva, Silveira, A. Singh, J. Singh, Sisay, Sitas, Sobngwi, Soofi, Soriano, Stathopoulou, Sufiyan, Tabarés-Seisdedos, Tabuchi, Takahashi, Tamtaji, Tarawneh, Taymoori, Tehrani-Banihashemi, M. Temsah, O. Temsah, B. Tesfay, F. Tesfay, Teshale, Tessema, Thapa, Tlaye, Topor-Madry, Tovani-Palone, Traini, B. Tran, K. Tran, Tsadik, Ullah, Uthman, Vacante, Vaezi, Varona Pérez, Vidale, Violante, Vlassov, Vollset, Vos, Vosoughi, Vu, Vujcic, Wachamo, Wagnew, Waheed, Weldegebreal, Weldesamuel, Wijeratne, Wondafrash, Wonde, Wondmieneh, Workie, Yadav, Yadegar, Yadollahpour, Yaseri, Yazdi-Feyzabadi, Yeshaneh, Yimam, Yimer, Yisma, Yonemoto, Younis, Yousefifard, Yu, Zabeh, Zadnik, Zahirian Moghadam, Zaidi, Zamani, Zandian, Zangeneh, Zaki, Zendehdel, Zenebe, Zewale, Ziapour, Zodpey, Murray. Statistical analysis: Fitzmaurice, Abate, Abbastabar, Abdulle, Abraha, Adedeji, Alemnew, Alene, Aljunid, Alsowaidi, Andrei, Ansari, Aremu, Atalay, Ausloos, Awoke, Bagherzadeh, Battista, Bekele, Belay, Bin Sayeed, Bogale, Chaturvedi, Chehrazi, Constantin, Damiani, Demis, Demissie, Deribe, Endalew, Endries, Farzadfar, Feyissa, Fisher, Gedefaw, Gelaw, Getachew, Ghajar, Girmay, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Hassen, S. Hay, Henry, Herteliu, Hidru, Hoang, Hosseinzadeh, Hussen, Ileanu, Irvani, Iseh, James, Karch, Kasaeian, Khater, Khayamzadeh, Khazaei, Khubchandani, A. Kisa, S. Kisa, Lake, Leigh, Limenih, Lopukhov, Manamo, Mansournia, Mantovani, Maswabi, McAlinden, Meier, H. Meles, Melku, Mohammad Darwesh, A. Mohammed, S. Mohammed, Mokdad, Moradi-Lakeh, Muche, Muhammed, Nagarajan, Neupane, Ngunjiri, Nguyen, Nnaji, Otstavnov, Pana, Varona Pérez, Pirestani, Prakash, Qorbani, M. Rabiee, N. Rabiee, Rafiei, Rana, Raoofi, Reiner, Sabbagh, Safiri, M. Salem, Samy, Sathian, Satpathy, Shaikh, Silva, Tarawneh, Tassew, B. Tesfay, Teshale, Tlaye, B. Tran, Uthman, Vacante, Vos, Vu, Wachamo, Weldegebreal, Weldesamuel, Wonde, Workie, Yadegar, Yu, Zabeh, Zaidi, Zenebe, Zewale, Ziapour. Obtained funding: Bagherzadeh, A. Briko, N. Briko, Iseh, Lauriola, Mokdad, Nahvijou, N. Rabiee, Sabbagh, Satpathy. Administrative, technical, or material support: Abd-Allah, Adedeji, Afarideh, Agius, Ahmadi, Akinyemiju, AlAbdulKader, Alam, Alipour, Aljunid, Allah Bakeshei, S. Amini, Amoako, Anbari, Ansariadi, Appiah, Arab-Zozani, Areri, Assadi, Atique, Awasthi, Bacha, Badawi, Berhane, C. Castro, F. Castro, Catalá-López, Chattu, Chaturvedi, Chiang, Dahlwai, Daryani, das Neves, Demissie, Denova-Gutiérrez, Desalegn, Doku, Dubey, El Razek, El Sayed Zaki, Emamian, Faramarzi, Farzadfar, Fentahun, Gankpe, P. Gupta, R. Gupta, R. Hay, Househ, Irvani, Jafari Balalami, Jenabi, Joo, Kamangar, Kasahun, Khalilarjmandi, Khosravi, Y. Kim, Krohn, Kumar, Liao, Lopez, Malekzadeh, N. Manafi, Mansourian, Merat, Moazen, Mohammadbeigi, M. Mohammadi, Mohammadian, Mohammadian-Hafshejani, Mohammadpourhodki, S. Mohammed, Moradpour, Morgado-da-Costa, Global Burden of Cancer, 1990 to 2017 Original Investigation Research jamaoncology.com (Reprinted) JAMA Oncology December 2019 Volume 5, Number 12 1767 Downloaded From: https://jamanetwork.com/ by a Tampere University User on 12/20/2019 Morisaki, Nagarajan, Najafi, Nazari, Nggada, Ningrum, Nourollahpour Shiadeh, Obsa, Oluwasanu, Omonisi, P A, Patil, Pennini, Pereira, M. Rabiee, Radfar, Rafiei, Rahim, Raoofi, Rath, A. Ribeiro, Roro, Rostami, Saad, Sabbagh, Samy, Satpathy, Sayyah, Seyedmousavi, Shamsizadeh, Si, Siabani, Silveira, Soriano, B. Tesfay, Wabinga, Wijeratne, Wondmieneh, Yadav, Yadegar, Yadollahpour, Younis, Zahirian Moghadam, Zandian, Zangeneh. Study supervision: Abualhasan, Alam, E. Amini, S. Amini, Anbari, Ataeinia, Atalay, Atique, Masoud Behzadifar, Meysam Behzadifar, Berfield, Daryani, Demoz, Dinberu, Drake, Dubljanin, El Sayed, El Sayed Zaki, Fadhil, Fukumoto, Gayesa, Gebremeskel, Ghafourifard, Gizaw, Guimaraes, Hadkhale, Irvani, Iseh, James, Jee, Karch, Khader, Khater, Kianipour, Koyanagi, Krohn, N. Manafi, Merat, B. Miazgowski, T. Miazgowski, Mills, Moazen, M. Mohammadi, A. Mohammed, Mokdad, Nabhan, Nagel, Nazari, Nixon, Obsa, Ota, Pakpour, Pana, Park, Piccinelli, Postma, Pourshams, D. Rawaf, Rezaei, H. Salem, Salomon, Sarveazad, Satpathy, Sepehrimanesh, Silveira, Soriano, Tabuchi, B. Tesfay, Ullah, Vidale, Vos, Vujcic, Zabeh, Zandian, Murray. Other—Provided expert opinion on regional trends: Diaz. Other—Future and further work: Nagarajan. Other—Advice on analysis and reporting strategy: Sitas. Other—Provided suggestions for future directions: Owolabi, Pakhale. Other—Advice on policy implications: Majeed. Conflict of Interest Disclosures: Dr Goulart reports receiving grants from the National Council for Scientific and Technological Development. Dr Haro reports being a contractor for Eli Lilly and Company and receiving personal fees from Lundbeck. Mr Hidru reports receiving grants, personal fees, nonfinancial support, and other support from Adigrat University. Dr Iseh reports receiving nonfinancial support from the Usmanu Danfodiyo University Teaching Hospital and the Institute of Human Virology, Nigeria. Dr Jakovljevic reports receiving grants from the Ministry of Education, Science and Technological Development of the Republic of Serbia. Dr James reports receiving grants from Sanofi Pasteur. Dr Lazarus reports receiving grants and personal fees from AbbVie, Gilead Sciences, and MSD. Dr Meretoja reports receiving grants from the Cancer Foundation Finland. Dr Moradi-Lakeh reports being a consultant for a project funded by Novartis. Dr Postma reports receiving grants from Quintiles and Bayer; personal fees from AbbVie, Astellas, and Pharmerit; grants and personal fees from Bristol-Myers Squibb, AstraZeneca, Sanofi, Novartis, Janssen, GlaxoSmithKline, Pfizer, MSD, and Asc Academics, as well as serving as an advisor for the organization; and earnings from stock in Ingress Health and PAB BV. Dr Savic reports being an employee of the GlaxoSmithKline group of companies and holds restricted shares in the GlaxoSmithKline group of companies. Dr J. Singh reports receiving personal fees from serving as a consultant for Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health, and the American College of Rheumatology; earnings from stocks in the Amarin Corporation and Viking Therapeutics; and nonfinancial support from serving as a member of OMERACT, the US Department of Veterans Affairs Rheumatology Field Advisory Committee, and committees of the American College of Rheumatology. No other disclosures are reported. Funding/Support: The Institute for Health Metrics and Evaluation received funding from the Bill & Melinda Gates Foundation. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions: We thank cancer registries worldwide for their efforts in generating data on cancer incidence. REFERENCES 1. United Nations General Assembly. Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. http://www.un.org/ en/ga/search/view_doc.asp?symbol=A/RES/73/2. Published October 17, 2018. Accessed February 6, 2019. 2. 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