Cancer mortality and predictions for 2022 in selected Australasian countries, Russia, and Ukraine with a focus on colorectal cancer : European Journal of Cancer Prevention

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Gastrointestinal cancers

Cancer mortality and predictions for 2022 in selected Australasian countries, Russia, and Ukraine with a focus on colorectal cancer

Pizzato, Margheritaa; La Vecchia, Carloa; Malvezzi, Matteoa; Levi, Fabiob; Boffetta, Paoloc,d; Negri, Evaa,c; Dalmartello, Michelaa

Author Information
European Journal of Cancer Prevention 32(1):p 18-29, January 2023. | DOI: 10.1097/CEJ.0000000000000762

Abstract

Introduction

Since 2018, we have been producing cancer mortality predictions for the Russian Federation, Ukraine, and selected Australasian countries (Carioli et al., 2019; Pizzato et al., 2021). We showed substantial differences in cancer mortality rates across the countries considered with an almost two-fold difference between the highest in Russia and the lowest in Korea, and generally favorable trends in rates over the last three decades, though the absolute number of cancer deaths did not decline due to population growth and aging.

There were consistent declines in stomach cancer rates in all countries considered over the last decades and in colorectal cancer over more recent years. Most considered countries also had favorable rates for breast cancer and for lung cancer in both sexes, with Hong Kong SAR, the Republic of Korea, and Australia having higher female death rates from lung cancer than breast cancer. In most countries considered, recent trends and predictions were also favorable for uterine, ovarian, prostate, and bladder cancers, but not for pancreatic cancer.

In the present paper, we report cancer mortality predictions for 2022 in the Russian Federation, Ukraine, and selected Australasian countries, together with long-term trends since 1970. We also estimated avoided cancer deaths over the last 3 decades, and we specifically focused on colorectal cancer mortality trends.

Methods

We retrieved official death certification data for total neoplasms and 10 selected major cancer sites, including stomach, colorectum, pancreas, lung, breast, uterus (cervix and corpus), ovary, prostate, bladder, and leukemia, from the WHO database (World Health Organization Statistical Information System, 2021). We obtained data for selected Australasian countries with over 7 million inhabitants and over 90% national death certification coverage (i.e. Israel, Hong Kong SAR, Japan, the Republic of Korea, and Australia) and two-major non-EU countries (i.e. the Russian Federation and Ukraine). Cancer deaths were recoded according to the 10th Revision of the International Classification of Diseases (World Health Organization, 1992).

We retrieved resident population estimates from the same WHO databases and, when data were missing, from the United Nations (UN) Population Division database (World Health Organization Statistical Information System, 2021; United Nations, Department of Economic and Social Affairs, Population Division, 2019).

We calculated country- and sex-specific death rates for each 5-year age group (from 0–4 to 85+ years), calendar year, and cancer site from the matrices of certified deaths and resident populations. We computed yearly and quinquennial age-standardized rates using world standard population per 100 000 persons at all ages, and for colorectal cancer, we also computed truncated rates for the 30–49, 50–69, and 70+ age groups.

Mortality figures for 2022 and the corresponding 95% prediction intervals (PIs) were derived by fitting a logarithmic Poisson regression model to the number of deaths in each 5-year age group (Kim et al., 2000). Predicted age-specific numbers of deaths were estimated by fitting a linear regression model to mortality data of each age group over the most recent segment identified by the joinpoint model. We computed age-specific and age-standardized death rates for 2022 and their corresponding 95% PIs using the predicted age-specific deaths counts and the predicted populations from the UN Population Division and the Japanese National Institute of Population and Social Security Research (IPSS) databases (United Nations, Department of Economic and Social Affairs, Population Division, 2019; Research NIoPaSS, 2012).

We estimated numbers of averted deaths over the years 1994–2022 by comparing observed and expected deaths based on the 1993 age-specific rate, since the highest rates in most countries occurred around that year.

Results

Total cancer mortality rates showed predicted favorable trends in all countries and both sexes, though the number of deaths is predicted to increase (Tables 1 and 2 and Fig. 1). Among men, falls in rates between 2016–2018 and 2022 ranged between −2.9% (the Russian Federation) and −20.6% (the Republic of Korea). The highest observed and predicted rates were in the Russian Federation, with values of 161.1/100 000 in 2016–2018 and of 156.4/100 000 in 2022. The lowest rates were reported in Israel (94.0/100 000 in 2016–2018 and 90.6/100 000 in 2022) and in the Republic of Korea (112.4/100 000 in 2016–2018 and 89.2/100 000). Among women, the decline between the two periods ranged between −1.4% (Israel) and −15.2% (the Republic of Korea). High rates among women were also reported in the Russian Federation (83.8/100 000 in 2016–2018 and of 81.4/100 000 in 2022), whereas the Republic of Korea showed the lowest ones (52.5/100 000 in 2016–2018 and of 44.5/100 000 in 2022).

Table 1 - Number of predicted deaths and mortality rates per 100 000 men for the year 2022 and comparison figures for the 2016–2018 (2016–2017 only for Hong Kong SAR), from Russia and selected Australasian countries, with 95% prediction intervals and percent differences between 2022 and 2016–2018 rates
Country Cancer site Observed number of deaths 2016–2018 a Predicted number of deaths 2022 (95% PI) Observed ASR 2016–2018 a Predicted ASR 2022 (95% PI) % difference 2022 vs. 2016–2018
Russian Federation
Stomach 16 721 15 690 (14 520–16 864) 16.76 14.1 (13.03–15.17) −15.9
Colorectum 18 233 20 080 (18 883–21 278) 18.07 17.99 (16.92–19.06) −0.4
Pancreas 9111 10 150 (9476–10 820) 9.21 9.41 (8.79–10.03) 2.1
Lung 41 204 42 290 (39 281–45 301) 41.45 38.46 (35.71–41.2) −7.2
Prostate 12 683 14 380 (13 049–15 710) 12.26 12.29 (11.1–13.49) 0.3
Bladder 4879 4720 (4232–5207) 4.77 4.14 (3.71–4.58) −13.1
Leukaemias 3858 3930 (3646–4204) 4.21 3.86 (3.58–4.14) −8.3
All cancers 159 363 170 310 (159 711–180 914) 161.11 156.44 (146.88–166) −2.9
Ukraine
Stomach 2777 3010 (2548–3479) 12.71 8.71 (7.37–10.06) −31.4
Colorectum 3744 5180 (4702–5659) 16.63 14.74 (13.42–16.06) −11.4
Pancreas 1651 2430 (2215–2655) 7.66 7.41 (6.74–8.09) −3.2
Lung 6521 8110 (7174–9046) 30.17 23.95 (21.24–26.66) −20.6
Prostate 2528 4170 (3758–4589) 10.61 11.21 (10.08–12.35) 5.7
Bladder 1093 1530 (1316–1752) 4.69 4.25 (3.65–4.85) −9.4
Leukaemias 746 960 (832–1079) 3.81 3.01 (2.55–3.47) −21
All cancers 29 236 39 320 (36 140–42 506) 135.6 116.59 (107.48–125.71) −14
Israel
Stomach 289 310 (268–349) 4.71 4.7 (4.02–5.38) −0.2
Colorectum 686 740 (667–810) 10.6 10.23 (9.12–11.34) −3.5
Pancreas 488 530 (474–585) 8.09 8.01 (7.03–8.98) −1
Lung 1247 1170 (1055–1285) 21.19 18.05 (16.11–19.99) −14.8
Prostate 435 460 (401–514) 5.76 5.48 (4.8–6.15) −4.9
Bladder 315 360 (319–410) 4.46 4.68 (4.13–5.23) 4.9
Leukaemias 276 300 (266–332) 4.34 4.28 (3.74–4.82) −1.4
All cancers 5896 6380 (6160–6599) 93.97 90.6 (87.24–93.96) −3.6
Hong Kong SAR
Stomach 424 450 (380–512) 5.29 4.53 (3.68–5.38) −14.3
Colorectum 1288 1440 (1318–1554) 16.03 15 (13.58–16.42) −6.4
Pancreas 378 430 (390–465) 5 5.12 (4.6–5.64) 2.4
Lung 2563 2750 (2561–2932) 32.07 28.6 (26.24–30.96) −10.8
Prostate 427 450 (399–502) 4.3 3.64 (3.2–4.08) −15.3
Bladder 149 120 (98–149) 1.54 1 (0.72–1.27) −35.3
Leukaemias 189 170 (147–199) 2.84 2.07 (1.41–2.72) −27.3
All cancers 8625 8800 (8363–9243) 111.77 96.71 (91.91–101.51) −13.5
Japan
Stomach 29 478 25 840 (25 008–26 680) 13.97 10.12 (9.46–10.79) −27.5
Colorectum 28 379 29 800 (28 628–30 974) 14.75 14.45 (13.83–15.08) −2
Pancreas 17 466 19 270 (18 779–19 756) 9.14 9.36 (8.99–9.73) 2.4
Lung 52 608 53 640 (51 421–55 864) 24.49 21.79 (20.22–23.36) −11
Prostate 12 022 12 560 (12 087–13 031) 4.39 4.02 (3.86–4.18) −8.4
Bladder 5871 6270 (5938–6611) 2.38 2.3 (2.16–2.43) −3.5
Leukaemias 5294 5510 (5285–5735) 3.1 2.74 (2.51–2.96) −11.7
All cancers 226 214 230 190 (225 268–235 110) 109.67 99.1 (95.68–102.53) −9.6
Republic of Korea
Stomach 5189 4230 (4007–4457) 11.78 7.4 (6.91–7.88) −37.2
Colorectum 5135 5260 (5002–5514) 11.65 9.33 (8.84–9.82) −19.9
Pancreas 3023 3450 (3278–3629) 6.85 6.22 (5.9–6.55) −9.1
Lung 13 261 13 750 (13 369–14 138) 29.31 23.13 (22.42–23.85) −21.1
Prostate 1854 2170 (2062–2276) 4.13 3.48 (3.29–3.66) −15.8
Bladder 1061 1180 (1095–1262) 2.39 1.96 (1.82–2.1) −18.2
Leukaemias 1049 1090 (1004–1170) 2.73 2.17 (1.87–2.47) −20.6
All cancers 49 477 50 790 (49 526–52 062) 112.38 89.23 (86.79–91.68) −20.6
Australia
Stomach 712 710 (643–777) 2.98 2.66 (2.38–2.93) −10.8
Colorectum 3066 2880 (2707–3053) 12.39 10.3 (9.71–10.88) −16.9
Pancreas 1555 1750 (1649–1861) 6.46 6.45 (6.03–6.87) −0.2
Lung 4979 5030 (4734–5323) 20.39 18.45 (17.59–19.31) −9.5
Prostate 3263 3290 (3160–3430) 10.66 9.17 (8.79–9.56) −13.9
Bladder 720 680 (597–761) 2.43 1.93 (1.69–2.17) −20.5
Leukaemias 1115 1110 (1022–1197) 4.39 3.72 (3.38–4.06) −15.3
All cancers 26 423 27 730 (27 076–28 375) 105.93 95.75 (93.52–97.98) −9.6
ASR, age-standardized mortality rates using the world standard population.
a2016–2017 for Hong Kong SAR.

Table 2 - Number of predicted deaths and mortality rates per 100 000 women for the year 2022 and comparison figures for 2016–2018 (2016–2017 only for Hong Kong SAR), from Russia and selected Australasian countries, with 95% prediction intervals and percent differences between 2022 and 2016–2018 rates
Country
Cancer site
Observed number of deaths 2016–2018 a Predicted number of deaths 2022 (95% PI) Observed ASR b 2016–2018 a Predicted ASR a 2022 (95% PI) % difference 2022 vs. 2016–2018
Russian Federation
Stomach 11 911 9410 (8215–10 600) 6.57 4.76 (4.19–5.32) −27.6
Colorectum 21 337 22 160 (20 369–23 947) 11.25 10.77 (9.92–11.63) −4.2
Pancreas 9100 10 680 (9895–11 460) 4.98 5.37 (4.99–5.74) 7.8
Lung 9588 10 550 (9868–11 238) 5.63 5.75 (5.4–6.11) 2.2
Breast 22 102 22 360 (20 827–23 898) 14.41 13.53 (12.79–14.27) −6.1
Uterus (cervix and corpus) 13 231 13 720 (12 910–14 523) 9.28 8.97 (8.54–9.41) −3.3
Ovary 7597 7480 (6945–8024) 5.12 4.7 (4.39–5.01) −8.2
Bladder 1251 1280 (1083–1481) 0.58 0.55 (0.48–0.63) −4.9
Leukaemias 3827 4050 (3766–4341) 2.6 2.41 (2.24–2.58) −7.3
All cancers 137 966 145 690 (135 924–155 458) 83.75 81.44 (76.77–86.11) −2.8
Ukraine
Stomach 1737 1900 (1550–2259) 4.84 3.23 (2.66–3.8) −33.4
Colorectum 3494 4410 (3878–4933) 9.11 7.34 (6.53–8.16) −19.4
Pancreas 1368 1920 (1718–2128) 3.63 3.38 (3.04–3.71) −6.9
Lung 1467 2040 (1818–2264) 4.12 3.73 (3.32–4.14) −9.4
Breast 4429 5920 (5411–6427) 13.71 11.77 (10.88–12.67) −14.1
Uterus (cervix and corpus) 2578 3680 (3433–3923) 8.8 8.11 (7.6–8.62) −7.8
Ovary 1416 1910 (1701–2127) 4.78 4.2 (3.76–4.64) −12.1
Bladder 212 310 (244–372) 0.49 0.48 (0.37–0.58) −2.7
Leukaemias 646 710 (596–830) 2.25 1.64 (1.33–1.95) −27
All cancers 23 070 30 710 (28 019–33 395) 69.78 59.32 (55.12–63.51) −15
Israel
Stomach 191 210 (173–244) 2.57 2.76 (2.28–3.25) 7.5
Colorectum 659 580 (509–661) 7.84 6.55 (5.69–7.42) −16.4
Pancreas 460 510 (451–570) 5.79 5.69 (4.92–6.46) −1.7
Lung 635 620 (547–684) 8.34 7.22 (6.23–8.2) −13.5
Breast 1053 1110 (1015–1197) 15.32 15.35 (13.91–16.79) 0.2
Uterus (cervix and corpus) 292 300 (264–342) 4.11 4.08 (3.54–4.62) −0.7
Ovary 308 330 (286–371) 4.62 4.63 (3.97–5.29) 0.2
Bladder 95 90 (75–110) 0.91 0.85 (0.66–1.05) −6.2
Leukaemias 238 250 (217–276) 2.93 2.8 (2.35–3.25) −4.4
All cancers 5762 6290 (6014–6567) 74.55 73.54 (70.4–76.69) −1.4
Hong Kong SAR
Stomach 273 280 (239–313) 2.89 2.44 (2.03–2.85) −15.6
Colorectum 903 1010 (916–1095) 8.93 8.07 (7.27–8.87) −9.6
Pancreas 307 340 (312–375) 3.29 3.27 (2.96–3.58) −0.5
Lung 1273 1380 (1252–1512) 13.11 12.03 (10.65–13.41) −8.3
Breast 711 790 (724–853) 9.36 9.52 (8.71–10.32) 1.7
Uterus (cervix and corpus) 324 420 (371–462) 4.16 4.83 (4.3–5.36) 16.1
Ovary 224 270 (238–307) 2.96 3.34 (2.88–3.79) 12.7
Bladder 62 50 (36–70) 0.42 0.29 (0.15–0.44) −29.8
Leukaemias 123 130 (110–158) 1.62 1.43 (0.82–2.04) −11.7
All cancers 5978 6430 (6076–6782) 65.64 61.13 (57.35–64.91) −6.9
Japan
Stomach 15 502 140 40 (13 547–145 43) 5.31 3.83 (3.53–4.14) −27.8
Colorectum 24 252 25 990 (25 481–26 495) 8.58 8.45 (8.19–8.71) −1.5
Pancreas 16 897 19 500 (19 025–19 973) 5.9 6.2 (5.93–6.47) 5.2
Lung 21 484 22 050 (21 397–22 706) 7.19 6.17 (5.77–6.57) −14.2
Breast 14 317 15 390 (14 995–15 787) 9.17 9.15 (8.83–9.48) −0.2
Uterus (cervix and corpus) 6585 6780 (6539–7026) 4.18 4.26 (4.05–4.47) 1.9
Ovary 4924 4820 (4609–5033) 3.07 2.78 (2.6–2.96) −9.5
Bladder 2744 2990 (2841–3134) 0.66 0.63 (0.58–0.67) −5.3
Leukaemias 3432 3480 (3322–3644) 1.67 1.35 (1.21–1.5) −18.9
All cancers 159 610 166 300 (163 619–168 977) 61.97 58.02 (56.46–59.58) −6.4
Republic of Korea
Stomach 2826 2180 (2000–2361) 4.58 2.73 (2.38–3.08) −40.4
Colorectum 3946 4080 (3889–4264) 6.02 4.95 (4.67–5.23) −17.7
Pancreas 2787 3130 (2996–3257) 4.48 4.14 (3.98–4.31) −7.6
Lung 4670 4750 (4572–4920) 7.34 5.92 (5.66–6.18) −19.4
Breast 2471 2660 (2519–2804) 5.45 5.53 (5.21–5.85) 1.5
Uterus (cervix and corpus) 1282 1330 (1244–1417) 2.57 2.36 (2.18–2.54) −8.1
Ovary 1226 1330 (1236–1422) 2.48 2.38 (2.18–2.58) −4.1
Bladder 348 400 (357–448) 0.47 0.43 (0.38–0.48) −8.3
Leukaemias 792 800 (717–874) 1.77 1.34 (1.05–1.63) −24.4
All cancers 30 786 32 200 (31 271–33 121) 52.53 44.52 (43.14–45.91) −15.2
Australia
Stomach 416 410 (361–459) 1.49 1.34 (1.15–1.53) −10.2
Colorectum 2612 2570 (2427–2710) 8.54 7.55 (7.13–7.97) −11.6
Pancreas 1441 1590 (1481–1692) 4.94 5.06 (4.76–5.37) 2.5
Lung 3442 3610 (3452–3768) 12.94 11.85 (11.23–12.47) −8.4
Breast 2958 2980 (2843–3122) 12.07 10.85 (10.28–11.41) −10.1
Uterus (cervix and corpus) 761 840 (777–905) 3.17 3.18 (2.93–3.43) 0.3
Ovary 983 1050 (975–1133) 3.81 3.58 (3.25–3.92) −5.9
Bladder 303 290 (247–331) 0.8 0.69 (0.58–0.8) −14.1
Leukaemias 738 740 (683–792) 2.54 2.18 (1.93–2.43) −14.1
All cancers 20 432 21 660 (21 239–220 77) 73.44 68.81 (67.46–70.17) −6.3
a2016–2017 for Hong Kong SAR.
bASR, age-standardized mortality rates using the world standard population.

F1
Fig. 1:
Bar-plot of age-standardized (world population) death rates per 100 000 persons-years for the years 2016–2018 (dark gray) and predicted rates for 2022 (light gray), with 95% prediction intervals, for total cancer in the Russian Federation, Ukraine and selected Australasian countries, in men and women.

Figure 2 shows age-standardized total cancer mortality trends from 1970–1975 to 2015–2017 and predicted rates for 2022 with 95% PIs in the selected countries for men and women. Total cancer mortality rates in men started to decrease between 1990 and 2000. A similar pattern emerged in the Russian Federation and Ukraine, whereas rates declined earlier in Hong Kong SAR and Australia (since the mid-1980s and the mid-1970s, respectively). In women, falls started earlier than in men, with the exception of the Russian Federation, the Republic of Korea, and Hong Kong SAR. Gaps in rates across countries are decreasing, and the predicted shrinkage is particularly evident in men (apart from the persisting high Russian rate).

F2
Fig. 2:
Age-standardized (world population) total cancer mortality rate trends from 1970-1975 to 2015–2017 and predicted rates for 2022 with 95% prediction intervals, for the Russian Federation (xs), Ukraine (diamonds), Israel (circles), Hong Kong SAR (squares), Japan (triangles), The Republic of Korea (crosses), and Australia (inverted triangles), in men and women.

Figure 3 shows age-standardized cancer mortality rates from 1970–1975 to 2015–2017 and predicted rates for 2022 by country for the 10 cancer sites, in men and women. Stomach cancer rates declined for all countries and both sexes over the whole period. Colorectal cancer rates increased up to the 2000s to then slightly decrease or level off. In Australia, decreases started earlier, both in men (around the 1990s) and in women (around the 1970s). Trends for pancreatic cancer slightly increased over the period, with some leveling off over the last calendar years. Favorable or stable trends were predicted, with the exception of Japan and the Russian Federation in women (+5.2% and +7.8%, respectively). Lung cancer rates were the highest over the whole period in men in all countries (from mid 1990s in Japan and the Republic of Korea) and in Hong Kong women. Trends in women reported increasing rates followed by a decline (from the early 1990s in Russia, Ukraine, and Hong Kong, and later in Australia, Israel, and Japan). Lung cancer predicted rates for 2022 were favorable for men and, to a lesser degree, for women. Bladder cancer showed stable or slightly decreasing trends with predicted rates below 5/100 000 in men and 1/100 000 in women. Trends for leukemias were also favorable, reaching predicted rates below 5/100 000 in men and 3/100 000 in women. Increasing trends in prostate cancer emerged in the Russian Federation and Ukraine, with a flattening of predicted trends for 2022. A steep fall in prostate cancer mortality from the late 1990s was evident in Israel, whereas slight decreases were reported in the other countries. Russia, Ukraine, Israel, and Australia had the highest breast cancer rates but also the greatest and most consistent falls from the early 2000s (Russia and Ukraine) or early 1990s (Australia and Israel). Japan, Korea, and Hong Kong SAR showed rising or stable trends over the observed period. A nearly three-fold difference in predicted rates was estimated between Korea (5.5/100 000) and Israel (15.4/100 000). In women, lung cancer mortality was higher than breast cancer rates in Hong Kong SAR and the Republic of Korea over the whole period and after about 2005 in Australia. Increasing rates for uterine cancer recently emerged for Hong Kong SAR and the Russian Federation, whereas they tended to level off in the most recent period in Australia and Japan. Appreciable falls were observed in Ukraine, the Republic of Korea, and, in the last period, in Israel. Ovarian cancer rates stabilized or slightly decreased in the most recent calendar years.

F3
Fig. 3:
Age-standardized (world population) cancer mortality rates from 1970–1975 to 2015–2017 and predicted rates for 2020 with 95% prediction intervals, for the Russian Federation, Ukraine and selected Australasian countries, in men (a) and women (b). Stomach (squares), colorectum (circles), pancreas (triangles), lung (crosses), prostate (ticked squares), bladder (asterisks), leukaemias (ticked diamonds), breast (xs), uterus (cervix and corpus) (diamonds), and ovary (inverted triangles).

Colorectal cancer mortality (Table 3) showed favorable trends between 2016–2018 and 2022 at all ages in all countries and also in each of the considered age groups (30–49, 50–69, and 70+) in Australia and Ukraine, in Korean men, and in Israeli women. Higher falls were generally predicted in the elderly but also in the young adult age group in Hong Kong SAR and Ukraine. Increasing rates for the 30–49 age group were predicted in Japan (+13.3 in men and +11.8 in women) and for the 50–69 years group in Hong Kong SAR (+14.2% in men and +7.5% in women). In earlier calendar periods (Supplementary Fig. 1, supplemental digital content 1, https://links.lww.com/EJCP/A360), colorectal cancer mortality rates for the 70+ age group increased in most of the countries for both sexes (up to late 1990s to early 2000s in Japan and Hong Kong SAR, and up to early 2000s to 2010s in the Republic of Korea and later for the Russian Federation) and then decreased. Favorable trends in this age group also emerged in Ukraine in the last years and in Israel from late 1990s. Falls in mortality over the observed period were evident in Australia, covering the whole period in women. To a minor extent, a similar favorable inversion of the trend also emerged for the 50–69 age group in the Republic of Korea, Ukraine, and Japan.

Table 3 - Age-standardized colorectal cancer mortality rates per 100 000 women and men in triennium 2016–2018 (2016–2017 only for Hong Kong SAR) and predicted rates for 2022 for all ages, 30–49, 50–69, and 70+ years age groups in Russia, Ukraine, and selected Australasian countries, with percent changes between 2022 and 2016–2018 rates
Country
Age
Men Women
Observed ASR 2016–2018 Predicted ASR 2022 (95% PI) % difference 2022 vs. 2016–2018 Observed ASR 2016–2018 Predicted ASR 2022 (95% PI) % difference 2022 vs. 2016–2018
Russian Federation
All ages 18.07 17.99 (16.92–19.06) −0.4 11.25 10.77 (9.92–11.63) −4.2
Truncated 30–49 years 4.47 4.5 (4.2–4.81) 0.7 4.17 3.82 (3.46–4.18) −8.3
Truncated 50–69 years 55.78 59.21 (55.93–62.49) 6.1 34.5 34.93 (31.95–37.9) 1.2
Truncated 70+ years 199.94 183.67 (160.46–206.89) −8.1 117.08 106.12 (88.52–123.72) −9.4
Ukraine
All ages 16.63 14.74 (13.42–16.06) −11.4 9.11 7.34 (6.53–8.16) −19.4
Truncated 30–49 years 4.29 3.6 (2.92–4.28) −16.1 3.61 2.32 (1.54–3.11) −35.6
Truncated 50–69 years 55.12 53.56 (50.76–56.35) −2.8 31.16 28.26 (26.24–30.28) −9.3
Truncated 70+ years 166.95 130.84 (100.01–161.66) −21.6 79.8 54.82 (36.78–72.87) −31.3
Israel
All ages 10.6 10.23 (9.12–11.34) −3.5 7.84 6.55 (5.69–7.42) −16.4
Truncated 30–49 years 3.68 3.16 (2.13–4.2) −14 4.31 3.69 (2.62–4.77) −14.3
Truncated 50–69 years 24.76 25.59 (20.04–31.15) 3.4 18.03 16.72 (12.72–20.71) −7.3
Truncated 70+ years 141.84 132.68 (117.31–148.05) −6.5 95.77 73.33 (60.38–86.28) −23.4
Hong Kong SAR
All ages 16.03 15 (13.58–16.42) −6.4 8.93 8.07 (7.27–8.87) −9.6
Truncated 30–49 years 4.76 2.88 (0.84–4.91) −39.6 3.06 2.1 (0.82–3.38) −31.4
Truncated 50–69 years 44.87 51.23 (44.46–57.99) 14.2 25.87 27.82 (24.88–30.76) 7.5
Truncated 70+ years 189.33 152.84 (134.17–171.51) −19.3 100 77.87 (64.08–91.65) −22.1
Japan
All ages 14.75 14.45 (13.83–15.08) −2 8.58 8.45 (8.19–8.71) −1.5
Truncated 30–49 years 4.07 4.61 (4.27–4.96) 13.3 3.38 3.78 (3.38–4.18) 11.8
Truncated 50–69 years 43.32 43.79 (40.29–47.29) 1.1 24.06 24.36 (22.98–25.74) 1.3
Truncated 70+ years 169.01 157.09 (150.74–163.44) −7.1 97.18 90.42 (88.25–92.59) −7
Republic of Korea
All ages 11.65 9.33 (8.84–9.82) −19.9 6.02 4.95 (4.67–5.23) −17.7
Truncated 30–49 years 2.88 2.52 (1.97–3.07) −12.7 2.58 2.64 (2.07–3.21) 2.3
Truncated 50–69 years 29.23 24.43 (22.71–26.15) −16.4 12.67 9.75 (8.7–10.8) −23
Truncated 70+ years 155.74 119.79 (110.33–129.24) −23.1 83.23 68.44 (64.24–72.64) −17.8
Australia
All ages 12.39 10.3 (9.71–10.88) −16.9 8.54 7.55 (7.13–7.97) −11.6
Truncated 30–49 years 4.33 3.98 (3.21–4.74) −8.1 3.68 3.67 (3.03–4.31) −0.3
Truncated 50–69 years 32.52 28.67 (26.16–31.18) −11.8 20.81 18.31 (16.5–20.12) −12
Truncated 70+ years 151.56 115.92 (106.28–125.56) −23.5 106.24 91.51 (85.19–97.84) −13.9
ASR, age-standardized mortality rates using the world standard population.

Based on the 1993 age-specific rates, all countries reported a substantial number of averted deaths over the 1994–2022 period (Fig. 4, light grey area). Over this period, a total of 1 487 000 deaths were estimated to have been avoided in the Russian Federation (1 198 000 in men and 289 000 in women), 502 000 in Ukraine (323 000 in men and 179 000 in women), 58 000 in Israel (31 000 in men and 27 000 in women), 102 000 in Hong Kong SAR (66 000 in men and 34 000 in women), 1 020 000 in Japan (741 000 in men and 279 000 in women), 533 000 in the Republic of Korea (409 000 in men and 124 000 in women), and 263 000 in Australia (180 000 in men and 83 000 in women). Over the same period, the estimated number of averted deaths for colorectal cancer was 55 000 in Australia (31 000 in men and 24 000 in women), 10 000 in Japan (6000 in men and 4000 in women), and 10 000 in Israel (5000 in men and 5000 in women) (Supplementary Fig. 2, supplemental digital content 1, https://links.lww.com/EJCP/A360). No avoided deaths were estimated for the other countries considered.

F4
Fig. 4:
Total avoided cancer deaths for the Russian Federation, Ukraine and selected Australasian countries, men and women, between the rate in 1993 and 2022 (light gray area); observed numbers of cancer deaths from 1993 to the latest available year (i.e. 2019 for the Russian Federation, Ukraine and the Republic of Korea,2018 for Australia, Japan and Israel and 2017 for Hong Kong SAR) and predicted cancer deaths from the last available year to 2022 (black line); estimated numbers of total cancer deaths by applying 1993 age-specific mortality rate (dark gray line).

Discussion

Falls in total cancer mortality in the Russian Federation, Ukraine, and the five selected Australasian countries are predicted to continue up to 2022 in both sexes. However, substantial differences in cancer mortality across the considered countries remain, despite some leveling off over the last decades. Declines over time were less pronounced and started later than in Europe (Dalmartello et al., 2022) and the USA (Hashim et al., 2016) except for Hong Kong and Australia. Similar to Europe and the USA, the number of total cancer deaths is still increasing, as a result of population growth and aging.

Colorectal cancer

Colorectal cancer is the second cause of cancer death worldwide and confirmed as such in the EU and USA (GBD 2017 Colorectal Cancer Collaborators, 2019), as well as in most of the considered countries. In Russian, Ukrainian, Japanese, and Korean, men colorectal cancer mortality rates have surpassed those of stomach cancer only recently, and in Israeli, Hong Kong, and Australian women colorectal cancer ranks third after lung and breast cancer. The predicted mortality rates for this cancer in Russia, Ukraine, Hong Kong, and Japan are higher than or comparable with those in the EU (Dalmartello et al., 2022), whereas those in Israel, Korea, and Australia are lower and closer to the USA (Araghi et al., 2019), but not as low as seen in some countries of Latin America (Carioli et al., 2022). Trends for colorectal cancer in the studied countries showed favorable trends, both registered and projected. The main recognized risk factors for colorectal cancer are overweight and obesity, sedentary lifestyles with a lack of physical exercise, alcohol and tobacco consumption, and selected dietary habits (e.g. low in fiber and high in red and processed meat) (Brenner and Chen, 2018). The age pattern in the difference in mortality between the sexes is suggestive that excess mortality in males and in selected geographic regions is due to risk factor exposure. The male-to-female-mortality-rate ratio is unity at young ages, and rates of men and women are close at age 30–49 (Carioli et al., 2020). In this perspective, explanations for the excess mortality in Russia (as well as the unfavorable projected trend in middle age) and Ukraine should be sought in patterns of unhealthy lifestyle behaviors, absent screening policies, and inadequate early diagnosis (Avksentyeva, 2010). In spite of the otherwise generally favorable trends, there is cause for concern in the lack of progress or rising trends seen among the young age groups in high-income countries (i.e. Australia, Korea, and Japan), with possible explanations including unfavorable lifestyle habits in the younger generations (GBD 2017 Colorectal Cancer Collaborators, 2019; Akimoto et al., 2021; Santucci et al., 2021; Patel et al., 2022).

Lung and other tobacco-related cancers

In most high-income countries, smoking prevalence has been decreasing in men for several decades, but only recently in women, with a corresponding effect on smoking related mortality with a lag of about a few decades (Islami et al., 2015). The trends of the tobacco epidemic showed substantial differences across countries, as well as country-specific sex disparities. In particular, Russia and Ukraine had traditionally high male and low female smoking rates; despite recent declines, smoking prevalence remains exceedingly high. Australia was among the countries worldwide where the tobacco epidemic started first (along with the USA and the UK), and smoking prevalence decreased in both sexes in the last decades (Youlden et al., 2008). The rise and subsequent decline of male smoking prevalence started earlier in Japan and Hong Kong than in other Asian countries, whereas female smoking remained traditionally low (Mackay et al., 2013). These differences in smoking prevalence and trends affected the reported tendencies for tobacco-related cancers mortality.

Variations in lung cancer mortality in the considered countries generally mirrored the above-mentioned smoking patterns and trends. Thus, in Australia, differences between men and women were largely explained by smoking trends, which peaked in the 1940s in men and in 1970s in women (Weber et al., 2021). Over recent years, lung cancer mortality has overtaken breast cancer in Australian, Korean and Hong Kong women, as in several other high-income countries (Dalmartello et al., 2022). Exposure to air pollution has also likely played a role in lung cancer incidence and mortality in Russia, Ukraine, and selected Asian countries (Zhang et al., 2021). Despite favorable prediction for the year 2022, more evident in men, lung cancer remains the major cause of cancer death in most of the considered countries.

Gastric cancer death rates have been declining steadily over time, and favorable trends are predicted for 2022. Large differences are evident across the considered countries, with lower rates in Australia and higher rates in Russia, Ukraine, Japan, and Israel, areas associated with high Helicobacter pylori infection prevalence, smoking prevalence in males, and diet high in sodium (Hooi et al., 2017,Etemadi et al., 2020). Beside the key role of H-pylori infection, for which Japan and Korea had exceedingly high prevalences in the past (Zamani et al., 2018), these lifestyle factors, along with improvements in socioeconomic conditions, antibiotic use, hygiene practices, and more affluent diet, have a significant impact on gastric cancer burden, accounting for the general favorable falls in rates but also for the persisting differences across countries (Hooi et al. 2017; Lin et al., 2021). As in the EU and the USA, the male–female death gap exists in all regions, with rates in men generally two-fold higher than those in women (Carioli et al., 2020).

Mortality due to pancreatic cancer is predicted to remain stable or increase in most considered countries. Although the causes of this tumor are still insufficiently understood, some main risk determinants include tobacco smoking, obesity, diabetes, heavy alcohol consumption, and, possibly, selected aspects of diet (Cai et al. 2021; Khalaf et al., 2021). These risk factors partly overlap with those for colorectal cancer, though they are quantitatively different, that is tobacco is more important for pancreas, and nutritional and dietary factors for colorectum. Exposure to lifestyle risk factors could explain higher rates observed in Russian men (Huang et al., 2021). Genetic and environmental factors, as well as high-quality health services and a tradition of valid certification, might explain the comparatively high rates observed for both sexes in Israel and Japan (GBD 2017 Pancreatic Cancer Collaborators, 2019; Hu et al., 2021).

Mortality trends for bladder cancer are predicted to remain favorable in both sexes (Bertuccio et al., 2021). Reductions in exposure to tobacco smoking and occupational carcinogens (particularly among men), and improved control of chronic urinary infections (especially among women), along with improvements in diagnosis and treatment (e.g. endoscopic resection and adjuvant intravesical instillation chemotherapy), are likely responsible for the declining patterns (Cumberbatch et al., 2018). Past and current higher prevalences of tobacco consumption in Russian and Ukrainian men likely remain the major determinant of the sex gap observed in bladder cancer mortality across sexes (i.e. male–female sex ratio over 8) (Richters et al., 2020).

Other cancer sites

Breast cancer has been the leading cause of female cancer-related deaths in the Russian Federation, Ukraine, and Israel, whereas it ranks second after lung in Australia over the last decade. In these high mortality countries, predicted declining trends likely account for advancements in diagnosis and treatment, rather than a decrease in exposure to risk factors (Duggan et al., 2021; Wojtyla et al., 2021). Flattening predicted trends in Israel could reflect a greater prevalence of inherited mutations in Israeli women associated with aggressive and early breast cancer development (Walsh et al., 2017). Comparatively low mortality rates in the Republic of Korea and Japan likely reflect a broader access to effective screening programs and to timely stage-specific treatments (Hamashima et al., 2016).

Mortality rates for uterine cancer are higher in Russia and Ukraine than those in Europe and the USA, mirroring similar patterns in cervical cancer, as in other areas of Eastern Europe (Wojtyla et al., 2020; Gu et al., 2021; He and Li, 2021). Data from the WHO database do not allow a valid distinction between cancers of the uterine cervix and corpus at all ages. Discrepancies across countries derive from striking diversities in health systems, particularly for cervical cancer screening (Arbyn et al., 2020). For example, the downward trend in Korea is largely due to an adequate adherence to cervical screening (Aoki et al., 2020). Other factors explaining the gap between high and low mortality countries may also include the higher exposure to risk determinants for endometrial cancer (overweight, western-type diet, and physical inactivity) (Barchuk et al., 2018).

In Europe and the USA, a major driving factor for ovarian cancer mortality decline has been the widespread long-term protection of oral contraceptives. This effect was mirrored in Australian and Israeli rates for women born after 1930. Higher rates could be explained by its less frequent and later use in other areas, greater exposure to ovarian cancer risk factors (e.g. low parity), or by delays in clinical advances in gynaecological cancer management (La Vecchia, 2017; Kim et al., 2019).

Prostate cancer incidence rates in Asia are among the lowest worldwide, with the exception of Israel (Culp et al., 2020). A similar pattern emerged for mortality rates, which recently stabilized in Hong Kong, Japan, and Korea and markedly decreased in Israel. In this area, differences in epidemiology and genetics of this neoplasm are likely, but data are inconsistent (Zhu et al., 2021). Recent downward trends in Australia, similar to those observed in Europe and the USA, are attributable to improvement in treatments (Dalmartello et al., 2022; Luo et al., 2022). Mortality from prostate cancer in Russia and Ukraine has increased over time, being likely attributable to a higher prevalence of some risk and progression factors, such as obesity, and to less effective treatment pathways (Culp et al., 2020). However, rates remain lower than in Western Europe, and predictions for 2022 in Ukraine are favorable (Dalmartello et al., 2022).

Disparities in rates from leukemias reflected substantial variation in incidence between countries, with higher rates observed in selected Eurasian countries and Australia, and lower in Eastern Asian ones (Miranda-Filho et al., 2018). The overall favorable predicted trends are largely attributable to improvements in disease molecular pathogenesis understanding, along with advancements in detection, and therapeutic strategies (Dong et al., 2020).

Caution is needed in the interpretation of cancer predictions. In order to limit random variability, we used data for 10 major cancer sites from relatively large populations with good death certification coverage. However, countries with critical geopolitical conditions (i.e. Russia and Ukraine) may have undocumented data quality issues. The Russia–Ukraine war will have an impact on cancer deaths, but quantification is not possible now. Moreover, our predictions for 2022 may be influenced by the COVID-19 pandemic. The harvesting effect on the elderly and the fragile populations may have led to a fall of certified cancer deaths. Further, health care systems worldwide have been affected by the emergency and lockdowns. Delays in cancer diagnosis and treatments could have led to a rise in cancer mortality, having, however, a major impact on more severe cancers, that is in future calendar years (Gosain et al., 2020; COVIDSurg Collaborative, 2021). Similar effects apply to cancer screening strategies (Drescher et al., 2022; Joung et al., 2022). Long-term effects depend on the adjustment of the health care system and the strengthening of services devoted to cancer care (Pinato et al., 2021).

In summary, despite persisting geographic variations, this report confirms declining mortality trends with a substantial number of averted deaths and generally favorable predictions for the year 2022.

Acknowledgments

This work was supported by the Italian Association for Cancer Research (AIRC, project N. 22987), Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR), with a SIR (Scientific Independence of Young Researchers) 2014 grant (project RBSI1465UH).

Data availability statement: the data that support the findings of this study are openly available in WHO database at https://www.who.int/data/data-collection-tools/who-mortality-database (World Health Organization Statistical Information System, 2021).

Conflicts of interest

There are no conflicts of interest.

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Keywords:

Australasia; cancer; mortality; projections; Russia; Ukraine

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