Introduction
Projected estimates on cancer mortality figures and rates are a useful instrument to evaluate disease control because mortality integrates the effects of incidence, stage at diagnosis, and treatment. In this paper, we present projected cancer mortality deaths and rates for the year 2023 in the seven most populous countries from Latin America: Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Venezuela, updating our work on the issue. Moreover, we analyzed and discussed stomach cancer in detail.
Materials and methods
We retrieved official death certification data for the following cancer sites: stomach, colorectum, pancreas, lung, breast, uterus, ovary, prostate, bladder, and leukemia, as well as all cancers combined from the WHO database (WHO, 1992). Corresponding International Classification of Diseases codes according to the 10th Revision are available in Supplementary Table S1, Supplemental digital content 1, https://links.lww.com/EJCP/A384. Resident population estimates were retrieved from the United Nations database (United Nations, 2017).
For each cancer site and country considered, we derived sex- and 5-year age group-specific mortality rates from 1970 up to the most recent available year. We obtained age-standardized mortality rates (ASR) using the world standard population and analyzed ASR trends by fitting joinpoint regression models (Kim et al., 2000).
To obtain projected ASRs for the year 2023, first, we fitted a logarithmic Poisson joinpoint regression model to the observed number of deaths in each 5-year age group for each cancer site. We then estimated the age-specific numbers of deaths for 2023 with the corresponding 95% prediction intervals, by applying a linear regression model to the mortality figures for each age group over the most recent trend segment identified by the joinpoint model. Finally, we calculated age-specific and age-standardized death rates (and related 95% prediction intervals) using the estimated age-specific number of death counts and the predicted populations, retrieved from the United Nations database (United Nations, 2017), for the year 2023.
We estimated the number of avoided deaths for each country for the period 1990–2023 by comparing observed and predicted deaths to those expected based on the 1990 age-specific peak rate. All analyses were performed using the software R version 4.1.1 (R Development Core Team, 2017), SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, USA), and Joinpoint Regression Program version 4.9.1.0 (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute).
Results
Table 1 reports the number of predicted deaths and ASRs per 100 000 men with the corresponding 95% prediction intervals from considered cancer sites in the seven selected Latin American countries for the year 2023, in comparison with observed data for the 2015–19 quinquennium. Table 2 shows the corresponding figures among women. Figure 1 shows ASR bar plots per 100 000 persons from all neoplasms combined for each country considered, according to sex, in the 2015–19 period, and the predicted rates for 2023, with corresponding 95% prediction intervals.
Table 1 -
Number of predicted deaths and mortality rates per 100 000 men for the year 2023 and comparison figures for the quinquennium 2015–19, from the seven selected Latin American countries, with 95% prediction intervals and percent differences between rates
| Cancer |
Observed number of deaths 2015–19 |
Predicted number of deaths 2023 (95% prediction interval) |
Observed ASR 2015–19 |
Predicted ASR 2023 (95% prediction interval) |
% Difference 2023 vs 2015–19 |
| Argentina |
|
|
|
|
|
| Stomach |
1888 |
1910 (1825–2004) |
7.13 |
6.48 (6.19–6.78) |
−9.12 |
| Colorectum |
4247 |
4190 (4005–4372) |
15.65 |
13.97 (13.35–14.58) |
−10.73 |
| Pancreas |
2069 |
2300 (2203–2400) |
7.76 |
7.67 (7.34–8.01) |
−1.16 |
| Lung |
6242 |
5910 (5682–6135) |
23.76 |
19.71 (18.90–20.53) |
−17.05 |
| Prostate |
3763 |
3790 (3644–3942) |
12.33 |
10.93 (10.50–11.37) |
−11.35 |
| Bladder |
1054 |
1060 (989–1128) |
3.67 |
3.28 (3.05–3.50) |
−10.63 |
| Leukemias |
1033 |
1030 (959–1103) |
4.07 |
3.59 (3.31–3.87) |
−11.79 |
| All cancers |
33 525 |
34 410 (33831–34993) |
125.01 |
114.21 (112.37–116.05) |
−8.64 |
| Brazil |
|
|
|
|
|
| Stomach |
9356 |
9870 (9625–10105) |
8.18 |
6.98 (6.80–7.15) |
−14.67 |
| Colorectum |
11 785 |
14 540 (14179–14897) |
10.30 |
10.30 (10.04–10.56) |
0.00 |
| Pancreas |
5275 |
6290 (6082–6503) |
4.64 |
4.50 (4.35–4.65) |
−3.02 |
| Lung |
16 142 |
17 500 (17106–17900) |
14.22 |
12.35 (12.07–12.63) |
−13.15 |
| Prostate |
15 271 |
17 250 (16910–17584) |
13.00 |
11.26 (11.03–11.5) |
−13.38 |
| Bladder |
2911 |
3300 (3139–3455) |
2.50 |
2.21 (2.11–2.32) |
−11.60 |
| Leukemias |
3810 |
4080 (3926–4226) |
3.48 |
3.18 (3.05–3.31) |
−8.62 |
| All cancers |
116 849 |
133 310 (131838–134791) |
102.63 |
94.9 (93.86–95.94) |
−7.53 |
| Chile |
|
|
|
|
|
| Stomach |
2186 |
2310 (2195–2432) |
17.18 |
14.29 (13.54–15.05) |
−16.82 |
| Colorectum |
1382 |
1540 (1450–1620) |
10.86 |
9.63 (9.10–10.16) |
−11.33 |
| Pancreas |
663 |
790 (724–847) |
5.30 |
5.05 (4.62–5.48) |
−4.72 |
| Lung |
1894 |
2090 (1961–2210) |
15.12 |
13.11 (12.29–13.93) |
−13.29 |
| Prostate |
2136 |
2280 (2163–2401) |
15.09 |
12.45 (11.83–13.07) |
−17.50 |
| Bladder |
376 |
390 (354–431) |
2.79 |
2.29 (2.06–2.52) |
−17.92 |
| Leukemias |
409 |
410 (375–454) |
3.57 |
3.13 (2.76–3.5) |
−12.32 |
| All cancers |
14 315 |
15 790 (15416–16167) |
112.24 |
98.29 (95.9–100.68) |
−12.43 |
| Colombia |
|
|
|
|
|
| Stomach |
3194 |
3550 (3423–3671) |
12.18 |
11.01 (10.61–11.41) |
−9.61 |
| Colorectum |
1995 |
2120 (1976–2266) |
7.55 |
6.44 (5.98–6.91) |
−14.70 |
| Pancreas |
891 |
1070 (996–1133) |
3.43 |
3.34 (3.12–3.56) |
−2.62 |
| Lung |
2687 |
2730 (2592–2862) |
10.24 |
8.20 (7.78–8.62) |
−19.92 |
| Prostate |
3106 |
3610 (3457–3758) |
10.92 |
9.82 (9.39–10.25) |
−10.07 |
| Bladder |
371 |
390 (351–429) |
1.35 |
1.11 (1.00–1.22) |
−17.78 |
| Leukemias |
1037 |
1060 (991–1121) |
4.09 |
3.70 (3.45–3.94) |
−9.54 |
| All cancers |
22 426 |
26 590 (26228–26949) |
84.72 |
81.41 (80.3–82.52) |
−3.91 |
| Cuba |
|
|
|
|
|
| Stomach |
528 |
560 (509–602) |
5.08 |
4.85 (4.40–5.31) |
−4.53 |
| Colorectum |
1204 |
1330 (1249–1401) |
10.94 |
10.50 (9.84–11.16) |
−4.02 |
| Pancreas |
451 |
490 (447–539) |
4.40 |
4.35 (3.90–4.79) |
−1.14 |
| Lung |
3525 |
3640 (3466–3815) |
34.02 |
30.47 (28.93–32.02) |
−10.44 |
| Prostate |
3095 |
3420 (3273–3560) |
24.22 |
23.01 (22.07–23.94) |
−5.00 |
| Bladder |
491 |
520 (468–580) |
4.23 |
3.98 (3.54–4.43) |
−5.91 |
| Leukemias |
333 |
330 (296–369) |
3.90 |
3.69 (3.12–4.25) |
−5.38 |
| All cancers |
14 736 |
16 290 (15832–16752) |
139.28 |
133.41 (129.61–137.22) |
−4.21 |
| Mexico |
|
|
|
|
|
| Stomach |
3289 |
3520 (3391–3643) |
5.49 |
4.93 (4.76–5.11) |
−10.20 |
| Colorectum |
3666 |
4130 (3922–4333) |
6.16 |
5.80 (5.50–6.10) |
−5.84 |
| Pancreas |
2077 |
2450 (2345–2551) |
3.55 |
3.48 (3.33–3.63) |
−1.97 |
| Lung |
4187 |
4040 (3855–4230) |
6.99 |
5.58 (5.31–5.84) |
−20.17 |
| Prostate |
6585 |
7680 (7416–7951) |
10.21 |
9.79 (9.47–10.12) |
−4.11 |
| Bladder |
795 |
830 (775–890) |
1.29 |
1.11 (1.03–1.18) |
−13.95 |
| Leukemias |
2439 |
2630 (2526–2733) |
3.98 |
3.85 (3.69–4.01) |
−3.27 |
| All cancers |
43 388 |
50 160 (49516–50806) |
71.71 |
69.80 (68.96–70.64) |
−2.66 |
| Venezuela |
|
|
|
|
|
| Stomach |
1116 |
1100 (1011–1182) |
8.34 |
6.66 (6.13–7.19) |
−20.14 |
| Colorectum |
1020 |
1150 (1075–1224) |
7.65 |
7.08 (6.62–7.54) |
−7.45 |
| Pancreas |
508 |
560 (515–607) |
3.85 |
3.46 (3.18–3.75) |
−10.13 |
| Lung |
2039 |
2010 (1884–2136) |
15.51 |
12.33 (11.57–13.09) |
−20.50 |
| Prostate |
2767 |
3310 (3162–3467) |
21.51 |
20.02 (19.10–20.95) |
−6.93 |
| Bladder |
241 |
280 (243–312) |
1.86 |
1.72 (1.50–1.94) |
−7.53 |
| Leukemias |
558 |
560 (519–609) |
3.96 |
3.68 (3.38–3.99) |
−7.07 |
| All cancers |
14 014 |
16 300 (15864–16740) |
105.52 |
100.88 (98.25–103.50) |
−4.40 |
ASR, age-standardized (world population) mortality rate.
Table 2 -
Number of predicted deaths and mortality rates per 100 000 women for the year 2023 and comparison figures for the quinquennium 2015–19, from the seven selected Latin American countries, with 95% prediction intervals and percent differences between rates
| Cancer |
Observed number of deaths 2015–19 |
Predicted number of deaths 2023 (95% prediction interval) |
Observed ASR 2015–19 |
Predicted ASR 2023 (95% prediction interval) |
% Difference 2023 vs 2015–19 |
| Argentina |
|
|
|
|
|
| Stomach |
1054 |
1100 (1023–1184) |
2.91 |
2.77 (2.56–2.97) |
−4.81 |
| Colorectum |
3671 |
3890 (3734–4047) |
9.51 |
9.24 (8.89–9.6) |
−2.84 |
| Pancreas |
2249 |
2450 (2347–2552) |
5.77 |
5.67 (5.42–5.93) |
−1.73 |
| Lung |
3160 |
3440 (3316–3561) |
9.36 |
9.04 (8.70–9.38) |
−3.42 |
| Breast |
5874 |
6200 (5965–6424) |
17.40 |
16.51 (15.92–17.1) |
−5.11 |
| Uterus |
2889 |
3290 (3162–3424) |
9.73 |
10.24 (9.79–10.69) |
5.24 |
| Ovary |
1220 |
1280 (1197–1355) |
3.81 |
3.61 (3.38–3.84) |
−5.25 |
| Bladder |
336 |
310 (268–356) |
0.78 |
0.68 (0.59–0.77) |
−12.82 |
| Leukemias |
823 |
840 (767–905) |
2.57 |
2.40 (2.19–2.61) |
−6.61 |
| All cancers |
31 068 |
33 070 (32022–34122) |
89.11 |
86.13 (84.00–88.25) |
−3.34 |
| Brazil |
|
|
|
|
|
| Stomach |
5263 |
5740 (5536–5950) |
3.62 |
3.29 (3.17–3.41) |
−9.12 |
| Colorectum |
12 092 |
14 510 (14174–14840) |
8.22 |
8.11 (7.94–8.29) |
−1.34 |
| Pancreas |
5329 |
6370 (6164–6570) |
3.60 |
3.48 (3.37–3.60) |
−3.33 |
| Lung |
11 806 |
13 180 (12644–13715) |
8.36 |
7.59 (7.27–7.91) |
−9.21 |
| Breast |
16 766 |
19 470 (19005–19943) |
12.22 |
12.12 (11.87–12.37) |
−0.82 |
| Uterus |
10 008 |
11 520 (11223–11826) |
7.37 |
7.29 (7.09–7.49) |
−1.09 |
| Ovary |
3913 |
4480 (4330–4634) |
2.87 |
2.74 (2.64–2.84) |
−4.53 |
| Bladder |
1329 |
1490 (1423–1562) |
0.84 |
0.74 (0.70–0.78) |
−11.90 |
| Leukemias |
3244 |
3490 (3359–3615) |
2.50 |
2.30 (2.2–2.40) |
−8.00 |
| All cancers |
105 134 |
124 900 (123544–126247) |
74.60 |
73.48 (72.68–74.27) |
−1.50 |
| Chile |
|
|
|
|
|
| Stomach |
1085 |
1160 (1088–1240) |
6.30 |
5.61 (5.22–6.00) |
−10.95 |
| Colorectum |
1414 |
1670 (1597–1751) |
8.15 |
7.97 (7.6–8.35) |
−2.21 |
| Pancreas |
783 |
910 (850–961) |
4.70 |
4.50 (4.21–4.80) |
−4.26 |
| Lung |
1320 |
1380 (1293–1461) |
8.11 |
6.93 (6.48–7.37) |
−14.55 |
| Breast |
1514 |
1570 (1495–1652) |
10.15 |
8.77 (8.31–9.22) |
−13.60 |
| Uterus |
956 |
930 (864–993) |
6.64 |
5.43 (4.99–5.87) |
−18.22 |
| Ovary |
488 |
520 (478–570) |
3.45 |
3.18 (2.87–3.49) |
−7.83 |
| Bladder |
184 |
200 (177–224) |
0.99 |
0.87 (0.75–0.99) |
−12.12 |
| Leukemias |
368 |
380 (338–411) |
2.69 |
2.34 (2.02–2.65) |
−13.01 |
| All cancers |
13 051 |
14 270 (13935–14607) |
81.44 |
73.25 (71.47–75.03) |
−10.06 |
| Colombia |
|
|
|
|
|
| Stomach |
2040 |
2340 (2233–2441) |
6.22 |
5.87 (5.62–6.13) |
−5.63 |
| Colorectum |
2188 |
2490 (2361–2624) |
6.67 |
6.3 (5.99–6.61) |
−5.55 |
| Pancreas |
1002 |
1180 (1120–1234) |
3.05 |
2.89 (2.75–3.04) |
−5.25 |
| Lung |
1983 |
2110 (2006–2213) |
6.05 |
5.13 (4.88–5.38) |
−15.21 |
| Breast |
3272 |
3780 (3595–3956) |
10.70 |
10.36 (9.84–10.88) |
−3.18 |
| Uterus |
2357 |
2600 (2478–2728) |
7.72 |
7.23 (6.86–7.60) |
−6.35 |
| Ovary |
1079 |
1230 (1158–1295) |
3.56 |
3.39 (3.19–3.59) |
−4.78 |
| Bladder |
173 |
200 (175–225) |
0.49 |
0.44 (0.39–0.50) |
−10.20 |
| Leukemias |
892 |
940 (875–1002) |
3.11 |
2.88 (2.67–3.10) |
−7.40 |
| All cancers |
23 293 |
27 330 (26769–27887) |
73.36 |
71.40 (70.1–72.7) |
−2.67 |
| Cuba |
|
|
|
|
|
| Stomach |
343 |
380 (336–415) |
2.76 |
2.68 (2.35–3.01) |
−2.90 |
| Colorectum |
1589 |
1670 (1584–1754) |
12.05 |
11.11 (10.5–11.71) |
−7.80 |
| Pancreas |
423 |
470 (423–523) |
3.42 |
3.40 (3.05–3.76) |
−0.58 |
| Lung |
2089 |
2340 (2221–2449) |
18.08 |
17.20 (16.19–18.21) |
−4.87 |
| Breast |
1585 |
1610 (1510–1714) |
13.81 |
12.24 (11.23–13.26) |
−11.37 |
| Uterus |
1183 |
1210 (1134–1295) |
10.96 |
9.96 (9.06–10.87) |
−9.12 |
| Ovary |
324 |
360 (322–402) |
3.18 |
3.39 (2.95–3.83) |
6.60 |
| Bladder |
175 |
190 (167–215) |
1.27 |
1.28 (1.12–1.45) |
0.79 |
| Leukemias |
265 |
250 (213–280) |
2.90 |
2.34 (1.80–2.89) |
−19.31 |
| All cancers |
10 892 |
11 930 (11633–12224) |
94.51 |
90.24 (87.56–92.92) |
−4.52 |
| Mexico |
|
|
|
|
|
| Stomach |
2876 |
3140 (3023–3249) |
4.01 |
3.68 (3.54–3.82) |
−8.23 |
| Colorectum |
3218 |
3540 (3383–3698) |
4.51 |
4.09 (3.89–4.28) |
−9.31 |
| Pancreas |
2261 |
2560 (2460–2653) |
3.18 |
2.94 (2.82–3.06) |
−7.55 |
| Lung |
2641 |
2810 (2693–2934) |
3.69 |
3.24 (3.09–3.39) |
−12.20 |
| Breast |
6789 |
8070 (7861–8278) |
9.88 |
9.93 (9.68–10.19) |
0.51 |
| Uterus |
5104 |
5680 (5513–5855) |
7.39 |
7.00 (6.79–7.21) |
−5.28 |
| Ovary |
2584 |
2640 (2445–2824) |
3.81 |
3.25 (3.01–3.50) |
−14.70 |
| Bladder |
339 |
330 (286–378) |
0.44 |
0.34 (0.29–0.40) |
−22.73 |
| Leukemias |
2095 |
2190 (2100–2289) |
3.16 |
2.97 (2.83–3.10) |
−6.01 |
| All cancers |
45 357 |
52 170 (51460–52876) |
64.68 |
62.49 (61.61–63.37) |
−3.39 |
| Venezuela |
|
|
|
|
|
| Stomach |
684 |
790 (721–855) |
4.22 |
3.94 (3.61–4.27) |
−6.64 |
| Colorectum |
1052 |
1240 (1154–1316) |
6.51 |
6.24 (5.83–6.65) |
−4.15 |
| Pancreas |
516 |
570 (526–606) |
3.22 |
2.85 (2.65–3.05) |
−11.49 |
| Lung |
1498 |
1660 (1561–1766) |
9.54 |
8.39 (7.83–8.94) |
−12.05 |
| Breast |
2415 |
2790 (2653–2930) |
15.40 |
15.11 (14.37–15.86) |
−1.88 |
| Uterus |
2101 |
2380 (2266–2491) |
13.33 |
12.99 (12.35–13.62) |
−2.55 |
| Ovary |
566 |
600 (550–640) |
3.63 |
3.21 (2.96–3.46) |
−11.57 |
| Bladder |
124 |
140 (122–166) |
0.74 |
0.69 (0.57–0.80) |
−6.76 |
| Leukemias |
416 |
430 (393–473) |
2.67 |
2.54 (2.28–2.81) |
−4.87 |
| All cancers |
13 610 |
16 490 (16063–16911) |
85.83 |
86.54 (84.34–88.73) |
0.83 |
ASR, age-standardized (world population) mortality rate.
;)
Fig. 1: Bar plots of age-standardized (world population) mortality rates (ASR) per 100 000 persons for the year 2018 and predicted ASR for 2023 with 95% prediction intervals for all cancers combined according to sex in Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Venezuela.
Male mortality from all neoplasms combined is predicted to be favourable in the seven countries investigated, with falls in ASRs between 2015–19 and 2023 ranging from −2.7% in Mexico and −12.4% in Chile (Table 1 and Fig. 1). Cuba showed the highest rates in both periods, with ASR of 139.3/100 000 during 2015–19 and projected 133.4/100 000 for 2023, while Mexico reported the lowest ones, 71.7/100 000 in 2015–19 and 69.8/100 000 predicted in 2023. For 2023, lung cancer is predicted to be the leading cancer cause of mortality in Argentina (19.7/100 000), Brazil (12.4), and Cuba (30.5); stomach cancer topped the list in Chile (14.3) and Colombia (11.0), while prostate cancer showed the highest rate among Mexican (9.8) and Venezuelan (20.0) men (Table 1).
Female total cancer mortality is predicted to decrease in all countries considered, except Venezuela where ASR remained stable (+0.8% between 2015–19 and 2023; Table 2 and Fig. 1). Declines in ASRs for all cancers combined ranged between −1.5% in Brazil and −10.1% in Chile. Mexican women showed the lowest ASRs: 64.7/100 000 observed in 2015–19 and 62.5 projected in 2023 while Cuban women had the highest ones, 94.5/100 000 in 2015–19 and 90.2 estimated in 2023. Mexico reported the lowest ASRs for most of the cancers considered as compared to the other analyzed Latin American countries, for both 2015–19 and 2023. For 2023, the neoplasm with the highest predicted ASRs is breast cancer, with rates ranging from 9.9/100 000 in Mexico to 16.5 in Argentina, followed by uterus (ASRs ranging from 5.4/100 000 in Chile to 13.0 in Venezuela); except for Cuban women for whom lung cancer (17.2/100 000) is predicted to be the leading cancer for 2023, followed by breast (12.2) and colorectal (11.1) cancers. Compared to 2015–19, we predicted increases in mortality rates for ovarian (+6.6%) and bladder (+0.8%) cancers among Cuban women and for cancer of the uterus (+5.2%) in women from Argentina (Table 2).
The number of deaths is predicted to rise in 2023 as compared to 2015–19 in all countries and both sexes; Colombia showed the largest increase in the absolute number of cancer deaths, almost 19% since 2015–19 among men, while Venezuela had the largest percent increase, over 21% among women.
Figure 2 shows trends in total cancer mortality rates in quinquennia, in men and women separately, from 1970–74 to 2015–19, and predicted rates for 2023 with the corresponding prediction intervals. Male rates in Argentina and Chile decreased over the whole period. Trends for Colombian and Mexican men started to decline between 1990 and 2000 while Brazil, Cuba, and Venezuela showed declines in ASRs over the last decade only. In women, rates in Argentina and Chile, starting from the highest ASRs in 1970–74 showed a favorable trend over the whole period. Mexico, Colombia, and Venezuela declined from 1990 to 2000 although Venezuela levelled off around 2010. Mortality rates in Cuban women started the decline around 2010, although showing the lowest rates until 2005 Brazil displayed an unfavourable trend that became stable in recent years.
Fig. 2: Age-standardized (world population) mortality rates (ASRs) in quinquennia from 1970 to 2019 and predicted ASRs for 2023, with 95% prediction intervals for all cancers combined according to sex in Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Venezuela, in men and women.
Figure 3 reports quinquennial ASR mortality trends for each cancer site and country analyzed. Male stomach cancer ASRs have been slowing down since 1970 in all countries considered, although it remains the leading cause of cancer deaths in Chile and Colombia. Trends for colorectal cancer increased until the 1990s, to then have more favourable trends in most recent years. In most countries, ASRs for lung cancer started to decline around 1990; Argentina showed a favourable trend since the 1970s; conversely, Cuba only started showing favorable trends over the last decade, starting from comparatively high rates and giving the highest predicted ASR, around 30/100 000 men. Prostate cancer rates have been rising since the early 2000s, and only declined over the last period, however maintaining relatively high rates, especially in Cuba and Venezuela, whose predicted ASRs are 23 and 20/100 000 respectively. Bladder cancer and leukaemias showed modest declines in most countries, reaching predicted ASRs for 2023 below 4/100 000. Among women, ASRs for stomach and uterus cancer were declining over the whole period. Mortality trends for uterine cancer declined substantially in all Latin American countries, although it remains among the top cancers with the highest rates observed in 2015–19 and predicted for 2023. Colorectal cancer trends were favorable over the most recent calendar years, up to 2023. Female lung cancer showed increases over time in all selected countries; trends started to level off or decline over most recent periods, with favorable predicted ASRs for 2023. From 1970, breast cancer ASRs decreased in Argentina, Cuba, and Chile, while Brazil, Colombia, Mexico, and Venezuela showed a less favorable tendency, that levelled off in recent years. Rates remain exceedingly high (predicted ASR: 17.2/100 000) in Cuba. Ovarian cancer, bladder cancer, and leukaemias showed some declines, with values of predicted rates lower than 3.5/100 000 women.
Fig. 3: Age-standardized (world population) mortality rates (ASRs) in quinquennia from 1970 to 2019 and predicted ASRs for 2023, with 95% prediction intervals for the considered cancer sites in the seven selected Latin American countries, according to sex.
Table 3 reports ASRs from stomach cancer in both sexes at all ages and in three age groups (25–49, 50–64, and 65+ years) in the 2010–14, and 2015–19 quinquennia and predicted ASRs for 2023. Falls were observed and predicted in the middle-aged and elderly in both sexes in most countries. In the 25–49 years age group, declines were observed in men, but less consistently in women, whose rates are lower, thus suggesting a plateau may have been reached.
Table 3 -
Age-standardized stomach cancer mortality rates in selected Latin American countries in men and women at all ages and at different age groups during 2010–14 and 2015–19 periods and predicted age-standardized mortality rates for 2023 and the corresponding prediction intervals, along with percentage differences between 2015–19 and 2023
|
Men |
Women |
|
ASR 2010–14 |
ASR 2015–19 |
Predicted ASR 2023 (95% prediction interval) |
% Difference 2023 vs
2015–19 |
ASR 2010–14 |
ASR 2015–19 |
Predicted ASR 2023 (95% prediction interval) |
%
Difference 2023 vs
2015–19 |
| Argentina |
|
|
|
|
|
|
|
|
| All ages |
7.54 |
7.13 |
6.48 (6.19–6.78) |
−9.12 |
3.16 |
2.91 |
2.77 (2.56–2.97) |
−4.81 |
| 25–49 years |
2.31 |
2.18 |
1.63 (1.29–1.97) |
−25.23 |
1.60 |
1.32 |
1.06 (0.81–1.31) |
−19.70 |
| 50–64 years |
19.01 |
17.97 |
16.82 (15.53–18.11) |
−6.40 |
7.92 |
7.34 |
7.57 (6.69–8.46) |
3.13 |
| 65+ years |
61.52 |
58.22 |
53.58 (50.52–56.65) |
−7.97 |
22.79 |
21.70 |
20.39 (18.28–22.49) |
−6.04 |
| Brazil |
|
|
|
|
|
|
|
|
| All ages |
9.27 |
8.18 |
6.98 (6.81–7.15) |
−14.67 |
4.01 |
3.62 |
3.29 (3.17–3.41) |
−9.12 |
| 25–49 years |
2.60 |
2.35 |
2.05 (1.89–2.22) |
−12.77 |
1.90 |
1.86 |
1.79 (1.67–1.91) |
−3.76 |
| 50–64 years |
22.06 |
19.77 |
18.37 (17.69–19.05) |
−7.08 |
8.84 |
8.29 |
8.27 (7.75–8.79) |
−0.24 |
| 65+ years |
79.29 |
69.14 |
55.85 (53.9–57.8) |
−19.22 |
31.91 |
27.63 |
23.15 (21.86–24.43) |
−16.21 |
| Chile |
|
|
|
|
|
|
|
|
| All ages |
20.37 |
17.18 |
14.31 (13.55–15.06) |
−16.71 |
7.49 |
6.30 |
5.61 (5.22–6) |
−10.95 |
| 25–49 years |
4.01 |
3.36 |
2.98 (2.12–3.84) |
−11.31 |
2.47 |
2.31 |
2.38 (1.88–2.88) |
3.03 |
| 50–64 years |
41.12 |
36.77 |
32.16 (29.1–35.22) |
−12.54 |
14.36 |
12.11 |
11.03 (9.41–12.65) |
−8.92 |
| 65+ years |
195.87 |
161.65 |
130.86 (122.59–139.13) |
−19.05 |
68.77 |
56.78 |
48.59 (44.56–52.63) |
−14.42 |
| Colombia |
|
|
|
|
|
|
|
|
| All ages |
13.30 |
12.18 |
11.01 (10.61–11.41) |
−9.61 |
6.62 |
6.22 |
5.87 (5.62–6.13) |
−5.63 |
| 25–49 years |
4.67 |
4.71 |
4.41 (3.88–4.93) |
−6.37 |
3.51 |
3.52 |
3.49 (3.13–3.85) |
−0.85 |
| 50–64 years |
30.74 |
28.35 |
26.74 (24.88–28.6) |
−5.68 |
13.35 |
13.47 |
14.32 (13.21–15.43) |
6.31 |
| 65+ years |
111.02 |
99.35 |
86.9 (83.06–90.74) |
−12.53 |
53.20 |
47.31 |
41 (38.54–43.46) |
−13.34 |
| Cuba |
|
|
|
|
|
|
|
|
| All ages |
5.57 |
5.08 |
4.84 (4.39–5.29) |
−4.72 |
3.06 |
2.76 |
2.68 (2.35–3.01) |
−2.90 |
| 25–49 years |
1.21 |
1.28 |
1.61 (0.93–2.29) |
25.78 |
0.83 |
0.98 |
1.12 (0.51–1.72) |
14.29 |
| 50–64 years |
14.53 |
12.81 |
11 (9.22–12.77) |
−14.13 |
7.17 |
6.26 |
5.19 (3.96–6.41) |
−17.09 |
| 65+ years |
46.73 |
42.83 |
41.34 (36.77–45.91) |
−3.48 |
26.49 |
23.14 |
23.6 (20.6–26.6) |
1.99 |
| Mexico |
|
|
|
|
|
|
|
|
| All ages |
5.66 |
5.49 |
4.93 (4.76–5.11) |
−10.20 |
4.17 |
4.01 |
3.68 (3.54–3.82) |
−8.23 |
| 25–49 years |
2.27 |
2.42 |
2.3 (2.11–2.49) |
−4.96 |
2.11 |
2.11 |
2.07 (1.88–2.27) |
−1.90 |
| 50–64 years |
12.63 |
12.51 |
12.33 (11.61–13.06) |
−1.44 |
9.92 |
9.68 |
9.18 (8.5–9.86) |
−5.17 |
| 65+ years |
46.52 |
43.63 |
36.56 (34.65–38.47) |
−16.20 |
31.19 |
29.28 |
25.68 (24.45–26.91) |
−12.30 |
| Venezuela |
|
|
|
|
|
|
|
|
| All ages |
9.40 |
8.34 |
6.66 (6.13–7.19) |
−20.14 |
5.16 |
4.22 |
3.94 (3.61–4.27) |
−6.64 |
| 25–49 years |
3.30 |
3.20 |
3.6 (3.08–4.12) |
12.50 |
2.25 |
2.18 |
2.23 (1.85–2.62) |
2.29 |
| 50–64 years |
21.76 |
18.66 |
15.69 (13.52–17.86) |
−15.92 |
11.64 |
9.45 |
9.04 (7.54–10.54) |
−4.34 |
| 65+ years |
78.35 |
69.27 |
48.93 (43.01–54.85) |
−29.36 |
41.21 |
32.48 |
28.76 (25.41–32.12) |
−11.45 |
ASR, age-standardized (world population) mortality rate.
Figure 4 shows the estimated number of avoided cancer deaths in men and women between 1991 and 2023, assuming constant age-specific rates in 1990 (light grey area). Over the 33-year period considered, we estimated a total of over 379 100 total avoided cancer deaths in Argentina (228 400 in men and 150 700 in women), 220 400 deaths in Chile (90 400 in men and 130 100 in women), 225 500 avoided deaths in Colombia (115 200 in men and 140 300 in women), 21 100 avoided deaths in Cuba (10 500 in men and 10 700 in women), 400 000 avoided deaths in Mexico (159 900 in men and 240 100 in women), and 75 600 deaths in Venezuela (23 000 in men and 52 700 in women). No appreciable reductions in cancer deaths were observed in Brazil.
Fig. 4: Total avoided cancer deaths for five of the seven Latin American countries considered, in both sexes between the top rate in 1990 and 2023 (light grey area); observed and predicted numbers of cancer deaths from 1991 to 2023 (black line); estimated numbers of total cancer deaths by applying 1990 age-specific peak mortality rates (grey line). During the 33-year period, a total of about 1 351 800 cancer deaths have been avoided in six of the seven countries considered (627 300 in men and 724 500 in women). No reduction in cancer deaths was registered in Brazil. In 2023 alone, about 48 100 deaths are predicted to be avoided in men and about 48 300 in women.
Discussion
Trends in cancer mortality in Latin American countries from all cancers and from most of the cancer sites analyzed in the present paper are predicted to be favorable, consistently with high-income areas worldwide (Sung et al., 2021; Malvezzi et al., 2023; Siegel et al., 2023). Some exceptions were observed among women: ASRs for all cancers remained stable in Venezuela while we predicted increases in mortality rates for a few cancers among Cuban women. In spite of the generally favorable pattern, the number of cancer deaths was still increasing, due to population growth and ageing.
Stomach cancer remains a major cancer worldwide and is responsible for over 1 million new cases in 2020 and an estimated 769 000 deaths, ranking fifth for incidence and fourth for mortality globally (Sung et al., 2021). Compared to other areas worldwide, South American men ranked third for stomach cancer incidence (with rates around 12/100 000 men and 6/100 000 women), following Asian (32.5/100 000 men and 13.2/100 000 women) and East-European men (17/100 000 men and 7.1/100 000 women) (Sung et al., 2021; Pineros et al., 2022). In a recent analysis of gastric mortality trends conducted on 36 countries worldwide since the 1990s, Brazil and Chile ranked among the countries with trends of the highest rates during the considered period. Stomach cancer remains the first leading cause of cancer death among men in Chile and Colombia (Collatuzzo et al., 2023). Analyses for different age groups showed a less pronounced decrease in mortality trends in the young, particularly women, for most countries considered reflecting a levelling of low rates and possible unfavourable trends among young adults (Camargo et al., 2011; Anderson et al., 2018; Arnold et al., 2020; Heer et al., 2020; Santucci et al., 2021; Torres-Roman et al., 2022). Genetic factors also have a possible relevant impact on the young (Corso et al., 2020). Among Argentinian men, the percentage of cardia incidence was low and limited to 5% and in Chile, it was 12%, while corresponding figures for women were 3.5% and 8%, respectively. Chronic Helicobacter pylori infection is the key determinant of stomach cancer, in particular for noncardia cancers, which represent the higher proportion of cases in these areas (Plummer et al., 2015). The prevalence of H. pylori infection has been estimated at around 50% in Argentina and Mexico, and over 70% in Brazil and Chile (Hooi et al., 2017). Established risk factors beyond H. pylori include nonmodifiable exposures, such as male sex, family history of gastric cancer, carrying some genetic variants, or even living in high-altitude countries, which is probably a surrogate for host genetic, bacterial, dietary, and environmental factors that may cluster in the mountainous regions (Torres et al., 2013; Boldo et al., 2022), but also lifestyle factors such as tobacco smoking, alcohol use, high consumption of red and processed beef (Nikitina et al., 2023) meat, and high-sodium diet (Bonequi et al., 2013; Praud et al., 2018; Arnold et al., 2020; Deng et al., 2021; Boldo et al., 2022). In addition, populations in mountainous areas tend to be of lower socioeconomic status, which is a recognized determinant risk for gastric cancer (Rota et al., 2020).
Conversely, higher levels of education and fruit and total vegetable consumption are associated with a moderately decreased risk. The decline in mortality from gastric cancer observed and predicted in both sexes and all Latin American countries considered is attributable to favorable changes of these modifiable and nonmodifiable factors for this neoplasm, including a decreased prevalence of H. pylori and improvements in the preservation and storage of foods.
Colorectal cancer mortality ranked third in the countries analyzed. Argentina showed the highest rates compared to the other Latin American countries as well as to other areas worldwide (Malvezzi et al., 2023; Siegel et al., 2023). This is consistent with its economic development and the extent of westernization. Moreover, Argentina is among the countries with the highest incidence and mortality rates for colorectal cancer in South America (following those from Uruguay), with two-fold excess rates as compared to Mexico. Among the major aetiological factors for this neoplasm, there are overweight, obesity, a sedentary lifestyle, tobacco smoking, and high consumption of red meat; conversely physical activity and a diet rich in fibres can play a positive role (Buamden, 2018; Siegel et al., 2019). Relatively low tobacco smoking in these countries may have played some role, too. The geographic variations in rates observed within these countries are probably due to differences in the prevalence of obesity, physical inactivity, and diet, as well as improvements in early diagnosis and treatments and healthcare infrastructure (Siegel et al., 2019; Stern et al., 2019).
Despite the favorable pattern observed and predicted for lung cancer mortality, it remains the leading cause of cancer mortality in Latin Americas, highlighting the need to intensify tobacco control programs (Prado-Galbarro et al., 2020) and improve access to diagnosis and treatment (Raez et al., 2018a). Mortality rates for lung cancer in Latin America are lower compared to those from other areas worldwide, particularly in Mexico (Hashim et al., 2016; Malvezzi et al., 2023; Siegel et al., 2023), due to the historically low levels of smoking in these countries (Raez et al., 2018b; Thomson et al., 2021), except for Cuba, particularly among women, characterized by high prevalence of smoking, resulting in the highest lung cancer rates (Pinheiro et al., 2017).
Compared to the European Union (EU) and North America (Malvezzi et al., 2023; Siegel et al., 2023), pancreatic cancer rates in Latin America remained relatively low. Diabetes and obesity are recognized etiologic factors for this cancer; the low smoking prevalence in this area contributed to this pattern (Wong et al., 2017); however, this cancer is difficult to diagnose, and these results should be interpreted with caution because underestimation and overestimation are possible in some countries.
The lower mortality rates from bladder cancer, compared to other geographical areas, can be explained by the more favourable smoking patterns in Latin America, too. Differences in rates between the two sexes may also reflect different occupational exposures. The presence of arsenic in drinking water found in selected areas of Chile and Argentina is also associated with this neoplasm (Khan et al., 2020).
Breast cancer mortality rates in Latin America were favourable and similar to or lower than in the EU and the USA (Malvezzi et al., 2023; Siegel et al., 2023), except for Argentina, a pattern that could be associated with factors like European ancestry. Besides improvements in disease diagnosis and treatment, the lower rates may be due to reproductive patterns in these countries (Romieu et al., 2018).
Mortality from ovarian cancer showed favourable rates in all countries, except for Cuba where the projected rate is expected to rise to reach the levels of the other Latin American countries considered. The use of oral contraceptives, which contrasts the effect of a high prevalence of obesity presumably has influenced the favorable trends (Stern et al., 2019).
The favorable patterns for uterus (both corpus and cervix) cancer mortality are principally due to falls in cervical cancer which are mostly attributable to screening, early diagnosis, and human papillomavirus vaccination, which has been implemented in over 80% of the Americas, and Latin American countries have high coverage, with an estimated 70% of the target population receiving the full recommended schedule doses during 2019 (Bruni et al., 2021). This will lead to a persisting favorable trend in the younger generation. Only Argentina showed unfavourable trends, possibly due to low screening coverage – below 50% during 2018 (Nuche-Berenguer and Sakellariou, 2021) – and possibly some increase in endometrial corpus not otherwise specified cancer mortality as seen in the US (Cronin et al., 2022).
Prostate cancer rates were higher than those from the EU and USA (Malvezzi et al., 2023; Siegel et al., 2023). The particularly high rates observed in Cuba are probably related to the considerable presence of Cubans of West African ancestry, characterized by a higher incidence and mortality for this neoplasm (Taitt, 2018; Dess et al., 2019); however, the favourable declines in prostate cancer mortality observed indicate the efficacy of improved therapies together with some possible impacts of earlier diagnosis (Culp et al., 2020; Reis et al., 2020).
Improved management also played a role in the declining patterns of leukaemias in Latin America; however, rates remained higher than in most high-income countries of the world due to delays in the adoption of innovative treatments and disparities in access to healthcare (Chiattone et al., 2020).
Predicted estimates should be interpreted with caution, considering the limitation of the model, which is not suited to detect very recent changes in trends or major long-term cohort effects; however, the analysis is limited to large countries, thus reducing issues of excessive random variation. Because observed cancer deaths for 2019 are available now in the WHO database, we compared observed cancer rates for 2019 with our previous predictions for that year (Carioli et al., 2020) and we found that for all cancers combined errors in our predictions were lower than 5%, except for Colombia and Mexico.
Improvements in cancer management and prevention are needed, particularly in Brazil where trends may be largely influenced by improved death certification, where we did not register a reduction in cancer deaths, and in Cuba and Venezuela, for which no substantial number of cancer deaths were avoided since 1991.
The estimates provided herein do not reflect the impact of severe acute respiratory syndrome coronavirus 2 because they are based on extrapolations of cancer data collected in years before the pandemic. Although the full extent of the impact of the coronavirus disease (COVID) 2019 pandemic in different world regions is currently unknown, delays in diagnosis and treatment are expected to cause a short-term decline in cancer incidence followed by increases in advanced-stage diagnoses and cancer mortality in some settings (Dinmohamed et al., 2020; Kutikov et al., 2020; Maringe et al., 2020; Sharpless, 2020). The impact of COVID on cancer mortality is however smaller than on cardiovascular and other major causes of death (Ruhm, 2022).
Acknowledgements
This work was supported by the Italian Association for Cancer Research (AIRC, project N. 22987).
Conflicts of interest
There are no conflicts of interest.
References
Anderson WF, Rabkin CS, Turner N, Fraumeni JF Jr, Rosenberg PS, Camargo MC (2018). The changing face of noncardia gastric cancer incidence among US non-Hispanic Whites. J Natl Cancer Inst 110:608–615.
Arnold M, Park JY, Camargo MC, Lunet N, Forman D, Soerjomataram I (2020). Is gastric cancer becoming a rare disease? A global assessment of predicted incidence trends to 2035. Gut 69:823–829.
Boldo E, Fernandez de Larrea N, Pollan M, Martin V, Obon-Santacana M, Guevara M, et al. (2022). Meat intake, cooking methods, doneness preferences and risk of gastric adenocarcinoma in the MCC-Spain Study. Nutrients 14:4852.
Bonequi P, Meneses-Gonzalez F, Correa P, Rabkin CS, Camargo MC (2013). Risk factors for gastric cancer in Latin America: a meta-analysis. Cancer Causes Control 24:217–231.
Bruni L, Saura-Lazaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, et al. (2021). HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019. Prev Med 144:106399.
Buamden S (2018). Association between food availability and mortality due to colorectal cancer in the Americas. Salud Colect 14:579–595.
Camargo MC, Anderson WF, King JB, Correa P, Thomas CC, Rosenberg PS, et al. (2011). Divergent trends for gastric cancer incidence by anatomical subsite in US adults. Gut 60:1644–1649.
Carioli G, Bertuccio P, Malvezzi M, Rodriguez T, Levi F, Boffetta P, et al. (2020). Cancer mortality predictions for 2019 in Latin America. Int J Cancer 147:619–632.
Chiattone C, Gomez-Almaguer D, Pavlovsky C, Tuna-Aguilar EJ, Basquiera AL, Palmer L, et al. (2020). Real-world analysis of treatment patterns and clinical outcomes in patients with newly diagnosed chronic lymphocytic leukemia from seven Latin American countries. Hematology 25:366–371.
Collatuzzo G, Santucci C, Malvezzi M, La Vecchia C, Boffetta P, Negri E (2023). Trends in gastric cancer mortality 1990-2019 in 36 countries worldwide, with predictions to 2025, and incidence, overall and by subtype. Cancer Med doi: 10.1002/cam4.5685. Online ahead of print.
Corso G, Montagna G, Figueiredo J, La Vecchia C, Fumagalli Romario U, Fernandes MS, et al. (2020). Hereditary gastric and breast cancer syndromes related to CDH1 germline mutation: a multidisciplinary clinical review. Cancers 12:1598.
Cronin KA, Scott S, Firth AU, Sung H, Henley SJ, Sherman RL, et al. (2022). Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer 128:4251–4284.
Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A (2020). Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol 77:38–52.
Deng W, Jin L, Zhuo H, Vasiliou V, Zhang Y (2021). Alcohol consumption and risk of stomach cancer: a meta-analysis. Chem Biol Interact 336:109365.
Dess RT, Hartman HE, Mahal BA, Soni PD, Jackson WC, Cooperberg MR, et al. (2019). Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol 5:975–983.
Dinmohamed AG, Visser O, Verhoeven RHA, Louwman MWJ, van Nederveen FH, Willems SM, et al. (2020). Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncol 21:750–751.
Hashim D, Boffetta P, La Vecchia C, Rota M, Bertuccio P, Malvezzi M, et al. (2016). The global decrease in cancer mortality: trends and disparities. Ann Oncol 27:926–933.
Heer EV, Harper AS, Sung H, Jemal A, Fidler-Benaoudia MM (2020). Emerging cancer incidence trends in Canada: the growing burden of young adult cancers. Cancer 126:4553–4562.
Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. (2017). Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 153:420–429.
Khan KM, Chakraborty R, Bundschuh J, Bhattacharya P, Parvez F (2020). Health effects of arsenic exposure in Latin America: an overview of the past eight years of research. Sci Total Environ 710:136071.
Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000). Permutation tests for joinpoint regression with applications to cancer rates. (Erratum in: Stat Med 2001;20: 655). Stat Med 19:335–351.
Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI (2020). A war on two fronts: cancer care in the time of COVID-19. Ann Intern Med 172:756–758.
Malvezzi M, Santucci C, Boffetta P, Collatuzzo G, Levi F, La Vecchia C, et al. (2023). European cancer mortality predictions for the year 2023 with focus on lung cancer. Ann Oncol S0923-7534(23)00048-0.
Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. (2020). The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol 21:1023–1034.
Nikitina E, Burk-Korner A, Wiesenfarth M, Alwers E, Heide D, Tessmer C, et al. (2023). Bovine meat and milk factor protein expression in tumor-free mucosa of colorectal cancer patients coincides with macrophages and might interfere with patient survival. Mol Oncol doi:10.1002/1878-0261.13390. Online ahead of print.
Nuche-Berenguer B, Sakellariou D (2021). Socioeconomic determinants of participation in cancer screening in Argentina: a cross-sectional study. Front Public Health 9:699108.
Pineros M, Laversanne M, Barrios E, Cancela MC, de Vries E, Pardo C, et al. (2022). An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. Lancet Reg Health Am 13:None.
Pinheiro PS, Callahan KE, Siegel RL, Jin H, Morris CR, Trapido EJ, et al. (2017). Cancer mortality in Hispanic ethnic groups. Cancer Epidemiol Biomarkers Prev 26:376–382.
Plummer M, Franceschi S, Vignat J, Forman D, de Martel C (2015). Global burden of gastric cancer attributable to Helicobacter pylori. Int J Cancer 136:487–490.
Prado-Galbarro FJ, Auchincloss AH, Perez-Ferrer C, Sanchez-Franco S, Barrientos-Gutierrez T (2020). Adolescent tobacco exposure in 31 Latin American cities before and after the framework convention for tobacco control. Int J Environ Res Public Health 17:7423.
Praud D, Rota M, Pelucchi C, Bertuccio P, Rosso T, Galeone C, et al. (2018). Cigarette smoking and gastric cancer in the Stomach Cancer Pooling (StoP) Project. Eur J Cancer Prev 27:124–133.
Raez LE, Nogueira A, Santos ES, Dos Santos RS, Franceschini J, Ron DA, et al2018a). Challenges in lung cancer screening in Latin America. J Glob Oncol 4:1–10.
Raez LE, Cardona AF, Santos ES, Catoe H, Rolfo C, Lopes G, et al2018b). The burden of lung cancer in Latin-America and challenges in the access to genomic profiling, immunotherapy and targeted treatments. Lung Cancer 119:7–13.
Reis RBD, Alias-Melgar A, Martinez-Cornelio A, Neciosup SP, Sade JP, Santos M, et al. (2020). Prostate cancer in Latin America: challenges and recommendations. Cancer Control 27:1073274820915720.
Romieu I, Biessy C, Carayol M, His M, Torres-Mejia G, Angeles-Llerenas A, et al. (2018). Reproductive factors and molecular subtypes of breast cancer among premenopausal women in Latin America: the PRECAMA study. Sci Rep 8:13109.
Rota M, Alicandro G, Pelucchi C, Bonzi R, Bertuccio P, Hu J, et al. (2020). Education and gastric cancer risk – an individual participant data meta-analysis in the StoP project consortium. Int J Cancer 146:671–681.
Ruhm CJ (2022). Excess deaths in the United States during the first year of COVID-19. Prev Med 162:107174.
Santucci C, Boffetta P, Levi F, La Vecchia C, Negri E, Malvezzi M (2021). Colorectal cancer mortality in young adults is rising in the United States, Canada, United Kingdom, and Australia but not in Europe and Asia. Gastroenterology 160:1860–1862.e2.
Sharpless NE (2020). COVID-19 and cancer. Science 368:1290.
Siegel RL, Torre LA, Soerjomataram I, Hayes RB, Bray F, Weber TK, et al. (2019). Global patterns and trends in colorectal cancer incidence in young adults. Gut 68:2179–2185.
Siegel RL, Miller KD, Wagle NS, Jemal A (2023). Cancer statistics, 2023. CA Cancer J Clin 73:17–48.
Stern MC, Barnoya J, Elder JP, Gallegos-Carrillo K (2019). Diet, physical activity, obesity and related cancer risk: strategies to reduce cancer burden in the Americas. Salud Publica Mex 61:448–455.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249.
Taitt HE (2018). Global trends and prostate cancer: a review of incidence, detection, and mortality as influenced by race, ethnicity, and geographic location. Am J Men’s Health 12:1807–1823.
Thomson B, Tapia-Conyer R, Lacey B, Lewington S, Ramirez-Reyes R, Aguilar-Ramirez D, et al. (2021). Low-intensity daily smoking and cause-specific mortality in Mexico: prospective study of 150 000 adults. Int J Epidemiol 50:955–964.
Torres J, Correa P, Ferreccio C, Hernandez-Suarez G, Herrero R, Cavazza-Porro M, et al. (2013). Gastric cancer incidence and mortality is associated with altitude in the mountainous regions of Pacific Latin America. Cancer Causes Control 24:249–256.
Torres-Roman JS, Alvarez CS, Guerra-Canchari P, Valcarcel B, Martinez-Herrera JF, Davila-Hernandez CA, et al. (2022). Sex and age differences in mortality trends of gastric cancer among Hispanic/Latino populations in the United States, Latin America, and the Caribbean. Lancet Reg Health Am 16:100376.
United Nations Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, Key Findings and Advance Tables.
Wong MCS, Jiang JY, Liang M, Fang Y, Yeung MS, Sung JJY (2017). Global temporal patterns of pancreatic cancer and association with socioeconomic development. Sci Rep 7:3165.
World Health Organization (1992). International classification of disease and related health problems: 10th revision. World Health Organization.
