the burden of early-onset colorectal cancer, the United States Preventive Services Taskforce (USPSTF) and many professional societies have modified their screening guidelines to recommend starting colorectal cancer screening at an earlier age (see Guidelines for Cancer Screening, p. 58). Researchers are also evaluating new and improved strategies including genetic testing and other approaches for prevention and early detection of colorectal cancer in the younger population (37). Another cancer for which U.S. incidence rate has been rising is cervical cancer (39,40). According to a recent analysis, the rate of advanced cervical cancer (that has spread to the bladder or rectum at diagnosis) increased by 1.3 percent per year from 2001 to 2018 (39). A second report showed that, among U.S. women ages 30 to 34 years, overall cervical cancer incidence increased by 2.5 percent per year between 2012 and 2019 (40). Considering that nearly all cervical cancers are caused by infection with human papillomavirus (HPV) and that HPV vaccination (see Prevent and Eliminate Infection from Cancercausing Pathogens, p. 48) and cervical cancer screening are extremely effective in reducing the burden of the disease, these data emphasize the importance of public health measures to boost cervical cancer prevention and early detection in the United States (see Screening for Early Detection, p. 54). The Global Burden of Cancer Beyond the United States, cancer is an ongoing global challenge (see Sidebar 4, p. 22). According to a recent analysis, there were an estimated 17.2 million new cancer cases (excluding nonmelanoma skin cancer) and 10 million cancer deaths globally, in 2019 (41). The study evaluated cancer burden in terms of cancer-related deaths, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs), which are two measures of cancer morbidity. Researchers found that among the 22 groups of diseases and injuries analyzed, cancer was second only to cardiovascular disease in the number of deaths, DALYs, and YLLs (41). The five leading causes of cancer-related morbidity among men and women combined were cancers of the lung, colon and rectum, stomach, breast, and liver. There is a stark disparity in the cancer burden among countries with different levels of socioeconomic development. Researchers use various metrics such as human development index (HDI) or sociodemographic index (SDI), which are composite measures of social and economic development, to identify where countries or geographic areas fall on the spectrum of development. SDI quantification considers income per capita, average years of education, and total fertility rate for citizens younger than 25 (42); HDI measurement considers income per capita, average years of education, and life expectancy at birth (43). While age-adjusted cancer incidence and mortality rates are declining in countries with high SDI, both rates are still trending upward in lower SDI countries (41). Based on a recent estimate, between 2010 and 2019, countries with the lowest SDI experienced the largest percent increase in the numbers of cancer cases and deaths (41). Considering the growth and aging of the global population and the negative impact of recent global crises such as the COVID-19 pandemic on cancer research and patient care (45), researchers caution that the burden of cancer worldwide may rise significantly in the coming decades. One area in which progress is urgently needed is the establishment of population-based cancer registries in all countries because the collection of high-quality cancer surveillance data is essential for developing effective national cancer control plans. Notably, only one in five low- and middle-income countries has the necessary data to drive policy and reduce the burden and suffering due to cancer, according to the International Agency for Research on Cancer (46). Another emerging concern among public health experts is the dramatic rise since the 1990s in the incidence of early-onset cancers, including cancers of the breast, colon, esophagus, kidney, liver, and pancreas, among others, around the world (47). While improvements in early detection may be attributable, in part, to this rising cancer incidence, researchers hypothesize that early life exposures to certain cancer risk factors (see Reducing the Risk of Cancer Development, p. 38), including diets rich in highly processed foods, alcohol, sedentary lifestyle, obesity, environmental carcinogens, and an unfavorable microbiome, many of which have become more prevalent in recent decades, are playing a role in the increased incidence of early-onset cancers (47). Notably, 44 percent of cancer deaths worldwide are caused by modifiable risk factors, such as smoking and drinking alcohol (48). To ensure equitable progress against cancer worldwide, it is imperative that the global medical research community work together and shares best practices to implement newer and more Pancreatic cancer incidence rates are rising in the United States and increasing faster among younger, particularly Black, women than among men of the same age (38). In high-income countries, most patients with cancer see a physician within a month of experiencing symptoms; in lowincome countries, this interval is 1.5 to 4 times longer for most cancer types (44). Cancer in 2023 AACR Cancer Progress Report 2023 21
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