Editor's Note: During the 2024 CACA Integrated Esophageal Cancer Academic Conference, Dr. Shaoming Wang from the Cancer Hospital Chinese Academy of Medical Sciences gave an in-depth explanation of research progress on the burden of upper gastrointestinal cancer. During the conference, Oncology Frontier had the pleasure of interviewing Professor Wang to further explore his team’s latest research findings on the global lifetime risk of gastrointestinal cancer.

Oncology Frontier: As the first author, you published a study based on the 2020 GLOBOCAN system analysis, exploring the lifetime risk of developing and dying from gastrointestinal cancers across 185 countries and regions. Can you introduce the background and significance of this study?

Dr. Shaoming Wang: This study was conducted against the backdrop of a rising global cancer burden. Traditionally, research on the cancer burden mainly focused on indicators such as incidence, mortality, survival rates, and cumulative risk. These indicators are crucial for understanding the epidemiology of cancer and evaluating the effectiveness of prevention and control measures. Previous assessments of the lifetime risk of developing or dying from cancer typically used the cumulative risk from ages 0 to 74 as an approximation for lifetime risk. However, with global population aging and increased life expectancy, more than 100 countries out of 185 had life expectancies over 74 years as of 2020. The traditional indicators have begun to show limitations.

Specifically, in areas with higher life expectancy, the cumulative risk from 0 to 74 tends to underestimate lifetime cancer risk, while in regions with lower life expectancy or higher competing mortality risks, it may overestimate it. Therefore, our team introduced a multi-primary cancer correction method, fully accounting for population background mortality probability, life expectancy, competing mortality risks, and adjustments for multiple primary cancers to estimate the lifetime risk of developing and dying from six types of digestive system cancers globally. The findings of this study can help countries develop targeted strategies for cancer prevention and control.

Oncology Frontier: Could you share the main findings of this study?

Dr. Shaoming Wang: The study reveals the grave burden of digestive system cancers worldwide. The global lifetime risk of developing digestive system cancers is approximately 8.20%, meaning that one in 12 people may develop a digestive system cancer during their lifetime. The lifetime risk of dying from these cancers is 6.17%, indicating that one in 16 people could die from a digestive system cancer. This highlights the severe threat posed by digestive system cancers to global public health.

We also found that men generally have a higher lifetime risk of digestive system cancers than women, with incidence and mortality risks increasing alongside the Human Development Index (HDI). Among cancer types, the lifetime risk of developing and dying from colorectal cancer is the highest globally, followed by stomach cancer, liver cancer, esophageal cancer, pancreatic cancer, and gallbladder cancer. There are also significant regional differences in cancer risk. For instance, East Asian populations face the highest lifetime risks of stomach, liver, esophageal, and gallbladder cancers. In Australia, New Zealand, and Southern Europe, the lifetime risk of colorectal cancer is highest, while in Western Europe, the highest lifetime risk is from pancreatic cancer. These data provide a reference for assessing cancer burdens and formulating prevention strategies across different countries.

Oncology Frontier: In the prevention and control of gastrointestinal cancers, which specific populations should be prioritized for screening, and how can comprehensive measures effectively reduce their cancer burden?

Dr. Shaoming Wang: We found that the risk of developing digestive system cancers before the age of 40 is low, but it increases rapidly from age 40 onwards. After age 70, there is still a 4.77% and 3.91% risk of developing and dying from these cancers, respectively. This aligns with the National Health Commission’s recommended starting age for gastrointestinal cancer screenings, indicating that individuals aged 40 and older should prioritize screenings.

Additionally, we found that East Asian populations, particularly in China, have the highest lifetime risks of stomach, liver, esophageal, and gallbladder cancers. This reflects the prevalence of key risk factors in these countries, such as widespread tobacco exposure, excessive alcohol consumption (in Mongolia), Helicobacter pylori infection (in China), hepatitis B (in China and Mongolia), hepatitis C (in Japan and Mongolia), and exposure to aflatoxin-contaminated food (in China, Japan, Korea, and Mongolia). This provides valuable insights into risk factor-based cancer control strategies for each country.

Moreover, the high ratio of lifetime mortality to incidence risk (about 0.75) for digestive system cancers indicates a challenge in early detection, difficulty in treatment, and low survival rates. Strengthening public health education and increasing public acceptance of risk factor control policies and cancer screenings are crucial for improving early diagnosis and treatment rates. In summary, by quantifying and comparing lifetime risks of various digestive system cancers across countries, this study provides valuable data for formulating appropriate prevention strategies, identifying key focus areas, and optimizing resource allocation. The prevention and control of digestive system cancers is a long-term mission that requires collaborative efforts from governments, healthcare institutions, social organizations, and the public across prevention, screening, diagnosis, treatment, and rehabilitation to reduce the burden of these serious malignancies.

Dr. Shaoming Wang

• Associate Researcher, Cancer Registration Office, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences
• Master’s Tutor, Peking Union Medical College
• Standing Committee Member and Secretary-General of the Esophageal Cancer Integrated Prevention Committee, Chinese Anti-Cancer Association
• Standing Committee Member of the Gastric Cancer Integrated Prevention Committee, Chinese Anti-Cancer Association
• Member of the Cancer Epidemiology Committee, Chinese Anti-Cancer Association
• Member of the Artificial Intelligence Oncology Committee, Chinese Anti-Cancer Association
• Member of the Oncology Nutrition Committee, Chinese Anti-Cancer Association
• Member of the Cancer Screening and Prevention Committee, Chinese Health Promotion and Education Association
• Standing Committee Member of the Digestive Oncology Committee, Beijing Association for Chronic Disease Prevention and Health Education
• Editorial Board Member of BMC Public Health

His main research direction is cancer epidemiology. He has presided over more than ten national and provincial-level projects in this field, published over 30 papers as the first or corresponding author in professional journals like Lancet Gastroenterol Hepatol, Science Bulletin, J Natl Cancer Inst, and Am J Gastroenterol, and has participated in compiling eight Chinese and English monographs.