Global burden of cancer in children and adolescents aged 0-19 years, 1990-2023:

# Global burden of cancer in children and adolescents aged 0–19 years, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 *The Lancet 2026* Articles Global burden of cancer in children and adolescents aged 0–19 years, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 GBD 2023 Childhood Cancer Collaborators* Summary Lancet 2026; 407: 1360–73 Background Information on childhood cancer burden is crucial for eective cancer policy planning. Unfortunately, See Comment page 1306 observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform eorts to address childhood cancer *Collaborators listed at the end of the Article burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, Correspondence to: which now include nine additional cancer causes compared with previous GBD analyses. Dr Lisa M Force, Institute for Health Metrics and Evaluation, Methods GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration University of Washington, systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0–19 years), mortality was Seattle, WA 98195, USA lforce@uw.edu estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled or mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths Dr Nickhill Bhakta, St Jude by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from Children’s Research Hospital, MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability- Memphis, TN 38105, USA adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by nickhill.bhakta@stjude.org geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Findings Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000–489 000), 144 000 deaths (131 000–162 000), and 11·7 million (10·7–13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5–36·1) globally, from 197 000 (173 000–218 000) in 1990, but increased in the WHO African region by 55·6% (25·5–92·4), from 31 500 (24 900–38 500) to 49 000 (42 600–58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5–26·5) in GBD 2017 to 10·5% (8·1–13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2–52·0) of global childhood cancer deaths in 2023. Interpretation Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Eorts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. Funding St Jude Children’s Research Hospital, Gates Foundation, and St Baldrick’s Foundation. Copyright © 2026 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies. Introduction preventable deaths associated with childhood cancer, Children diagnosed with cancer in high-income countries WHO initiated the Global Initiative for Childhood Cancer (HICs) are estimated to have a 5-year overall survival that (GICC)4 at the UN General Assembly in 2018, with the exceeds 80%.1,2 Unfortunately, these positive outcomes goal of improving childhood cancer outcomes and have not translated globally, with 5-year net survival reducing suering due to childhood cancer globally. estimated to be less than 20% for children who develop To eectively address childhood cancer globally, it is cancer in some low-income and middle-income countries crucial to understand the burden of childhood cancers at (LMICs).3 Factors contributing to the inequity in outcomes the global, regional, national, and community levels. include multilevel challenges such as access to timely However, disease surveillance systems that record and diagnosis, resource-optimised treatments, and supportive report cancer burden data, such as population-based care. In recognition of the major disparities and cancer registries and vital registration systems, are not 1360 Articles Research in context Evidence before this study complete understanding of childhood cancer burden on global, We searched PubMed for English-language articles estimating regional, and national scales and are steps towards the ability to global childhood cancer burden and published between track progress towards WHO GICC targets globally. In addition, Jan 1, 2010, and Oct 15, 2023, using the terms “childhood or this is the first GBD analysis of changes in global childhood child or pediatric” and “cancer or malignancy or tumor or cancer burden over time, presenting estimates from 1990 to neoplasm or oncology” and “global or international or world or 2023. Our analysis suggests that the WHO GICC target cancer worldwide” and “burden or incidence or mortality or survival or types comprised approximately half of childhood cancer deaths prevalence or DALYs”. We identified separate studies that globally in 2023, with variation by world region. While the total presented global estimates of select measures of childhood number of childhood cancer deaths globally decreased between cancer burden, including incidence, mortality, and survival, 1990 and 2023, it increased in the WHO African region, and each focused on estimates for one calendar year. Analyses of premature loss of life due to childhood cancer was greatest in childhood cancer burden estimates from previous rounds of the countries with the least resources in 2023. Childhood cancer Global Burden of Diseases, Injuries, and Risk Factors Study was in the top ten causes of childhood death globally in 2023, (GBD) have been published, which incorporate multiple and when compared with adult cancers, was the second-leading measures including incidence, mortality, prevalence, years of cause of cancer DALY burden in countries with a low Socio- life lost, years lived with disability, and disability-adjusted life- demographic Index in 2023. years (DALYs). Each of the aforementioned publications Implications of all the available evidence presented important aspects of childhood cancer burden, but Childhood cancers contribute substantial burden within global no previous publication analysed global childhood cancer child health and global oncology. In countries with the least burden estimates inclusive of index cancers identified for resources, children with cancer still suffer the greatest monitoring progress of the WHO Global Initiative for Childhood premature mortality, highlighting that while progress has been Cancer (GICC) across multiple measures and time. made in outcomes globally over the past several decades, Added value of this study disparities remain. The WHO GICC is a crucial collaborative To our knowledge, GBD 2021 was the first study to capacity building and implementation strategy that has comprehensively and separately quantify the global burden of fundamentally changed the landscape of childhood cancer since several cancer types which are relevant in childhood and it was established in 2018. The target cancers identified for adolescence, and our analysis of GBD 2023 results is the first monitoring of progress in the WHO GICC comprise a sizeable formal GBD analysis of these additional cancer types in the child portion of childhood cancer burden globally, but a considerable and adolescent age group. These cancer types include portion of childhood cancer burden is not part of the identified retinoblastoma, neuroblastoma, Burkitt lymphoma, soft tissue targets, and this is greater in some world regions than others. sarcomas, bone cancers, and hepatoblastoma, and their These findings reflect the need for WHO GICC efforts to address addition to GBD allows for comparisons to other cancer types strengthening of health systems and childhood cancer needs and diseases estimated with cohesive methodology and across and priorities as a whole in order to implement equitable and time. Estimates of these cancer types will contribute to a more sustainable improvements in childhood cancer outcomes. available everywhere in the world, and there is a estimates of the global burden of childhood cancers particular dearth of reliable data in LMICs.5,6 Previous presented results using multiple measures with a focus on studies have analysed the international burden of disability-adjusted life-years (DALYs), a measure that childhood cancer with a focus on incidence,7 incidence incorporates both the morbidity and premature mortality and mortality,8 and survival9 where data are available. of a disease.11 However, with the advent of the WHO GICC Model-based estimates of the global burden of childhood a year later, monitoring gaps remained. In particular, cancer, which aim to provide estimates where data do incidence, mortality, and DALY estimates for only three of not exist as well as estimates at a global level, have been the six index GICC childhood cancers were available in the produced for incidence,10 incidence and mortality,11,12 and GBD 2017 analysis. Additionally, only approximately survival.3,13 73·5% of childhood cancer DALYs were categorised in the The Global Burden of Diseases, Injuries, and Risk previous analysis, as important childhood cancer types Factors Study (GBD)14 generates global estimates for were not separately reported in the GBD 2017 cause list. diseases, including cancers, across time and incorporates In this analysis, we aimed to summarise the updated improvements in each iteration, oering a sustainable estimates of global childhood cancer burden in 2023 and framework for childhood cancer burden estimation. These across time from 1990 to 2023. These results present, for estimates support crucial cancer control work worldwide the first time in a formal GBD analysis of childhood and while ongoing eorts to expand cancer surveillance adolescent cancer burden, an additional nine new cancer systems continue.15,16 A previous analysis of GBD 2017 causes, representing closer alignment with the six GICC Articles index cancers. In aggregate, these results add important vital registration system mortality data to increase the health policy data to support health delivery considerations. data available for retinoblastoma (appendix 1 pp 56–58). This manuscript was produced as part of the GBD Cancer cause-specific mortality estimates generated Collaborator Network and in accordance with the GBD using CODEm were scaled to independently modelled Protocol.17 all-cause mortality to produce final cancer mortality estimates. Years of life lost (YLLs) were estimated by Methods multiplying the number of cancer-specific deaths in a Overview given age group by the standard life expectancy at the age GBD provides a framework for estimating global disease of death. To evaluate the relationship between age- burden and aims to produce comprehensive and standardised YLLs and Socio-demographic Index (SDI), comparable measures of disease burden across geography we fitted a linear regression model and calculated the and time. GBD is updated at regular intervals, with each Pearson correlation. round incorporating new data, improving methods, and Non-fatal cancer estimation begins by transforming generating updated estimates for all included locations, final cancer mortality estimates to incidence estimates by age groups, sexes, and years. Updated GBD estimates thus dividing the mortality estimates by their corresponding supersede the estimates of previous rounds. We present MIRs.21 Prevalence across 10 years was modelled using estimates produced by the most recent round, incidence estimates and modelled survival based on GBD 2023,14,18,19 in this analysis. Details on GBD 2023 data MIRs, then divided into phases of cancer care to estimate For GBD 2023 data sources see sources are available on the Global Health Data Exchange years lived with disability (YLDs). Phases of cancer care https://ghdx.healthdata.org/ (GHDx) website for GBD 2023. The study is compliant diered for cohorts based on whether they were gbd-2023/sources with the GATHER statement.20 GBD used de-identified estimated to survive or not. For the cohort surviving for data, and the waiver of informed consent was reviewed 10 years after their cancer diagnosis, two phases were and approved by the University of Washington Institutional estimated: (1) diagnosis and treatment and (2) remission. Review Board (study number 9060). For the cohort not surviving for 10 years after their cancer diagnosis, four phases were estimated: (1) diagnosis and Cancer estimation in GBD treatment, (2) remission, (3) metastatic or disseminated, Data sources for cancer estimation in GBD include and (4) terminal. The prevalence of each phase was population-based cancer registries, vital registration multiplied by a phase-specific disability weight to See Online for appendix 1 systems, and verbal autopsy data (appendix 1 pp 22–51; generate YLD estimates. Disability weights are meant to maps of site-years of cancer data available in GBD 2023 represent the magnitude of health loss associated with See Online for appendix 2 are available in appendix 2 pp 2–4).21 Cancer mortality health outcomes and range from 0 (full health) to 1 estimates are generated using cancer-specific and sex- (equivalent to death; appendix 1 p 81). The estimates of specific Cause of Death Ensemble models (CODEm).22 YLDs and YLLs were summed to generate DALY CODEm uses all available mortality data and cause- estimates. specific covariates to estimate mortality for each age All point estimates in this analysis represent the mean group, sex, location, and year estimated in GBD 2023, of the estimated draws and are reported with selecting the optimal model based on out-of-sample corresponding 95% uncertainty intervals (UIs), estimated predictive validity (appendix 1 pp 59–74). Mortality data as the 2·5th and 97·5th percentiles of 250 draws at each included in cancer CODEm models include vital cancer estimation step and propagated through each step registration system and verbal autopsy data, as well as (appendix 1 pp 51–81). More detailed method descriptions population-based cancer registry incidence data that have can be found in appendix 1 and in the broader GBD 2023 been transformed into mortality data through mortality- capstone publications.14,18,19,21 to-incidence ratios (MIRs). This transformation allowed for increased data availability, particularly for locations Reporting definitions where mortality data were scarce. In GBD 2023, cancer Childhood cancers were defined as those occurring at registry data were adjusted to align with vital registration ages 0–19 years for this analysis. As some countries and system data; where cancer registry data directly overlapped organisations define childhood cancers as occurring at with vital registration data, cancer registry data were ages 0–14 years, results are available for this age range For the GBD Results Tool see excluded from CODEm models.21 MIRs were primarily and more specific age group subsets in the GBD Results https://vizhub.healthdata.org/ estimated using a spatiotemporal Gaussian process Tool. Cancers as defined in ICD-10 chapter II,23 C00–C97, gbd-results regression (ST-GPR).18 For hepatoblastoma and are included in this analysis (details on cancer types retinoblastoma, two cancers with lower data availability estimated and their corresponding definitions are and relatively fewer deaths, MIRs were estimated using included in appendix 1 pp 12–21). Other malignant negative binomial models. ST-GPR modelling used epithelial neoplasms were not a GBD cancer cause but incidence and mortality data from population-based were grouped together for the purposes of this analysis cancer registries, while negative binomial models used in an eort to present results in similar categories as the cancer registry incidence and mortality data as well as International Classification of Childhood Cancer, 3rd 1362 Articles edition (ICCC-3),24 and included the following GBD Role of the funding source cancer causes: bladder cancer, breast cancer, cervical The funders of the study had no role in study design, cancer, colon and rectum cancer, lip and oral cavity data collection, data analysis, data interpretation, or the cancer, malignant skin melanoma, nasopharynx cancer, writing of the report. pancreatic cancer, stomach cancer, thyroid cancer, and tracheal, bronchus, and lung cancer. For results of Results cancer burden presented in alignment with the WHO There were 377 000 incident cases of childhood GICC, the GBD cause brain and central nervous system cancers (95% UI 288 000–489 000), 144 000 deaths (CNS) cancers was used in place of the WHO indicator (131 000–162 000), and 11·7 million (10·7–13·2) DALYs cancer low-grade gliomas, and the GBD cause kidney estimated due to cancer in children globally in 2023 cancer was used in place of the more specific WHO (table). These DALYs were composed of a greater number indicator cancer Wilms tumour. Results are presented of YLLs (11·5 million [10·5–13·0]) than YLDs (176 000 by various groupings, including GBD world super- [108 000–279 000]; appendix 2 p 18). While higher SDI regions, SDI quintiles,18 WHO world regions,25 and settings had the greatest age-standardised incidence World Bank income groupings26 (appendix 2 pp 8–12). rates for childhood cancer, they generally had the lowest Rates are reported per 100 000 person-years, with the age-standardised mortality rates (table). The majority of GBD 2023 world standard population used for childhood cancer burden occurred in settings with calculation of age-standardised rates (appendix 1 limited resources, with 85·1% (82·9–87·5) of incident pp 81–82). GBD 2023 provides estimates for additional cases, 94·1% (93·5–94·8) of deaths, and 94·1% For GBD Compare see https:// vizhub.healthdata.org/gbd- cancer types, measures, and groupings that are not (93·4–94·7) of DALYs occurring in LMICs (comprising compare/ included in this Article but are available online through low-income, lower-middle-income, and upper-middle- For GBD Cancer Compare see the GBD Results Tool, GBD Compare, and GBD Cancer income countries by World Bank grouping; appendix 2 https://vizhub.healthdata.org/ Compare visualisations. p 15). The WHO Western Pacific region and African gbd-compare/cancer Incident cases, Age- Percentage of Deaths, Age- Percentage of DALYs, millions Age- Percentage of thousands standardised global cases thousands standardised global deaths standardised global DALYs incidence mortality DALY rate per rate per rate per 100 000 person- 100 000 person- 100 000 person- years years years Global 377 14·3 100·0% 144 5·4 100·0% 11·7 443·6 100·0% (288–489) (10·9–18·6) (100·0–100·0) (131–162) (4·9–6·1) (100·0–100·0) (10·7–13·2) (404·0–498·0) (100·0–100·0) WHO regions African region 91·3 14·3 24·4% 49·0 7·7 34·1% 4·01 628·6 34·2% (74·6–112) (11·7–17·6) (21·2–27·8) (42·6–58·2) (6·7–9·1) (31·8–36·6) (3·50–4·77) (546·9–747·0) (31·8–36·9) Eastern Mediterranean 52·4 16·1 13·9% 21·9 6·7 15·2% 1·79 548·1 15·2% region (40·1–68·0) (12·3–20·9) (12·7–14·8) (18·5–25·0) (5·7–7·7) (13·9–16·3) (1·51–2·04) (463·0–626·1) (13·9–16·3) European region 40·0 18·6 10·6% 8·02 3·7 5·6% 0·660 303·6 5·6% (27·6–55·6) (12·7–25·9) (9·0–11·9) (7·64–8·38) (3·5–3·8) (5·0–6·1) (0·627–0·690) (288·3–318·2) (5·0–6·2) Region of the 49·5 17·1 13·1% 14·3 4·9 10·0% 1·16 397·9 9·9% Americas (37·5–67·5) (12·9–23·4) (11·8–14·4) (13·6–14·8) (4·6–5·1) (8·9–10·9) (1·11–1·20) (379·4–413·2) (8·8–10·8) South-East Asia 49·2 7·9 13·1% 23·3 3·7 16·2% 1·88 303·7 16·0% region (38·6–63·1) (6·2–10·2) (11·3–14·6) (19·8–27·6) (3·2–4·4) (14·4–17·9) (1·59–2·22) (257·3–356·0) (14·2–17·7) Western Pacific region 93·0 17·3 24·5% 26·9 4·8 18·7% 2·19 396·7 18·7% (65·1–135) (12·1–25·0) (21·7–27·8) (24·2–31·1) (4·3–5·5) (17·1–20·3) (1·99–2·53) (358·7–453·9) (17·1–20·3) SDI quintiles High 102 18·6 26·8% 19·5 3·4 13·6% 1·60 284·0 13·6% (69·0–149) (12·5–27·4) (23·4–30·6) (18·3–20·9) (3·2–3·7) (12·3–14·7) (1·50–1·71) (266·1–305·8) (12·3–14·9) High-middle 73·6 16·4 19·5% 23·7 5·1 16·5% 1·92 421·4 16·4% (54·1–102) (12·0–22·7) (18·2–21·1) (21·9–26·0) (4·8–5·6) (15·5–17·3) (1·78–2·10) (391·4–460·8) (15·4–17·3) Middle 46·3 14·0 12·3% 18·5 5·6 12·9% 1·51 453·8 12·9% (35·2–61·4) (10·6–18·6) (11·7–12·8) (16·9–20·8) (5·1–6·2) (12·3–13·5) (1·37–1·69) (412·8–508·4) (12·2–13·5) Low-middle 47·2 10·4 12·6% 23·1 5·1 16·1% 1·87 414·3 16·0% (38·2–57·5) (8·4–12·7) (11·1–13·7) (20·1–26·7) (4·4–5·9) (15·1–17·0) (1·62–2·15) (358·8–478·7) (15·0–16·9) Low 108 12·7 28·8% 58·8 6·9 40·9% 4·81 566·1 41·0% (90·3–133) (10·6–15·6) (24·9–32·3) (51·7–68·7) (6·1–8·1) (39·0–43·3) (4·22–5·61) (496·8–660·9) (39·0–43·4) Values in parentheses are 95% uncertainty intervals. Estimates are presented to three significant figures for counts, or to one decimal place for rates and percentages. DALYs=disability-adjusted life-years. SDI=Socio-demographic Index. Table: Global burden of childhood cancer in 2023, globally and by WHO region and SDI quintile, for all sexes combined Articles region had the most childhood cancer cases, while the to 49 000 (42 600–58 200; table; appendix 2 p 32; GBD WHO African region had the most childhood cancer Results Tool). From 1990 to 2023, overall childhood deaths (table). Deaths due to childhood cancer decreased deaths decreased by 56·5% (55·8 to 57·3) globally and by 27·0% (15·5–36·1) globally between 1990 and 2023, childhood cancer incident cases changed by –0·9% from 197 000 (173 000–218 000) to 144 000 (–27·1 to 38·6; GBD Results Tool; appendix 2 p 26). Age- (131 000–162 000), but increased in the WHO African standardised mortality rates decreased between 1990 and region by 55·6% (25·5–92·4), from 31 500 (24 900–38 500) 2023 globally and in all WHO world regions, most 350000 300000 250000 200000 150000 100000 50000 Figure 1: Global childhood cancer incidence and DALY burden in 2023, by 5-year age group and overall for age 0–19 years, for all sexes combined (A) Number of incident cases (left) and proportion of incident cases among all cases of childhood cancer (right), by cancer type. (B) Number of DALYs (left) and proportion of DALYs among all childhood cancer DALYs (right), by cancer type. The <20 years age group represents the total of the age-specific categories. DALYs=disability-adjusted life-years. 1364 sesac tnedicnI )%( sesac tnedicnI 75 25 11000000 10000000 9000000 8000000 7000000 6000000 5000000 4000000 3000000 2000000 1000000 0–4 5–9 10–14 15–19 <20 sYLAD )%( sYLAD Other malignant neoplasms Retinoblastoma Other malignant epithelial neoplasms Neuroblastoma and other peripheral nervous cell tumours Ovarian cancer Brain and CNS cancer Testicular cancer Other non-Hodgkin lymphoma Soft tissue and other extraosseous sarcomas Burkitt lymphoma Malignant neoplasm of bone and articular cartilage Hodgkin lymphoma Other liver cancers Other leukaemia Hepatoblastoma Chronic myeloid leukaemia Kidney cancer Acute myeloid leukaemia Other eye cancers Acute lymphoid leukaemia A B 75 25 0–4 5–9 10–14 15–19 <20 Age group (years) Age group (years) Articles A Age-standardised incidence rate Quintile 1 (<9·0 per 100000 person-years) Quintile 2 (9·0 to <11·5 per 100000 person-years) Quintile 3 (11·5 to <14·5 per 100000 person-years) Quintile 4 (14·5 to <19·0 per 100000 person-years) Quintile 5 (≥19·0 per 100000 person-years) Eastern Caribbean and central America Persian Gulf Balkan Peninsula Southeast Asia West Africa Mediterranean Northern Europe B Age-standardised mortality rate Quintile 1 (<2·7 per 100000 person-years) Quintile 2 (2·7 to <3·7 per 100000 person-years) Quintile 3 (3·7 to <4·8 per 100000 person-years) Quintile 4 (4·8 to <6·5 per 100000 person-years) Quintile 5 (≥6·5 per 100000 person-years) Eastern Caribbean and central America Persian Gulf Balkan Peninsula Southeast Asia West Africa Mediterranean Northern Europe Figure 2: Global map of age-standardised childhood cancer incidence rates (A) and mortality rates (B) in 2023, for all sexes combined Articles notably in high and high-middle SDI settings (appendix 2 [8·2–13·8]), and other malignant neoplasms (ie, p 32). uncategorised cancers; 10·5% [8·1–13·1]). The Across the childhood cancer age groups globally contribution of solid tumours to total cancer DALY in 2023, the greatest numbers of incident cases and burden was higher in the 0–4 years (28·2% [22·9–33·7]) DALYs occurred in the 0–4 years age group, with and 15–19 years (44·8% [41·3–48·8]) age groups than in 124 000 cases (95% UI 92 200–169 000) and 3·65 million the 5–9 years (16·9% [14·1–19·3]) and 10–14 years (21·6% (3·20–4·22) DALYs, followed by the 15–19 years age [17·6–25·9]) age groups. The proportion of uncategorised group (99 400 cases [78 500–123 000] and 2·96 million cancers (other malignant neoplasms) was greatest in the [2·66–3·29] DALYs; figure 1). The majority of childhood 0–4 years age group at 14·1% (10·5–17·9). The majority cancer DALY burden for ages 0–19 years was from of global childhood cancer DALY burden in 2023 was leukaemias (31·9% [28·2–37·1]), brain and CNS cancers composed of YLLs, at 98·5% (97·6–99·1; appendix 2 (16·2% [13·6–19·7]), non-Hodgkin lymphoma (10·6% p 40). The global burden of several cancer types estimated for the first time in GBD in the 2021 iteration, and presented for childhood and adolescent age groups for the first time in this GBD 2023 analysis, are detailed in appendix 2 (p 41). These new cancer causes (Burkitt lymphoma, other non- Hodgkin lymphoma, soft tissue and other extraosseous sarcomas, malignant neoplasms of bone and articular cartilage, neuroblastoma and other peripheral nervous cell tumours, hepatoblastoma, retinoblastoma, and other eye cancers) comprised 29·6% (95% UI 25·9–33·2) of childhood cancer DALYs globally in 2023 (figure 1). Among this newly modelled burden, malignant neoplasms of bone and articular cartilage accounted for a particularly large proportion of overall childhood cancer DALYs in the 10–14 years (12·3% [8·4–16·6]) and 15–19 years (14·8% [10·6–19·4]) age groups, while other non-Hodgkin lymphoma comprised the largest proportion among the new cancer types in the 0–4 years (7·9% [5·8–11·2]) and 5–9 years (8·5% [6·2–11·1]) age groups (figure 1). The global geographical distribution of age- standardised childhood cancer incidence rates in 2023 was most prominent in HICs, while age-standardised childhood cancer mortality rates was weighted towards lower-income countries in the WHO African and Eastern Mediterranean regions (table; figure 2; appendix 2 p 15). The WHO regions with greatest mortality also tended to be regions with sparse data and consequently greater uncertainty in estimates (appendix 2 pp 2–5). In 2023, age-standardised YLLs due to childhood cancer, reflective of premature mortality, were inversely correlated with country-level SDI (Pearson correlation coecient –0·658 [95% UI –0·708 to –0·604]). There was generally a wider spread of age-standardised YLL rates in lower SDI settings than higher SDI settings (figure 3). Childhood cancer was the eighth-leading cause of childhood death globally in 2023, following neonatal 0 10 20 30 40 50 60 70 80 90 disorders, congenital birth defects, road injuries, and several communicable diseases such as lower respiratory infections and malaria, but with greater Figure 3: The association between SDI and age-standardised rates of burden than other communicable diseases such as childhood cancer YLLs in 2023, for all sexes combined Results are presented at the country level. Each circle represents one country, measles, tuberculosis, and HIV/AIDS (figure 4A). The with size relative to the contry’s total population aged 0–19 years. The grey line contribution of childhood cancer to childhood deaths in and shading represent the mean and 95% UI, respectively, for a linear regression 2023, as represented by ranking of the number of between SDI and the age-standardised YLL rate (Pearson correlation coefficient deaths compared with those caused by other diseases –0·675 [95% UI –0·723 to –0·618]). SDI=Socio-demographic Index. UI=uncertainty interval. YLLs=years of life lost. and injuries, was greater in higher SDI settings, 1366 )sraey-nosrep 000001 rep( sLLY desidradnats-egA Population 50000 500000 5000000 50000000 250000 000 GBD Super-region Central Europe, eastern Europe, and central Asia High income Latin America and Caribbean North Africa and Middle East South Asia Southeast Asia, east Asia, and Oceania Sub-Saharan Africa SDI Articles ranking third in high SDI and fifth in high-middle SDI were in the African region (28·6% [23·7–34·0]) and quintiles, and lower in lower SDI settings, ranking South-East Asia region (36·6% [30·7–43·8]), with the seventh in the middle SDI and low-middle SDI other WHO GICC indicator cancers contributing greater quintiles, and 13th in the low SDI quintile (figure 4A). proportional deaths in the African region than in the Childhood cancer was the 11th-leading cause of other WHO world regions (figure 5). Globally, of the childhood DALYs globally in 2023, with this burden WHO GICC indicator cancers, acute lymphoid leukaemia ranking higher in high SDI and high-middle SDI contributed the most deaths (32 200 [24 300–41 100]) in quintile settings compared with other SDI quintiles 2023, followed by brain and CNS cancers (23 200 (appendix 2 p 6). [18 900–29 000]), Hodgkin lymphoma (3310 [2090–4670]), When compared with cancers occurring in adults (age retinoblastoma (3230 [1270–7010]), kidney cancer (3190 ≥20 years), childhood cancers as a group ranked 18th in [2410–3960]), and Burkitt lymphoma (2960 [1960–4930]; deaths globally in 2023 out of 37 cancers, but seventh in appendix 2 p 43). Further detailed estimates for these low SDI quintile settings (appendix 2 p 7). Childhood cancer types, and all cancer types reported in this cancer burden expressed in DALYs was the ninth-leading analysis, globally and by WHO world region, are available cause of total cancer DALYs globally in 2023, following in appendix 2 (pp 44–51). more common or more fatal cancers of adulthood such as lung cancer, colon and rectum cancer, breast cancer, Discussion and stomach cancer (figure 4B). In lower SDI quintile Since the completion of the GBD 2017 analysis on global settings, childhood cancer DALYs were ranked higher, childhood cancer burden, major health policy and ranking second in low SDI and sixth in low-middle SDI academic initiatives have shifted the landscape of and middle SDI settings. childhood cancer control worldwide. First, WHO and Target cancers for the WHO GICC comprised 47·3% multiple global partners launched the GICC in 2018.4 (95% UI 42·2–52·0) of global childhood cancer deaths Since then, more than 75 governments have in 2023 (figure 5). This percentage varied by WHO world demonstrated a commitment to implementing childhood region, with greater contributions of childhood cancer cancer control programmes either as WHO GICC focus deaths in the region of the Americas of 55·7% countries or through activities aligned with the initiative’s (53·6–57·3) and lesser contributions in the South-East CureAll framework.27 Second, with the launch of the St Asia region of 42·1% (35·9–49·4). Brain and CNS Jude Global Alliance28 in 2018, over 400 hospitals and cancers and acute lymphoid leukaemia comprised the non-profit foundations in more than 90 countries are largest proportion of deaths out of the WHO index working collaboratively to implement novel and evidence- cancers in each region. The smallest percentages of based interventions29,30 and improve health-care delivery childhood cancer due to these two cancers combined services for childhood cancer at the institutional level. A Rank Global High High-middle Middle Low-middle Low Deaths (95% UIs) SDI SDI SDI SDI SDI Neonatal disorders 1630000 (1510000–1 750 000) 1 1 1 1 1 1 Lower respiratory infections 712000 (588000–855000) 2 6 3 3 2 2 Congenital birth defects 510000 (396000–647000) 3 2 2 2 3 5 Malaria 473000 (180000–876000) 4 92 17 5 5 3 Diarrhoeal diseases 380000 (279000–525000) 5 19 6 6 4 4 Road injuries 220000 (170000–282000) 6 4 4 4 6 7 Meningitis 148000 (112000–208000) 7 2 1 1 8 10 8 8 Childhood cancer 144000 (131000–162000) 8 3 5 7 7 13 Measles 142000 (57700–252000) 9 52 36 26 20 6 Drowning 127000 (95 300–166 000) 10 9 7 8 9 11 Pertussis 113000 (65000–185 000) 11 32 1 4 12 12 10 Protein-energy malnutrition 105000 (75500–142000) 12 45 1 3 24 16 9 Tuberculosis 87800 (59400–124000) 13 47 2 2 16 14 12 Sexually transmitted infections excluding HIV 74100 (27100–143000) 14 35 1 6 15 17 15 HIV/AIDS 72000 (61900–84700) 15 38 1 1 29 21 14 Interpersonal violence 68900 (57200–87000) 16 10 8 13 15 19 Self-harm 63400 (53500–76300) 17 7 9 20 11 26 Typhoid and paratyphoid 60500 (31900–101000) 18 48 2 0 23 10 17 Invasive non-typhoidal salmonella 59300 (43000–80500) 19 77 5 3 44 28 16 COVID-19 52900 (48300–57800) 20 15 1 5 9 30 23 (Figure 4 continues on next page) Articles B Rank Global High High-middle Middle Low-middle Low DALYs (95% UIs) SDI SDI SDI SDI SDI Tracheal, bronchus, and lung cancer 46600000 (42400000–50700000) 1 1 1 1 2 7 Colon and rectum cancer 26100000 (23700000–28500 000) 2 2 3 3 7 6 Breast cancer 24500000 (21600000–28000 000) 3 4 4 2 1 3 Stomach cancer 22500000 (19200000–25900 000) 4 3 2 4 5 4 Oesophageal cancer 14000000 (12600000–15800000) 5 6 5 10 4 8 Liver cancer 13500000 (11800000–15500000) 6 7 6 5 9 5 Cervical cancer 13100000 (10000000–17100000) 7 1 5 7 7 3 1 Pancreatic cancer 12300000 (11400000–13100 000) 8 5 8 8 17 16 Childhood cancer 11700000 (10700000–13200000) 9 20 9 6 6 2 Prostate cancer 8910000 (7870000–10000000) 10 8 12 12 11 10 Brain and CNS cancer 7260000 (6340000–8670000) 11 9 10 9 16 17 Non-Hodgkin lymphoma 7080000 (6160000–8080000) 12 10 13 13 13 11 Lip and oral cavity cancer 6420000 (5540000–7570000) 13 18 11 15 8 9 Ovarian cancer 6400000 (5400000–7540 000) 14 12 14 11 10 12 Other malignant neoplasms 5460000 (4720000–6110 000) 15 14 15 14 14 13 Bladder cancer 4620000 (4220000–5120000) 16 11 18 18 21 20 Gallbladder and biliary tract cancer 4000000 (3460000–4800000) 17 16 16 21 18 18 Kidney cancer 3780000 (3390000–4200 000) 18 13 20 24 28 30 Larynx cancer 3560000 (2990000–4290000) 19 23 17 19 15 15 Other pharynx cancer 3330000 (2680000–4160000) 20 24 19 23 12 14 Acute myeloid leukaemia 3310000 (2800000–3920000) 21 17 21 17 22 23 Uterine cancer 2900000 (2470000–3390000) 22 21 25 22 23 26 Multiple myeloma 2810000 (2540000–3130000) 23 19 24 28 24 28 Nasopharynx cancer 2500000 (2080000–2950000) 24 25 22 16 19 19 Malignant neoplasm of bone and articular cartilage 2120000 (1680000–2690000) 25 28 23 20 20 21 Malignant skin melanoma 1810000 (1600000–2 130000) 26 22 30 32 32 31 Acute lymphoid leukaemia 1740000 (1150000–2350000) 27 30 26 25 29 25 Soft tissue and other extraosseous sarcomas 1700000 (1380000–2150000) 28 26 29 29 25 22 Other leukaemia 1690000 (1300000–2190000) 29 29 27 26 26 29 Thyroid cancer 1500000 (1260000–1780 000) 30 31 28 27 27 24 Chronic lymphoid leukaemia 983000 (866000–1180000) 31 27 31 34 34 35 Hodgkin lymphoma 922000 (700000–1200000) 32 34 32 31 30 27 Chronic myeloid leukaemia 720000 (562000–922000) 33 33 34 30 31 32 Mesothelioma 624000 (553000–695000) 34 32 35 35 35 36 Testicular cancer 552000 (443000–686000) 35 35 33 33 33 33 Eye cancer 196000 (150000–261000) 36 36 37 36 36 34 Neuroblastoma and other peripheral nervous cell tumours 121000 (104000–147000) 37 37 36 37 37 37 Figure 4: Contribution of childhood cancer to global child deaths and all-age cancer DALYs in 2023, for all sexes combined (A) Rankings by cause comparing the absolute number of global deaths among the top 20 Level 3 categories of disease in GBD in ages 0–19 years. (B) Rankings by cause comparing the absolute number of global DALYs in GBD for childhood cancer (all cancers for ages 0–19 years) with individual cancer causes for ages 20 years to ≥95 years (these cancer-specific rows exclude DALYs for ages 0–19 years). For both sets of rankings, causes are ordered in descending absolute value of the global estimates, with childhood cancer in bold. Cells are coloured according to rank, ranging from highest rank (red) to lowest rank (green). The final five columns provide the rankings of these top global causes within each SDI quintile. DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. SDI=Socio-demographic Index. UI=uncertainty interval. Third, eorts to expand capacity for local childhood this framework and the WHO initiative, however, are the cancer data collection and dissemination were initiated need for improved epidemiological data to better inform in 2020 with the childhood oshoot of the International stakeholders interested in improving childhood cancer Agency for Research on Cancer’s Global Initiative for outcomes through health systems and health service Cancer Registries (ChildGICR),15,16 which holds great delivery interventions. Estimates of international and promise for improving the currently inadequate observed national cancer burden patterns are important to inform cancer surveillance data globally.13 More recently, the these eorts as well as national cancer control plans, but 2020 Lancet Oncology Commission on sustainable care not every country has the surveillance systems necessary for children with cancer31 was completed, providing an to generate these data. investment case and roadmap to monitoring childhood To contribute to the broader ongoing eorts to improve cancers through a proposed indicator framework focused outcomes for childhood cancers globally, we updated on reducing financial hardship for patients and families, estimates of global, regional, and national childhood increasing access to multimodal therapy, and ensuring cancer burden across time and incorporated cancer types quality in the provision of health services. Underlying with substantial burden in childhood and adolescent 1368 Articles years, such as Burkitt lymphoma, soft tissue sarcomas, malignant bone tumours, retinoblastoma, hepato- blastoma, and neuroblastoma. This is the first time that a global estimation group has provided a formal analysis of estimates for these key cancers relevant to WHO GICC goals, building to the potential to monitor global childhood cancer control eorts and providing 75 information relevant to childhood cancer policy development. There were an estimated 144 000 deaths (95% UI 131 000–162 000) due to childhood cancer in 2023, and target cancers for the WHO GICC comprised approximately 47·3% (42·2–52·0) of global childhood 25 cancer deaths. With the addition of the nine new cancer types into the GBD framework, only 10·5% (8·1–13·1) of c c G d h o i B s m i e l D d a p h s a 2 e o r s 0 o e , 1 d d 7 . w w C it c i h h t a h i n l d e c a h a e c p o r h p o d ro r D e x c q i A a m u n L i c Y a r e t s i e r n s l g y r r e d e 2 p m i 6 v r · e e a 5 r s i % s n e e n t ( h 2 u a e 6 n a · s l c p 5 t a h e – t c e 2 t g s 6 r e o · u r r 5 m v i ) s i c e e i o d n s f , Global African region Europea R n e g re io g n io o n f the A S m o e u r t i h ca - s East Asia W re e g st io er n n Pacific region ranging from chemotherapy and radiation access to dierent surgical subspeciality services, such as paediatric surgery, ophthalmology, orthopaedics, or Figure 5: Proportion of total childhood cancer deaths due to index cancers for the WHO GICC in 2023, globally and by WHO region, for all sexes neurosurgery. With greater granularity of estimates by combined cancer types, health-care providers and policy makers Childhood cancer is defined as that occurring at ages 0–19 years. GICC=Global can plan human resource requirements, referral Initiative for Childhood Cancer. *All other cancer types includes all those not networks, and financial products for cancer subtypes reported separately as WHO GICC index cancers. included in the GICC, such as retinoblastoma and Burkitt lymphoma. with country-level SDI, indicating that premature The GBD framework also provides estimates of DALYs mortality due to childhood cancer is greatest in countries for each cancer type and childhood cancers in total, with the least resources available to address it. This with 11·7 million (95% UI 10·7–13·2) DALYs estimated finding is consistent with an analysis of childhood cancer globally for childhood cancers in 2023. The Lancet Oncology burden using GBD 2017 estimates, which found that age- Commission on sustainable care for children with standardised mortality rates were weighted towards cancer31 advocated for the inclusion of childhood cancers settings with lower SDI, and underscores the need for in essential benefits packages and financial risk global collaboration and investment in childhood cancer protection for families of children with cancer through that targets support for LMICs. Additionally, deaths due the elimination of out-of-pocket expenditures. To meet to childhood cancers decreased by 27·0% (15·5–36·1) this goal, health policy makers and economists often rely globally between 1990 and 2023. During the same time on GBD-estimated DALYs, in combination with other period, overall childhood deaths decreased by 56·5% data, to determine which interventions to cover as part of (55·8 to 57·3) and childhood cancer incident cases their universal health coverage scale-up.32–37 Decision changed by –0·9% (–27·1 to 38·6). While these findings making regarding health benefits packages and broader suggest progress in childhood cancer care globally for health policy priorities are complex and context children eectively diagnosed, this progress has been dependent, but data on the burden of childhood cancer unbalanced, with childhood cancer deaths increasing in relative to other diseases of childhood and to adult the African region by 55·6% (25·5–92·4), from 31 500 cancers might be useful for some countries. We found (24 900–38 500) in 1990 to 49 000 (42 600–58 200) in 2023. that childhood cancers were the eighth-leading cause of This increase in childhood cancer deaths is likely partially childhood death and the ninth-leading cause of total driven by regional population changes, as childhood cancer DALYs globally in 2023, with variation by SDI. cancer age-standardised mortality rates decreased These comprehensive and more granular new results globally and in all WHO world regions. Additionally, will be important for the ongoing implementation work although global eorts to address childhood cancer associated with the WHO GICC and for the many global burden are ongoing, the distal impacts of current global partners working on childhood cancer control initiatives childhood cancer control eorts will take years to locally and internationally. visualise in GBD models. Further analyses forecasting From a broader perspective, GBD 2023 estimates the burden of childhood cancer over the coming decades continue to show persistent inequities in childhood will be important, allowing for national and international cancer burden globally. In 2023, age-standardised YLL policy makers to project the changing disease burden rates due to childhood cancers were inversely correlated and adjust policies and interventions accordingly. )%( shtaed recnac doohdlihc lla fo noitroporP Acute lymphoid leukaemia Kidney cancer Brain and CNS cancer Retinoblastoma Burkitt lymphoma All other cancer types* Hodgkin lymphoma Mediterr E a a n s e t a e n rn r e g ion WHO region Articles While the estimates of the burden of childhood and related sarcomas of the bone. Fourth, as access to cancers produced by GBD 2023 are valuable and quality of childhood cancer services improves contributions to global childhood cancer control, there worldwide, there will be an increasing number of are limitations as well as future opportunities to expand survivors, and the current GBD framework does not estimation eorts. First, while UIs are estimated and estimate the lifelong disease burden anticipated in this provided with all measures in GBD, there is greater growing population. Eorts to address this challenging uncertainty in countries that generally have fewer data limitation are under consideration. Fifth, current GBD available and likely fewer resources to support the estimation cannot completely account for cancer recording and reporting of these data. Additionally, UI mimics that might result in misdiagnosis in children estimates cannot account for every potential bias. In and potentially inaccurate cause-of-death data.13 Finally, GBD, corrections to the data are made to address GBD does not currently externally report estimates of measurement error and, in cause-of-death estimation, childhood cancer survival, and previous modelling ensemble modelling is used to deal with model eorts have been single publications that are not misspecification bias as much as possible; however, updated over time with new data or improved methods. residual bias aecting results cannot be excluded. The generation of global childhood cancer survival Relatedly, because models are fitted across each cancer estimates in a continuously updated modelling cause’s entire age range, data for age groups older than framework that routinely produces estimates across 19 years might influence childhood cancer estimates, time, such as GBD, would allow for formal tracking of particularly when data are unavailable in childhood age WHO GICC progress where survival data are not groups. These challenges underscore the importance of currently available, and should be a priority in the reliable incidence and mortality data to inform future. This does not negate the importance of childhood cancer burden estimates, and eorts under supporting and generating childhood cancer survival way through the ChildGICR initiative15 to establish and results as locally as possible around the world, but improve childhood cancer registration systems are would aid country planning where this information is crucial to inform our understanding of the burden of not available, and would help overall global tracking childhood cancer. As the ability to capture and report eorts. More general limitations of the GBD study have more detailed aspects of childhood cancer diagnoses been discussed in other publications.14,18,19,21 and outcomes develops, incorporating these data into In summary, this updated analysis of the global burden future GBD rounds would be expected to improve of childhood cancer provides estimates for 20 cancer estimates of childhood cancer burden locally, regionally, categories—including for nine additional cancer causes and globally. compared with previous GBD analyses, which represent A second limitation of this study is that, given delays important cancers in children—from 1990 to 2023. The in population-based data availability during the addition of new cancer types relevant to children is an COVID-19 pandemic, this analysis did not incorporate important step towards aligning with WHO GICC changes in childhood cancer burden due to the influence targets. This study highlights that childhood cancer of the pandemic. Reports thus far suggest a decrease in persists as a substantial contributor to health loss in diagnosis of childhood cancers in some locations and children, and that considerable disparities in childhood reduced access to treatment services during the early cancer burden persist globally across a range of pandemic period, with treatment access challenges demographic factors, including by SDI and world region. greater in LMICs.38,39 As cancer surveillance data We found that resource-limited settings are continue to emerge with adequate diversity in disproportionately burdened by childhood cancer, geographical representation and across the span of indicating that future eorts to decrease the global time, understanding the eect of the COVID-19 childhood cancer burden must focus on addressing pandemic on childhood cancer burden on a global scale inequities and expanding access to comprehensive will be important to informing future preparation cancer services. We anticipate that these estimates will endeavours. Third, GBD estimates currently do not enhance eorts by UN agencies, governments, and other separately report burden due to low-grade gliomas, a relevant childhood cancer stakeholders to design and childhood cancer subgroup that causes substantial implement cancer control programmes and interventions burden in children40 and a GICC index cancer type. Our worldwide. current analysis used malignant CNS cancer burden as GBD 2023 Childhood Cancer Collaborators a surrogate for low-grade gliomas and thus likely Lisa M Force*, Jonathan M Kocarnik, Miranda L May, overestimated the fatal burden of WHO target cancers Kayleigh Bhangdia, Andrew Crist, Louise Penberthy, Natalie Pritchett, in total. Similarly, several new GBD causes are based on Alistair Acheson, Lee Deitesfeld, Hasan Aalruz, Yohannes Habtegiorgis Abate, Mohamed Abouzid, ICCC-3 diagnostic groups, such as malignant bone Lucas Guimarães Abreu, Salahdein Aburuz, Fatemeh Afrashteh, tumours and soft tissue sarcomas, and are not currently Muhammad Sohail Afzal, Danish Ahmad, Ayman Ahmed, disaggregated into clinically important subgroups such Syed Anees Ahmed, Hanadi Al Hamad, Mohammed Albashtawy, Wafa A Aldhaleei, Robert Kaba Alhassan, Abid Ali, Sabah Al-Marwani, as rhabdomyos arcoma, osteosarcoma, or Ewing sarcoma 1370 Articles Awais Altaf, Safwat Aly, Karem H Alzoubi, Nguyen Hoang Anh, Munkhtuya Tumurkhuu, Aniefiok John Udoakang, Muhammad Umair, Saeid Anvari, Mosab Arafat, Aleksandr Y Aravkin, Demelash Areda, Srikanth Umakanthan, Yasir Waheed, Ahmed Bilal Waqar, Abdulfatai Aremu, Benedetta Armocida, Mahwish Arooj, Muhammad Waqas, Ronny Westerman, Hong Xiao, Galal Yahya, Mohammad Asghari-Jafarabadi, Seyyed Shamsadin Athari, Zeamanuel Anteneh Yigzaw, Dong Keon Yon, Mohammed G M Zeariya, Maha Moh’d Wahbi Atout, Lemessa Assefa A Ayana, Shahkaar Aziz, Mohammed Zuber, Theo Vos, Christopher J L Murray, Ahmed Y Azzam, Razieh Bahreini, Soham Bandyopadhyay, Carlos Rodriguez-Galindo†, Nickhill Bhakta*†. Shirin Barati, Mohammad-Mahdi Bastan, Maryam Bemanalizadeh, *Co-corresponding authors. †Co-senior authors. Jasvinder Singh Bhatti, Cem Bilgin, Catherine Bisignano, Affiliations Sri Harsha Boppana, Souad Bouaoud, Yasser Bustanji, Giulia Carreras, See appendix 3 (pp 3–10) for collaborators’ aliations. See Online for appendix 3 Ferrán Catalá-López, Chiranjib Chakraborty, Promit Ananyo Chakraborty, Anis Ahmad Chaudhary, Dong-Woo Choi, Contributors Isaac Sunday Chukwu, Bashir Dabo, Xiaochen Dai, Lalit Dandona, See appendix 3 (pp 10–13) for more detailed information about Rakhi Dandona, Samuel Demissie Darcho, Aso Mohammad Darwesh, individual author contributions to the research, divided into the Aragaw Tesfaw Desale, Thao Huynh Phuong Do, Paul Narh Doku, following categories: managing the overall research enterprise; writing Robert Kokou Dowou, John Dube, Abdel Rahman E’mar, the first draft of the manuscript; primary responsibility for applying Maysaa El Sayed Zaki, Hala Rashad Elhabashy, Mohammed Elshaer, analytical methods to produce estimates; primary responsibility for Chadi Eltaha, Theophilus I Emeto, Sayeh Ezzikouri, seeking, cataloguing, extracting, or cleaning data; designing or coding Adewale Oluwaseun Fadaka, Adeniyi Francis Fagbamigbe, figures and tables; providing data or critical feedback on data sources; Omotayo Francis Fagbule, Ayesha Fahim, Mohammad Farahmand, developing methods or computational machinery; providing critical Morenike Oluwatoyin Folayan, Takeshi Fukumoto, feedback on methods or results; drafting the manuscript or revising it Miglas Welay Gebregergis, Teferi Gebru Gebremeskel, critically for important intellectual content; and managing the Saroja Devi Geetha, Genanew K Getahun, Nermin Ghith, estimation or publications process. The corresponding authors Logan M Glasstetter, Veer Bala Gupta, Awoke Derbie Habteyohannes, (L M Force and N Bhakta) had final responsibility for the decision to Dariush Haghmorad, Arvin Haj-Mirzaian, Nadia M Hamdy, submit for publication. Membersof the Institute for Health Metrics and Md Kamrul Hasan, Hamidreza Hasani, Ali Hasanpour- Dehkordi, Evaluation Cancer Team had full access to the underlying data used to Johannes Haubold, Simon I Hay, Khezar Hayat, Mehdi Hosseinzadeh, generate estimates presented in this Article. All other authors had access Kiavash Hushmandi, Hong-Han Huynh, Bing-Fang Hwang, Arit Inok, to and reviewed estimates as part of the research evaluation process, Md Irteja Islam, Md Rabiul Islam, Akhil Jain, which includes additional stages of formal review. Ammar Abdulrahman Jairoun, Farahnaz Joukar, Ali Kabir, Declaration of interests Abdulkareem Kabir, Arman Karimi Behnagh, Foad Kazemi, L M Force reports support for the present manuscript from St Jude Alireza Khalilian, Shaghayegh Khanmohammadi, Haitham Khatatbeh, Children’s Research Hospital and the Gates Foundation; grants or Hamid Reza Khayat Kashani, Khalid A Kheirallah, Feriha Fatima Khidri, contracts from St Baldrick’s Foundation, Conquer Cancer Foundation, and Majid Khosravi, Sepehr Khosravi, Min Seo Kim, Adnan Kisa, Sezer Kisa, National Institutes of Health Loan Repayment Program; leadership or Farzad Kompani, Ashwin Laxmikant Kotnis, Claudia E. Kuehni, fiduciary role in other board, society, committee or advocacy group G Anil Kumar, Carlo La Vecchia, Tuo Lan, Minh Huu Nhat Le, (unpaid) as a Lancet Oncology International Advisory Board member, Sang-woong Lee, Seung Won Lee, Wei-Chen Lee, Ming-Chieh Li, all outside the submitted work. N M Ghith reports support for attending Xuefeng Liu, Hawraz Ibrahim M. Amin, Hassan Magdy Abd El Razek, meetings and travel from the Danish Data Science Institute at the Vahid Mansouri, Yasith Mathangasinghe, Endalkachew Belayneh Melese, Technical University of Denmark (travel grant in July, 2023), outside the Tomislav Mestrovic, Sachith Mettananda, Irmina Maria Michalek, submitted work. J Kocarnik reports support for the present manuscript Giuseppe Minervini, Mizan Kiros Mirutse, Nouh Saad Mohamed, from the Institute for Health Metrics and Evaluation, the Gates Ali H Mokdad, Lorenzo Monasta, Mohammad Moradi-Joo, Foundation, and the American Lebanese Syrian Associated Charities. Paula Moraga, Rohith Motappa, Soroush Najdaghi, M-C Li reports grants or contracts from the National Science and Hastyar Hama Rashid Najmuldeen, Gopal Nambi, Shumaila Nargus, Technology Council, Taiwan (grant number 113-2314-B-003-002) and the Muhammad Naveed, Athare Nazri-Panjaki, Robina Khan Niazi, “Higher Education Sprout Project” of National Taiwan Normal University; Syed Toukir Ahmed Noor, Chisom Adaobi Nri-Ezedi, leadership or fiduciary role in other board, society, committee or advocacy Ogochukwu Janet Nzoputam, Chimezie Igwegbe Nzoputam, group (paid or unpaid) as a Technical Editor of the Akinyemi O D Ofakunrin, Hany A Omar, Sok King Ong, Michal Ordak, Journal of the American Heart Association, all outside the submitted work. Verner N Orish, Jagadish Rao Padubidri, Georgios D Panos, L Monasta reports support for the present manuscript from the Italian Romil R Parikh, Jay Patel, Shankargouda Patil, Prince Peprah, Ministry of Health (Ricerca Corrente 34/2017), payments made to the Konrad Pesudovs, Dimitri Poddighe, Jagadeesh Puvvula, Institute for Maternal and Child Health IRCCS Burlo Garofolo. Raghu Anekal Radhakrishnan, Pracheth Raghuveer, Saeed Rahmani, G D Panos reports support for attending meetings and travel from Roche Mahmoud Mohammed Ramadan, Shakthi Kumaran Ramasamy, Hellas and Bayer Hellas, all outside the submitted work. Kiana Ramezanzadeh, Ashkan Rasouli-Saravani, Nima Rezaei, Y L Samodra reports grants or contracts from Taipei Medical University Nazila Rezaei, Nitai Roy, Priyanka Roy, Cameron John Sabet, and National Science and Technology Council for National Taiwan Mohammad Reza Saeb, Umar Saeed, Mehdi Safari, Sher Zaman Safi, University; leadership or fiduciary role in other board, society, committee Sare Safi, Narjes Saheb Sharif-Askari, Fatemeh Saheb Sharif-Askari, or advocacy group (paid or unpaid) as Co-founder of Benang Merah Amirhossein Sahebkar, S Mohammad Sajadi, Mohamed A Saleh, Research Center; other financial or non-financial interests as mentor with Leili Salehi, Yoseph Leonardo Samodra, Abdallah M Samy, Jago Beasiswa (idebeasiswa.com), all outside the submitted work. Made Ary Sarasmita, Aswini Saravanan, Tanmay Sarkar, B M Schaarschmidt reports grants or contracts from Else Kröner-Fresenius Maheswar Satpathy, Benedikt Michael Schaarschmidt, Art Schuermans, Foundation, Deutsche Forschungsgemeinschaft, and PharmaCept; Allen Seylani, Samiah Shahid, Hamid R Shahsavari, payment or honoraria for lectures, presentations, speakers bureaus, Moyad Jamal Shahwan, Masood Ali Shaikh, Muhammad Aaqib Shamim, manuscript writing or educational events from AstraZeneca, Boston Anas Shamsi, Alfiya Shamsutdinova, Mohammed Shannawaz, Scientific, and MedMile; support for attending meetings and/or travel Maryam Shayan, B Suresh Kumar Shetty, Premalatha K Shetty, from Bayer, all outside the submitted work. R Tabares-Seisdedos reports Mahabalesh Shetty, Aminu Shittu, Zahra Shokati Eshkiki, grants or contracts from Valencian Regional Government’s Ministry of Seyed Afshin Shorofi, Sunil Shrestha, Emmanuel Edwar Siddig, Education (PROMETEO/CIPROM/2022/58) and The Spanish Ministry of Surjit Singh, Paramdeep Singh, Reed J D Sorensen, Science, Innovation and Universities (PID2021-129099OB-I00). Muhammad Suleman, Chandan Kumar Swain, Lukasz Szarpak, Sree Sudha T Y, Rafael Tabarés-Seisdedos, Jabeen Taiba, Iman M Talaat, Data sharing Nathan Y Tat, Abdelghani Tbakhi, Mohamad-Hani Temsah, To download the data used in these analyses, please visit the Global Rasiah Thayakaran, Marcos Roberto Tovani-Palone, Thang Huu Tran, Health Data Exchange (https://ghdx.healthdata.org/gbd-2023). The Articles statistical code used for data processing and analysis is available upon 18 GBD 2023 Disease and Injury and Risk Factor Collaborators. request; requests should be sent to engage@healthdata.org. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and Acknowledgments territories, including 660 subnational locations, 1990–2023: This work was supported by St Jude Children’s Research Hospital, the a systematic analysis for the Global Burden of Disease Study 2023. Gates Foundation, and St Baldrick’s Foundation. We are grateful for the Lancet 2025; 406: 1873–922. contributions of the cancer registries and vital registration systems that 19 GBD 2023 Demographics Collaborators. Global age-sex-specific all- generate data on cancer around the world; observed data are crucial to cause mortality and life expectancy estimates for 204 countries and understanding cancer burden. We also thank the many GBD territories and 660 subnational locations, 1950–2023: a demographic collaborators who contributed to the GBD 2023 cancer estimates. analysis for the Global Burden of Disease Study 2023. Lancet 2025; We acknowledge the children and families impacted by childhood 406: 1731–810. cancer—we deeply hope that the estimates provided in this analysis help 20 Stevens GA, Alkema L, Black RE, et al, and The GATHER Working to reduce the burden of childhood cancer globally in the future. Group. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet 2016; 388: e19–23. Editorial note: The Lancet Group takes a neutral position with respect to 21 Force LM, Kocarnik JM, May ML, et al, and the GBD 2023 Cancer territorial claims in published maps, figures, tables, and institutional Collaborators. The global, regional, and national burden of cancer, aliations. 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023. Lancet 2025; 406: 1565–86. References 1 Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. 22 Foreman KJ, Lozano R, Lopez AD, Murray CJ. Modeling causes of CA Cancer J Clin 2023; 73: 17–48. death: an integrated approach using CODEm. Popul Health Metr 2012; 10: 1. 2 Botta L, Gatta G, Capocaccia R, et al, and the EUROCARE-6 Working Group. Long-term survival and cure fraction estimates for 23 WHO. ICD-10: international statistical classification of diseases and childhood cancer in Europe (EUROCARE-6): results from a related health problems: tenth revision, 2nd edn. 2004. https://iris. population-based study. Lancet Oncol 2022; 23: 1525–36. who.int/handle/10665/42980 (accessed July 18, 2024). 3 Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Girardi F, Atun R. Global 24 Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International childhood cancer survival estimates and priority-setting: Classification of Childhood Cancer, third edition. Cancer 2005; a simulation-based analysis. Lancet Oncol 2019; 20: 972–83. 103: 1457–67. 4 WHO. The Global Initiative for Childhood Cancer. https://www. 25 WHO. Countries. https://www.who.int/countries (accessed who.int/initiatives/the-global-initiative-for-childhood-cancer Oct 17, 2023). (accessed Oct 17, 2023). 26 The World Bank. World Bank country and lending groups. https:// 5 Union for International Cancer Control. Global Initiative for Cancer datahelpdesk.worldbank.org/knowledgebase/articles/906519-world- Registries (GICR). https://www.uicc.org/what-we-do/sharing- bank-country-and-lending-groups (accessed July 1, 2024). knowledge/global-initiative-cancer-registries-gicr (accessed 27 WHO. CureAll framework: WHO global initiative for childhood Jan 8, 2024). cancer: increasing access, advancing quality, saving lives. World 6 Siddiqui AH, Zafar SN. Global availability of cancer registry data. Health Organization, 2021. https://iris.who.int/handle/10665/ J Glob Oncol 2018; 4: 1–3. 347370 (accessed July 9, 2024). 7 Steliarova-Foucher E, Colombet M, Ries LAG, et al, and the IICC-3 28 St. Jude Children’s Research Hospital. About St. Jude Global contributors. International incidence of childhood cancer, 2001–10: Alliance. https://global.stjude.org/en-us/global-alliance/about.html a population-based registry study. Lancet Oncol 2017; 18: 719–31. (accessed July 18, 2024). 8 Huang J, Chan SC, Ngai CH, et al, and the NCD Global Health 29 Agulnik A, Muniz-Talavera H, Pham LTD, et al, and the EVAT Study Research Group, Association of Pacific Rim Universities (APRU). Group. Eect of paediatric early warning systems (PEWS) Global incidence, mortality and temporal trends of cancer in children: implementation on clinical deterioration event mortality among a joinpoint regression analysis. Cancer Med 2023; 12: 1903–11. children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study. Lancet Oncol 2023; 24: 978–88. 9 Allemani C, Matsuda T, Di Carlo V, et al, and the CONCORD Working Group. Global surveillance of trends in cancer survival 2000–14 30 McNeil MJ, Garcia Quintero X, Gonzalez M, et al. Preventing and (CONCORD-3): analysis of individual records for 37 513 025 patients treating pain and anxiety during needle-based procedures in diagnosed with one of 18 cancers from 322 population-based registries children with cancer in low- and middle-income countries. in 71 countries. Lancet 2018; 391: 1023–75. Cancers (Basel) 2024; 16: 1025. 10 Johnston WT, Erdmann F, Newton R, Steliarova-Foucher E, Schüz J, 31 Atun R, Bhakta N, Denburg A, et al. Sustainable care for children Roman E. Childhood cancer: estimating regional and global with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; incidence. Cancer Epidemiol 2021; 71: 101662. 21: e185–224. 11 GBD 2017 Childhood Cancer Collaborators. The global burden of 32 Institute for Health Metrics and Evaluation. Government of childhood and adolescent cancer in 2017: an analysis of the Global Ethiopia using Global Burden of Disease evidence to achieve equity Burden of Disease Study 2017. Lancet Oncol 2019; 20: 1211–25. and access to health care for all. https://www.healthdata.org/news- events/insights-blog/acting-data/government-ethiopia-using-global- 12 Sharma R. A systematic examination of burden of childhood burden-disease-evidence (accessed Oct 13, 2023). cancers in 183 countries: estimates from GLOBOCAN 2018. Eur J Cancer Care (Engl) 2021; 30: e13438. 33 Institute for Health Metrics and Evaluation. Burden of disease data help to illuminate new policy priorities in Rwanda. https://www. 13 Bhakta N, Force LM, Allemani C, et al. Childhood cancer burden: healthdata.org/news-events/insights-blog/acting-data/burden-disease- a review of global estimates. Lancet Oncol 2019; 20: e42–53. data-help-illuminate-new-policy-priorities (accessed Oct 16, 2023). 14 GBD 2023 Causes of Death Collaborators. Global burden of 34 Institute for Health Metrics and Evaluation. Using burden of 292 causes of death in 204 countries and territories and disease data to prioritize national health resources in the 660 subnational locations, 1990–2023: a systematic analysis for the Philippines. https://www.healthdata.org/news-events/insights- Global Burden of Disease Study 2023. Lancet 2025; 406: 1811–72. blog/acting-data/using-burden-disease-data-prioritize-national- 15 WHO, International Agency for Research on Cancer. Targeting health (accessed Oct 16, 2023). childhood cancer through the Global Initiative for Cancer Registry 35 Institute for Health Metrics and Evaluation. Understanding the ‘big Development (ChildGICR). https://gicr.iarc.fr/child-gicr/ (accessed picture’ can lead to a healthier population in Ghana. https://www. Jan 8, 2024). healthdata.org/news-events/insights-blog/acting-data/ 16 WHO, International Agency for Research on Cancer. The Global understanding-big-picture-can-lead-healthier-population-ghana Initiative for Cancer Registry Development. https://gicr.iarc.fr/ (accessed Oct 16, 2023). about-the-gicr/ (accessed Oct 17, 2023). 36 Institute for Health Metrics and Evaluation. Disease burden data 17 Institute for Health Metrics and Evaluation. Protocol for the Global guide spending, health policy in Mexico. https://www.healthdata. Burden of Diseases, Injuries, and Risk Factors Study (GBD). org/news-events/insights-blog/acting-data/disease-burden-data- https://www.healthdata.org/research-analysis/about-gbd/protocol guide-spending-health-policy-mexico (accessed Oct 16, 2023). (accessed July 9, 2024). 1372 Articles 37 Institute for Health Metrics and Evaluation. NIH to use burden of 39 Vasquez L, Sampor C, Villanueva G, et al. Early impact of the disease data to maximize lifesaving impact of its funding. https:// COVID-19 pandemic on paediatric cancer care in Latin America. www.healthdata.org/news-events/insights-blog/acting-data/nih-use- Lancet Oncol 2020; 21: 753–55. burden-disease-data-maximize-lifesaving-impact-its (accessed 40 Armstrong GT, Conklin HM, Huang S, et al. Survival and long-term Oct 16, 2023). health and cognitive outcomes after low-grade glioma. Neuro Oncol 38 Graetz D, Agulnik A, Ranadive R, et al. Global eect of the 2011; 13: 223–34. COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Health 2021; 5: 332–40. --- [PDF原文](https://sci-net.xyz/storage/7932541/8702361eff3814dde1046a517f3cbf0e046272e219af16049d0b0778c101d848/Global-burden-of-cancer-in-children-and-adolescents-aged-0-19-years-1990-2023-a-systematic.pdf) DOI: 10.1016/S0140-6736(26)00200-X