Global epidemiological trend of cancer incidence and death in adults aged 60 years and older: a systematic analysis of data from GLOBOCAN 2022 and GBD2021.

Introduction

Cancer is a multifaceted challenge with profound societal, public health, and economic implications, disproportionately affecting older adults’ health outcomes and quality of life [ 1 ]. Epidemiological evidence confirms age as a non-modifiable risk factor, with the majority of patients diagnosed in individuals aged ≥ 60 years [ 2 ]. With the global population aging, the escalating cancer burden in elderly populations necessitates urgent systemic adaptations in healthcare infrastructure and resource allocation worldwide [ 3 ]. The epidemiological transitions and demographic changes underscore the critical need for age-specific epidemiological research to promote healthy aging and guide precision prevention and health policy formulation in the aging global population.

Although the majority of patients with cancer and those who die from cancer are adults aged over 60 years, relatively little is known about the cancer burden in this age group. Previous epidemiological studies on cancer statistics predominantly focused on individual cancers or specific areas, which is not conducive to a comprehensive assessment of trends for all cancers among the elderly globally [ 4 – 7 ]. Several studies reported the burden of cancer statistics for adults aged 85 years and older, sometimes referred to as the “oldest old” [ 8 , 9 ]. However, their data overlooked the cancer epidemiological data for the 60–85 age group, which constitutes the largest proportion of the elderly population. The “oldest old” are distinct populations with systematic differences in demographics and health status compared to adults aged 60–85. The two groups differ fundamentally in age range and exhibit clear disparities in gender, marital status, socioeconomic status, and health differences. Thus, more comprehensive, updated, and population-based epidemiological studies for adults aged over 60 years are essential for healthcare decision-making and planning.

The implementation of population-based cancer surveillance programs is one of the most effective measures to control the cancer burden. The Global Cancer Observatory (GLOBOCAN) and Global Burden of Diseases (GBD) databases are the two most widely used cancer epidemiological resources, providing high-level global cancer estimates, including incidence, mortality, prevalence, and risk factors for various types of cancer worldwide. Based on the latest GLOBOCAN 2022 and GBD 2021 estimates, our group and others have published many high-quality cancer epidemiology reports for all populations [ 10 , 11 ].

In this study, we explore the latest cancer statistics for adults aged over 60 years worldwide by incorporating the up-to-date, population-based data from GLOBOCAN 2022 and GBD2021 to provide a comprehensive epidemiological overview. We also focus on the dynamics of cancer epidemiology in older adults over the past three decades. In addition, we applied a Bayesian Age-Period-Cohort (BAPC) model to project future incidence and mortality burdens using global demographic data, accounting for age, period, and cohort effects. Our study could support the worldwide urgent need for public health planning on an aging society, resource allocation on geriatric oncology, and policymaking to effectively reduce the burden of cancer in the elderly aged 60 years and older.

Methods

Data sources and collection

Population-based cancer incidence and mortality data, along with their corresponding 95% uncertainty intervals (UIs), are collected from the GLOBOCAN 2022 database and the GBD2021 database. Data about cancer incidence and mortality estimates at the global, regional, and national levels in 2022 were obtained from the GLOBOCAN 2022 database. Data about cancer incidence and mortality estimates at the global, regional, and national levels from 1992 to 2021 were extracted from GBD2021. We used the ICD-10 (the International Classification of Diseases, 10th revision) classification to identify the cancer types. All cancers, excluding Non-Melanoma Skin Cancer (NMSC, C44), were included in the overall estimation of the total cancer burden. Colon, rectum, and anus were combined as colorectal cancer (CRC, ICD-10 codes C18–C21) in this study. The variables extracted were sex, age, location, and cancer type. For age-specific incidence analysis, 8 broad age groups were used (60–64 years, 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85–89 years, 90–94 years, and 95 years or older). We also characterized the burden according to the socio-demographic Index (SDI) based on income, education, and fertility rates into the predefined five-tier (low, low-middle, middle, high-middle, and high SDI) (Table S1). The High-income North America region refers exclusively to Canada and the United States of America (USA), based on the World Bank income classification and regional groupings used by GLOBOCAN2022 and GBD2021. Table S1 lists all countries along with their respective regions and super-regions. The GLOBOCAN estimates have been documented and are described online at the Global Cancer Observatory (GCO) ( https://gco.iarc.who.int ). The GBD estimates have been made publicly available and can be accessed online ( http://ghdx.healthdata.org/gbd-results-tool ). The procedures for collecting, processing, and generating GLOBOCAN and GBD estimates have been extensively reported in previous studies [ 10 – 12 ].

Statistical analysis

A descriptive analysis was performed to characterize the burden of cancer among adults aged ≥ 60 years. The absolute numbers of incidence and death are presented only to illustrate the scale of the disease burden. We used age-standardized rates (ASR) to compare the incidence and mortality of cancer over time across different age groups, sexes, regions, and countries. Temporal trends in incidence and mortality rates from 1992 to 2021 were examined by fitting joinpoint models. We applied a maximum of 5 joinpoints (6 line segments) restriction to all models. An average annual percent change (AAPC) was used to evaluate trends, and the Z test was used to assess whether the AAPC was statistically different from zero. In describing trends, the ASR is considered to have an upward trend when the estimated AAPC value and its lower 95% CI are both > 0. Conversely, the ASR is considered a downward trend if the estimated AAPC value and its upper 95% CI are both < 0. The ASR is regarded as stable only if the trend is not statistically significant. Long-term projections of cancer burden among the elderly population were generated using Bayesian Age-Period-Cohort (BAPC) modeling, covering the forecast period 2022–2050. The BAPC model assumes separable age, period, and cohort effects following a Poisson distribution, and second-order random walk (RW2) priors were assigned to the age, period, and cohort effects. For the precision parameters of the RW2 model and the intercept term, standard weakly informative priors recommended by the BAPC software package were adopted. Estimation and inference of the model’s posterior distribution were performed using Integrated Nested Laplace Approximation (INLA). Population data from the World Health Organization (WHO) were used. The R statistical environment (version 4.4.2) was employed for both computational analysis and visualization. Results with a two-sided p-value below 0.05 were deemed statistically significant.

Results

Global cancer patterns among adults aged ≥ 60 years

Table 1 summarizes the global estimates of new cancer cases and age-standardized incidence rate (ASIR) by cancer type. In 2022, there were approximately 11.3 million new cancer diagnoses among adults aged ≥ 60 years, which represents 65% of all new cancer diagnoses, with males exhibiting higher incidence rates and ASIRs than females (Fig. 1 A; Table 1 ). While absolute cancer incidence declined with advancing age, ASIRs demonstrated an upward trend (Fig. 1 A). The five most frequently diagnosed cancers were tracheal, bronchus, and lung (TBL) cancer, CRC, prostate cancer, breast cancer, and stomach cancer (Fig. 2 ). Across different age groups, TBL consistently had the highest ASIR among adults aged 60–84 years, while CRC had the highest ASIR among those aged over 85. (Figure S1; Figure S2).

In 2022, approximately 7.2 million cancer deaths occurred among adults aged ≥ 60 years, representing 74% of global cancer mortality (Table 2 ). The number of cancer deaths among men exceeds that among women, and males exhibit higher ASMR than females (Fig. 1 B). While the absolute number of deaths declined progressively with age, ASMR displayed a contrasting upward trend, peaking in individuals aged > 90 years (Fig. 1 B). TBL cancer was the predominant cause of cancer-related death, followed by CRC, stomach cancer, prostate cancer, pancreatic cancer, and esophageal cancer (Fig. 2 ). Across different age groups, TBL cancer remained the leading contributor to cancer mortality in adults aged 60–89 years (Figure S1; Figure S2). However, CRC surpassed it as the primary cause of death in those aged > 90 (Figure S1; Figure S2).

Geographic variation in cancer among adults aged ≥ 60 years

Table S2 compiled the ASIR and ASMR of different cancers in adults aged 60 years and older at global, regional, and SDI levels. In 2022, the USA and Canada recorded the highest ASIR of cancer among adults aged ≥ 60 years, followed by Australasia and Western Europe (Fig. 3 ; Table S2). Regarding cancer-related deaths, the top three regions with the highest ASMR were Central Europe, East Asia, and Western Europe (Fig. 3 ; Table S2). TBL was the most frequently diagnosed cancer and the leading cause of cancer-related deaths in most regions (Figure S3; Table S2). The highest ASIR for TBL, breast cancer, and prostate cancer were observed in the USA and Canada (Figure S3; Table S2). The highest ASIR for digestive cancer was found in High-income Asia Pacific, including CRC, liver cancer, and pancreatic cancer (Figure S3; Table S2). East Asia suffered the Highest ASMR of TBL, stomach cancer, esophageal cancer, and liver cancer (Figure S3; Table S2).

At the national level, China, the United States of America, Japan, India, and Germany recorded the highest absolute numbers of cancer cases and deaths in adults aged over 60 years old (Table S3). Monaco, Bermuda, and the United States of America had the highest ASIR (Table S3), and the highest ASMR was observed in Monaco, Mongolia, Greenland, Zimbabwe, and Uruguay (Table S3).

SDI-related disparities in the burden of cancer among adults aged ≥ 60 years

The global burden of cancer in adults aged ≥ 60 years demonstrated significant disparities across SDI levels. ASIR and ASMR exhibited a positive correlation with SDI, with the highest rates observed in high-SDI regions and the lowest in low-SDI regions (Figure S4; Table S2). The relationship between SDI and ASIR or ASMR followed a non-linear, near-exponential pattern (Fig. 4 ). Trends suggest a potential positive association between ASMR and SDI, though variability indicates contributions from other factors. The cancer pattern among adults aged ≥ 60 years also exhibited a significant difference with SDI levels. TBL had the highest ASIR and ASMR in most SDI regions (Figure S5). However, in low SDI regions, the most commonly diagnosed cancers and the leading cause of cancer death were prostate cancer (Figure S5).

Trends in cancer incidence and mortality among adults aged ≥ 60 years from 1992 to 2021

Between 1992 and 2021, ASIR and ASMR of cancer among adults aged ≥ 60 years demonstrated a consistent decline (Fig. 5 ; Table S4). Cancer site-specific analyses showed most cancer types suffered a decreasing ASIR trend, including TBL, stomach cancer, and bladder cancer. However, some cancer types, including breast cancer, prostate cancer, and CRC, displayed an increasing incidence rate (Figure S6A, Table S5). Mortality trends presented that most cancer types suffered the general downward mortality trend, whereas some cancer types, such as pancreatic cancer and liver cancer, showed an increasing trend of ASMR (Figure S6B, Table S5).

In the regional levels, most regions suffered a growth in ASIR, but regions with Central Asia, the USA and Canada, Australasia, High-income Asia Pacific, and Southern Latin America experienced a decline in ASIR (Figure S7A; Table S6). Most regions had a decreasing trend in ASMR. However, Western Sub-Saharan Africa, Southern Sub-Saharan Africa, Southeast Asia, and South Asia experienced an increasing trend in ASMR (Figure S7B; Table S6). The trend in burden of cancer among adults aged ≥ 60 years also showed SDI-related disparities. High SDI regions showed a decreasing trend in ASIR, while others showed a rising trend in ASIR (Fig. S7C; Table S6). For mortality, Low-middle SDI showed a rising trend in ASMR, and others presented a decreasing trend (Fig. S7D; Table S6).

At the national levels, Egypt and Romania reported the highest AAPC in ASIR, and the highest AAPC in ASMR could be found in Lesotho, Egypt, and Georgia (Table S7). San Marino, Kazakhstan, and the Maldives had the lowest AAPC in ASIR and ASMR (Table S7).

Cancer incidence and death predictions of cancer among adults aged ≥ 60 years

Using the BAPC model, we forecasted the global number of cancer incidences and deaths for cancer in adults aged ≥ 60 years to 2050 (Table S8). The analysis reveals a sustained upward trajectory in both metrics over the coming decades (Fig. 6 ). By 2050, the total number of incidences is expected to reach 22.2 million, and the deaths are estimated at 12.9 million. For males, the number of incidences is projected to reach 12.3 million, and the number of deaths is projected to reach 9.9 million. For Females, in 2050, the predicted incidence is estimated to be 7.2 million, while the number of deaths will grow to 5.7 million.

Cancer site-specific projections indicate that TBL will remain the leading cause of cancer incidence and death, with projected incidence reaching 3.0 million and deaths estimated at 2.7 million (Table S9). Breast cancer is projected to be the second most significant contributor to the global cancer burden, with incidence expected to reach 2.4 million and death expected to reach 0.9 million (Table S9).

Disscussion

With the ongoing trend of population aging globally, cancer patterns in the elderly are an important focus of public health [ 13 ]. In this study, we provide the most up-to-date and comprehensive epidemiological overview of the global cancer burden among adults aged ≥ 60 years. We have reviewed and combined several reports of cancer burden, including the GLOBOCAN 2022 and GBD2021, to investigate the current cancer situation in adults aged ≥ 60 years and projections to the year 2050, which would provide epidemiological insights for optimizing resource allocation and preventive strategies in aging populations.

In our study, we revealed that individuals aged ≥ 60 years accounted for 65% of all cancer cases and 74% of all cancer-related deaths globally in 2022, indicating that cancer remains predominantly influential among the elderly [ 14 ]. With the continued acceleration of global aging, it is foreseeable that the cancer burden will further intensify in the future [ 15 ]. In this study, projections suggested that by 2050, annual cases among this demographic may surge to 22.2 million, with deaths potentially reaching 12.9 million. In this situation, the development of specialized research and healthcare strategies tailored to aging populations is the most effective measure to reduce cancer burden globally. Recently, inspired by ASCO’s 5-Year Strategic Plan, the ASCO Geriatric Oncology Community of Practice outlines the field along three fundamental pillars: education, research, and implementation [ 16 ]. The implementation of ASCO’s infrastructure could help to improve care for older adults with cancer.

From the perspective of gender differences, cancer had a greater negative impact on males than on females. Males had higher incidences, death counts, ASIR, and ASMR related to cancer. This is primarily because males’ lifestyles encompass a higher prevalence of risk factors associated with cancer development [ 17 ]. Behaviors such as tobacco use, excessive alcohol consumption, and occupational exposures contribute significantly to cancer etiology [ 18 – 20 ]. Gender-specific prevention strategies may be warranted to address this disparity.

Regarding age-specific patterns, both ASIR and ASMR exhibited a progressive increase with advancing age, peaking in individuals over 85 years old. However, the absolute number of cases and deaths was highest in the 60–74 age group. The primary reason for this age disparity may be attributed to demographic factors, as the 60–74 age group represents the largest subpopulation within the elderly demographic [ 13 ].

In 2022, the elderly suffered a significant burden of TBL cancer, which exhibited the highest absolute incidence and ASIR, and demonstrated the highest mortality rate among all malignancies. Recently, smoking and ambient particulate matter pollution have remained the main risk factors for TBL cancer [ 10 ]. Tobacco control policies and air quality improvement initiatives represent two cornerstone interventions for mitigating the global burden of TBL cancers. CRC, one of the digestive system cancers, had the highest ASIR and ASMR in adults aged over 90 in 2022. Adjusting dietary patterns, such as limiting red meat consumption and increasing vegetable and fruit intake, is crucial for the prevention of digestive system cancers [ 21 ]. For some countries or regions, considering the substantial challenges associated with implementing large-scale lifestyle modifications or effective primary prevention measures for CRC risk reduction, population-based screening programs, such as colonoscopy and fecal immunochemical testing, emerge as the most impactful public health intervention for mortality mitigation in this vulnerable demographic [ 22 ]. Other digestive system cancers, including gastric and pancreatic cancers, also impose a significant burden on elderly patients, especially in high-income countries. Helicobacter pylori is a major pathogenic factor for gastric cancer, and conducting Helicobacter pylori screening in high-risk groups, including patients with chronic atrophic gastritis and individuals with a family history of gastric cancer, will help reduce the burden of gastric cancer [ 23 ]. Pancreatic cancer has a 5-year survival rate of < 10%, largely due to late diagnosis and limited treatment options, posing a major public health challenge [ 24 ]. A proactive and multi-faceted approach that focuses on risk reduction, early detection, standardized care, and health equity is crucial to reducing the impact of pancreatic cancer on individuals and societies. Breast cancer is still one of the cancers with the highest incidence and mortality rates in older females [ 25 ]. Raising public awareness of breast cancer, encouraging regular self-examinations and clinical screenings, as well as promoting healthy lifestyles, are key to reducing the disease burden in this demographic. Prostate cancer remains one of the most common malignant tumors in the older male reproductive system [ 26 ]. Prostate-Specific Antigen (PSA) is verified as an effective tumor marker for prostate cancer [ 27 ]. Promoting PSA screening and integrating it into public health programs will help reduce the burden of prostate cancer among elderly patients.

The global burden of cancer among elderly populations exhibited significant regional and national disparities. In 2022, the USA and Canada faced a particularly severe cancer incidence burden, recording the highest ASIR for TBL, breast cancer, prostate cancer, bladder cancer, and pancreatic cancer. These findings underscore the urgent need to enhance early prevention and screening programs for these malignancies in the region. Meanwhile, Asia emerged as another hotspot for cancer burden, with notably elevated ASIRs and ASMRs for digestive cancer, far exceeding rates observed in other regions, particularly gastric cancer, esophageal cancer, liver cancer, and pancreatic cancer. This observation is strongly associated with region-specific dietary patterns and lifestyle behaviors [ 28 ]. In 2022, Central Europe recorded the world’s highest cancer mortality rates, underscoring an urgent need to strengthen investments in regional cancer research and healthcare resource allocation. At the national level, the United States of America, China, and India reported the highest absolute numbers of cancer cases and deaths—a trend likely influenced by their large populations, though systemic healthcare challenges and demographic factors also play critical roles [ 29 – 31 ]. For the governments of these nations, addressing the growing cancer burden among aging populations presents a significant public health challenge. To mitigate this issue, prioritizing early prevention initiatives, expanding screening programs, and optimizing diagnostic and treatment frameworks will be essential strategies to reduce cancer-related incidence and mortality in the elderly demographic. Results in this study from small-population regions, such as Greenland, Monaco, and the Maldives, should be interpreted as ecological signals rather than precise metrics. Stochastic variation, migratory healthcare-seeking, and underfunded registry infrastructure may disproportionately affect these regions.

In addition, there was a positive correlation between the incidence and mortality of cancer and the SDI at the country level. The higher SDI countries were experiencing higher ASIR and ASMR, while the lower SDI countries reported lower ASIR and ASMR. This aligns with the long-standing perception of cancer as a “disease of development”– where affluent societies face disproportionately higher cancer burdens due to aging populations, lifestyle factors, and diagnostic capacity, while resource-constrained healthcare systems in low-SDI settings struggle to deliver complex oncology services, potentially masking true epidemiological trends through underdiagnosis [ 32 ]. Cancer pattern among adults aged ≥ 60 years also exhibited a significant difference with SDI levels. In most regions, TBL predominated as the most frequently diagnosed malignancy and the primary cause of cancer-related mortality. The epidemiological profile shifts markedly in low SDI regions, with prostate cancer demonstrating dual predominance in both incidence and mortality. Therefore, governments in low-SDI regions should prioritize enhancing healthcare system capacities for cancer prevention and control, focusing particularly on prostate cancer rather than TBL cancers.

From 1992 to 2021, although the ASIR and ASMR showed a consistent global downward trend, intensified efforts are needed to target regions and cancer types with persistently increasing trends. Targeted preventive strategies have helped reduce the ASIR for breast cancer, prostate cancer, and CRC. Given the rising ASMR trends observed in pancreatic and liver cancer, future research on these diseases should be prioritized to improve prognostic outcomes. For regions with persistently high mortality rates, especially Western Sub-Saharan Africa, Southern Sub-Saharan Africa, Southeast Asia, and South Asia, strengthening diagnostic and treatment capacity remains critically important.

This study has several limitations. First, the accuracy of our findings is contingent upon the quality of the original data sourced from the GLOBOCAN and GBD studies. As a secondary analysis of these datasets, our research inherits inherent limitations, including potential issues related to data quality and completeness. While GLOBOCAN and GBD databases employ standardized methodologies, residual heterogeneity persists in cancer registration practices across jurisdictions. High-income regions report higher histological verification rates, whereas low-income regions often rely on proxy data, increasing misclassification risk. Second, given the retrospective cross-sectional design of the study, the interpretation of results may be subject to bias and confounding factors. Confounding factors, such as advances in diagnostic technology and enhanced quality of registry data, can significantly impact the interpretation of cancer incidence trends. Advances in diagnostic technology could lead to overestimation of incidence or shifts in tumor stage distribution, which may not reflect actual changes in disease burden. Poor registry quality introduces selection bias or information bias, reducing the comparability of results across settings. Third, the geographic coverage of the data source is limited, as it does not encompass all countries globally. Finally, while the predictive model provided a broad estimation of future trends, its projections should be interpreted with caution due to the inherent uncertainties in long-term forecasting.

Conclusion

In 2022, the escalating global cancer burden in elderly populations continued to pose a formidable public health challenge. TBL cancer persisted as the predominant cause of cancer-related incidence and mortality in this age group. A striking feature of geriatric cancer epidemiology was its pronounced heterogeneity across sex, age strata, geographic regions, and SDI levels, underscoring the imperative for context-specific control strategies aligned with local disease patterns. From 1992 to 2021, while both ASIR and ASMR declined globally, there were ongoing increases in the cancer burden for certain cancers, including breast, prostate, colorectal, pancreatic, and liver cancers. Projections suggested a marked expansion of the elderly cancer burden in future decades, with both incidence and mortality poised to surge. TBL cancers will remain the leading cause of cancer incidence and death, followed by breast cancer. Our study offers a comprehensive epidemiological overview for prioritizing precision interventions targeting high-risk populations and policy formulation for aging societies.

Supplementary Information

Supplementary Material 1.

Acknowledgements

The authors sincerely express gratitude to the International Agency for Research on Cancer, the World Health Organization, and the Global Burden of Disease study 2021 collaborators for providing open access to global cancer estimates.

Abbreviations

Global cancer observatory

Global burden of disease study

Age-standardized rate

Age-standardized incidence rate

Age-standardized mortality rate

Average annual percentage change

Bayesian age-period-cohort

Non-melanoma skin cancer

Tracheal, bronchus, and lung

Socio-demographic index

Uncertainty intervals

The international classification of diseases, 10th revision

Colorectal cancer

Second-order random walk

Integrated nested laplace approximation

World health organization

Prostate-specific antigen

United states of america

Authors’ contributions

Zegui Tu: Conceptualization; Data curation; Formal analysis; Visualization; Project administration; Writing - original draft.Yang Yu: Resources; Data curation; Formal analysis; Investigation; Methodology; Writing - original draft.Caili Li: Validation; Visualization; Methodology; Writing - review & editing. Qipeng Hu: Validation; Methodology. Chengzhi Cai: Resource; Visualization.Jieyan Luo: Writing - review & editing.Meijuan Huang: Conceptualization; Project administration; Writing - review & editing.All authors read and approved the final manuscript.

Funding

Not applicable.

Data availability

All source data are publicly available and accessible through the Global Cancer Observatory ( https://gco.iarc.fr/today/home ) and IHME( http://ghdx.healthdata.org/gbd-results-tool ). Data generated in this study are provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

This study was a retrospective, observational cohort study and used anonymized and publicly available data. Therefore, the requirement for ethical approval and informed consent was waived by our institutional review board.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

not applicable.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Zegui Tu, Email: tuzegui1996@163.com, Email: tuzeguidoctor@stu.scu.edu.cn.

Meijuan Huang, Email: hmj107@163.com, Email: hmj107@163.com.

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Associated Data

Supplementary Materials

Supplementary Material 1.

Data Availability Statement

All source data are publicly available and accessible through the Global Cancer Observatory ( https://gco.iarc.fr/today/home ) and IHME( http://ghdx.healthdata.org/gbd-results-tool ). Data generated in this study are provided within the manuscript or supplementary information files.