Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019
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  • Published on:
    Evidence that nuclear atmospheric test fallout is responsible

    The Zhao et al publication drew attention to an anomalous and unexplained increase in cancer in the under 50 age group. Genetic damage from nuclear tests should be raised as a possible cause of this effect. As early as 1994 I drew attention to evidence of an increase in cancer in Wales, relative to England beginning some 20 years after the fallout, measured as Strontium-90 [Busby 1994]. That genetic effects followed exposure to Sr-90 was shown by studies of mice in 1963 [Luning et al 1963]. Early infant mortality increased in the peak period of Sr-90 in milk in UK and USA, 1959-1963 and fell after the test ban treaty [Whyte 1992]. Individuals born in this period who did not die, will arguably have carried non-fatal genetic damage, which will have affected their risk from cancer in their lifetime, as could the Sr-90 exposure of those who were children at the time. In order to investigate this, in August 2021, I carried out a pilot study involving the creation of an indicator R which divides the cancer rate in a high fallout area by that in a comparable low fallout area. I have drawn attention elsewhere to failures in the radiation risk model, and there I pointed out that the increase of cancer in all ages in Wales 20years after the fallout was consistent with an error in the current radiation risk model for these fallout exposures of some 300-fold.
    In the pilot study employing the metric R, I looked at high and low fallout States of the USA. The high rainfall/fallout...

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    Conflict of Interest:
    I am Scientific Secretary of the European Committee on Radiation Risk which has published reports criticising the current radiation risk model.
  • Published on:
    Increase in cancer burden is largely explained by population growth
    • Volker Arndt, Head of Epidemiological Cancer Registry of Baden-Württemberg German Cancer Research Center

    Dear Editors,
    the results by Zhao et al. show a striking increase in the global incidence of early-onset cancers between 1990 and 2019. The authors highlight the finding that “Global incidence of early-onset cancer increased by 79.1% and the number of early-onset cancer deaths increased by 27.7% between 1990 and 2019”. However, focusing on absolute case numbers does not take into account that the global population in the age group 15-49 increased by 45% and in the age group 40-49 (where most incident cases have occurred) by 86% during the study period (see Table S2).
    Both, age specific and age standardized rates show no increase in incidence in incidence and mortality for the period 1995 to 2020 (Figure 5). Age standardized mortality declined substantially during the study period.
    The observed increase in cancer burden in terms of absolute case numbers is largely explained by population growth.

    Conflict of Interest:
    None declared.
  • Published on:
    Epidemic news, but no epidemic of cancer. Comment on Zhao et al: Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019. BMJ Oncology 2023; 2: e000049.
    • Henrik Møller, Lead epidemiologist The Danish Clinical Registries, Denmark
    • Other Contributors:
      • Janne Pitkäniemi, Director
      • Giske Ursin, Director

    Epidemic news, but no epidemic of cancer. Comment on Zhao et al: Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019. BMJ Oncology 2023; 2: e000049.

    We were surprised to see the suggestion by Zhao et al of a dramatic increase globally of cancer in young persons. This conclusion does not fit with what we have observed in our own countries over the past decades. However, important trends can be overlooked, and we therefore used the NORDCAN database, covering currently more than 27 million persons, to assess changes from 1990 until 2020. An advantage of the Nordic countries is that we can easily assess cancer cases and compute rates, as we have solid population counts (denominator estimates) at any point in time.

    Zhao et al report 79% increase in actual number of cases from 1990 to 2019, but this figure can be misleading, as it does not take account of population growth. The authors therefore also report estimated annual percent change (EAPC) of the incidence rates of various cancers. However, it is unfortunate that the press has largely focused on the overall number rather than the per capita risk of cancer, giving the impression that we are facing an epidemic of cancer in young individuals.

    Using the publicly available NORDCAN database, we find less of an increase over time than reported by Zhao et al. The average annual increase in the cancer incidence rate in 15-49 year old people in the Nordic countri...

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    Conflict of Interest:
    None declared.
  • Published on:
    military war data
    • kristi hilton, retired combat veteran military United States Military soldier

    During the time you gathered this data there was war going on with Iraq and Afganistan. I had breast cancer within 2 years of returning from Iraq that was not BRAC positive. Studies in the United States show that female soldiers are 40% higher in having breast cancer after deployment around age 40. Your data didn't take in to account how many military people had cancer.
    Study on Incidence of Breast Cancer Among Active Duty Service Members -

    Conflict of Interest:
    None declared.
  • Published on:
    Accounting for increase in global population

    My interest in this article was drawn after reading a news article that reported the 80% increase in early-onset cancer incidence. After reading the research paper quickly, I am left with one question. Is this 80% increase corrected for with the global increase in population? Because in the same period (1990-2019) as the 80% increase, the world population increased by around 45% (from 5.3 billion to 7.7 billion). The population under 50 years of age probably increased a little it less.

    I do not see any mention of this increase in population in the article, but maybe I missed it as I am not familiar with the methods in this research field. I would say this increase could, at least partially, explain the increase in early-onset cancer incidence. Because if there are more people, and the percentage of cancer-incidence remains the same, there will be more cases in absolute numbers.

    Conflict of Interest:
    None declared.