i Global Health Metrics Total cancers Summary Total cancers resulted in 23-6 million (22-2-24-9) incident cases, 10-0 million (9-36-10-6) deaths, and 250 million (235-264) DALYs globally in 2019. Total cancers was the second-leading cause of death and second-leading cause of DALYs among Level 2 causes globally in 2019. Definition This summary cause incorporates death and disability resulting from malignant neoplasms, including ICD-10 codes such as C00-C96. This category includes non-melanoma skin cancers but excludes benign and in-situ neoplasms. Total sources Incidence 4317 Prevalence 3 Remission 0 Causes of death 5466 Other 268 Table 1:Total sources used in GBD 2019 estimation What is new in GBD 2019? • New location-years of population-based cancer registry data were added, with a focus on paediatric cancer data. • Age restrictions for modelling were updated using incidence data from the Surveillance, Epidemiology, and End Results prog ramme. • Garbage code redistribution of cancer causes was updated to incorporate additional coding systems and improve mapping of codes that include secondary cancers. • Mortality-to-incidence ratio models included additional data and were modified to perform more smoothing acrosstimeandage. • Survival estimation was updated to use age-specific rather than all-ages survival curves, affecting age-specific prevalence andYLD estimates. Prevalence Incidence Deaths YLLs YLDs DALYs Cases Rate (per Cases Rate (per Deaths Rate(per Counts Rate(per Counts Rate (per Counts Rate (per (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) 2019 Both sexes 85-8 1046-7 23-6 290-5 10-0 124-7 242 2951-1 7-84 95-9 250 3047-0 (80-3 to (977-6 to (22-2 to (274-0 to (9-36 to (116-4 to (227 to (2769-2 to (5-76 to (70-5 to (235 to (2856-9 to 92-1) 1122-0) 24-9) 307-1) 10-6) 132-0) 256) 3122-9) 10-1) 124-2) 264) 3222-3) Females 45-2 1056-0 10-6 246-1 4-34 99-9 106 2482-3 3-85 89-6 110 2571-9 (41-8 to (975-2 to (9-92 to (229-8 to (3-97 to (91-5 to (97-9 to (2298-8to (2-82 to (65-7to (101 to (2376-Oto 48-6) 1134-1) 11-4) 263-1) 4-66) 107-3) 114) 2667-9) 4-99) 116-3) 118) 2764-8) Males 40-6 1058-5 12-9 348-7 5-69 156-1 137 3499-5 4-00 105-3 141 3604-7 (37-3 to (975-5 to (12-lto (327-3 to (5-25 to (143-9 to (12 6 to (3226-4 to (2-93 to (77-4 to (130 to (3325-3 to 44-5) 1159-2) 13-8) 370-8) 6-10) 167-2) 147) 3770-3) 5-10) 133-9) 151) 3872-5) Percentage change 2010- 19 Both sexes 287% 2-7% 26-3% -1-1% 20-9% -5-9% 15-7% -6-8% 26-8% 0-7% 16-0% -6-6% (21-2 to (-3-2 to (20-3 to (-5-8 to (14-2 to (-11-0 to (8-8 to (-12-2 to (19-3 to (-5-2 to (9-3 to (-11-9 to 36-3) 8-7) 32-3) 3-5) 27-6) -0-9) 22-6) -1-3) 34-7) 6-8) 22-8) -1-1) Females 26-0% 1-7% 24-7% -1-2% 22-2% -4-4% 17-5% -4-7% 25-0% 0-5% 17-8% -4-6% (17-6 to (-5-1 to (18-0 to (-6-5 to (14-2 to (-10-7 to (9-3 to (-11-5 to (16-2 to (-6-5 to (9-4 to (-11-2 to 34-8) 8-7) 31-5) 4-2) 30-1) 1-7) 25-8) 1-9) 34-0) 7-8) 26-0) 2-0) Males 31-9% 3-8% 27-6% -1-5% 19-9% -7-3% 14-3% -8-4% 28-5% 0-7% 14-7% -8-2% (22-1 to (-3-6 to (19-9 to (-7-1 to (11-0 to (-13-7to (5-1 to (-15-5 to (l8-7to (-6-7 to (5-9 to (-15-0 to 42-1) 11-5) 35-7) 4-4) 29-3) -0-5) 23-9) -0-9) 39-1) 8-8) 24-1) -0-9) Numbers in parentheses are 95% uncertainty intervals. Table 2: Global prevalence. incidence, deaths, YLLs,YLDs, and DALYs in counts and age-standardised rates for both sexes combined, females, and males, 2019, with percentage change between 2010 and 2019 Deaths YLLs YLDs DALYs 1990 2nd 6th 21st 6th 2010 2nd 3rd 20th 3rd 2019 2nd 2nd 20th 2nd Table3'- Rank among Level 2 causes for global deaths, YLLs, YLDs, and DALYs in 1990,2010, and 2019, for both sexes combined □ Oesophageal cancer ■ Brain and central nervous □ Stomach cancer system cancer □ Liver cancer □ Non-Hodgkin lymphoma □ Tracheal, bronchus, and ■ Leukaemia lung cancer ■ Other malignant □ Breast cancer neoplasms □ Cervical cancer O Other causes □ Prostate cancer □ Colon and rectum cancer □ Lip and oral cavity cancer □ Pancreatic cancer □ Ovarian cancer Figure 1: Composition of DALYs by constituent Level 3 causes for both sexes combined, 2019 S44 www.thelancet.com Vol 396 October 17,2020 Global Health Metrics I Smoking Alcohol use High body-mass index Unsafe sex High fasting plasma glucose Ambient particulate matter pollution Occupational exposure to asbestos Diet low in whole grains Diet low in milk Secondhand smoke 10 15 Percentage Figure 2: Percentage of DALYs attributable to top risk factors for both sexes combined, 2019 GBD super-region ■ High income # Central Europe, eastern Europe, and central Asia ♦ South Asia • Southeast Asia, east Asia, and Oceania • Sub-Saharan Africa A Latin America and Caribbean T North Africa and Middle East 8000 6000 o. 4000 * SO SDI Females Males □ YLDs CHYLDs □ ylls CHYLLs 40 000- 30 000- .null -x „t1- jh jh jh jh jh jh & jh jh jh & jh jh jh & jh jh jh jh jh ^ » » v * ^ * » » w » » » » «• » » » » 9 jP- . j~3> j~3> j~3> yli." \ť~ \Vs \Vs \Vs \Vs \Vs \^ Age group Figure 3: Age-standardised DALY rates for each location by SDI, both sexes combined, 2019 Figure 4- Composition of DALYs by YLLs and YLDs, age group, and sex, 2019 Figure 5: Age-standardised DALY rates (per 100 000) by location, both sexes combined, 2019 www.thelancet.com Vol 396 October 17,2020 S45