The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Trente ans de lutte contre l’onchocercose en Afrique de l’Ouest. Traitements larvicides et protection de l’environnement

La lutte contre l'onchocercose, ou cécité des rivières, une maladie parasitaire endémique, fut entreprise en Afrique de l'Ouest dans une perspective do développement durable. Tous les moyens technologiques disponibles ont de ce fait été mobilisés pour le contrôle du vecteur, une simulie, puis du parasite responsables de cette maladie, par le Programme de Lutte contre l’Onchocercose en Afrique de l'Ouest (OCP). La lutte antivectorielle consistant en épandages d’insecticides chimiques sur les sites de développement de la simulie dans les rivières, il est apparu indispensable d’assurer la sauvegarde de l’environnement aquatique qui fournit aux communautés riveraines eau et ressources biologiques. Les technologies les plus modernes ont été mises en œuvre dès leur mise au point, pour combattre la maladie, contribuant ainsi à la protection de ce milieu. Le programme de surveillance écologique des rivières traitées par des larvicides anti-simulies a été mis en place dès le lancement d’OCP. et assuré par des spécialistes de I' hydrobiologie des pays africains participants du Programme, sous la supervision d’un groupe international d’experts indépendants, le Groupe Écologique. OCP est incontestablement un succès aussi bien pour ce qui est du contrôle de la maladie que de la protection de l'environnement. Il est l'exemple unique au monde d’un programme de santé publique de longue durée qui depuis son origine a mis en œuvre tout ce qui était possible pour harmoniser les enjeux de l’amélioration de la santé et ceux de la protection de l’environnement. Il s'est achevé avec la satisfaction de laisser aux générations montantes un environnement non dégradé et des vallées libérées de l’onchocercose, qui permettront d’accroître la productivité agricole des pays africains.The control of onchocerciasis, or river blindness, an endemic parasitic disease, was implemented in West Africa in the perspective of sustainable development AH the available technological means to fight this disease, by way of the control of its blackfly vector, then its parasite, were therefore implemented by the Onchocerciasis Control Programme in West Africa (OCP). Vector control being achieved through applications of chemicals on its river breeding sites, it was necessary, at the same time, to fight for the preservation of the aquatic environment, which supplies the communities that live along the rivers with water and biological resources. This was the spirit in which the OCP was set up and implemented, and the most modem technologies were used as they become available to fight the disease, thus facilitating the preservation of the aquatic environment. This Programme has indisputably been a success as regards the control of the disease as also from the point of view of the preservation of the environment The aquatic monitoring programme of the rivers under treatment with anti-simulid larvicides was set up right from the very beginning, and performed by national experts of the Participating Countries of the Programme, under the aegis of a group of international independent experts, the Ecological Croup The Onchocerciasis Control Programme in West Africa is an unique example in the world of a long-term public health programme which has made every effort possible from its inception to adequately combine health and environment issues. It ended with the satisfaction of bequeathing to the coming generations a non degraded environment and valleys freed from onchocerciasis which would increase the agricultural productivity of the countries