Malignant neoplasms, malignant tumors or cancers, are leading causes of death in the Region of the Americas. An estimated 40% of cancers can be prevented through healthy lifestyles. A third of cancers can be diagnosed at early stages through screening and early detection programs. All people with cancer can benefit from appropriate treatment and palliative care.

This visualization presents the level and trends of mortality and burden of malignant neoplasms (all malignant cancers combined), 23 types of cancer, and a group of other malignant neoplasms, by age, sex, and year across countries of the Americas from 2000 to 2019.

Mortality

In 2019, regionwide cancer (all malignant neoplasms combined) accounts for:

  • 1.4 million deaths, 706,653  deaths in men, and 654,124 deaths in women.
  • The age-standardized death rate due to cancer was estimated at 115.7 deaths per 100,000 population.
  • Age-standardized deaths rates from cancer vary across countries from a high in Grenada (155.2 deaths per 100,000 population) to a low in El Salvador (68.7 deaths per 100,000 population).
  • For most countries, age-standardized death rates from cancer are higher in men than women, except in Bolivia, Guyana, and El Salvador.

Countries with the highest level of age-standardized death rates:

  1. Grenada
  2. Uruguay
  3. Jamaica
  4. Barbados
  5. Saint Vincent and the Grenadines
  6. Cuba
  7. Haiti

Years of life lost due to premature mortality

In 2019, cancer accounted for:

  • 31.0 million years of life lost (YLLs), equivalent to 3,072 years per 100,000 population.
  • The number of YLLs increased from 25.2 million years in 2000 to 31.0 million years in 2019.
  • The crude YLL per population remained constant from 2000 to 2019.
  • The age-standardized YLL per population slightly decreased from 2000 to 2019. 

Countries with the highest level of age-standardized YLL rates:

  1. Uruguay
  2. Grenada
  3. Saint Vincent and the Grenadines
  4. Jamaica
  5. Barbados
  6. Cuba
  7. Haiti

The top 5 types of cancers impacting the years of life lost due to premature mortality are:

  1. Trachea, bronchus, lung cancers
  2. Breast cancer
  3. Colon and rectum cancers
  4. Leukemia
  5. Lymphomas, multiple myelomas

Years lived with disability

In 2019, regionwide, cancer account for:

  • 1.7 million years of life lived with disability (YLDs), equivalent to 168.6 YLDs per 100,000 population.
  • 168.6 YLDs per 100,000 population (crude rate), which increased from 135.7 YLDs  per 100,000 population in 2000.
  • 133.6 YLDs per 100,000 population (age-standardized rate), which decreased from 142.2 yaars per 100,000 population in 2000.

The countries with the highest levels of age-standardized YLDs rates are:

  1. Uruguay
  2. Grenada
  3. Saint Vincent and the Grenadines
  4. Jamaica
  5. Barbados
  6. Cuba
  7. Haiti

The top 5 types of cancers impacting years lived with disability are:

  1. Breast cancer
  2. Prostate cancer
  3. Colon and rectum cancers
  4. Melanoma and other skin cancers
  5. Lymphomas, multiple myelomas
Suggested citation

PAHO. The burden of cancer in the Region of the Americas, 2000-2019. ENLACE data portal. Pan American Health Organization, 2021.

Cancer mortality and burden of disease presented in the visualization

The visualization shows mortality (death rates) and disease burden measures (disability-adjusted life years [DALYs], years lived with disability [YLDs], and years of life lost [YLLs]) due to Malignant Neoplasms (All cancers), and 28 types of cancers. Annual rates per 100,000 population are presented as crude rates for all-ages, age-specific rates, and age-standardized rates by sex and location for the period 2000 to 2019.

Crude death rates equal the total number of cancer deaths during a specific year in the population category of interest, divided by the at-risk population for that category and multiplied by 100,000.

Crude rates don't take into account the population's age distribution, so they are influenced by the underlying age distribution of the country’s population. In one location or population group with an older population, the death rate will be higher than a location with a younger population as cancer mortality increases with age. For this reason, crude rates are not a good measure for comparing mortality between two or more countries of population groups. A population's age distribution (the number of people in particular age categories) can change over time and be different in different geographic areas.

Age-standardized death rates ensure that variations in the risk of mortality between geographic areas and from one year to another are not due to differences in the age distribution of the populations being compared. The World Standard Population was used to compute the age-standardized death rates by the direct method of standardization.

The direct method of rate standardization

In the direct method of age standardization, an age-standardized rate is a weighted average of the age-specific (crude) rates, where the weights are the proportions of persons in the corresponding age groups of a standard population. The potential confounding effect of age is reduced when comparing age-standardized rates computed using the same standard population.

Crude, age-standardized, and age-specific death, DALYs, YLDs, and YLLs rates are used to plan for population-based cancer prevention and control interventions.

DATA CLASSIFICATION

The data is presented in five discrete classes created using the quantile classification method in the map and horizontal bar chart. Each class contains 20% of countries, which is easy to interpret. The quintile classes are labeled sequentially from Quintile 1 as the first quintile including the lowest fifth (0 to 20%) of the data to Quintile 5, the fifth quintile representing the class with the highest fifth (80% to 100%) of the data.

INDICATOR DEFINITION

Measure: Death, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) due to premature death.  

Metric: Rate.

Unit of measurement: For mortality measures: deaths per 100,000 population. For measures of burden of disease: years per 100,000 population. 

Topic: Mortality and burden of disease.

Rationale: Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries affect people–to assess the effectiveness of a country’s health system. Statistics of causes of death and disease burden help health authorities focalize and prioritize public health actions.

Definition: Crude (all-ages) death rates due to cancer were calculated as the number of deaths due to cancer in a year, sex, and location divided by the total population in the given year, sex and location and multiplied by 100 000. Death rates were age-standardized by the direct method using the WHO world standard population. 

Cancer types and ICD-10 codes:

The full list of cause categories and corresponding ICD-10 codes is included in the WHO methods and data sources for country-level causes of death 2000-2019, Annex A, page 62.

The cause list is organized hierarchically with four levels of aggregation. The cause list is mutually exclusive and collectively exhaustive at every level of aggregation; causes not individually specified are captured in residual categories, such as “Other malignant neoplasms”.  

Disaggregation: Age, Sex, Country, and Year.

The categories "All-ages", and "Age-standardized" from the dimension Age, combined with the metric "Rate" have the following meaning:

  • All-ages indicate that the rate is crude (without removing the effect of age distribution across population groups).
  • Age-standardized indicates that the rate refers to all ages but the rate was age-standardized by the direct method using the WHO world standard population.

Method of estimation: Mortality estimates by cause, age, sex, location (countries, and the region) were extracted from the WHO Global Health Estimates (GHE) 2019. These estimates represent WHO's best estimates, computed using standard categories, definitions, and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to input data and methods changes, these estimates are not comparable to previously published WHO estimates.

Methodological details:

Data sources and methods for estimating causes of deaths and burden of diseases are described in the following documents:

As part of the estimation methods, deaths due to cancers with unspecified sites (ICD10 codes C76, C80, C97) were distributed pro-rata to all sites excluding liver, pancreas, ovary, and lung. Additionally, deaths coded as cancer of the uterus, part unspecified (C55) are distributed pro-rata to cervix uteri (C53) and corpus uteri (C54). 

Method of estimation of global and regional aggregates: Computed by aggregating both the absolute measure (number of deaths, DALYs, YLDs, YLLs) as the numerator and population estimates from the World Population Prospect 2019, produced by the UN Population Division, as denominators for all countries included in the region.

Preferred data sources: Civil Registration and Vital Statistics (CRVS) system with complete coverage and medical certification of cause of death.

The Pan American Health Organization is working with countries in the Americas to reduce premature deaths from non-communicable diseases (NCDs), including cancer, by 25% relative to the 2010 level by the year 2025, and as part of the 2030 UN Agenda for Sustainable Development (SDG) by one-third relative to the 2015 level to be reached in 2030.

Through PAHO's Plan of Action for the Prevention and Control of NCDs in the Americas 2013-2019, launched in 2013, the Organization promotes the reduction of tobacco use and harmful use of alcohol, promotes healthy diet and increased physical activity, supports the introduction of HPV vaccines and HPV testing to prevent cervical cancer, and promotes improvements in quality and access to early diagnosis of breast cancer. PAHO also supports improvements in radiotherapy services and access to affordable essential chemotherapy drugs; and promotes the expansion of palliative care policies, programs, and opioids for pain relief and symptom management.

Strategies proposed by PAHO/WHO to reduce the risk of cancer and other noncommunicable diseases include:

  • Increasing taxes, restricting access, and warning about the dangers of tobacco and harmful use of alcohol;
  • Promoting public awareness about healthy diet, physical activity, and healthy weight
  • Immunizing infants against hepatitis B to prevent liver cancer, and immunizing girls against human papillomavirus to prevent cervical cancer;
  • Organizing screening programs for cervical cancer and breast cancer to detect them at early stages, when they are more amenable to treatment;
  • monitor the cancer burden (as part of the work of the Global Initiative on Cancer Registries);
    identify “best buys” and other cost-effective, priority strategies for cancer prevention and control;
  • develop standards and tools to guide the planning and implementation of interventions for prevention, early diagnosis, screening, treatment, and palliative and survivorship care for both adult and child cancers;
  • strengthen health systems at national and local levels to improve access to cancer treatments;
  • support governments to improve survival for childhood cancer through directed country support, regional networks and global action as part of the WHO Global Initiative for Childhood Cancer using the CureAll approach; and 
  • provide technical assistance for rapid, effective transfer of best practice interventions to countries.
  1. WHO. WHO methods and data sources for country-level causes of death 2000-2019. Geneva: World Health Organization; 2020. Available online (accessed 1 February 2021).
  2. WHO. WHO methods and data sources for global burden of disease estimates, 2000-2019. Geneva: World Health Organization, 2020. Available online (accessed 1 February 2021).
  3. PAHO. Methodological Notes, NMH Data Portal. Pan American Health Organization. 2021
  4. WHO. Factsheet: Cancers. World Health Organization. Available online (accessed 17 June 2021).

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