Global Burden of Urologic Cancers, 1990-2013

Context: Kidney, prostate, and bladder cancers increase with age and are influenced partly by modifiable risk factors. Urological cancer rates may increase substantially amid a growing, aging population. Objective: To describe kidney, bladder, and prostate cancer incidence, mortality, and risk factor-attributable bladder and kidney cancer deaths between 1990 and 2013, by age, sex, and development status. Evidence acquisition: Cancer mortality data were derived from global vital registries. Incidence data from cancer registries were transformed to mortality estimates using separately estimated mortality incidence ratios. These sources served as input data for an ensemble modeling approach to estimate bladder, prostate, and kidney cancer mortality. Cause-specific mortality estimates were transformed into incidence estimates using mortality incidence ratios. Evidence synthesis: In 2013, 2.1 million kidney, bladder, and prostate cancers cases occurred worldwide, increasing 2.5-fold since 1990. Mortality increased 1.6-fold between 1990 and 2013. Eight-two percent of new cases in 2013 occurred in individuals aged 60 yr and older. Men from developed countries had the highest age-standardized death rates among all three cancers. Smoking-attributable kidney cancer deaths decreased while obesity-related deaths rose, most prominently in women from developing countries. Smoking-related bladder cancer deaths increased among women from developed countries and decreased among men. Conclusions: Urologic cancer burden has increased globally amid population growth and aging. High income countries face the highest incidence and death rates; however, obesity-attributed kidney cancer deaths are increasing in developing countries. Efforts to expand the global oncologic workforce and reduce preventable factors may lessen cancer disparities in developing countries. Patient summary: We describe the impact of population growth, aging, and lifestyle factors such as smoking and obesity, on kidney, bladder, and prostate cancer rates worldwide. More new cancer cases and deaths occur in developed countries compared with developing countries. In addition to preventive efforts, healthcare systems must emphasize training of a urologic oncology workforce. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.