Burden of cancer in Africa, 1990-2023: a systematic analysis from the Global Burden of Disease Study 2023.
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BACKGROUND: Cancer remains a leading cause of death and disability worldwide, with a disproportionately rising burden across Africa. Effective policy responses have been consistently hampered by fragmented and incomplete cancer surveillance data. Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we estimated the burden of 48 cancer types across all 54 African countries over the period 1990 to 2023. These age-disaggregated and sex-disaggregated findings provide a crucial empirical foundation to inform regional control strategies and monitor progress towards global health targets. METHODS: We applied GBD 2023 methodology to estimate fatal and non-fatal outcomes of cancer alongside risk-attributable burden from 88 modifiable risk factors, across all 54 African countries. The estimation of cancer burden attributable to risk factors followed the comparative risk assessment framework. Estimates of incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were stratified by age, sex, location, and year (1990-2023) and reported as counts and age-standardised rates per 100 000 population. Mean estimates represent the mean across 250 draws, with 95% uncertainty intervals calculated from the 2·5th and 97·5th percentiles. FINDINGS: In 2023, cancer, including non-melanoma skin cancer, accounted for an estimated 1·54 million (95% uncertainty interval 1·37-1·75) incident cases, 923 000 (824 000-1 020 000) deaths, and 33·9 million (30·6-37·1) DALYs across all ages and both sexes in Africa, of which 98·2% (97·9-98·3) were attributable to YLLs. In Africa, 10·7 million (8·9-12·9) DALYs and 306 000 (254 000-363 000) cancer deaths in 2023 were attributable to the 88 risk factors assessed in GBD 2023, equivalent to 31·6% (26·8-35·9) of total DALYs and 33·1% (28·7-37·2) of total cancer deaths across all ages and both sexes. Between 1990 and 2023, deaths attributable to risk factors increased by 216·0% (159·3-284·5) for both sexes combined. In 2023, incident cancer cases in females numbered 960 000 (821 000-1 130 000), with breast and cervical cancers together accounting for 53·5% (44·7-62·2) of all female incident cases. In males, prostate, liver, tracheal, bronchus and lung, and colorectal cancers were the leading types, together accounting for 44·8% (36·2-54·3) of all male cancers in Africa in 2023. Childhood cancer (ages 0-19 years) in Africa accounted for 104 000 (84 600-130 000) incident cases and 54 700 (47 500-64 500) deaths, representing 27·7% (26·6-29·4) of global incidence and 38·0% (36·3-40·0) of global deaths in 2023. Cancers in adolescents and young adults (ages 15-39 years) contributed 26·6% (26·4-27·5) of total cancer DALYs in Africa, those in older adults aged 40-64 years contributed 44·8% (43·8-45·6), and those in adults aged 65 years and older contributed 18·3% (17·4-19·1). INTERPRETATION: Cancer is a growing contributor to the disease burden in Africa, with rising cases, deaths, and DALYs disproportionately affecting children, adolescents, and young adults. The increase in age-standardised mortality and DALY rates stands in sharp contrast to the ambitions of the Sustainable Development Goals for 2030 and the African Union Agenda 2063. Addressing this burden will require coordinated national and international action, with health-system strengthening and context-specific cancer-control strategies spanning prevention, early diagnosis, and treatment. FUNDING: Gates Foundation.