Burden of cancer in Africa, 1990–2023: a systematic analysis from the Global Burden of Disease Study 2023

In 2023, Africa recorded 1.50 million (95% UI 1.32–1.68 million) new cases of cancer, corresponding to an age-standardised incidence rate of 166.9 per 100,000 (148.8–185.9). New cases were higher in females (941,000; 808,000–1,110,000) than in males (553,000; 478,000–627,000), yielding a female-to-male ratio of 1.70 (1.68–1.77). In the same year, cancer caused 923,000 deaths (824,000–10,200,000) in Africa, with an age-standardised death rate of 114.2 per 100,000 (100.6–125.8). Female deaths numbered 505,000 (441,000–570,000) and male deaths 417,000 (350,000–481,000), resulting in a female-to-male death ratio of 1.21 (1.18–1.26). Overall, cancer accounted for 33.94 million DALYs (30.62–37.10 million), of which 98.2% (97.9–98.3%) were attributable to years of life lost (YLLs) and 1.8% (1.7–2.1%) to years lived with disability (YLDs). Between 1990 and 2023, new cancer cases increased by 210.5% (160.8–263.4), deaths by 185.0% (151.9–219.4), and DALYs by 162.5% (128.5–194.9). Over the same period, the age-standardised incidence rate rose by 23.7% (5.9–42.5%), the age-standardised death rate by 15.5% (2.3–31.9%), and the age-standardised DALY rate changed by 11.5% (–1.6–24.6) for both sexes combined. The distribution of cancer across regions in 2023 differed for age-standardised incidence and mortality rates. In 2023, the age-standardised cancer incidence rate was highest in the Southern Sub-Saharan Africa (203.8 [95% UI 188.0–226.3]) and lowest in the Western Sub-Saharan Africa (143.1 [122.9–161.7]). Similarly, the highest age-standardised death rate was in the Central Sub-Saharan Africa (139.0[111.3–159.9]), while the lowest was the Northern Africa (96.2 [83.5–109.6]; table 1 and 2)

Table 1, Figure 2, and Supplementary Tables S1–S2 present the burden of cancer across African countries and regions in 2023, stratified by sex. The highest age-standardised death rates were observed in Equatorial Guinea (178.6per 100,000; 95% UI143.9–208.1), Ethiopia (169.9; 147.5–190.5), Madagascar (161.3; 137.8–187.9), South Sudan (161.3; 137.8–185.2), and Uganda (155.7; 137.2–174.7) for both sexes. In contrast, the lowest rates were recorded in Algeria (62.6; 47.9–77.6), Gambia (58.8; 47.7–71.2), and the Comoros (53.0; 45.9–60.2). Between 1990 and 2023, the largest relative increases in age-standardised death rates occurred in Equatorial Guinea (74.8% [37.8–124.7]), Ethiopia (53.5% [27.3–91.3]), Gabon (46.9% [22.4–81.2]), and Congo (43.5% [22.3–75.4]) for combined sexes. The leading causes of cancer burden in Africa varied widely across countries and between sexes in 2023. In both sexes combined, breast cancer was the predominant cause of cancer DALYs in 22 countries, followed by cervical cancer in 20 countries, liver cancer in five countries, and tracheal, bronchus, and lung cancer in four countries. Among males, prostate cancer was the leading cause of cancer death in 39 countries, whereas liver cancer and tracheal, bronchus, and lung cancer each ranked first in five countries. Among females, breast cancer was the leading cause of cancer death in 34 countries, followed by cervical cancer in 21 countries. Marked heterogeneity was observed across regions and nations, reflecting differences in exposure to infection-related and lifestyle-related risk factors, health system capacity, and cancer prevention and control efforts. Figures 3A and 3B and appendix figures S1 and S2 show the leading causes of cancer death and DALYs by sex across African countries and subregions. Detailed estimates of age-standardised incidence (ASIR), death (ASDR), and DALY rates for each cancer type (Levels 3 and 4) across all nations, subregions, and the continent overall are provided in the supplementary results (file 2), stratified by sex for 2023.

In 2023, the age-standardised incidence rate (ASIR) of cancer in Africa was 189·6 per 100 000 population (95% uncertainty interval [UI] 163·8–220·9) in females and 145·1 per 100 000 (124·6–165·3) in males. The corresponding age-standardised death rates (ASDRs) were 112·3 per 100 000 (97·1–126·0) in females and 118·5 per 100 000 (97·8–137·9) in males. Although incidence was higher among women, mortality rates were similar between sexes, reflecting differences in cancer type distribution and access to early detection and treatment. Among females, breast, cervical, colorectal cancer, liver cancer and stomach cancer were top five leading causes of cancer deaths in 2023. Together, cervical and breast cancer accounted for more than half of all female cancer cases (53.7% [43.9-62.0]), 45.9% (37.3-54.7) of deaths, and 47·6% (37.8-57.3) of DALYs (appendix pp S3–S10). In contrast, among males, prostate, liver cancer, tracheal–bronchus–lung, and colorectal accounted for 44·7% (35.9-55.1) of incident cases, 51.2% (41.1-62.6) of deaths, and 42·2% (33.1-52.1) of DALYs. The predominance of infection-related cancers among women and the growing burden of prostate and metabolic-related cancers among men underscore Africa's dual transition in cancer risk profiles and the need for sex-specific prevention and treatment strategies.

Childhood cancers remain a major public health concern in Africa, contributing substantially to premature mortality and long-term disability among children. In 2023, childhood cancer ranked as the sixth most common cancer by incidence, the ninth leading cause of cancer death, and the 11th leading cause of cancer-related DALYs in both sexes combined.

An estimated 80 200 (95% uncertainty interval [UI] 63 600–100 600) new cases and 41 400 (35 600–49 100) deaths occurred in 2023, resulting in 3·50 million (3·01–4·17) DALYs across the continent. These figures accounted for 5·3% (4·8–6·0) of all incident cases, 4·5% (4·3–4·8) of all deaths, and 10·3% (9·8–11·3) of total DALYs in the region. Leukaemia, non-Hodgkin lymphoma, brain and central nervous system (CNS) cancers, and malignant neoplasms of bone and articular cartilage were the leading causes of childhood cancer incidence in Africa, with corresponding age-standardised incidence rates of 1·6 (1·0–2·1), 1·3 (0·9–1·8), 1·0 (0·7–1·2), and 0·7 (0·5–1·0) per 100 000 population, respectively (appendix pp S11–S13). Despite relatively low incidence compared with adult cancers, the high fatality and DALY burden highlight persistent diagnostic delays, limited access to specialised paediatric oncology care, and inadequate treatment capacity across many African health systems.

In 2023, adolescent and young adult cancers (ages 15–39 years) in Africa accounted for 24·1% (22·5–26·1) of all cancer cases, 16·3% (16·0–16·9) of all cancer deaths, and 26·6% (25·8–27·8) of total cancer disability-adjusted life-years (DALYs). Among older adults aged 40–64 years, cancers contributed 44·7% (43·6–44·6) of all cancer cases, 43·0% (42·6–43·3) of all cancer deaths, and 44·8% (43·9–45·5) of total cancer DALYs. These findings indicate that cancer disproportionately affects individuals in adolescent and middle adulthood in Africa, with substantial contributions to both mortality and disease burden. In contrast, cancers in older adults aged 65 years and older comprised 25·1% (25·3–25·9) of all cancer cases, 36·2% (34·6–37·3) of all cancer deaths, and 18·3% (17·4–19·0) of total cancer DALYs. Although older adults experienced higher mortality rates, their overall contribution to cancer burden in terms of DALYs was comparatively lower.

In 2023, 33·1% (95% uncertainty interval [UI] 28·7–37·2) of cancer deaths and 31·6% (26·8–35·9) of cancer DALYs in Africa were attributable to all risk factors combined. Behavioural risks accounted for the largest share of cancer deaths at 27·0% (22·2–31·5), followed by metabolic risks at 5·9% (4·0–8·0) and environmental and occupational risks at 2·9% (2·0–3·8). The leading three Level 2 risk factors for both sexes combined in 1990 were unsafe sex, tobacco, dietary risks and high alcohol use, while in 2023 they were unsafe sex, tobacco, dietary risks, and high body-mass index.

The proportion of cancer deaths attributable to risk factors was higher among females (38·1% [31·3–44·6]) than males (27·1% [23·3–31·2]). Among females, the leading Level 2 risk factors contributing to cancer deaths were unsafe sex, dietary risks, high body-mass index, and tobacco use. Among males, the leading risk factors were tobacco use, high alcohol consumption, dietary risks, and air pollution. The proportion of deaths attributable to risk factors increased only modestly over time—from 29·8% (95% UI 25·7–34·4) in 1990 to 31·4% (27·1–35·7) in 2010—representing a 22·0% (2·0–48·6) overall rise in age-standardised risk-attributable cancer death rates from 1990 to 2023. In 2023, unsafe sex was the leading individual risk factor for cancer mortality in Africa, accounting for 108 000 deaths (74 000–151 000), followed by tobacco use (72 000 [55 000–94 000]), dietary risks (50 000 [15 000–85 000]), and high body-mass index (33 000 [15 000–52 000]) in both sexes combined. These findings highlight the persistent dominance of infection-related cancers among women and tobacco- and metabolic-related cancers among men, underscoring the need for integrated prevention strategies tailored to regional and sex-specific risk profiles.