The GBD cancer estimation process starts with mortality.
Mortality estimates are made based on vital registration system (83% of data), cancer registry (16% of data) (eTable 3 in the Supplement), and verbal autopsy data (1% of data) using an ensemble model approach.9 (link),10 (link) Predictive covariates used in the model can be found in the eAppendix (eTable 8 in the Supplement). Single-cause mortality estimates are scaled into the separately estimated all-cause estimate.9 (link) To estimate cancer incidence, mortality estimates are divided by a separately estimated MIR for each cancer type, sex, 5-year age group, location, and year; additional information regarding incidence and MIR estimation can be found in the eAppendix and eFigure 2 in the Supplement. Data sources used for estimating MIRs are described in eTable 2 in the Supplement. MIRs allow for a uniform method to estimate incidence. Other cancer estimation frameworks11 (link),12 (link) have set a precedent for using MIRs for decades and have detailed its benefits, including greater representativeness, especially in settings that lack quality or complete population-based cancer registry systems. By determining incidence using mortality, we are able to account for uncaptured incident cases and, if mortality and incidence are determined correctly, estimating incidence based on MIRs should result in the similar results if using incidence directly. The correlation between survival data and the MIR is used to estimate 10-year cancer prevalence. Total prevalence is partitioned into 4 sequelae: (1) diagnosis/treatment, (2) remission, (3) metastatic/disseminated, and (4) terminal phase. Each sequela prevalence is multiplied by a disability weight to estimate YLDs. Lifetime prevalence of procedure-related disability is estimated for larynx, breast, colorectal, bladder, and prostate cancers. A standard life expectancy is used to estimate years of life lost (YLLs).9 (link) DALYs are the sum of YLDs and YLLs. To determine the contribution of population aging, population growth, and change in age-specific rates on the change in incident cases between 2007 and 2017, we use hypothetical demographic scenarios holding 2 of these 3 components constant. Results are stratified by quintiles of Socio-demographic Index (SDI), which is a composite indicator including fertility, education, and income.7 (link)
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