IJC

International Journal of Cancer

Estimating the global cancer incidence and mortality in 2018:

GLOBOCAN sources and methods
1
J. Ferlay , M. Colombet1, I. Soerjomataram1, C. Mathers3, D.M. Parkin 2
, M. Piñeros1, A. Znaor 1
and F. Bray 1

1
Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex, 08, France
2
Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
3
Mortality and Health Analysis, World Health Organization, Geneva, Switzerland

Estimates of the worldwide incidence and mortality from 36 cancers and for all cancers combined for the year 2018 are now
available in the GLOBOCAN 2018 database, compiled and disseminated by the International Agency for Research on Cancer
(IARC). This paper reviews the sources and methods used in compiling the cancer statistics in 185 countries. The validity of the
national estimates depends upon the representativeness of the source information, and to take into account possible sources

Cancer Epidemiology
of bias, uncertainty intervals are now provided for the estimated sex- and site-specific all-ages number of new cancer cases
and cancer deaths. We briefly describe the key results globally and by world region. There were an estimated 18.1 million
(95% UI: 17.5–18.7 million) new cases of cancer (17 million excluding non-melanoma skin cancer) and 9.6 million (95% UI:
9.3–9.8 million) deaths from cancer (9.5 million excluding non-melanoma skin cancer) worldwide in 2018.

Introduction 20 world regions is provided elsewhere.4 This paper reviews

GLOBOCAN 2018 updates the previously published estimates
of cancer incidence and mortality in the year 2012.1 The basic
units for estimation are countries, although we also present
aggregated results globally and in 20 world regions, as defined
by the United Nations.2 The list of cancer sites available in the
2018 edition of GLOBOCAN has significantly increased—with
36 cancer sites (alongside other and unspecified cancers and
all cancers combined) estimated by sex and for 18 age groups.
The methods of estimation in assembling regional and
global profiles still rely upon the best available data on cancer
incidence and mortality at the country level, but for the first
time we also present uncertainty intervals attached with the
estimates, in order that GLOBOCAN 2018 complies with the
Guidelines for Accurate and Transparent Health Estimates
Reporting (GATHER).3 Facilities for the tabulation and
graphical visualisation of the full dataset of 185 countries and
world regions by sex can be accessed via the Global Cancer
Observatory (GCO) homepage (http://gco.iarc.fr). A complete
assessment of the geographic variability observed across
Key words: incidence, mortality, cancer, global estimates,
GLOBOCAN
Additional Supporting Information may be found in the online
version of this article.
DOI: 10.1002/ijc.31937
History: Received 1 Aug 2018; Accepted 10 Oct 2018;
Online 23 Oct 2018
Correspondence to: Jacques Ferlay, Section of Cancer Surveillance
International Agency for Research on Cancer, 150 Cours Albert
Thomas, 69372 Lyon Cedex 08, France, E-mail: ferlayj@iarc.fr; Tel.:
+33 (0)4 72 73 84 90
the sources and methods used in compiling cancer incidence
and mortality estimates for 2018 in 185 countries or territories
worldwide.
Data
Incidence data are produced by population-based cancer regis-
tries (PBCR). Although PBCR may cover national populations,
more often they cover smaller, subnational areas, and, particu-
larly in countries undergoing development, only selected
urban areas. According to the most recent incidence data sup-
plied by PBCR at IARC for Cancer Incidence in Five Conti-
nents (CI5) Vol. XI5 or by the African Cancer Registry
Network,6 about 24% of the world population was covered by
PBCR around 2010, with lower coverage in South America
(19% of the total population), Asia (15%) and Africa (13%).
While cancer registries in lower resource settings may find it
difficult to match the strict criteria of data quality set for inclu-
sion in CI5, the information generated by PBCR remains of
critical importance to cancer control as a unique and relatively
unbiased source of information on the profile of cancer.7
Mortality statistics are collected and made available by the
WHO.8 Their great advantage is their national coverage and
long-term availability in higher income settings, although
quality of datasets varies. For some countries, coverage of the
population is incomplete, and in others, the quality of cause
of death information is poor. In 2010, one-third of the world
population was covered by official mortality statistics around
2010.8 While almost all countries in the Europe and the
Americas have comprehensive death registration systems,
most African and Asian countries (including the populous
countries of Nigeria, India and Indonesia) do not. In our

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

 2 GLOBOCAN 2018 sources and methods

What’s new?
The GLOBOCAN database, compiled by the International Agency for Research on Cancer (IARC), is updated regularly, providing
timely estimates on national cancer incidence and mortality. Here, the authors, associated with the IARC, describe the data
sources and methods used to compute global cancer incidence and mortality estimates for 38 specific cancers detailed in
GLOBOCAN 2018. The authors further describe novel uncertainty intervals, newly derived from a method incorporating
covariates that contribute to uncertainty in cancer estimation. Uncertainty intervals are presented alongside overall estimates,
which indicate that 18.1 million new cancer cases and 9.6 million cancer deaths occurred globally in 2018.

study, we benefited from additional information from a num-
ber of Chinese PBCR so that, overall, 43% of the world popu-
lation was covered by some form of cancer mortality statistics.
The geographical definition of the regions follows the rules
as defined by the UN, except for Cyprus, which is included in
Southern Europe instead of Western Asia (Fig. 1). The source
Cancer Epidemiology
3 years and with at least 20 cases (all ages) recorded
(method 2a or 2b).
• For 50 countries where no historical national cancer inci-
dence data existed, or where national mortality data was not
available, the most recent cancer incidence rates (as specified
above) from one cancer registry (method 2a, 29 countries) or

of information (incidence and mortality) used to estimate the
burden of cancer in each country is given in the Annex
A. National population estimates for 2018 were extracted from
the United Nations website.2
Methods of Estimation
Cancer incidence and mortality rates for 2018 by sex and for
18 age groups (0–4, 5–9, 10–14, 15–19,...,75–79,80–84, 85 and
over) were estimated for the 185 countries or territories of the
world having a total population greater than 150,000 in 2018.2
Results are presented for 38 major cancer sites or cancer types
as defined by the 10th edition of the International Classifica-
tion of Diseases (ICD-10, version 2010)9 and for all cancers
combined. These are listed in Annex B. One of the major
changes in GLOBOCAN 2018 is the estimate of the incidence
of, and mortality from non-melanoma skin cancers (NMSC,
excluding basal-cell carcinoma [BCC]).
The methods of incidence and mortality estimation
described below are undertaken at the national level and
hence their validity depends upon the representativeness and
quality of the source information from the country itself. The
methods are largely those developed previously for the GLO-
BOCAN 2008 study,10 based on short term predictions or
modelling of mortality to incidence (M:I) or incidence to mor-
tality (I:M) ratios.
Estimates of cancer incidence by country
• For 45 countries with at least six and up to 10 years of
recent national cancer incidence data available, correspond-
ing rates for 2018 were predicted using short-term predic-
tion models developed at IARC based on the prediction
methods of Dyba and Hakulinen.11 Cancer- and sex-specific
prediction models were fitted only when at least 50 cancer-
specific cases for all ages were recorded per year. This
method (denoted method 1) has proved to be sufficiently
robust for short-term predictions of incidence.12 For the
cancer and sex combinations where these criteria were not
satisfied, the rates for 2018 were derived from the annual
average rates recorded in the most recent period of at least
from multiple registries (method 2b, 21 countries) within the
country were used as proxy for 2018.
• When registries were subnational and where national mor-
tality data were available, national incidence was estimated
from national mortality using statistical models, with the
fitted mortality to incidence (M:I) ratios derived from
recorded data from one or more cancer registries within the
country (method 3a, 14 countries) or derived from recorded
data from neighbouring countries, with M:I ratios between
countries scaled according to levels of Human Development
Index (HDI)13 (method 3b, 37 countries). These comprised
one model for Africa; one for Caribbean; two for Asia; two
for Europe and one for Oceania (see Annex C).
• When neither national or subnational registries, nor
national mortality data were available, and the within-
country source information was considered to lack the nec-
essary level of accuracy, a set of age- and sex-specific
national incidence rates for all cancers combined were
obtained averaging overall rates from neighbouring coun-
tries. These rates were then partitioned to obtain the
national incidence for specific sites using available cancer-
specific relative frequency data (method 4, 7 countries).
• When neither national or regional registries, nor national
mortality data were available, and the within-country
source information was either unavailable or compatible,
average incidence rates from neighbouring countries in the
same region were used to derive national incidence within
the country (method 9, 32 countries).
Estimates of cancer mortality by country
To maximise comparability across countries, deaths coded to ill-
defined categories (ICD-10, chapter XVIII)9 were redistributed
pro rata across cancers (malignant neoplasms ICD-10 ‘C’ cate-
gory) and all other causes excluding injuries, by year and sex.
The corrected “cancer deaths” ‘C’ category was then partitioned
into cancer-specific categories using proportions from the uncor-
rected data. Vital registration is also known to be incomplete
during the period under study for some countries and the source
data were therefore corrected using the estimated completeness

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

Ferlay et al.
Figure 1. Global map showing the 20 world regions. [Color figure can be viewed at wileyonlinelibrary.com]
as reported by the WHO14 when necessary. Depending on the
coverage, completeness and degree of detail of the mortality data
available, four methods were utilised:
• For 81 countries where national mortality data were avail-
able historically and a sufficient number of recorded cancer
deaths were available, mortality rates were, as for incidence,
projected to 2018 using the short-term prediction models
and applied to the 2018 national population estimate
(method 1)
• When recent mortality data were available from national or
subnational sources, the most recent mortality rates from
one source within the country (method 2a, 19 countries) or
from multiple sources (method 2b, 1 country) within the
country, were used as proxy for 2018.
• For 81 countries where recent mortality data were not
available, national mortality was estimated from national
incidence using statistical models, with the fitted incidence
to mortality (I:M) ratios derived from recorded data from
cancer registries, with I:M ratios between countries scaled
according to levels of HDI (method 3). These comprised
two models for Africa; three for Asia and one for Oceania
(see Annex C).
• When recent mortality data were not available from
national sources, and I:M ratios could not be derived using
the previous method, the country-specific rates represent
simply those of neighbouring countries in the same region
(method 9, 3 countries).
Random fluctuations in the predicted age-specific inci-
dence and mortality rates were smoothed using a lowess func-
tion, a locally weighted regression, by country, sex and cancer
Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC
3
Cancer Epidemiology
site. Estimates for the 20 world regions were obtained by the
population-weighted average of the incidence and mortality
rates of the component countries. These rates were applied to
the corresponding population estimate for the region for 2018
to obtain the estimated numbers of new cancer cases and
deaths in 2018. The rates were age-standardised (ASRs per
100,000 person-years) using the direct method and the World
standard population as proposed by Segi15 and modified by
Doll.16 The cumulative risk of developing or dying from can-
cer before the age of 75 in the absence of competing causes of
death was also calculated using the age-specific rates and
expressed as a percentage. Both of these indicators allow com-
parisons between populations that are not influenced by dif-
ferences in their age structures.
Uncertainty intervals
In order to show a degree of certainty of the estimates and
fulfil the GATHER statement,3 uncertainty intervals (95% UI)
of the estimated sex- and site-specific number of new cancer
cases and cancer deaths for all ages have been computed using
the standard error se of the crude incidence or mortality rate
used in the estimation. The se have been calculated on the log
scale and the UI back on the arithmetic scale using the after
formulae:
UIlower = exp (log(CR2018pcs) – 1.96*se)* P2018ps/100,000.
UIupper = exp (log(CR2018pcs) + 1.96*se)* P2018ps/100,000.
Where CR2018pcs is the estimated crude incidence/mortal-
ity rate per 100,000 in 2018 for country p, cancer c and sex s;
P2018ps is the population of country p and sex s in 2018, and
 4 GLOBOCAN 2018 sources and methods
Cancer Epidemiology

Figure 2. Flow charts depicting methods of estimation (a) Incidence data. (b) Mortality data. [Color figure can be viewed at
wileyonlinelibrary.com]

se the standard error. The standard error se should be cor- three categorical variables having the same range of values
rected for three major causes of bias: from 0 (high) to 10 (low) has been introduced:

1. Coverage: the population used in the computation of the

crude rate may not cover the entire country, particularly
when incidence data is concerned;
2. The lag time: the data may be more or less recent com-
pared to 2018;
3. The quality of the data.
For sake of simplicity, the three biases have been consid-
ered to have the same importance, and a correction based on
se final ¼ se* 100=ð100 −cÞ* 100=ð100 −tÞ* 100=ð100 − qÞ ð1Þ
Where c represents the coverage of the dataset; t the time
lag expressed in year and q describes the quality of the dataset.
For each country, these three categorical variables can be sex
and cancer-specific, depending upon the amount and the
quality of available data. The formulae used to compute the
standard error for both sexes combined, for all sites, and for

Table 1. Estimated number of testicular cancer cases and uncertainty intervals (95% UI) in selected countries, 2018
Penalties
Estimated Estimated
Country Method se numbers and 95% UI Coverage Quality Lag time corrected se numbers and 95% UI
Australia 1 0.071801 927 (805.3–1,067.1) 0 0 0 0.071801 927 (805.3–1,067.1)
Lebanon 2a 0.118125 121 (96.0–152.5) 1 3 9 0.135174 121 (92.8–157.7)
Tanzania 2b 0.707107 50 (12.5–199.9) 7 6 6 0.860491 50 (9.3–270.1)
Chile 3a 0.102815 981 (802–1,200) 6 2 8 0.121315 981 (773.4–1,244.3)
Bolivia 3b 0.311086 91 (49.5–167.4) 10 10 16 0.457210 91 (37.1–223.0)
Indonesia 4 0.157720 1,382 (1,014.5–1,882.6) 10 8 8 0.207047 1,382 (921–2,073.7)
Burundi 9 0.707107 12 (3.0–48.0) 10 10 6 0.928693 12 (1.9–74.1)

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

 Table 2. Estimated new cancer cases and uncertainty intervals (95% UI, all ages, in thousands), age standardised rates (ASRs, per 100,000) and cumulative risks to age 75 (%) by sex
and cancer site worldwide, 2018
Both sexes Males Females
Ferlay et al.

ASR Cum. Risk ASR Cum. Risk ASR Cum.

Cancer Numbers 95% UI (World) (0–74) Numbers 95% UI (World) (0–74) Numbers 95% UI (World) Risk (0–74)
Lip, oral cavity 354.9 (339.3–371.2) 4.0 0.46 246.4 (233.7–259.8) 5.8 0.66 108.4 (99.6–118.1) 2.3 0.26
Salivary glands 52.8 (46.8–59.5) 0.6 0.06 29.3 (24.7–34.7) 0.7 0.07 23.5 (19.9–27.9) 0.5 0.05
Oropharynx 92.9 (86.0–100.3) 1.1 0.13 74.5 (68.4–81.1) 1.8 0.21 18.4 (15.5–21.9) 0.4 0.05
Nasopharynx 129.1 (118.8–140.2) 1.5 0.16 93.4 (84.8–103.0) 2.2 0.24 35.7 (30.5–41.7) 0.8 0.09
Hypopharynx 80.6 (72.5–89.6) 0.9 0.11 67.5 (60.1–75.8) 1.6 0.19 13.1 (10.1–17.0) 0.3 0.03
Oesophagus 572.0 (552.1–592.7) 6.3 0.78 399.7 (383.2–416.9) 9.3 1.15 172.3 (161.4–184.1) 3.5 0.43
Stomach 1,033.7 (1,006.3–1,061.9) 11.1 1.31 683.8 (661.6–706.7) 15.7 1.87 349.9 (334.1–366.6) 7.0 0.79

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

Colon 1,096.6 (1,046.3–1,149.3) 11.5 1.31 575.8 (540.2–613.7) 13.1 1.51 520.8 (485.9–558.2) 10.1 1.12
Rectum 704.4 (697.0–711.9) 7.7 0.91 430.2 (424.6–436.0) 10.0 1.20 274.1 (269.3–279.0) 5.6 0.65
Anus 48.5 (43.8–53.8) 0.5 0.06 20.2 (17.1–23.9) 0.5 0.05 28.3 (24.8–32.3) 0.6 0.07
Liver 841.1 (817.6–865.2) 9.3 1.08 596.6 (577.0–616.8) 13.9 1.61 244.5 (231.9–257.8) 4.9 0.57
Gallbladder 219.4 (207.1–232.5) 2.3 0.25 97.4 (89.6–105.9) 2.2 0.25 122.0 (112.6–132.2) 2.4 0.26
Pancreas 458.9 (443.3–475.1) 4.8 0.55 243.0 (231.6–255.0) 5.5 0.65 215.9 (205.3–227.0) 4.0 0.45
Larynx 177.4 (166.0–189.6) 2.0 0.25 155.0 (144.2–166.5) 3.6 0.45 22.4 (18.8–26.8) 0.5 0.06
Lung 2,093.9 (2,058.0–2,130.3) 22.5 2.75 1,368.5 (1,338.5–1,399.2) 31.5 3.80 725.4 (705.7–745.6) 14.6 1.77
Melanoma of skin 287.7 (277.5–298.3) 3.1 0.35 150.7 (143.6–158.2) 3.5 0.39 137.0 (129.8–144.6) 2.9 0.31
Non-melanoma skin 1,042.1 (818.5–1,326.7) 10.1 0.97 637.7 (462.5–879.5) 13.9 1.31 404.3 (280.4–583.1) 7.0 0.67
Mesothelioma 30.4 (25.9–35.8) 0.3 0.04 21.7 (17.8–26.4) 0.5 0.05 8.8 (6.6–11.7) 0.2 0.02
Kaposi sarcoma 41.8 (30.9–56.5) 0.5 0.04 28.2 (20.0–39.9) 0.7 0.06 13.6 (7.4–24.9) 0.3 0.03
Breast 2,088.8 (2,003.7–2,177.6) 46.3 5.03 - 2,088.8 (2003.7–2,177.6) 46.3 5.03
Vulva 44.2 (39.5–49.6) 0.9 0.09 - 44.2 (39.5–49.6) 0.9 0.09
Vagina 17.6 (14.0–22.2) 0.4 0.04 - 17.6 (14.0–22.2) 0.4 0.04
Cervix uteri 569.8 (545.8–595.0) 13.1 1.36 - 569.8 (545.8–595.0) 13.1 1.36
Corpus uteri 382.1 (375.4–388.8) 8.4 1.01 - 382.1 (375.4–388.8) 8.4 1.01
Ovary 295.4 (281.0–310.6) 6.6 0.72 - 295.4 (281.0–310.6) 6.6 0.72
Penis 34.5 (28.9–41.1) 0.8 0.09 34.5 (28.9–41.1) 0.8 0.09 -
Prostate 1,276.1 (1,196.5–1,361.0) 29.3 3.73 1,276.1 (1,196.5–1,361.0) 29.3 3.73 -
Testis 71.1 (63.8–79.3) 1.7 0.14 71.1 (63.8–79.3) 1.7 0.14 -
Kidney 403.3 (387.3–419.9) 4.5 0.52 254.5 (241.7–268.0) 6.0 0.69 148.8 (139.4–158.7) 3.1 0.35
Bladder 549.4 (529.9–569.6) 5.7 0.65 424.1 (406.9–442.0) 9.6 1.08 125.3 (116.4–134.9) 2.4 0.27
Brain, central nervous 296.9 (282.4–312.1) 3.5 0.36 162.5 (151.8–174.0) 3.9 0.40 134.3 (124.8–144.6) 3.1 0.31
system
Thyroid 567.2 (535.1–601.3) 6.7 0.68 130.9 (116.4–147.2) 3.1 0.33 436.3 (408.1–466.6) 10.2 1.03
Hodgkin lymphoma 80.0 (72.5–88.3) 1.0 0.08 46.6 (40.8–53.1) 1.1 0.10 33.4 (28.8–38.8) 0.8 0.07

(Continues)
5

Cancer Epidemiology
 6 GLOBOCAN 2018 sources and methods

world regions are provided in Annex D. The values of the cat-

(World) Risk (0–74) egorical variables c, t, and q are provided by country in

18.25
17.71
Annex E. Table 1 shows the results of the correction for the
Cum.

0.51

0.17
0.40
0.51

0.43
various methods of estimation using the incidence of testicular
cancer as an example.

(8,218.8–9,046.1) 182.6
(7,826.2–8,629.9) 175.6
Finally, the list of the 185 countries or territories together
ASR

4.7

1.4
4.3
5.2

4.0
with their corresponding methods of estimation is given in
Annex A. The full description of GLOBOCAN 2018 in terms
(219.4–230.5)

(177.7–198.0)
(213.9–241.0)

(185.8–211.2) of the data sources and methods used for each country is
(64.6–76.0)

also available online at the Global Cancer Observatory

Numbers 95% UI

(http://gco.iarc.fr).

Results
Females

8,622.5
8,218.2

Tables 2 and 3 show the estimated number of cases and

224.9

187.6
227.1

198.1
70.1

deaths for all cancers combined and for 38 specific cancers

Cancer Epidemiology

in males, females and both sexes, together with the corre-

Cum. Risk

sponding uncertainty intervals, ASRs and the cumulative

(World) (0–74)

22.41
21.38

risk. We estimated that 18.1 million (95% UI: 17.5–18.7 mil-

0.72

0.24
0.57
0.70

0.59

lion) new cancer cases (17 million excluding NMSC) and 9.6
million (95% UI: 9.3–9.8 million) cancer deaths (9.5 million
(9,037.2–9,895.1) 218.6
(8,418.9–9,237.5) 204.7

excluding NMSC) occurred in 2018 worldwide, and, on aver-

ASR

6.7

2.1
6.1
6.8

5.3

age, there is about a 20% risk of getting a cancer before age

75, and 10% of dying from it. Table 4 shows the most com-
(278.6–291.0)

(238.0–261.5)
(266.9–297.3)

(217.2–245.3)

mon types of cancer in terms of new cases and deaths in

(83.6–96.7)

each of the 20 world regions in 2018. In men, prostate cancer

Numbers 95% UI

was the most frequently diagnosed cancer in men in

12 regions of the world, followed by lung cancer (four
regions), NMSC (two regions), lip and oral cavity, and liver
9,456.4
8,818.7

cancers in one region. Lung cancer was the most frequent

Males

284.7

249.5
281.7

230.8
89.9

cause of death from cancer in 14 regions of the world, fol-

lowed by prostate and liver cancers in five and one area
Cum. Risk

respectively. In women, breast cancer was the most fre-

(World) (0–74)

20.20
19.42

quently diagnosed cancer in all regions of the world, except

0.61

0.20
0.48
0.60

0.50

in Eastern Africa where cervical cancer dominated. Breast

cancer was also the most frequent cause of death from can-
18,079.0 (17,493.0–18,684.5) 197.9
17,036.9 (16,473.1–17,620.0) 187.8

cer in 11 regions of the world, lung cancer in five regions

ASR

5.7

1.7
5.2
5.9

4.6

(including Eastern Asia) and cervical cancer in the four

regions of sub-Saharan Africa. These seven cancers represent
half of the global incidence and mortality burden in 2018.
(501.3–518.0)

(151.5–168.9)
(421.8–452.8)
(488.8–529.5)

(410.4–448.3)

Figure 3a and b summarise the estimated numbers of new

cancer cases and cancer deaths worldwide in 2018 by type of
Numbers 95% UI

cancer and by sex, while Figure 4 shows the distribution of

the global cancer cases and deaths (all types of cancer) by
Both sexes

world region. Most cases (5.6 million, 31.1% of the total)

and deaths (3.5 million, 36.2%) occurred in Eastern Asia
509.6

160.0
437.0
508.8

428.9

with its vast population (1.7 billion, 22% of the global popu-
lation in 2018). Northern America ranks second in terms of
number of new cases (2.4 million, 13.2%) but fourth
Unspecified cancers

(698,000, 7.3%) in terms of cancer deaths after South-Central

Multiple myeloma
Table 2. Continued

Non-melanoma
All cancers excl.
Other specified

Asia (1.2 million, 12.2%) and Eastern Europe (699,000,

skin cancer
Non-Hodgkin
lymphoma

7.3%). Almost a quarter of the new cases (4.2 million) and

All cancers
Leukaemia

cancers

one fifth of the deaths (1.9 million) occurred in the four

Cancer

European regions, despite containing only 9% of the global

population.

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

 Table 3. Estimated cancer deaths and uncertainty intervals (95% UI, all ages, thousands), age standardised rates (ASRs, per 100,000) and cumulative risks to age 75 (%) by sex and
cancer site worldwide, 2018
Both sexes Males Females
Ferlay et al.

ASR Cum. Risk ASR Cum. Risk ASR Cum. Risk

Cancer Numbers 95% UI (World) (0–74) Numbers 95% UI (World) (0–74) Numbers 95% UI (World) (0–74)
Lip, oral cavity 177.4 (167.7–187.7) 2.0 0.23 119.7 (111.8–128.1) 2.8 0.32 57.7 (52.2–63.8) 1.2 0.14
Salivary glands 22.2 (19.0–25.9) 0.2 0.03 13.4 (10.9–16.5) 0.3 0.03 8.7 (6.9–11.1) 0.2 0.02
Oropharynx 51.0 (46.1–56.4) 0.6 0.07 42.1 (37.6–47.2) 1.0 0.12 8.9 (7.1–11.1) 0.2 0.02
Nasopharynx 73.0 (66.5–80.1) 0.8 0.10 54.3 (48.6–60.6) 1.3 0.15 18.7 (15.8–22.2) 0.4 0.05
Hypopharynx 35.0 (32.0–38.3) 0.4 0.05 29.4 (26.0–33.3) 0.7 0.08 5.6 (4.9–6.4) 0.1 0.01
Oesophagus 508.6 (492.5–525.2) 5.5 0.67 357.2 (343.7–371.2) 8.3 1.00 151.4 (142.9–160.4) 3.0 0.36
Stomach 782.7 (738.3–829.7) 8.2 0.95 513.6 (477.8–552.0) 11.7 1.36 269.1 (243.7–297.2) 5.2 0.57

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

Colon 551.3 (535.7–567.3) 5.4 0.54 290.5 (279.5–302.0) 6.4 0.66 260.8 (249.8–272.2) 4.6 0.44
Rectum 310.4 (305.5–315.3) 3.2 0.35 184.1 (180.4–187.9) 4.2 0.46 126.3 (123.1–129.5) 2.4 0.26
Anus 19.1 (16.1–22.8) 0.2 0.02 9.6 (7.5–12.4) 0.2 0.03 9.5 (7.5–12.1) 0.2 0.02
Liver 781.6 (737.6–828.3) 8.5 0.98 548.4 (511.6–587.8) 12.7 1.46 233.3 (209.9–259.2) 4.6 0.53
Gallbladder 165.1 (156.3–174.3) 1.7 0.18 70.2 (64.5–76.3) 1.6 0.17 94.9 (88.3–102.0) 1.8 0.19
Pancreas 432.2 (419.0–445.9) 4.4 0.50 226.9 (217.3–237.0) 5.1 0.59 205.3 (196.4–214.7) 3.8 0.41
Larynx 94.8 (88.3–101.8) 1.0 0.13 81.8 (75.7–88.4) 1.9 0.23 13.0 (10.9–15.5) 0.3 0.03
Lung 1,761.0 (1,700.6–1,823.5) 18.6 2.22 1,184.9 (1,134.2–1,238.0) 27.1 3.19 576.1 (543.7–610.3) 11.2 1.32
Melanoma of skin 60.7 (55.9–65.9) 0.6 0.07 34.8 (31.3–38.7) 0.8 0.08 25.9 (22.8–29.4) 0.5 0.05
Non-melanoma skin 65.2 (59.6–71.2) 0.6 0.06 38.3 (34.2–43.0) 0.8 0.08 26.8 (23.3–30.8) 0.5 0.04
Mesothelioma 25.6 (22.3–29.4) 0.3 0.03 18.3 (15.6–21.6) 0.4 0.04 7.2 (5.6–9.4) 0.1 0.02
Kaposi sarcoma 19.9 (14.7–26.9) 0.2 0.02 13.1 (8.3–20.8) 0.3 0.03 6.8 (4.5–10.1) 0.2 0.01
Breast 626.7 (606.1–648.0) 13.0 1.41 - 626.7 (606.1–648.0) 13.0 1.41
Vulva 15.2 (12.9–17.9) 0.3 0.03 - 15.2 (12.9–17.9) 0.3 0.03
Vagina 8.1 (6.1–10.6) 0.2 0.02 - 8.1 (6.1–10.6) 0.2 0.02
Cervix uteri 311.4 (303.9–319.0) 6.9 0.77 - 311.4 (303.9–319.0) 6.9 0.77
Corpus uteri 89.9 (83.8–96.5) 1.8 0.21 - 89.9 (83.8–96.5) 1.8 0.21
Ovary 184.8 (175.5–194.6) 3.9 0.45 - 184.8 (175.5–194.6) 3.9 0.45
Penis 15.1 (12.2–18.8) 0.3 0.04 15.1 (12.2–18.8) 0.3 0.04 -
Prostate 359.0 (343.4–375.3) 7.6 0.60 359.0 (343.4–375.3) 7.6 0.60 -
Testis 9.5 (7.6–11.9) 0.2 0.02 9.5 (7.6–11.9) 0.2 0.02 -
Kidney 175.1 (166.2–184.5) 1.8 0.20 113.8 (106.6–121.6) 2.6 0.28 61.3 (56.3–66.7) 1.1 0.12
Bladder 199.9 (190.5–209.8) 1.9 0.18 148.3 (140.2–156.8) 3.2 0.29 51.7 (47.1–56.7) 0.9 0.08
Brain, central 241.0 (230.5–252.1) 2.8 0.30 135.8 (127.9–144.3) 3.2 0.35 105.2 (98.4–112.5) 2.3 0.25
nervous system
Thyroid 41.1 (37.5–45.0) 0.4 0.05 15.6 (13.2–18.3) 0.4 0.04 25.5 (22.9–28.5) 0.5 0.05
Hodgkin lymphoma 26.2 (23.0–29.8) 0.3 0.03 15.8 (13.4–18.5) 0.4 0.04 10.4 (8.3–13.0) 0.2 0.02

(Continues)
7

Cancer Epidemiology
 8 GLOBOCAN 2018 sources and methods

Cum. Risk
Discussion
(World) (0–74) The primary aim of this paper is to document the sources and
0.21
0.10
0.26
0.27
0.33
8.70
8.66
methods used to build up the global and region-specific esti-
mates of the cancer burden. While IARC’s estimation
methods have been refined in the last decades to account for

(4,030.0–4,313.6) 83.1
(4,003.4–4,286.6) 82.7
ASR

2.0
0.9
2.8
2.7
3.2
the increasing availability and quality of available data, the
underlying methodological principles have remained
unchanged: wherever possible, national estimates are based
(121.7–137.7)
(118.3–134.4)
(159.5–176.3)
(99.3–106.3)

upon local sources of cancer incidence (from population-

(43.1–51.9)

based cancer registries) and cancer mortality (mainly from

Numbers 95% UI

vital registration systems).

With respect to estimates within GLOBOCAN 2018, an
advance is the inclusion of uncertainty intervals (95% UI) that
Females

4,169.4
4,142.6
102.8

129.5
126.1
167.7

aim to capture, alongside the inherent random variation, the

47.3

uncertainty in the source information, taking into account

Cancer Epidemiology

three important biases: coverage, lag time and the quality of

Cum. Risk

the data. Penalties are used to correct the standard error for
(World) (0–74)

12.71
12.65
0.35
0.15
0.40
0.38
0.49

each bias in the UI calculation, and the interval thus widens

when the recorded incidence or mortality data cover a rela-
(5,230.3–5,545.6) 122.7
(5,192.3–5,507.0) 121.9

tively low proportion of the total population, or are considered

ASR

3.3
1.3
4.2
3.7
4.6

less timely or of poorer quality. Categorising the robustness of

the underlying data relied mainly on our previous work on the
topic,1 with incidence considered of the highest quality if the
(141.9–150.1)

(170.3–189.3)
(146.4–164.8)
(193.1–212.1)
(54.1–64.0)

contributing PBCR were included in one of the last two vol-

umes of CI5.5 Otherwise, incidence rates per 100,000 that were
Numbers 95% UI

judged reasonably accurate and representative of the underly-

ing registry catchment area (e.g. population-based) were
deemed the next level of quality, followed by datasets that
5,385.6
5,347.3
Males

146.0

179.5
155.3
202.3
58.8

could at least be used to assess cancer profiles by sex

(e.g. hospital- or pathology-based). For national mortality, data
Cum. Risk

were available through the WHO mortality database; the pro-

(World) (0–74)

10.63
10.58

portions of ill-defined causes of deaths, and of unknown and

0.27
0.12
0.33
0.33
0.41

ill-defined cancer deaths were used as standard indicators of

the quality of vital registration systems,8,13 and in developing
(9,345.4–9,769.4) 101.1
(9,280.6–9,703.9) 100.5

the corresponding penalties for the UI.

ASR

2.6
1.1
3.5
3.2
3.9

The estimation of the UI was modified on a site-specific

basis, given the extent to which local cancer registration pro-
(243.4–254.2)

(296.8–321.7)
(269.5–293.9)
(357.6–382.9)

cesses and data availability vary by cancer type. Given inci-

(99.7–112.9)

dence rates depend on the ability to diagnose cancer cases,

Numbers 95% UI

the degree of reporting will depend on the adequacy and uti-

lisation of diagnostic services, particularly for NMSC, leukae-
Both sexes

mia and for cancers of the brain, lung, liver and pancreas.
9,555.0
9,489.9

Conversely, there is the prospect of an inflation of incidence

248.7
106.1
309.0
281.5
370.1

rates for certain cancers where there has been an evolution

in diagnostic procedures and practices, such as for cancers of
Non-melanoma skin cancer

the prostate and thyroid in many higher-income countries.

For certain countries and sites, national mortality statistics
Non-Hodgkin lymphoma

Other specified cancers

from the “limited tabulation list” were not available at the

Unspecified cancers

necessary level of granularity, e.g. mesothelioma, Kaposi sar-

Multiple myeloma
Table 3. Continued

All cancers excl.

coma, Hodgkin lymphoma, and cancers of the vulva, vagina,

testis, kidney, thyroid in Belarus and the Russian Federation.
All cancers
Leukaemia

In these circumstances, the penalty was increased to inflate

Cancer

the standard error, reflecting higher degree of uncertainty

surrounding the corresponding estimates. Combining

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

 Ferlay et al.

Table 4. Leading types of cancer in terms of new cases (i) and deaths (m) by sex in each of the 20 world regions in 2018 [Color table can be viewed at wileyonlinelibrary.com]

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

9

Cancer Epidemiology
 10 GLOBOCAN 2018 sources and methods
Cancer Epidemiology

Figure 3. Distribution of the estimated new cases and deaths for the 10 most common cancers in 2018 in males (a) and females (b). For each
sex, the area of the pie chart reflects the proportion of the total number of cases or deaths. NHL: Non-Hodgkin Lymphoma. [Color figure can
be viewed at wileyonlinelibrary.com]

multiple sources of biases to fully quantify uncertainty is an (e.g. as a result of some sources of uncertainty missing or
area where research is increasingly needed. In many cases, impossible to measure). Our approach is to report a quanti-
the data and the information required are however absent tative measure of uncertainty; we duly acknowledge that it

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

Ferlay et al. 11

Cancer Epidemiology

Figure 4. Estimated global numbers of new cases and deaths with proportions by world regions in 2018 in males (a), females (b) and both
sexes (c). For each sex, the area of the pie chart reflects the proportion of the total number of cases or deaths. [Color figure can be viewed at
wileyonlinelibrary.com]

reflects only a subset of all possible sources of bias in the col- There are a number of additional cancer sites estimated in
lection and analysis of the data that is presently available the 2018 release of GLOBOCAN. We provide global estimates
worldwide. for colon and rectum cancers separately, and for HPV-related

Int. J. Cancer: 00, 1–13 (2018) © 2018 UICC

 12 GLOBOCAN 2018 sources and methods

cancers17: anus, vulva, vagina and penis, as well as for NMSC
and for mesothelioma.
Our estimates of the incidence of NMSC (excluding
basal-cell carcinoma (BCC), see Annex B) are based exclu-
sively on cancer registry data which report the first occur-
rence of the cancer,5 and therefore may differ widely from
surveys published elsewhere (e.g. Australia18). NMSC are
particularly common in fair-skinned populations of
European descent, with high incidence rates found in
Australia/New Zealand, North America, and northern
Europe. Given the completeness of registration of NMSC
varies widely, the results should be interpreted with consider-
able caution, particularly in Australia/New Zealand and
North America, where the estimates are based on a single
registry in Australia (Tasmania) and Canada (Manitoba).
Cancer Epidemiology
been described in detail elsewhere.10,21 Due to the lack of
recent data on survival statistics in lower-income settings, we
did not use modelled survival to derive mortality from
incidence,1 but rather fitted site-, sex- regional models of I:M
ratios as proxies of survival, scaled a given country according
to HDI level13 (see also Annex C). As previously we would
caution against comparisons of estimates compiled in this and
previous versions of GLOBOCAN; the changes in the inci-
dence and mortality counts or rates are in part due to an
increasing availability and quality of the incidence data from
cancer registries worldwide that is the basis for the more
robust set of methods and estimates described herein.
As well as providing a global snapshot of the cancer
burden in 2018, the GLOBOCAN estimates bring a focus to
the need for regional and national prioritisation of cancer

Care should also be taken when comparing the overall can-
cer incidence estimates for 2018 to previous versions of
GLOBOCAN. It is noteworthy that the estimated worldwide
mortality rates of all types of NMSC –but BCC is rarely
fatal- is higher than the corresponding rates of melanoma,
mesothelioma, oropharynx and thyroid cancer.
With an estimated 30,400 (95% UI: 27,800–33,400) new
cases and 25,600 (22,300–29,400) deaths worldwide, our
global estimates of mesothelioma incidence and mortality are
lower than the 38,400 deaths estimated from a recent study,19
but in line with the 34,760 (32,505–36,461) cases and 30,200
(28,298- 31,877) deaths in 2016 estimated by the Global Bur-
den of Disease (GBD) study.20 The number of specific cancer
sites included in successive iterations of GLOBOCAN should
continue; the third most common cancer diagnosed in Africa
in both males and females is cancer of “other specified sites”,
which encompasses cancers including male breast, bone, con-
nective tissues and the eye. Such cancers will be included in
the future to reflect the large variability of the occurrence of
cancers worldwide.
The use of site-, sex- and age-specific M:I ratios from can-
cer registries to estimate national incidence rates from
national mortality has been validated and applied extensively
over several decades and the possible sources of bias have
control efforts given the cancer patterns observed today.
There are many critical observations among these results that
can serve to provide the evidence base and impetus for
developing such strategies to reduce the cancer burden
worldwide in the decades to follow. Finally, estimation of the
cancer incidence worldwide would not be possible without
population-based cancer registries (PBCR), yet many LMICs
have limited or no such surveillance systems in place. Led by
IARC, the Global Initiative for Cancer Registry Development
(GICR, http://gicr.iarc.fr) is a partnership of leading cancer
organisations attempting to address these inequities by pro-
viding the necessary technical assistance and advocacy to
ensure a step-change in quality, comparability and use of
registry data in the next few years.
Acknowledgements
The authors gratefully acknowledge cancer registries worldwide and their
staff for their willingness to contribute their data to this exercise, and par-
ticularly the members of the African Cancer Registry Network. We also
thank Prof Malekzadeh and Dr Roshandel (Ministry of Health and Cancer
Institute of Iran), Dr Chen (National Cancer Center, China), Dr Sangraj-
rang (National Cancer Institute, Thailand) for useful comments on their
country estimates, Dr Fidler and Dr Pilleron at IARC for their careful
review of the estimates, and Dr Rutherford (University of Leicester, UK)
for advice regarding the computation of the uncertainty intervals.

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