Cancer is one of the leading causes of death globally. Disability-adjusted life years (DALYs) is a broad indicator that combines the impact of premature mortality and the years of life lived with disability caused by cancer. It is important to understand cancer DALYs and observe trends in it, as this information can guide global cancer control initiatives and the prioritisation of healthcare resources. Here, an attempt has been made to address current worldwide patterns of cancer and DALYs, with a special emphasis on public health perspectives.
The burden of cancer
Cancer affects millions each year, and places a heavy burden on families, communities, and health systems. Reporting only its incidence and mortality does not present a real picture of the cancer burden. Years lived in disability, years lost due to premature mortality, and years lived with decreased quality of life must also be considered. To quantify this total burden, the metric of DALYs is applied, which emphasises both years of life lost due to premature death and years of life lived with the disabling consequences of cancer in a collective rate. In a population where a disease/health condition is common, DALYs measure the total number of years of life lost due to premature mortality (YLLs) and years of healthy life lost due to disability (YLDs). DALYs are represented when both these matrices (YLL and YLD) are combined into a single metric.
DALYs are an important tool: they provide a picture of the real impact of cancer, helping researchers and policymakers in the judicial use of resources and in the formulation of plans for the prevention, management, and survivorship of cancer.
DALYs in global cancer burden
Cancer is the second-leading cause of death and disability worldwide, after cardiovascular diseases. DALYs estimates of about 250 million were caused by cancer worldwide in 2019; this represents a significant loss of healthy life years as a result of both early death and disability caused by different types of cancer. The total number of cancer cases, deaths, and DALYs have increased dramatically, especially in low and middle-sociodemographic index (SDI) countries, despite some reduction and stabilisation in age-standardised cancer mortality and incidence rates in higher-income regions. About 97% of DALYs related to cancer are attributable to YLL from premature death, while the remaining percentage comes from YLD. Lung, breast, colorectal, stomach, and liver cancers contribute the highest DALYs globally.
There is a variation of the burden by region, where high SDI countries reflect higher YLD proportions indicating improved survival and subsequent disability. In contrast, low-income regions experience higher YLLs due to late diagnosis and limited treatment access. Data from the Global Burden of Disease (GBD) study and the Global Cancer Observatory show that worldwide, cancer DALYs have risen largely due to growing and ageing populations.
For example, India is expected to experience an increase to nearly 30 million cancer DALYs by 2025; this reflects both demographic changes and enhanced detection capabilities. There are significant variations in the incidence and types of cancer seen in India, which may be due to variations in socioeconomic status, wide differences in lifestyle, and poor access to healthcare. Primary risk factors including dietary risks, tobacco and alcohol consumption, and air pollution, are responsible for cancer DALYs in males. Northeastern states of India including Mizoram (3,642 per 100,000 population) and Meghalaya (3,394) have recorded the highest cancer DALYs. This can be attributed to region-specific risk factors such as betel nut use, high tobacco intake, dietary practices and environmental exposures etc. This indicates that there is a critical need for public education campaigns on modifiable risk factors, region-specific cancer screening programmes, and improved healthcare delivery in each State based on the particular challenges they face.
Cancer type, gender disparities
Cancer accounted for 14.57% of total deaths and 8.8% of total DALYs in both sexes globally in 2021. The age-standardised incidence (ASIR) and age-standardised deaths (ASDR) were 790.33 and 116.49 respectively. Compared to males (673.09), females (923.44) exhibited higher ASIR. On the other hand, the ASDR was higher for males versus females (145.69 versus 93.60). Among the various cancers, the highest ASIR in both sexes was of non-melanoma skin cancer (74.10), while digestive cancers accounted for 39.29% of all cancer-related deaths. Breast cancer had the highest ASIR (46.40) and ASDR (14.55) in females, whereas tracheal, bronchial, and lung cancer had the highest ASIR (37.85) and ASDR (34.32) in males.
Higher SDI countries report higher incidence rates for cancers of the brain and central nervous system but lower mortality and DALYs, indicating improved access to healthcare. Because they have fewer resources, lower SDI regions frequently have higher mortality rates and DALYs. The younger age distribution of India’s cancer burden is a noteworthy feature; approximately half of DALYs occur in individuals between the ages of 40 and 64, whereas half globally occur in those 65 and older. Childhood cancers occur in 3% of boys and 1.8% of girls aged 0-14 years in India, though rural underreporting is a concern.
Policy and research implications
The estimated cancer burden in terms of DALYs is expected to increase from 26.7 million in 2021 to nearly 29.8 million by 2025, reflecting the sharp rise in both cancer incidence and cancer-related DALYs. This increase suggests improvements in diagnostics, as well as changes in demographics, and epidemiology.
The clear heterogeneity in cancer DALYs across regions and cancer types necessitates tailored policy responses. Utilising DALYs as a core metric allows policymakers to prioritise resource allocation to areas and cancer types with the highest burden. Furthermore, incorporating DALYs into cancer surveillance and research can shed light on emerging trends, the effectiveness of interventions, and long-term survivorship challenges. Strengthening cancer registries and improving data quality at the regional and State levels is crucial for precise burden estimations and evidence-based decision-making.
Understanding DALY trends enables policymakers to prioritise cancer types and populations with the highest health loss. For instance, in India, cervical and breast cancer burdens are the most prevalent, so efforts should be made towards improved screening and vaccination programmes targeting the human papillomavirus. Similarly, in males, lung, oral cavity, and other tobacco-related cancers predominate, which emphasises the critical importance of tobacco control policies. To address these challenges, there is a need for integrated health policies that consider gender-specific risk behaviours and biological susceptibilities.
Challenges and limitations
The estimation of DALYs is dependent on quality data inputs, which may vary across countries. There are a number of limitations of the current DALY estimation methodology, which include incomplete cancer registries, underreporting of cancer cases, and differences in disability weights assigned to cancer phases. Methodological challenges persist in integrating advances in cancer survival and quality of life into DALY calculations, necessitating ongoing refinement. The importance of survivorship care is highlighted by the fact that YLDs will contribute more to overall DALYs as cancer survival improves globally. By combining DALYs with quality-of-life and economic data, more nuanced health policies can be created.
Research should focus on improving data quality and extending the utility of DALYs in assessing the global cancer burden. Health system should focus not only on non-survival but also on enhancing the quality of life of cancer survivors through chronic care and rehabilitation. The important goal of healthcare systems should be accurately estimating the economic value of cancer-related DALYs. It is to be noted that currently 30–50% of cancers can be prevented by avoiding risk factors and by implementing existing evidence-based prevention strategies.
(Dr. Shalini Kapoor is professor, department of periodontology, faculty of dental sciences, SGT University, Haryana shalinikapoor_fds@sgtuniversity.org; Chandra Mouli Pandey is assistant professor, department of chemistry, faculty of applied & basic sciences, SGT University, Haryana Cmp.npl@gmail.com; Himani is a post-graduate student, department of periodontology, SGT University, Haryana himanigupta2903@gmail.com)
Published – October 27, 2025 04:09 pm IST
