High BMI Drives Worldwide Surge in Ovarian, Uterine Cancer Cases – The American Journal of Managed Care® (AJMC®)

Report on the Global Burden of High BMI-Attributable Gynecological Cancers and Implications for Sustainable Development Goals

Introduction: A Challenge to SDG 3 (Good Health and Well-being)

A recent study published in Frontiers in Oncology reveals a substantial increase in the global burden of ovarian and uterine cancers attributable to high body mass index (BMI) between 1990 and 2021. These findings present a significant challenge to the achievement of Sustainable Development Goal 3, particularly Target 3.4, which aims to reduce premature mortality from non-communicable diseases (NCDs). The research quantifies the health impact across various demographic and geographic strata, providing critical data for public health policy aligned with the SDGs.

Methodology

The analysis utilized data from the Global Burden of Disease (GBD) 2021 study, covering 204 countries and territories. Researchers assessed the following metrics for women aged 20-49:

• Mortality and Incidence Rates
• Disability-Adjusted Life-Years (DALYs)
• Age-Standardized Rates (ASRs)
• Estimated Annual Percentage Changes (EAPCs)

Disparities were evaluated using the Sociodemographic Index (SDI), and future trends were forecasted using ARIMA and ES models. This comprehensive approach allows for a detailed understanding of the health inequalities that contravene SDG 10 (Reduced Inequalities).

Key Findings: Rising Cancer Burden and Setbacks for SDG 3

The study documents a consistent and concerning rise in the burden of both uterine and ovarian cancers linked to high BMI, moving global health trends away from SDG 3 targets.

Uterine Cancer

The global burden increased significantly from 1990 to 2021:

1. DALYs: Increased from 372,641 to 880,147.
2. Deaths: Increased from 13,893 to 33,134.
3. Years Lived with Disability (YLDs): Increased from 27,755 to 88,263.

The EAPC for DALYs was 0.86, indicating a steady upward trend in the overall disease burden, which disproportionately affects women’s health and well-being, a key concern for SDG 5 (Gender Equality).

Ovarian Cancer

A similar increasing trend was observed for ovarian cancer attributable to high BMI:

1. DALYs: Increased from 1,888,874 to 477,248.
2. Deaths: Increased from 6,850 to 17,344.
3. Years Lived with Disability (YLDs): Increased from 5,269 to 14,419.

The EAPC for DALYs was 1.09, highlighting an accelerating health crisis that requires urgent intervention to meet global health goals.

Analysis of Disparities: A Reflection on SDG 10 (Reduced Inequalities)

The report underscores significant inequalities in the cancer burden across different socio-demographic regions, directly challenging the principles of SDG 10.

• Low- and Middle-SDI Regions: Experienced steady increases in ASRs for both uterine and ovarian cancer. The steepest rise in case numbers was observed in low-middle SDI regions, indicating that the most vulnerable populations are bearing a growing burden.
• High-SDI Regions: Showed a decrease in ASRs for ovarian cancer after 2002, suggesting that access to better healthcare and public health initiatives may be mitigating the impact. However, uterine cancer ASRs continued to rise steadily.

This divergence widens the global health gap and demonstrates an urgent need for targeted, equitable health strategies to ensure no one is left behind.

Future Projections and Policy Implications

Forecasts predict a continued increase in the burden of high BMI-related cancers, signaling an urgent need for preventative action to realign with SDG 3.

• Uterine Cancer: The number of cases is projected to rise, although the ASR may stabilize.
• Ovarian Cancer: Projections indicate increases across most indicators, including incidence and DALYs.

These projections serve as a critical warning. Without effective public health interventions targeting high BMI—a key risk factor for NCDs—the global community will fail to meet its commitments under the 2030 Agenda for Sustainable Development. The study’s limitations, particularly data underreporting in low-SDI countries, suggest the true burden may be even greater.

Conclusion: A Call for Integrated Action on SDGs

The escalating burden of uterine and ovarian cancers attributable to high BMI is a critical public health issue that intersects with multiple Sustainable Development Goals. To address this challenge, an integrated approach is necessary:

1. Strengthen Health Systems (SDG 3): Implement and scale up policies to prevent and manage high BMI and provide equitable access to cancer screening, diagnosis, and treatment.
2. Reduce Health Inequalities (SDG 10): Prioritize interventions in low- and middle-income countries to close the growing gap in health outcomes.
3. Promote Gender Equality (SDG 5): Address a health crisis that exclusively impacts women, ensuring their health and well-being are central to development agendas.
4. Enhance Global Partnerships (SDG 17): Foster international collaboration for research, data collection, and the implementation of effective health strategies.

Future research should focus on subtype-specific burdens and the impact of emerging therapies to develop more targeted and effective interventions.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s primary focus is on the “global burden of ovarian and uterine cancer,” which are non-communicable diseases. It analyzes health metrics such as mortality, incidence, and disability-adjusted life-years (DALYs), directly aligning with the goal of ensuring healthy lives and promoting well-being.
• SDG 10: Reduced Inequalities: The article explicitly discusses and quantifies disparities in the cancer burden across different socioeconomic regions. It analyzes data based on the “sociodemographic index (SDI)” and highlights how the burden varies significantly between “high, middle, low-middle, and low SDI regions,” thereby addressing the issue of inequality in health outcomes among countries.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: The article directly addresses this target by quantifying the rising mortality and disease burden from two non-communicable diseases (ovarian and uterine cancer) in women, including a specific age group (20-49) which constitutes premature mortality. The link to a preventable risk factor, “high body mass index (BMI),” and the call to “develop effective measures to mitigate its impact” underscore the relevance of prevention and treatment to reduce this burden.
2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome.
   • Explanation: The article provides clear evidence of inequalities in health outcomes. It demonstrates that the burden of these cancers is not distributed equally, stating that for ovarian cancer, “Case numbers generally rose across all SDI regions, with the steepest slope in low-middle SDI regions.” This differential impact based on a country’s socioeconomic status is a direct example of an inequality of outcome that this target aims to reduce. The finding that data quality is “particularly pronounced in low SDI countries” also points to inequalities in health information systems.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.4, the article mentions several direct indicators:
  • Mortality and Incidence Rates: The study quantifies the number of “deaths” and “cases” for both cancers over a 30-year period. For example, it states that for uterine cancer, deaths rose from “13,893… in 1990 to 33,134… in 2021.” These metrics are fundamental for tracking progress in reducing mortality from non-communicable diseases.
  • Disability-Adjusted Life-Years (DALYs): The article extensively uses DALYs, a comprehensive measure of disease burden. It provides specific figures, such as DALYs for ovarian cancer increasing from “1,888,874… in 1990 to 477,248… in 2021” (Note: the 1990 DALY figure for ovarian cancer appears to have a typo in the article, but it is used as a key metric). This indicator measures the total years of healthy life lost, which is a core component of Target 3.4.
  • Age-Standardized Rates (ASRs): The researchers calculated and analyzed ASRs for mortality, DALYs, and other metrics. The use of ASRs allows for standardized comparison of the disease burden across different populations and time periods, making it a crucial indicator for monitoring trends.
• For Target 10.3, the article implies an indicator for measuring health inequality:
  • Disparities in Health Burden by Sociodemographic Index (SDI): The article uses the cancer burden (measured by ASRs and case numbers) stratified by SDI level as a direct indicator of inequality. The finding that “uterine cancer ASRs rose steadily in high, middle, low-middle, and low SDI regions” while ovarian cancer ASRs “decreased in high SDI regions after 2002” provides a quantifiable measure of the diverging health outcomes between different socioeconomic groups of countries.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com