Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

International variation


There were an estimated 10 million new cases, 6 million deaths and 22 million persons living with cancer in the year 2000. The most common cancers are, in terms of new cases, lung (1.2 million), breast (1.05 million), colon–rectum (945 000), stomach (876 000) and liver (564 000). The geographic distributions of some 20 types of cancer for which national estimates have been made are summmarized. These patterns are examined with respect to the likely reasons in terms of variation in exposure to carcinogens (in the external environment or through lifestyle choices) or in genetic susceptibility to them. Related data from studies of migrant populations (that allow comparisons of genetically similar populations living in different environments) and from comparisons between different ethnic groups living in the same country are used to help in the interpretation of the geographic patterns. Information on the burden of disease also has a very important role in the planning and monitoring of programmes of cancer control.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10


  • Arbyn M and Geys H . (2002). Int. J. Cancer, 102, 649–654.

  • Armstrong B and Doll R . (1975). Int. J. Cancer, 15, 617–631.

  • Bassett MT, Chokunonga E, Mauchaza B, Levy L, Ferlay J and Parkin DM . (1995). Int. J. Cancer, 63, 29–36.

  • Bergström A, Pisani P, Wolk A and Adami HO . (2001). Int. J. Cancer, 91, 421–430.

  • Bosch FX, Lorincz A, Munoz N, Meijer CJ and Shah KV . (2002). J. Clin. Pathol., 55, 244–265.

  • Bouchardy C, Mirra AP, Khlat M, Parkin DM, de Souza JM and Gotlieb SL . (1991). Cancer Epidemiol. Biomarkers Prev., 1, 21–27.

  • Bouchardy C, Parkin DM, Wanner P and Khlat M . (1996). Int. J. Epidemiol., 25, 5–13.

  • Bouchardy C, Wanner P and Parkin DM . (1995). Cancer Cause Control, 6, 539–544.

  • Breslow N, Chan CW, Dhom G, Drury RA, Franks LM, Gellei B, Lee YS, Lundberg S, Sparke B, Sternby NH and Tulinius H . (1977). Int. J. Cancer, 20, 680–688.

  • Brinton LA, Benichou J, Gammon MD, Brogan DR, Coates R and Schoenberg JB . (1997). Int. J. Cancer, 73, 349–355.

  • Coggon D, Osmond C and Barker DJ . (1990). Br. J. Cancer, 61, 573–574.

  • Correa P, Sasano N, Stemmerman N and Haenszel W . (1973). J. Natl. Cancer Inst., 51, 1449–1459.

  • Doll R and Peto R . (1981). The Causes of Cancer. Oxford University Press: Oxford.

    Google Scholar 

  • Donato F, Boffetta P and Puoti M . (1998). Int. J. Cancer, 75, 347–354.

  • Dorn HF and Cutler SJ . (1959). Morbidity from cancer in the United States: Parts I and II, Public Health Monograph No. 56 US Dept of Health, Education and Welfare: Washington, DC.

    Google Scholar 

  • Easton DF . (1994). Br. Med. Bull., 50, 527–535.

  • Editorial committee for the Atlas of Cancer Mortality (1979). Atlas of Cancer Mortality in the People's Republic of China. China Map Press: Beijing.

  • Ferlay J, Bray F, Pisani P and Parkin DM . (2000). GLOBOCAN 2000: Cancer incidence, mortality and Prevalence Worldwide, IARC Cancer Base No. 5, IARC Press: Lyon.

    Google Scholar 

  • Fu YS, Berek JS and Hilborne LH . (1987). Appl. Pathol., 5, 47–56.

  • Geddes M, Parkin DM, Khlat M, Balzi D and Buiatti E (eds) (1993). Cancer in Italian Migrant Populations, IARC Scientific Publication No. 123 IARC: Lyon, France.

    Google Scholar 

  • Goedde HW, Agarwal DP, Fritze G, Meier TD, Singh S, Beckmann G, Bhatia K, Chen LZ, Fang B, Lisker R, Paik YK, Rothhammer F, Saha N, Segal B, Srivastava LM and Czeizel A . (1992). Hum. Genet., 88, 344–346.

  • Griffith GW . (1968). Br. J. Cancer, 22, 163–172.

  • Gustafsson L, Ponten J, Bergström R and Adami HO . (1997). Int. J. Cancer, 71, 159–165.

  • Hartge P and Devesa SS . (1992). Cancer Res., 52, 5566s–5569s.

  • Helicobacter and Cancer Collaborative Group (2001). Gut, 49, 347–353.

  • Hirsch A . (1883). Handbook of Geographical and Historical Pathology. Vols. I–III. The New Sydenham Society: London, Translated from the Second German Edition by Creighton C).

    Google Scholar 

  • IARC Monograph on the Evaluation of Carcinogenic Risks to Humans, Vol. 61 (1994). Schistosomes, Liver Flukes and Helicobacter pylori. International Agency for Research on Cancer: Lyon, France.

  • Ishibe N and Kelsey KT . (1997). Cancer Causes Control, 8, 504–513.

  • Kolonel LN, Hinds MW and Hankin JH . (1980). Genetic and Environmental factors in Experimental and Human Cancer, Gelboin HV, MacMahon B, Matsushima T, Sugimura T, Takayama S and Takebe H (eds) Japan Scientific Societies Press: Tokyo, Japan, pp. 327–340.

    Google Scholar 

  • Lauren P . (1965). Acta. Pathol. Microbiol. Scand., 64, 31–49.

  • Lee HP, Day NE and Shanmugaratnem K . (1988). Trends in Cancer Incidence in Singapore 1868–1882, IARC Scientific Publication No. 91 IARC: Lyon, France.

    Google Scholar 

  • Mahboubi E, Kmet J, Cook PJ, Day NE, Ghadirian P and Salmasizadeh S . (1973). Br. J. Cancer, 28, 197–214.

  • McKeown-Eyssen G . (1994). Cancer Epidemiol. Biomarkers Prev., 3, 687–695.

  • McMichael AJ, McCall MG, Hartshorne JM and Woodings TL . (1980). Int. J. Cancer, 25, 431–437.

  • McPherson K, Steel CM and Dixon JM . (2000). Br. Med. J., 321, 624–628.

  • Miller BA, Kolonel LN, Bernstein L, Young JL, Swanson GM, West D, Key CR, Liff JM, Glover CS and Alexander GA (eds) (1996). Racial/Ethnic patterns of cancer in the United States 1988–1992, NIH Publication No. 96-4104 National Cancer Institute: Bethesda, MD.

    Google Scholar 

  • Muñoz N . (1988). Gastric Carcinogenesis, Reed PI and Hill MJ (eds) Elsevier Science: Amsterdam, pp. 51–69.

    Google Scholar 

  • Muñoz N, Bosch FX, Shah KV and Meheus A . (1992). The Epidemiology of Cervical Cancer and Human Papillomavirus, IARC Scientific Publication No. 119, IARC: Lyon, France.

    Google Scholar 

  • Muñoz N and Day NE . (1996). Cancer Epidemiology and Prevention, 2nd edn. Schottenfeld D and Fraumeni Jr JF (eds) Oxford University Press: Oxford, New York, pp. 681–706.

    Google Scholar 

  • Muñoz N and Franceschi S . (1997). Saluda Publica Mex., 39, 318–330.

  • Murray CJL and Lopez A . (1996). The Global Burden of Disease. Harvard University Press: USA.

    Google Scholar 

  • Norppa H . (1997). Environ. Health Perspect., 105, 829–835.

  • Parkin DM . (1989). Eur. J. Cancer Clin. Oncol., 25, 1917–1925.

  • Parkin DM . (2001). Lancet Oncol., 2, 533–543.

  • Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas J, Wabinga H and Whelan S . (2003). Cancer in Africa: Epidemiology and Prevention, IARC Scientific Publications No. 153 IARC: Lyon.

    Google Scholar 

  • Parkin DM and Khlat M . (1996). Eur. J. Cancer, 32A, 761–771.

  • Parkin DM, Ohshima H, Srivatanakul P and Vatanasapt V . (1993). Cancer Epidemiol. Biomarkers Prev., 2, 537–544.

  • Parkin DM, Pisani P and Ferlay J . (1999a). Int. J. Cancer, 80, 827–841.

  • Parkin DM, Pisani P, Lopez AD and Masuyer E . (1994). Int. J. Cancer, 59, 494–504.

  • Parkin DM, Pisani P, Muñoz N and Ferlay J . (1999b). In: Newton N, Beral V and Weiss RA (eds). Infections and Human Cancer, Cancer Surveys, 33, 5–33.

  • Parkin DM, Whelan SL, Ferlay J, Teppo L and Thomas DB (eds) (2002). Cancer Incidence in Five Continents, Vol VIII, IARC Scientific Publications No. 155 IARC: Lyon, France.

    Google Scholar 

  • Peto R, Lopez AD, Boreham J, Thun M, Heath Jr C and Doll R . (1994). Mortality from Smoking in Developed Countries 1950–2000. Oxford University Press: Oxford.

    Google Scholar 

  • Pham THA, Nguyen NT, Herrero R, Vaccarella S, Smith JS, Nguyen TT, Nguyen HN, Nguyen BD, Ashley R, Snijders PJF, Meijer CJLM, Muñoz N, Parkin DM and Franceschi S . (2002). Int. J. Cancer, 104, 213–220.

  • Pisani P, Bray F and Parkin DM . (2002). Int. J. Cancer, 97, 72–81.

  • Pisani P, Parkin DM, Bray F and Ferlay J . (1999). Int. J. Cancer, 83, 18–29.

  • Prentice RL and Sheppard L . (1990). Cancer Causes Control, 1, 81–87.

  • Pukkala E, Söderman B, Okeanov A, Storm H, Rahu M, Hakulinen T, Becker N, Stabenow R, Bjarnadottir K, Stengrevics A, Gurevicius R, Glattre E, Zatonski W, Men T and Barlow L . (2001). The Cancer Atlas of Northern Europe, Cancer Society of Finland, Publication No. 62 Suomen Graafiset Palvelut: Helsinki.

    Google Scholar 

  • Rose EF and McGlashan ND . (1975). Br. J. Cancer, 31, 197–206.

  • Rothman KJ and Greenland S . (1998). Modern Epidemiology, 2nd edn Lippincot-Raven: Philadelphia, USA.

    Google Scholar 

  • Sadjadi A, Malekzadeh R, Derakhshan MH, Sepehr A, Nouraie S, Sotoudeh M, Yazdanbod A, Shokoohi B, Mashayekhi A, Arshi S, Majidpour A, Babaei M, Mosavi A, Mohagheghi MA and Alimohammadian M . (2003). Int. J. Cancer, 107, 113–118.

  • Shibata A and Whittemore A . (1997). Prostate, 32, 65–72.

  • Sigurdsson K . (1995). Eur. J. Cancer, 31A, 728–734.

  • Silvi J . (2003). Epidemiol Bull/PAHO, 24, 1–6.

  • Sitas F, Yarnell J and Forman D . (1992). Gut, 33, 1582.

  • Smans M, Muir CS and Boyle P . (1992). Atlas of Cancer Mortality in the European Economic Community, IARC Scientific Publication No. 107 IARC: Lyon.

    Google Scholar 

  • Tanaka H, Hiyama T, Tsukuma H, Okubo Y, Yamano H, Kitada A and Fujimoto I . (1994). Cancer Causes Control, 5, 409–413.

  • Tuyns AJ and Masse G . (1975). Int. J. Epidemiol., 4, 55–59.

  • Tuyns AJ and Masse LM . (1973). Int. J. Epidemiol., 2, 241–245.

  • Tyczynski J, Tarkowski W, Parkin DM and Zatonski W . (1994). Eur. J. Cancer, 30A, 478–484.

  • World Cancer Research Fund (WCRF) Panel (1997). Diet, Nutriton and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund: Washington, USA.

  • World Health Organization (2002). National Cancer Control Programmes: Policies and Managerial Guidelines. WHO: Geneva.

  • Yatani R, Chigusa I, Akazaki K, Stemmerman GN, Welsh RA and Correa P . (1982). Int. J. Cancer, 29, 611–616.

  • Yokoyama A, Kato H, Yokoyama T, Tsujinaka T, Muto M, Omori T, Haneda T, Kumagai Y, Igaki H, Yokoyama M, Watanabe H Fukuda H and Yoshimizu H . (2002). Carcinogenesis, 23, 1851–1859.

  • Yu MC, Ross RK, Chan KK, Henderson BE, Skipper PL, Tannenbaum SR and Coetzee GA . (1995). Cancer Epidemiol Biomarkers Prev, 4, 861–864.

  • Yu MC, Skipper PL, Taghizadeh K, Tannenbaum SR, Chan KK, Henderson BE and Ross RK . (1994). J. Natl. Cancer Inst., 86, 712–716.

  • Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, Wu Williams AH, Kolonel LN, Horn Ross PL, Rosenthal JF and Hyer MB . (1993). J. Natl. Cancer Inst., 85, 1819–1827.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Donald M Parkin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Parkin, D. International variation. Oncogene 23, 6329–6340 (2004).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • geography
  • incidence
  • mortality
  • migrants
  • ethnicity

Further reading


Quick links