Sources and Methods

A note about maps in this edition of The Cancer Atlas: Many maps throughout the Atlas were created using data from GLOBOCAN, a database of estimated cancer statistics created and maintained by the International Agency for Research on Cancer. A full description of the methods for creating these estimates can be found on the Global Cancer Observatory website (http://gco.iarc.fr/today/data-sources-methods).

Foreword

Romero Y, Trapani D, Johnson S, et al. National cancer control plans: a global analysis. Lancet Oncol. 2018;19(10):e546-e555.

Introduction

Ferlay J, Ervik M, Lam F, Plummer M, Vignat J, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC, 2018. Available from: https://gco.iarc.fr/today.

Risk Factors

Section Divider:
WHO global report on trends in prevalence of tobacco smoking 2000–2025, 2nd edition. Geneva: World Health Organization; 2018.

WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Overview of Risk Factors

Potentially modifiable risk factors:
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923–94.

Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol. 2017;28(10):2567–2574.

Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31–54.

Access creates progress:
Turner, PC, et al. Reduction in exposure to carcinogenic aflatoxins by postharvest intervention measures in west Africa: a community-based intervention study. Lancet. 2005;365(9475):1950–1956.

Text:
Bouvard V, Baan R, Straif K, et al. A review of human carcinogens–Part B: biological agents. Lancet Oncol. 2009;10(4):321–322.

Bruni L, Diaz M, Barrionuevo-Rosas L, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016;4(7):e453-463.

Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch FX, de Sanjose S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010;202(12):1789–1799.

El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens–part D: radiation. Lancet Oncol. 2009;10(8):751–752.

GBD Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1345–1422.

GBD Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389(10082):1885-1906.

Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018.

IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol 100E: Personal Habits and Indoor Combustions. Lyon: IARC Press; 2012.

Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol. 2017;28(10): 2567–2574.

Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31–54.

Islami F, Stoklosa M, Drope J, Jemal A. Global and regional patterns of tobacco smoking and tobacco control policies. Eur Urol Focus. 2015(1):3–16.

Liu Y, Wu F. Global burden of aflatoxin-induced hepatocellular carcinoma: a risk assessment. Environ Health Perspect. 2010;118(6):818–824.

Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol. 2018;6(6):e6-e15.

Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016;4(9):e609-616.

Prüss-Ustün A, Wolf J, Corvalán C, Bos R, Neira M. Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. Switzerland, Geneva: WHO Press; 2016.

Schuz J, Espina C, Villain P, et al. European Code against Cancer 4th Edition: 12 ways to reduce your cancer risk. Cancer Epidemiol. 2015;39 Suppl 1:S1-10.

World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: a global perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.

Xia C, Zheng R, Zeng H, et al. Provincial-level cancer burden attributable to active and second-hand smoking in China. Tob Control. 2018.

Map:
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. Available at: https://www.who.int/substance_abuse/publications/global_alcohol_report/en/

Figure 1:
Bouvard V, Baan R, Straif K, et al. A review of human carcinogens–Part B: biological agents. Lancet Oncol. 2009;10(4):321–322.

Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: A synthetic analysis. Lancet Glob Health. 2016;4(9):e609-616.

Figure 2:
Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch FX, de Sanjose S. Cervical human papillomavirus prevalence in 5 continents: Meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010;202(12):1789–1799.

Bruni L, Diaz M, Barrionuevo-Rosas L, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: A pooled analysis. Lancet Glob Health. 2016;4(7):e453-463.

Figure 3:
Liu Y, Wu F. Global burden of aflatoxin-induced hepatocellular carcinoma: a risk assessment. Environ Health Perspect. 2010;118(6):818–824.

Figure 4:
Prüss-Ustün A, Wolf J, Corvalán C, Bos R, Neira M. Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. Geneva: WHO Press; 2016.

Text box:
Schuz J, Espina C, Villain P, et al. European Code against Cancer 4th Edition: 12 ways to reduce your cancer risk. Cancer Epidemiol. 2015;39 Suppl 1:S1-10.

Risks of Tobacco

Male smoking prevalence:
Dr. Michael Thun, personal communication

Access creates progress:
Siu AL, for the US Preventive Services Task Force. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: USPSTF Recommendation Statement for Interventions for Tobacco Smoking Cessation. Ann Intern Med. 2015;163(8):622–634.

Text:
Asma S, Mackay J, Song SY, et al. The GATS Atlas. Atlanta, GA: CDC Foundation 2015. Available at www.gatsatlas.org.

Drope J, Schluger N, Cahn Z, et al. The Tobacco Atlas. Atlanta: American Cancer Society and Vital Strategies, 2018 Available at https://tobaccoatlas.org/topic/prevalence/.

Thun MJ, Freedman ND. Tobacco. In: Thun MJ, Linet MS, Cerhan JR, Haiman CA, Schottenfeld (Eds), Schottenfeld and Fraumeni. Cancer Epidemiology and Prevention, (4th ed., pp 185–211). New York: Oxford University Press, 2018

Gentzke AS, Creamer M, Cullen KA, et al. Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep. 2019;68:157–164.

Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: How the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tobacco Control. 2019;28:146–151.

US National Cancer Institute. Patterns of tobacco use, exposure, and health consequences. In: The Economics of Tobacco and Tobacco Control, Tobacco Control Monograph 21. Bethesda, MD and Geneva: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute and World Health Organization. 2016.

IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 100: A Review of Human Carcinogens. Part E: Personal Habits and Indoor Combustions. Lyon, France: IARC,2012.

US Department of Health and Human Services. The Health Consequences of Smoking- 50 Years of Progress: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

Map:
Tobacco Atlas 6th edition, https://tobaccoatlas.org/topic/prevalence/

Figure 1:
Gentzke AS, Creamer M, Cullen KA, et al. Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep. 2019;68:157–164.

Figure 2:
Notes: Lip cancer classified as causal in 1964, other oropharyngeal cancers in 1971. Lung cancer classified as causal in men in 1964 and in women in 1968. Esophagus, lung, and kidney include multiple histologic subtypes. Source: Modified from US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

Infection

Cancer in sub-Saharan Africa related to infection:
Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016 Sep;4(9):e609-16.

Text:
de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017 Aug 15;141(4):664–670.

de Martel C, Shiels MS, Franceschi S, et al. Cancers attributable to infections among adults with HIV in the United States. AIDS. Oct 23 2015;29(16):2173–2181.

Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016 Sep;4(9):e609-16.

Map & Figures 1-3:
Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016 Sep;4(9):e609-16. Licence CC BY-NC-ND 4.0

Figure 3:
Notes: Stomach includes cardia, non-cardia, and NHL of gastric location. Liver includes cholangiocarcinoma. Other anogenital includes vulva, vagina, penile, and anus. Head and neck includes oropharynx, nasopharynx, oral cavity, and larynx. Other includes Hodgkin lymphoma, non-Hodgkin lymphoma, Burkitt adult T cell lymphoma, Kaposi sarcoma, and bladder.

Body Weight, Physical Activity, Diet, and Alcohol

Alcoholic beverage consumption:
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Alcohol consumption and ethyl carbamate. Vol. 96. Lyon, France: IARC Press; 2010.

Department of Health and Human Services [USA] 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services, 2018. https://health.gov/paguidelines/second-edition/report/ Accessed Feb. 28, 2019.

Text:
Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: A population-based study. Lancet Oncol. 2015 Jan; 16(1): 36–46.

Department of Health and Human Services [USA] 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services, 2018.
https://health.gov/paguidelines/second-edition/report/

International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Alcohol consumption and ethyl carbamate. Vol. 96. Lyon, France: IARC Press; 2010.

Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer: Viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794–798.

World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: A global perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org. Accessed Nov. 9, 2018.

World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. https://www.who.int/substance_abuse/publications/global_alcohol_report/en/ Accessed Feb. 28, 2019.

World Health Organization. Obesity and Overweight. http://www.who.int/gho/ncd/risk_factors/physical_activity_text/en/ Accessed October 30, 2018.

Map:
Adult obesity is defined as BMI greater than or equal to 30.

World Health Organization Global Health Observatory Data Repository. https://www.who.int/gho/en/. Accessed May 30, 2019.

Figure 1:
World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: A global perspective.
Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.

Figure 2:
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0. See page 89 of the report.

Ultraviolet Radiation

Prevention of skin cancer by use of sun protection:
Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? Melanoma Res. 1993;3(6):395–401.

Lucas RM, McMichael AJ, Armstrong BK, Smith WT. Estimating the global disease burden due to ultraviolet radiation exposure. Int J Epidemiol. 2008;37(3):654–667.

Text:
Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Euro J Cancer Prevention. 2015; 24:141–149.

Green AC, Wallingford SC, McBride P. Childhood exposure to ultraviolet radiation and harmful skin effects: epidemiological evidence. Progr Biophysics Mol Biol. 2011; 107:349–55.

Guy GP, Jr., Zhang Y, Ekwueme DU, Rim SH, Watson M. The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis. J Am Acad Dermatol. 2017;76:226–233.

IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC Monographs. Radiation. Volume 100D. A review of human carcinogens. Lyon, France: 2012.

Karimkhani C, Fitzmaurice C, Green AC, et al. The global burden of melanoma: Results from Global Burden of Disease Study 2015. Brit J Dermatol. 2017; 177:134–40.

Wallingford SC, Iannacone MR, Youlden DR, et al. Comparison of melanoma incidence and trends among youth under 25 years in Australia and England, 1990-2010. Int J Cancer. 2015; 137:2227–2233.

World Health Organization. Solar Ultraviolet Radiation: Global Burden of Disease from solar ultraviolet radiation. 2012.

Map:
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC, 2018. Available from: https://gco.iarc.fr/today.

Figure 1:
Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Euro J Cancer Prev. 2015; 24:141–149.

Reproductive and Hormonal Factors

Breastfeeding duration:
Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–490.

Text:
Brown SB, Hankinson SE. Endogenous estrogens and the risk of breast, endometrial, and ovarian cancers. Steroids. 2015;99(Pt A):8–10.

Islami F, Liu Y, Jemal A, et al. Breastfeeding and breast cancer risk by receptor status–a systematic review and meta-analysis. Ann Oncol. 2015;26(12):2398–2407.

Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol. 2017;216(6):580 e581–580 e589.

Murphy N, Ward HA, Jenab M, et al. Heterogeneity of colorectal cancer risk factors by anatomical subsite in 10 European Countries: A multinational cohort study. Clin Gastroenterol Hepatol. 2018.

Williams CL, Jones ME, Swerdlow AJ, et al. Risks of ovarian, breast, and corpus uteri cancer in women treated with assisted reproductive technology in Great Britain, 1991-2010: data linkage study including 2.2 million person years of observation. BMJ. 2018;362:k2644.

Map 1 and Figure 1:
Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017): 475–490.

Quigley MA, Carson C. Breastfeeding in the 21st century. Lancet. 2016;387(10033): 2087–2088.

Map 2:
United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, custom data acquired via website.

Figure 2:
United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, custom data acquired via website.

Figure 3:
Note: Etiologic heterogeneity is an active area of research for most of these cancers. For example, there is active research into the disparate role of parity in the etiology of estrogen receptor positive compared to triple negative breast cancer. The table considers the hormonal and reproductive risk factors in association to risk of the cancer site overall.

Evidence is based more strongly on studies with prospective exposure assessment.

An N. Oral Contraceptives Use and Liver Cancer Risk: A Dose-Response Meta-Analysis of Observational Studies. Medicine. 2015;94(43):e1619.

Appleby P, Beral V, et al. for the International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007;370(9599):1609–1621.

Ben Khedher S, Neri M, Papadopoulos A, et al. Menstrual and reproductive factors and lung cancer risk: A pooled analysis from the international lung cancer consortium. Int J Cancer. 2017;141(2):309–323.

Brinton LA, Felix AS. Menopausal hormone therapy and risk of endometrial cancer. Journal Steroid Biochem Molecular Biol. 2014;142:83–89.

Brown SB, Hankinson SE. Endogenous estrogens and the risk of breast, endometrial, and ovarian cancers. Steroids. 2015;99(Pt A):8–10.

Camargo MC, Goto Y, Zabaleta J, Morgan DR, Correa P, Rabkin CS. Sex hormones, hormonal interventions, and gastric cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2012;21(1):20–38.

Chlebowski RT, Anderson GL, Sarto GE, et al. Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Women’s Health Initiative Randomized Trial. J Natl Cancer Inst. 2016;108(3).

Chlebowski RT, Schwartz AG, Wakelee H, et al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women’s Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet. 2009;374(9697):1243–1251.

Costas L, de Sanjose S, Infante-Rivard C. Reproductive factors and non-Hodgkin lymphoma: a systematic review. Crit Rev Oncol Hematol. 2014;92(3):181–193.

Cote ML, Alhajj T, Ruterbusch JJ, et al. Risk factors for endometrial cancer in black and white women: a pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2). Cancer Causes Control. 2015;26(2):287–296.

Gaudet MM, Gapstur SM, Sun J, Teras LR, Campbell PT, Patel AV. Oophorectomy and hysterectomy and cancer incidence in the Cancer Prevention Study-II Nutrition Cohort. Obstet Gynecol. 2014;123(6):1247–1255.

Gaudet MM, Gierach GL, Carter BD, et al. Pooled Analysis of Nine Cohorts Reveals Breast Cancer Risk Factors by Tumor Molecular Subtype. Cancer Res. 2018;78(20):6011–6021.

Green J, Roddam A, Pirie K, et al. Reproductive factors and risk of oesophageal and gastric cancer in the Million Women Study cohort. Br J Cancer. 2012;106(1):210–216.

International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical carcinoma and reproductive factors: collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies. Int J Cancer. 2006;119(5):1108–1124.

Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol. 2017;216(6):580 e581–580 e589.

LaCroix AZ, Chlebowski RT, Manson JE, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA. 2011;305(13):1305–1314.

Ma X, Zhao LG, Sun JW, et al. Association between breastfeeding and risk of endometrial cancer: a meta-analysis of epidemiological studies. Eur J Cancer Prev. 2018;27(2):144–151.

Murphy N, Strickler HD, Stanczyk FZ, et al. A Prospective Evaluation of Endogenous Sex Hormone Levels and Colorectal Cancer Risk in Postmenopausal Women. J Natl Cancer Inst. 2015;107(10).

Murphy N, Ward HA, Jenab M, et al. Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study. Clinl Gastroenterol Hepatol. 2019;17(7):1323–1331 e1326.

Roura E, Travier N, Waterboer T, et al. The Influence of Hormonal Factors on the Risk of Developing Cervical Cancer and Pre-Cancer: Results from the EPIC Cohort. PloS one. 2016;11(1):e0147029.

Setiawan VW, Yang HP, Pike MC, et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol. 013;31(20):2607–2618.

Tsilidis KK, Allen NE, Key TJ, et al. Oral contraceptives, reproductive history and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2010;103(11):1755–1759.

Zhong GC, Liu Y, Chen N, et al. Reproductive factors, menopausal hormone therapies and primary liver cancer risk: a systematic review and dose-response meta-analysis of observational studies. Hum Reprod Update. 2016;23(1):126–138.

Environmental and Occupational Exposures

Outdoor air pollution exposure:
World Health Organization. Global Health Observatory data repository. https://www.who.int/gho/en/. Accessed April 24, 2019.

Percent of cancers worldwide attributed to occupational exposure:
Driscoll T, Takala J, Steenland K, Corvalan C, Fingerhut M. Review of estimates of the global burden of injury and illness due to occupational exposures. Am J Ind Med. 2005;48: 491–502.

Rushton L, Hutchings SJ, Fortunato L, et al. Occupational cancer burden in Great Britain. Br J Cancer. 2012;107 Suppl 1: S3-7.

Text:
Loomis D, Guha N, Straif K. Identifying occupational carcinogens: An update from the IARC Monographs. Occupational Environ Med. 2018;75:593-603.

World Health Organization Global Health Observatory Data Repository, http://apps.who.int/gho/data/node.home.

Maps 1–2, and Figure 1:
Health Effects Institute. State of Global Air 2019.

Data source: Global Burden of Disease Study 2017. IHME, 2018.

Population-weighted annual average: Instead of calculating average air pollution levels where all areas receive equal weight, as is typically done, population-weighted averages give weight to the areas in proportion to their population, so that greater weight is given to exposures in areas where the most people live.

Figure 2:
Loomis D, Guha N, Straif K. Identifying occupational carcinogens: an update from the IARC Monographs. Occupational Environ Med. 2018;75:593–603.

Human Carcinogens Identified by the IARC Monographs Program

Text and Figures:
IARC. IARC Monographs on the Evolution of Carcinogenic Risks to Humans. Lyon, France: International Agency for Research on Cancer; accessed on September 20, 2018. https://monographs.iarc.fr/.