Forecasting mortality and decomposition analysis for cancer deaths in Egypt (2014-2030)

Cancer represents a significant public health challenge in Egypt, with its burden projected to rise due to ongoing epidemiological and demographic transitions. Understanding the drivers of cancer mortality is crucial for effective public health planning.

We used a time series analysis of national vital registration data for 19 cancer types from 2014 to 2023. We employed a hybrid forecasting model combining ARIMA and ETS to project mortality trends through 2030. A decomposition analysis was performed to quantify the influence of population growth, population aging, and age-specific mortality rates on the observed and projected CMR.

Our analysis revealed a 14.1% [95% CI: 12.7, 15.5] increase in total cancer deaths, while the ASMR rose by a more modest 8.2% [95% CI: 3.1, 13.3], primarily driven by demographic factors. Despite this, ASMR for most major cancer types stabilized or declined; liver cancer ASMR decreased by 12.1% [95% CI: -20.8,-3.4] and female breast cancer deaths fell by 29.0% [95% CI: -33.3,-24.6]. A notable epidemiological shift was also observed, with CMR from less common cancers like multiple myeloma increasing by over 700% and skin cancer by 349%. Forecasting models project a continued decline for these major cancers through 2030, with a projected 12.3% decrease in lung cancer CMR for both sexes and a 41.5% reduction for female breast cancer.

The growing cancer mortality burden in Egypt is primarily a function of demographic shifts rather than an increase in age-standardized risk. The decline in ASMR for major cancers demonstrates the success of targeted interventions specifically, liver cancer ASMR reflecting the success of national Hepatitis C elimination. These findings highlight the need for a dual-pronged strategy: sustaining efforts to combat prevalent cancers while proactively developing new programs to address the emerging threats posed by lifestyle- and aging-related malignancies, particularly those disproportionately affecting women.