The global cancer burden can be evaluated from many different perspectives. To date, the intergenerational consequences of the cancer burden have been afforded scarce attention. The study findings derived from GLOBOCAN estimates and published on 20 November 2022 in the Nature Medicine provide global, regional and national estimates of maternal orphans due to cancer. The study pointed out to estimate of approximately 1 million new maternal orphans due to cancer in 2020. Furthermore, a point prevalence of 7 million maternal orphans due to cancer implies that cancer deaths were responsible for approximately 15% of prevalent maternal orphans in 2020. The disaggregation of maternal orphans by cause of cancer-related death, country and Human Development Index (HDI) highlights further dimensions of global health inequities, as well as the preventability of many of the cancer deaths worldwide.
Overall, 71% of cancer deaths occur at the age of 60 years or older, by which time most children of deceased adults are already aged 18 years or older meaning that at the time of death, most women last gave birth over 18 years ago. However, cancer deaths at younger ages can result in orphans. At these younger ages, both globally and in lower-income countries (LICs) in particular, women are disproportionately affected by cancer deaths compared to men. This is primarily due to deaths from common cancers that predominantly or exclusively affect women, in particular breast and cervix. Additionally, cancer deaths in LICs are more likely to result in maternal orphans because LICs are characterised by younger populations and, hence, lower average age of cancer diagnosis, as well as higher fertility and later maternal age at last birth. In LICs, if a women dies prematurely from cancer, her children are likely to still be minors.
The consequences of orphanhood from any cause of parental death can have a long-term impact on a child’s life in multiple domains, many of which are family, context and setting specific. Maternal orphans have higher rates of mortality in childhood than their peers, both in low- and high-income settings. As they grow up, orphaned children are at an increased risk of mental health disorders and suicide, as well as experiencing sexual violence. Orphanhood is also associated with raised risks of teenage pregnancy, infectious diseases, including HIV/AIDS during adolescence and chronic diseases later in life. In some settings, orphans are more likely to leave school prematurely and become entangled in a cycle of poverty.
Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. In this study, the authors aimed to fill the information gap on maternal orphans due to cancer. They focused on maternal orphans given the disproportionate burden of cancer deaths at young ages in women, the availability of high-quality fertility estimates and the central role of a mother in a child’s development, caregiving and education.
The study aims were to provide country, regional and global estimates for 2020 in terms of the number of new maternal orphans due to cancer for all cancers combined and by cancer site, risk of a child becoming a maternal orphan due to cancer, the number of new maternal orphans per 100 female cancer deaths, the number of prevalent maternal orphans due to cancer by country, and the age-distribution of new and prevalent maternal orphans due to cancer. The authors also examined variations of these estimates by a country’s place in the HDI.
The study team estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths by country, cancer type and age derived from GLOBOCAN estimates were multiplied by each woman’s estimated number of children under the age of 18 years at the time of her death, accounting for child mortality and parity-cancer risk associations. Fertility data were derived from United Nations World Population Prospects for birth cohort.
Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (25%), cervix (20%) and upper gastrointestinal cancers (13%), and 48% occurred in Asia (15% in India, 10% in China, 23% in rest of Asia) and 35% in Africa. Globally, there were 40 new maternal orphans due to cancer per 100,000 children, with a declining trend with a higher HDI (range, 121 in Malawi to 15 in Malta). An estimated 7 million children were prevalent maternal orphans due to cancer in mid 2020.
The authors concluded that children are affected on large scale by the loss of their mothers due to cancer globally. Accelerating the implementation of the cancer control plans, propelling programmes to prevent cervical and breast cancer has the potential to avert not only millions of preventable female cancer deaths, but also the associated, often-overlooked, intergenerational consequences of these deaths. Alongside these efforts, support to families and communities caring for orphaned children is needed to ensure that these children receive the same opportunities, education and good health as other children worldwide.
This work was funded by the US National Cancer Institute.
Reference
Guida F, Kidman R, Ferlay J, et al. Global and regional estimates of orphans attributed to maternal cancer mortality in 2020. Nature Medicine; Published online 20 November 2022. DOI: https://doi.org/10.1038/s41591-022-02109-2