Transcript Global Cancer Epidemic: Impact, Challenges and Future Trends

Global Cancer Epidemic: Impact,
Challenges and Future Trends
Thomas Gross, MD, PhD
Deputy Director of Science
Center for Global Health
National Cancer Institute
Bethesda, MD 20892
Email: [email protected]
Summary of Presentation
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Cancer rates, cancer types & cancer mortality vary widely
around the world
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Eight environmental or lifestyle risk factors that account
for ~50% of all cancer deaths
• Tobacco exposure is by far the most prominent
• Strategies to reduce these risk factors will have a
tremendous impact on reducing the burden of cancer
globally
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Socioeconomic factors affect cancer rates and mortality
and will become a bigger challenge in the future
Fast Facts About Cancer
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Cancer is a global epidemic and a leading
cause of death worldwide, accounting for
7.6 million deaths or around 13% of all
deaths in 2008.
•
Worldwide, cancer now causes more deaths
than HIV/AIDS, tuberculosis, and malaria
combined.
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More than 70% of all cancer deaths occur in
low- and middle-income countries.
CANCER RATES, TYPE AND
MORTALITY VARIES WORLDWIDE
The Worldwide Burden of Cancer in Men
(Top 10 Cancer Sites)
Total: 6,629,100
Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90
Total: 4,225,700
Most Common Cancer Site in Males
Source: GLOBOCAN 2008 via the American Cancer Society
The Worldwide Burden of Cancer in Women
(Top 10 Cancer Sites)
Total: 4,225,700
Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90
Total: 3,345,800
Most Common Cancer Site in Females
Source: GLOBOCAN 2008 via the American Cancer Society
CAUSES OF CANCER
VARY WORLDWIDE
Genetic Pre-disposition vs Environment Exposure
Male Stomach Cancer ASRs from Population-based Registries:
0
Japan, Hiroshima
Korea
China, Shanghai
USA, Los Angeles: Korean
Russia, St Petersburg
Peru, Trujillo
Singapore: Chinese
Slovenia
Brazil, Cuiaba
Poland, Cracow
USA, Hawaii: Japanese
USA, Los Angeles: Japanese
China, Hong Kong
Switzerland, Ticino
France, Manche
Spain, Zaragoza
USA, SEER (9): Black
Algeria, Setif
India, Mumbai
Egypt, Gharbiah
10
Rate per 100,000
20
30
40
50
60
70
80
90
80.3
65.9
34.1
33
32.7
25.2
21.5
20.9
19.2
17.7
17.2
17.1
14.7
13.9
13.3
12.3
11
7.1
4.6
3.3
Data Source: Curado. M. P., Edwards, B., Shin. H.R., Storm. H.,
Ferlay. J., Heanue. M. and Boyle. P., eds (2007) Cancer
Incidence in Five Continents, Vol. IX
IARC Scientific Publications No. 160, Lyon, IARC.
http://www-dep.iarc.fr/
Eight Risk Factors Account for 50% of Deaths from Cancer
Risk Factors Vary In Their Contribution
To Cancers In Different Settings
Percentage of
Cancers
Attributable to
Risk Factor
Source: The Cancer Atlas
Diseases Associated with Tobacco Exposure
Cancers
Lung
Oral
Bladder
Larynx
Esophagus
Pancreas
Colorectal
Stomach
Leukemia
Cervix
Other Medical Conditions
Cardiovascular Diseases
Respiratory Diseases
Asthma control
Sudden infant death
Fetal death, stillbirth
Reduced fertility
Low birth weight
Pregnancy complications
Lung function in infants
Low bone density
Erectile Dysfunction
Peptic ulcer disease
Dental diseases
The Health Consequences of Smoking: A Report of the Surgeon General , 2004
Infections cause about:
•
18% of cancers
globally
(>2 million cases/year)
•
26% of cancers in
LMICs
•
40% of cancers in
Africa
10
Liver Cancer Kills 1% of the World’s Population
S. Korea
China
Territories are sized
in proportion to the
absolute number of
people who died
from liver cancer
annually
India
Taiwan
Japan
(from Worldmapper, www.worldmapper.org
Cancer of the liver cause ~1% of all deaths worldwide (~100 deaths per
million people per year) and 9% of all deaths from cancer.
IMPACT OF SOCIOECONOMIC
STATUS ON CANCER BURDEN
Overall (non-adjusted) Cancer Incidence Rates
(Per 100K, Both Genders; All Cancers Except Non-Melanoma Skin)
Data Source: Globocan 2008
Trends in Cancer Incidence
Developed vs. Less Developed Countries
Cancer incidence with age in USA
Annual Cancer Cases (Millions)
2500
2000
1500
1000
500
25
Less Developed
More Developed
20
15
10
12.9
7.5
5
57%
5.7
7.4
2010
2030
0
0
Ages < Ages Ages Ages
20 20-49 50-64 65-74
Data from SEER 2010
Ages
75+
Data derived from GLOBOCAN
2008
64%
% of All Cancers
Cancer in 0-14 yr olds as % of all cancer
Globocan 2002
• Incidence per capita of pediatric cancer is similar around the world
Trends in Cancer Mortality
Developed vs. Less Developed Countries
 Cancer mortality in more developed countries

projected decrease by <30% by 2030

projected to increase by >70% by 2030
 Cancer mortality in less developed countries
By 2030 - 85% of all cancer deaths may be occurring in low-middle income
countries
 The increase In cancer mortality in LMIC is largely due to:
 Delay in accurate diagnoses
 Lack of unawareness about cancer and potential value of therapy
 Lack of access and ability to deliver potentially curative therapy
 Abandonment of therapy
Breast Cancer and Socioeconomic Status
Female Breast Cancer Incidence
(Per 100,000)
Data Source: Globocan 2008
Total Expenditure on Health
(for 2011 in US$)
RISK FACTORS FOR BREAST CANCER IN
DEVELOPED COUNTRIES
• Higher maternal age at first birth
• Reduced parity
– Each live birth results in a decrease
of 7% in relative risk of breast
cancer (Lancet 2002;360:187-195)
• Reduced breast feeding
– For every 12 months of breast
feeding results in a decrease of 4%
in relative risk of breast cancer
(Lancet 2002;360:187-195)
• Obesity & “lifestyle” factors
Incidence of Breast Cancer & Outcomes Correlate with GDP
Source: Harford JB, Lancet Oncol. 2011 Mar;12(3):306-12.
Institute of Medicine (IOM REPORT)
High-income countries should:
•Resist the temptation to focus on exporting the
latest, most expensive technologies that may
be appropriate for wealthy countries…
•Partner with countries to develop resourceappropriate strategies focused on decreasing
the burden and mortality due to cancer.
IOM Report
Some low- or middle income countries
(including physicians & governments) have a
related temptation to WANT the latest, most
expensive technologies as opposed to more
resource-appropriate “alternatives” which may
be seen as 2nd rate solutions.
A National Cancer Control Program in Context
Broader Social Context
Healthcare System
National Cancer
Control Program
Primary
Prevention
Early
Detection
Curative
Treatment
Palliative
Care
Survivorship
NCI - CGH Global Footprint
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Acknowledgments
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Ted Trimble, MD, MPH – Director of NCI-CGH
Lisa Stevens, PhD – Deputy Director of NCI-CGH
Joe Harford, PhD - Senior Advisor NCI-CGH
Ann Chao, PhD – East Asia Representative, NCI-CGH