Transcript Epidemiology of Cancer in EMRA

Contents
Marrakech, Morocco, 18-19 June 2010
1
Global burden of cancer
2
Regional burden of cancer
3
Regional challenges in cancer prevention and control
4
Cancer control strategy and framework for country action
5
Recommendations
Contents
Marrakech, Morocco, 18-19 June 2010
✓
1
Global burden of cancer
2
Regional burden of cancer
3
Regional challenges in cancer prevention and control
4
Cancer control strategy and framework for country action
5
Recommendations
Cancer projected global deaths
(2004-2030)
• Cancer is the second most common killer today,
13% of death worldwide are currently caused by it.
• By 2030, cancer will become the leading cause of
death, ahead of ischemic heart disease & stroke.
• The estimated number of cases of cancer is
expected to rise each year from 11 million in 2002
to 27 million by 2030 .
• The majority of new cases are expected to occur
in less developed countries.
Cancer projected global deaths
Recent IARC Report , June 2010.
•In 2008, best estimates: 12.7 million new cancer
cases and 7.6 million cancer deaths. Cancers
Stroke
•Over half (56%) of new cancer cases and 63% of
deaths in developing regions of the World.
•Approx. 21.4 million new cases will be diagnosed
and 13.2 million deaths from cancer will occur in
2030.
Cancer projected global deaths
(2004-2030)
12
Cancers
Deaths (millions)
10
Ischaemic heart disease
Stroke
8
6
Acute respiratory infections
4
Road traffic accidents
2
Perinatal
HIV/AIDS
TB
Malaria
0
2000
2005
2010
2015
2020
2025
2030
Contents
Marrakech, Morocco, 18-19 June 2010
✓
1
Global burden of cancer
2
Regional burden of cancer
3
Regional challenges in cancer prevention and control
4
Cancer control strategy and framework for country action
5
Recommendations
Regional burden of cancer
• Cancer is the 4th ranked cause of death in the
Eastern Mediterranean Region, following
cardiovascular diseases, infectious diseases
and injuries;
• It is estimated that cancer kills 272,000 people
each year in the Region;
• Half of the cancer occur before age 55 years;
• The majority of cancer cases diagnosed at
relatively advanced stage.
Summary Statistics
Regional Statistics
WHO EAST MEDITERRANEAN REGION (EMRO)
Male
Female
Both sexes
297428
282779
580208
214.7
214.8
429.5
109.3
104.4
106.3
11.7
10.8
11.2
WHO EAST MEDITERRANEAN REGION (EMRO)
Male
Female
Both sexes
Number of cancer deaths (thousands)
169.9
144.5
314.3
88.6
73.2
80.5
9.6
7.9
8.7
Population (thousands)
Number of new cancer cases (thousands)
Age-standardised rate (W)
Risk of getting cancer before age 75 (%)
Age-standardised rate (W)
Risk of dying from cancer before age 75 (%)
Reference: Globocan 2008 (IARC), Country Fast State
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993
Most common cancers in the Region
Eastern Mediterranean countries, incidence (all ages)
GLOBOCAN 2002 estimates: http://www-dep.iarc.fr/
5 Most common cancers in the Region
Male
Female
Both sexes
Lung
Breast
Breast
Bladder
Cervix uteri
Lung
Stomach
Colorectum
Colorectum
Non-Hodgkin lymphoma
Ovary
Stomach
Colorectum
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma
Reference: Globocan 2008 (IARC), Country Fast State
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993
Most frequent cancers (Incidence & Mortality) in
MEN
♂
Reference: Globocan 2008 (IARC), Country Fast State
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993
Most frequent cancers (Incidence & Mortality) in
WOMEN
♀
Reference: Globocan 2008 (IARC), Country Fast State
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993
Most frequent cancers (Incidence & Mortality) in
BOTH SEXES
♀
Reference: Globocan 2008 (IARC), Country Fast State
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993
♂
Childhood cancers
Regional burden of cancer
EMR countries
In the Region, the most common childhood cancers
are cancers of the blood.
All sites
Incidence of childhood cancer in the Region is
comparable to that in industrialized countries, but
mortality is much higher.
Lessons learned
From international experiences
• 40% of cancers can be prevented.
• 40% of cancers can be detected early and
cured.
• Suffering from the remaining 20% of
cancers can be reduced by palliative
therapy.
Oman
United Arab Emirates
Saudi Arabia
Sudan
90
80
70
60
50
Bahrain
Islamic Republic of Iran
Kuwait
Morocco
Egypt
Pakistan
Qatar
Palestine
Lebanon
Jordan
Syrian Arab Republic
Djibouti
Tunisia
Yemen
Prevalence of tobacco smoking
Among adults in the Region
Males > 15 yr
Females > 15 yr
40
30
20
10
0
Yemen
Afghanistan
Somalia
60
Pakistan
70
Sudan
80
Djibouti
Oman
Iraq
Lebanon
Morocco
Syrian Arab Republic
Islamic Republic of Iran
Libyan Arab Jamahiriya
United Arab Emirates
Qatar
Saudi Arabia
Tunisia
Bahrain
Jordan
Egypt
Kuwait
Prevalence of overweight & obesity
in the Region
90
BMI ≥ 25 Males
BMI ≥ 25 Females
50
40
30
20
10
0
World cancer burden caused by infection
in 2002
Total caused by infection, 17.8%
6.0%
4.9%
5.2%
5.6%
(bladder cancer)
5.0%
• Helicobacter pylori
4.0%
(stomach cancer)
3.0%
• Hepatitis B and C
2.0%
1.0%
The major infections are:
• Schistosomiasis
0.9% 1.0%
0.1% 0.1% 0.1%
(liver cancer)
• Human papillomavirus
(cervical cancer)
Sc
hi
st
os
om
ia
si
s
H
TL
Li
ve V-1
rf
l
H u ke
IV
/H s
H
V
-B
H
E
BV B V
&
H
C
V
H
PV
H
.P
yl
or
i
0.0%
Source: Parkin DM. International journal of cancer, 2006,
118(12):3030–44.
Cancer related to infection and corresponding burden In
EMR
Cancers
Infectious agent (attributable fraction Crude incidence in the Eastern
for the whole world)
Mediterranean Regiona
(per 100 000 population)
Bladder
Schistosoma (3%)
5.0
Stomach
Helicobacter pylori (63%)
3.8
Non-Hodgkin
lymphoma
Cervix
HTLV-I (18%)
3.3
HPV (100%)
2.8
Liver
HBV, HCV (86%)
2.4
Hodgkin lymphoma
EBV (46%)
1.5
Nasopharyngeal
carcinoma
EBV (98%)
0.9
Source: The cancer atlas. American Cancer Society, 2006.
Contents
Marrakech, Morocco, 18-19 June 2010
✓
1
Global burden of cancer
2
Regional burden of cancer
3
Regional challenges in cancer prevention and control
4
Cancer control strategy and framework for country action
5
Recommendations
1. Screening and early detection
Regional challenges in cancer prevention
• In the Region, the vast majority of cancers are diagnosed
at an advanced stage when cure is improbable even with
the best treatment.
Stage of
diagnosis
Breast cancer
Cervical cancer
United
States
EMR Country
United
States
EMR Country
Early stage
65%
25.5%
58%
35.9%
Advanced
stages
30%
58%
33%
53.2%
5%
16.5%
9%
10.9%
2. Cancer management in the Region
Regional challenges in cancer prevention
• Human resources (oncologists, nurses) are insufficient in
the majority of countries;
• Medicine availability and affordability for patients in the
majority of countries (out-of-pocket expense);
• Radiotherapy machines, radio-oncologists and radiotechnicians are not sufficient to cover the needs in many
countries;
• Multidisciplinary management of cases is not instituted in
all referral centres.
3. Palliative care
Regional challenges in cancer prevention
• Misconceptions
about pain relief use;
• Training Gaps;
• Lack of awareness;
• Inadequate policies
restricting access to
pain relief medications;
• Accessibility & affordability
of medication for pain relief
4. Cancer data
Regional challenges in cancer prevention
• 11 countries have hospital-based cancer registry and
published reports, but the quality of the data and reports
from these registries is very heterogeneous.
• Cancer registry is not exist in 8 Member States have no
cancer registry.
• Data about stage at presentation, mortality and survival
are lacking in almost all Member States.