marrakech, morocco, 18-19 june 2010 contents global burden of cancer recommendations regional...

Epidemiology of Cancer in EMR

Marrakech, Morocco, 18-19 June 2010Contents

Global burden of cancer

Recommendations

Regional challenges in cancer prevention and control

Regional burden of cancer

Cancer control strategy and framework for country action

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Recommendations




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• 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(2004-2030)

Cancers

Stroke

Recent IARC Report , June 2010.

Cancer projected global deaths

• In 2008, best estimates: 12.7 million new cancer cases and 7.6 million cancer deaths.

• 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.

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Cancers

Stroke

Road traffic accidents

HIV/AIDSTB

Malaria

Acute respiratory infections

Ischaemic heart disease

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Cancer projected global deaths



Recommendations




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• 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

WHO EAST MEDITERRANEAN REGION (EMRO) Male Female Both sexes

Population (thousands) 297428 282779 580208

Number of new cancer cases (thousands) 214.7 214.8 429.5

Age-standardised rate (W) 109.3 104.4 106.3

Risk of getting cancer before age 75 (%) 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

Age-standardised rate (W) 88.6 73.2 80.5

Risk of dying from cancer before age 75 (%) 9.6 7.9 8.7

Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993

Regional Statistics

Most common cancers in the RegionEastern 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


Most frequent cancers (Incidence & Mortality) in MEN

Reference: Globocan 2008 (IARC), Country Fast Statehttp://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993

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Most frequent cancers (Incidence & Mortality) in WOMEN


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Most frequent cancers (Incidence & Mortality) in BOTH SEXES


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Incidence of childhood cancer in the Region is comparable to that in industrialized countries, but mortality is much higher.

All sites

In the Region, the most common childhood cancers are cancers of the blood.

EMR countries

Childhood cancersRegional burden of cancer

• 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.

Lessons learnedFrom international experiences

Prevalence of tobacco smokingAmong adults in the Region

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Prevalence of overweight & obesityin the Region

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World cancer burden caused by infectionin 2002

The major infections are:• Schistosomiasis

(bladder cancer)• Helicobacter pylori

(stomach cancer)• Hepatitis B and C

(liver cancer)• Human papillomavirus

(cervical cancer)

Source: Parkin DM. International journal of cancer, 2006, 118(12):3030–44.

0.1% 0.1%0.1%

0.9% 1.0%

4.9%5.2%

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Total caused by infection, 17.8%

Cancer related to infection and corresponding burden In EMR

Cancers Infectious agent (attributable fraction for the whole world)

Crude incidence in the Eastern Mediterranean Regiona

(per 100 000 population)

Bladder Schistosoma (3%) 5.0

Stomach Helicobacter pylori (63%) 3.8

Non-Hodgkin lymphoma

HTLV-I (18%) 3.3

Cervix 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.



Recommendations




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• In the Region, the vast majority of cancers are diagnosed at an advanced stage when cure is improbable even with the best treatment.

1. Screening and early detectionRegional challenges in cancer prevention

Stage of diagnosis

Breast cancer Cervical cancerUnited 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%

• 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 radio-technicians are not sufficient to cover the needs in many countries;

• Multidisciplinary management of cases is not instituted in all referral centres.

2. Cancer management in the RegionRegional challenges in cancer prevention

3. Palliative careRegional challenges in cancer prevention

• Misconceptionsabout pain relief use;

• Training Gaps;• Lack of awareness;• Inadequate policies

restricting access to pain relief medications;

• Accessibility & affordability of medication for pain relief

• 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.

4. Cancer dataRegional challenges in cancer prevention

marrakech, morocco, 18-19 june 2010 contents global burden of cancer recommendations regional...

Documents

cancer prevention

majority of cancer cases

regional statistics

country action slide

global deaths

majority of new cases

eastern mediterranean

country fast state http