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Priorities for cancer prevention: the requirement for a regional agenda
Dr Christopher P Wild PhD Director
Global cancer burden – incidence, mortality and prevalence (2008)
Cancer prevention
Rationale for cancer prevention – the requirement for a regional agenda
Wild CP J. Natl. Cancer Institute 2012 Available online Open Access.
Cancer prevention
Priorities for cancer prevention
LIVER CANCER INCIDENCE COLORECTAL CANCER INCIDENCE
Cancer pattern varies by region and country
Jemal et al. Cancer 2012
Human Development Index (HDI) 2007
source: United Nations Development Programme http://hdr.undp.org/en/statistics/hdi/
The HDI is a composite index of three dimensions of human development • Long and healthy life (life expectancy at birth) • Access to knowledge (adult literacy rate/primary to tertiary education enrolment rates) • Decent standard of living (GDP per head, adjusted for purchasing power parity)
Cancer prevalence – an extension of GLOBOCAN 2008
Cancer prevalence provides useful information on resource needs • measures the absolute number and relative proportion of individuals
living with the disease in a population • provides an indication of the number of patients potentially requiring
treatment or support services
Globocan provides estimates of five-year prevalence in 184 countries and world regions, partitioned according to three different phases of cancer care:
• initial treatment (within 1 year) • clinical follow-up (2-3 years) • cure (4-5 years)
http://globocan.iarc.fr/
Five-year prevalence of cancer by Human Development Index (in people >15 years old)
Population (thousands)
Prevalence (million)
Proportion (%)
Very high 835,216 13.61 1.63
High 700,245 4.39 0.63
Medium 3,159,839 10.33 0.33
Low 219,437 0.48 0.22
Total 4,916,969 28.81 0.59
Prevalence (million)
Proportion (%)
Bray F et al. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer (in press)
Very high High Medium Low
Breast Breast Breast Cervix
Prostate Prostate Cervix Breast
Colorectum Colorectum Colorectum K. sarcoma
Lung Cervix Stomach Prostate
Bladder Lung Lung Colorectum
Most prevalent cancers in different HDI groups in the adult population in 2008
Bray F et al. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer (in press)
Global cancer burden Disability-adjusted life years (DALYs)
Definition: DALYs are comprised of 2 components: − years of life lost (YLL) (mortality x life expectancy) − years lived with disability (YLD) (disease duration x disability weights)
• DALYs reflect the impact of cancer occurring at younger ages
• DALYs link the burden of cancer mortality with the degree of illness and disability among cancer patients and long-term survivors
Rates of DALYs by Human Development Index
HDI DALYs per 100,000
YLLs per 100,000
YLDs per 100,000
ProportionYLLs/DALYs
(%)
Very High 2404 2041 363 84.9 High 2491 2295 195 92.2 Medium 2329 2207 122 94.8 Low 2433 2356 77 96.8
Globally in 2008 168.1 million years of healthy life were lost, the majority (>90%) years of life lost (YLLs) rather than years living with disability (YDLs)
Soerjomataram I, et al. Disability-adjusted life years: country-specific estimates for 27 cancers in 12 world regions. Lancet (in press).
Regional variation in cancer burden: age-adjusted DALYs by world region
Soerjomataram I, et al. Disability-adjusted life years: country-specific estimates for 27 cancers in 12 world regions. Lancet (in press).
Global burden of cancer – projections to 2030
Assuming no change in underlying incidence
(millions)
Time trends in cancer incidence
Bray F et al. Global cancer transitions according to the Human Development Index (2008-2030): a population based study. Lancet Oncol 2012; 13:790-801
0 1 2 3 4 5 6 7 8 9 10 11
Low HDI
Medium HDI
High HDI
Very high HDI
2008 2030 2030*
0 1 2 3 4 5 6 7 8 9 10 11
Low HDI
Medium HDI
High HDI
Very high HDI
2008 2030 2030*
Assuming no change in underlying incidence
Projected global burden of cancer (incidence 2008-2030)
million new cases
Bray F et al. Global cancer transitions according to the Human Development Index (2008-2030): a population based study. Lancet Oncol 2012; 13:790-801
0 1 2 3 4 5 6 7 8 9 10 11
Low HDI
Medium HDI
High HDI
Very high HDI
2008 2030 Assuming no change in underlying incidence
million new cases
% Increase 2008-2030
Bray F et al. Global cancer transitions according to the Human Development Index (2008-2030): a population based study. Lancet Oncol 2012; 13:790-801
Projected global burden of cancer (incidence 2008-2030)
Global cancer transitions by HDI index (2008-2030)
• High and Very high HDI: breast, lung, colorectum and prostate most common
• Medium HDI: oesophagus, stomach and liver cancers also common
• Low HDI: cervical cancer more common than breast and liver
• Medium and high HDI: decreases in cervical and stomach cancer incidence offset by increases in breast, prostate and colorectum
Cancer prevention
Priorities for cancer prevention
De Martel C and Plummer M et al. Lancet Oncol. 2012;13(6):607-615.
Regional variation in cancer risk factors: infection related cancers
Cancer prevention
Priorities for cancer prevention
Sankaranarayanan R et al. Lancet Oncol. 2010;11(2):165-73
Localized tumours
Locally invasive tumours
%
Less developed health services (Costa Rica, India, Philippines, Saudi Arabia, Thailand)
More developed health services (China [Hong Kong], Singapore, Turkey)
Breast cancer 5–year survival rates by clinical extent of disease
Cancer prevention
Priorities for cancer prevention
Cancer-specific priority interventions: requirement for a regional agenda
Primary prevention of infection associated cancers • Hepatitis B virus (HBV) vaccination - liver cancer
Primary prevention of infection associated cancers • Hepatitis B virus (HBV) vaccination - liver cancer
• Human papilloma virus (HPV) vaccination - cervical cancer
Population-based secondary prevention • Screening - cervical cancer
• Early detection and treatment - cervical, breast, colorectal, and occupational carcinogens oral cancers
Priorities for cancer research
Improved surveillance • Strengthen cancer registries – incidence, mortality,
prevalence and survival • Surveillance of cancer risk factors
Cancer etiology • Improve understanding of the effects of known risk factors • Research into major cancers where etiology remains poorly
understood
Prevention and implementation research • Development and evaluation of interventions adapted to
local needs and resources
Acknowledgements
To Drs Freddie Bray, David Forman and colleagues in the Section of Cancer Information, IARC