priorities for cancer prevention: the requirement for a ... · projected global burden of cancer...

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


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


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


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


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


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

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