Global Cancer Epidemic: Impact, Challenges and Future Trends

Thomas Gross, MD, PhDDeputy Director of Science

Center for Global HealthNational Cancer Institute

Bethesda, MD 20892Email: thomas.gross@nih.gov

Summary of Presentation

• Cancer rates, cancer types & cancer mortality vary widely around the world

• 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

• Socioeconomic factors affect cancer rates and mortality and will become a bigger challenge in the future

Fast Facts About Cancer

• 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.

• More than 70% of all cancer deaths occur in low- and middle-income countries.

CANCER RATES, TYPE AND MORTALITY VARIES WORLDWIDE

Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90

The Worldwide Burden of Cancer in Men(Top 10 Cancer Sites)

Total: 6,629,100 Total: 4,225,700

Most Common Cancer Site in Males

Source: GLOBOCAN 2008 via the American Cancer Society

Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90

The Worldwide Burden of Cancer in Women(Top 10 Cancer Sites)

Total: 4,225,700 Total: 3,345,800

Most Common Cancer Site in Females

Source: GLOBOCAN 2008 via the American Cancer Society

CAUSES OF CANCERVARY WORLDWIDE

Male Stomach Cancer ASRs from Population-based Registries:

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/

Genetic Pre-disposition vs Environment Exposure

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

LungOralBladderLarynxEsophagusPancreasColorectal StomachLeukemiaCervix

Sudden infant deathFetal death, stillbirthReduced fertilityLow birth weightPregnancy complicationsLung function in infants

Cardiovascular DiseasesRespiratory DiseasesAsthma control

Low bone densityErectile Dysfunction Peptic ulcer diseaseDental diseases

The Health Consequences of Smoking: A Report of the Surgeon General , 2004

Cancers Other Medical Conditions

Infections cause about:

•18% of cancers globally(>2 million cases/year)

•26% of cancers in LMICs

•40% of cancers in Africa

(from Worldmapper, www.worldmapper.org

Territories are sized in proportion to the absolute number of

people who died from liver cancer

annually

Liver Cancer Kills 1% of the World’s Population

Cancer of the liver cause ~1% of all deaths worldwide (~100 deaths per million people per year) and 9% of all deaths from cancer.

S. Korea

China

Taiwan Japan

India

10

IMPACT OF SOCIOECONOMIC STATUS ON CANCER BURDEN

Data Source: Globocan 2008

Overall (non-adjusted) Cancer Incidence Rates (Per 100K, Both Genders; All Cancers Except Non-Melanoma Skin)

An

nu

al C

an

cer

Cas

es (

Mil

lio

ns)

5.7 7.4

7.5

12.9

0

5

10

15

20

25

2010 2030

Less DevelopedMore Developed

57%

64%

Trends in Cancer IncidenceDeveloped vs. Less Developed Countries

Data derived from GLOBOCAN 2008

Data from SEER 2010

Cancer incidence with age in USA

Cancer in 0-14 yr olds as % of all cancer

Globocan 2002

% o

f A

ll C

ance

rs

• 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

Cancer mortality in less developed countries projected to increase by >70% by 2030

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

Data Source: Globocan 2008

Female Breast Cancer Incidence(Per 100,000)

Total Expenditure on Health (for 2011 in US$)

Breast Cancer and Socioeconomic Status

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 resource-appropriate 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

PrimaryPrevention

EarlyDetection

PalliativeCare

CurativeTreatment

Survivorship

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NCI - CGH Global Footprint

Acknowledgments

• 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