51071.ppt
- 1. Global Cancer Epidemic: Impact, Challenges and Future Trends Thomas Gross, MD, PhD Deputy Director of Science Center for Global Health National Cancer Institute Bethesda, MD 20892 Email: thomas.gross@nih.gov
- 2. 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
- 3. 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.
- 4. CANCER RATES, TYPE AND MORTALITY VARIES WORLDWIDE
- 5. 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
- 6. Most Common Cancer Site in Males Source: GLOBOCAN 2008 via the American Cancer Society
- 7. 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
- 8. Most Common Cancer Site in Females Source: GLOBOCAN 2008 via the American Cancer Society
- 9. CAUSES OF CANCER VARY WORLDWIDE
- 10. 80.3 65.9 34.1 33 32.7 25.2 21.5 20.9 19.2 17.7 17.2 17.1 14.7 13.9 13.3 12.3 11 7.1 4.6 3.3 0 10 20 30 40 50 60 70 80 90 Japan, Hiroshima Korea China, Shanghai USA, Los Angeles: Korean Russia, St Petersburg Peru, Trujillo Singapore: Chinese Slovenia Brazil, Cuiaba Poland, Cracow USA, Hawaii: Japanese USA, Los Angeles: Japanese China, Hong Kong Switzerland, Ticino France, Manche Spain, Zaragoza USA, SEER (9): Black Algeria, Setif India, Mumbai Egypt, Gharbiah Rate per 100,000 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
- 11. Eight Risk Factors Account for 50% of Deaths from Cancer
- 12. Risk Factors Vary In Their Contribution To Cancers In Different Settings Percentage of Cancers Attributable to Risk Factor Source: The Cancer Atlas
- 13. Diseases Associated with Tobacco Exposure Lung Oral Bladder Larynx Esophagus Pancreas Colorectal Stomach Leukemia Cervix Sudden infant death Fetal death, stillbirth Reduced fertility Low birth weight Pregnancy complications Lung function in infants Cardiovascular Diseases Respiratory Diseases Asthma control Low bone density Erectile Dysfunction Peptic ulcer disease Dental diseases The Health Consequences of Smoking: A Report of the Surgeon General , 2004 Cancers Other Medical Conditions
- 14. Infections cause about: • 18% of cancers globally (>2 million cases/year) • 26% of cancers in LMICs • 40% of cancers in Africa
- 15. (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
- 16. IMPACT OF SOCIOECONOMIC STATUS ON CANCER BURDEN
- 17. Data Source: Globocan 2008 Overall (non-adjusted) Cancer Incidence Rates (Per 100K, Both Genders; All Cancers Except Non-Melanoma Skin)
- 18. Annual Cancer Cases (Millions) 5.7 7.4 7.5 12.9 0 5 10 15 20 25 2010 2030 Less Developed More Developed 57% 64% Trends in Cancer Incidence Developed vs. Less Developed Countries Data derived from GLOBOCAN 2008 0 500 1000 1500 2000 2500 Ages < 20 Ages 20-49 Ages 50-64 Ages 65-74 Ages 75+ Data from SEER 2010 Cancer incidence with age in USA
- 19. Cancer in 0-14 yr olds as % of all cancer Globocan 2002 % of All Cancers • Incidence per capita of pediatric cancer is similar around the world
- 20. 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
- 21. Data Source: Globocan 2008 Female Breast Cancer Incidence (Per 100,000) Total Expenditure on Health (for 2011 in US$) Breast Cancer and Socioeconomic Status
- 22. 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
- 23. Incidence of Breast Cancer & Outcomes Correlate with GDP Source: Harford JB, Lancet Oncol. 2011 Mar;12(3):306-12.
- 24. 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.
- 25. A National Cancer Control Program in Context Broader Social Context Healthcare System National Cancer Control Program Primary Prevention Early Detection Palliative Care Curative Treatment Survivorship
- 26. This is for title • This is for text NCI - CGH Global Footprint
- 27. 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
Editor's Notes
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