The Global Burden. Freddie Bray ۰ Cancer Surveillance Section International Agency for Research on Cancer Lyon, France

Transcription

1 The Global Burden Freddie Bray ۰ Cancer Surveillance Section International Agency for Research on Cancer Lyon, France

2 The Global Burden: inequity to action Increasing but inequitable cancer burden Changing profile linked to development Regional and between-country diversity Very limited data to inform cancer control

3 Global causes of death Source: WHO Global Health Observatory Data Repository Leading causes, all ages, 2011 Leading causes, ages 30-69, 2011

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5 Source: UNPD Trends in the Human Development Index (HDI) Income Knowledge Health

6 Median age of population Number of children per women Source: UNPD

7 % increase by HDI % increase by region 19 million new cases by million new cases by 2030

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11 Trends in the incidence rates in selected populations worldwide Cancer Incidence in Five Continents + other sources of published cancer registry incidence data

12 Age-standardized (World) incidence rates per by calendar year, for selected populations, breast and cervical cancer

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14 Chronic diseases have not simply displaced acute infectious ones in developing countries. Rather, such countries now experience a polarized and protracted double burden of disease. Yach et al, JAMA 2004;291.

15 Top 5 cancer in selected countries

16 The 10 most commonly diagnosed cancers, Kuwaitis (13.8% of total) Courtesy of Dr Amani Elbasmi, Kuwait Cancer Registry: Annual Report 2012

17 Chokunonga et al. Int J Cancer Cervical cancer: cumulative incidence low and high top 10 (ages 0-74) Age-standardized (World) incidence rates per by calendar year, Harare, Zimbabwe : common female cancers

18 Age-standardized (World) incidence rates per by calendar year, for selected populations, cervical cancer

19 Age-standardized (World) incidence rates per by calendar year, for selected populations, cervical cancer

20 Cervical (incl. uterus part unspecified) cancer mortality, years

21 Cervical cancer incidence by registry stratified by level of human development. Estimated Annual Percentage Change Source: Cancer Incidence in Five continents

22 Site Males Females Sousse 1 Kampala 2 Harare 3 Sousse 1 Kampala 2 Harare 3 All cancers -0.1% Breast Prostate Colorectal Lung Cervix Liver Stomach Oesophagus Kaposi sarcoma Missaoui et al, Int J Cancer 2010 (period ) 2 Wabinga et al, Int J Cancer 2014 (period ) 3 Chokunonga et al, Int J Cancer 2013 (period )

23 Predic'on of cervical cancer incidence

24 Future cancer incidence prediction 2030: Building in a trends scenario Demographic changes + average trends in rates (101 cancer registries ): annual decreases in stomach (-2 5%) annual decreases in cervical cancer (-2%) annual decreases in lung cancer (-1%) [high / very high HDI, males] annual increases in colorectal (+1%) annual increases in female breast (+2%) annual increases in prostate cancer (+3%) 56% 14% 70% annual increases in lung cancer (+1%) [high / very high HDI, females] 23.6 million cases 2030 Bray F et al. Lancet Oncol 2012; 13

25 National Cancer Control Programmes require surveillance & monitoring: - What is the cancer burden in the country? - where to invest and How is it likely to evolve? - How successful are implemented cancer control policies? Two cancer surveillance mechanisms available (and complementary): For mortality: vital statistics on deaths (by cause) For incidence (and survival): disease (cancer) registers

26 MORTALITY 15% INCIDENCE 36% Only 34 of 178 countries report high quality mortality data to WHO 1 Only 67 of 184 countries report high quality incidence data to IARC 2 1 WHO Mortality Database 2 Cancer Incidence in Five Continents

27 Cancer Incidence in Five Continents: geographical representation % of regional population represented Volume I 1965 Volume V 1985 Volume X 2005 Africa Asia C/S America Europe Oceania N America Total

28 IARC Technical Publication No. 43 A joint IACR-IARC publication Developed with WHO with financial support from the GAVI Alliance Technical advice to planners and in LMICs wishing to plan/develop population-based cancer registries (PBCR): Role and status of PBCRs worldwide Planning and developing PBCRs Sources of information Quality control Reporting the results

29 Need ۰ Inequity Opportunity Action