Ahmedin Jemal, DVM, PhD American Cancer Society

Transcription

1 The 2 nd Edition of The Cancer Atlas Cancer Interventions and Potential for Impact Ahmedin Jemal, DVM, PhD American Cancer Society Session code: CTS

2 Interventions Across the Cancer Continuum PRIMARY PREVENTION EARLY DETECTION TREATMENT SURVIVORSHIP & QUALITY OF LIFE END-OF-LIFE CARE e.g., e.g., e.g., e.g., e.g., Tobacco control Pap test/via Radiotherapy Psychosocial care Pain control Vaccination Mammography Surgery Colonoscopy Chemotherapy 05 December, 2014

3 Tobacco 1.3 billion smokers worldwide (most in LMIC) 1 in 2 regular smokers die of smoking-related diseases, about 6 million deaths each year (Doll et al. BMJ 1994) Compared to never smokers, smokers shortened their life expectancy by: 10 years (all smokers) ~ 20 years (die from smoking-related diseases in middle age) (Doll et al. BMJ 2004, Jha et al NEJM 2013)

4 Effect of Smoking Cessation on Survival to 80 Years of Age, According to Four Age Groups at the Time of Quitting Age Age years gained 9 years gained Age Age years gained 4 years gained Jha and Peto. N Engl J Med 2013;368:

5 Tools to Promote Cessation & Discourage Initiation MPOWER In 2008, WHO introduced the MPOWER measures to assist in country-level implementation of the WHO FCTC provisions. MPOWER MEASURES M MONITOR tobacco use and prevention policies P PROTECT people from tobacco smoke O OFFER help to quit tobacco use W WARN about the dangers of tobacco E ENFORCE bans on tobacco advertising, promotion, and sponsorship R RAISE taxes on tobacco

6 Effects of Tobacco Control Policies in Brazil Aggressively implemented tobacco control measures since 1989 Smoking prevalence decreased by 46% by 2010 Estimated contributions of tobacco control measures to declines in tobacco use: Cigarette price 230% 14% 10% 8% 6% 14% Tax contribution Anti-smoking campaigns Warning labels 48% Ad bans Smoke-free laws Cessation programs Averted Deaths ü 420,000 deaths ( ) ü 6.6 million deaths in 40 years Levy D, et al. PLoS Med. 2012; 9(11): e

7 Share of Total Taxes in the Retail Price of the Most Widely Sold Brand of Cigarettes, 2012 In only 32 countries does the share of cigarette tax exceed 75% of retail price Note: Tobacco sales were banned in Bhutan in WHO Report on the Global Tobacco Epidemic, 2013

8 Vaccinations Infections cause 16% of cancers worldwide, 2 million cases/year Hepatitis B virus (HBV) infection Human papillomavirus (HPV) infection

9 HBV Infection & Vaccine (Background) HBV Infection Vaccine 2 billion total population infected Available since million chronically infected (sub-saharan Africa, Asia) 3 doses, 1 st dose within 24 hrs after birth 340,000 liver cancer cases (500, ,000 deaths from liver cancer & cirrhosis) each year Taiwan, 1 st country to introduce nationwide infant vaccination program in 1984

10 The Effect of Taiwan s 30-Year National Hepatitis B Immunization Program on Liver Cancer Incidence Rates Age-specific incidence rate by sex in cohorts born before and after the implementation of the program, 1984 Rate per 100,000 80% lower Chiang et al. JAMA. 2013;310(9):

11 Percentage of One-year-olds Given the Three-series Hepatitis B Vaccination,* countries introduced national HBV vaccination program as of 2012 *Countries with no data may represent countries where hepatitis B is not endemic (e.g. Scandinavian countries) and national hepatitis B vaccination programs have not been introduced. WHO, 2013.

12 HPV Vaccination (Background) 12 high-risk oncogenic HPV types are responsible for Nearly all cervical cancers (530,000 cancer cases/year) 40-90% of vaginal, vulvar, penile, anal cancers 26% of oropharyngeal cancers HPV 16/18 infections account for 70% of cervical cancers 90% of remaining HPV-related cancers HPV 6/11 (low risk) cause 90% of genital warts

13 Two Prophylactic Vaccines Against HPV infections Quadrivalent vaccine (16/18/6/11): available since 2006 Bivalent vaccine (16/18): available since 2007 WHO recommends 2-dose series for girls aged 9-13 years, prior to initiation of sexual activity (Weekly epidemiological record, No. 43, 24 October 2014) Indicated for prevention of cervical, anal, vaginal, vulvar, and penile pre-cancerous lesions and genital warts

14 Real World Evidence for the Effectiveness of the HPV Vaccine Australia introduced 3-dose HPV vaccine in 2007 <18 years years Figure: Trends in incidence of highgrade cervical abnormalities before and after the implementation of the program in Victoria, Australia, in four age groups (Brotherton et al. Lancet. 2011; 377: ) years years 30 years

15 HPV Vaccine Introduction 45 countries have introduced the vaccine nationally as of 2013 Cost of vaccine (US$100 per dose): major barrier to the introduction of vaccine in LMIC GAVI: low price (US$4.50 per dose) for low-income countries US: 37% coverage Since 2013, GAVI has funded HPV vaccine demonstration projects in 20 countries (yellow dots), and funds the national HPV vaccine program in Rwanda Rwanda: 93% coverage WHO, 2013

16 9-Valent Vaccine, Under FDA Regulatory Assessment Contribution of 9-valent vaccine to cervical cancer worldwide Luxembourg, Sanjose et al. Lancet Oncol. 2010; 11:

17 Early Detection Cervical cancer Colorectal cancer Breast cancer Lung cancer

18 Limited Progress in Reducing Cervical Cancer in LMIC Low- and Middle-Income Countries Uganda (Kyadondo County) High-Income Countries 60 Denmark 50 UK (Scotland) Rate per 100, Colombia (Cali) Philippines (Manilla) Brazil (Goiania) Australian Capital Territory USA (SEER 9, White) CI5 Plus

19 Countries without Large-scale Cervical Cancer Screening Most of the countries without HPV vaccine introduction also lack screening programs Note: Countries without large-scale screening may have subnational programs or limited availability of screening IARC, 2014.

20 Visual Inspection With Acetic Acid & HPV DNA Test Cumulative prevalence of high-grade cervical abnormalities at 12 months, South Africa (Denny et al, JAMA 2005) 8.0 Hazard ratio for cervical cancer deaths by age, India- VIA Screening (Sankaranarayanan et al. Lancet 2007) 2.0 Prevalence (%) Hazard ratio HPV DNA Group N=2,163 VIA Group N=2,227 Delayed Evaluation (Control) Group N=2, Overall years years years years

21 Integration of cervical cancer screening programs into health systems of LMICs Rwanda, national cervical cancer screening program using Care HPV DNA Test and VIA with support from Merck (Binagwaho et al., Bull World Health Organ 2013) HIV care services, Zambia, Zimbabwe, Kenya, Botswana

22 Inequalities in Availability of Cancer Treatment Surgery Radiation Chemotherapy

23 Availability of Radiotherapy for Percentage of Cancer Patients by Country 1 radiotherapy machine treats 500 patients per year 60% of cancer patients benefit from radiotherapy %= # machines 500 cases/0.6 new cases/ year * 100 5,000 additional radiotherapy machines are required to meet patient needs in LMIC *Disparities in access to radiotherapy may still exist in those countries with 100% coverage International Atomic Energy Agency, 2014.

24 Conclusions Many proven interventions for primary prevention, early detection, and treatment but large geographic inequalities in the availability of services remain Expansion of known interventions to low- and middleincome countries requires innovative solutions, commitment and collaboration

25 Thank You!