The Global Burden Freddie Bray ۰ Cancer Surveillance Section International Agency for Research on Cancer Lyon, France
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
Global causes of death 2011. Source: WHO Global Health Observatory Data Repository Leading causes, all ages, 2011 Leading causes, ages 30-69, 2011
Source: UNPD Trends in the Human Development Index (HDI) 1980-2012 Income Knowledge Health
Median age of population 1950-2100 Number of children per women 1950-2100 Source: UNPD
% increase 2012-2025 by HDI % increase 2012-2030 by region 19 million new cases by 2025 22 million new cases by 2030
Trends in the incidence rates in selected populations worldwide Cancer Incidence in Five Continents + other sources of published cancer registry incidence data
Age-standardized (World) incidence rates per 100 000 by calendar year, for selected populations, breast and cervical cancer 1983 2007.
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.
Top 5 cancer in selected countries
The 10 most commonly diagnosed cancers, Kuwaitis. 2012. (13.8% of total) Courtesy of Dr Amani Elbasmi, Kuwait Cancer Registry: Annual Report 2012
Chokunonga et al. Int J Cancer 2013. Cervical cancer: cumulative incidence low and high top 10 (ages 0-74) Age-standardized (World) incidence rates per 100 000 by calendar year, Harare, Zimbabwe : common female cancers 1991 2010
Age-standardized (World) incidence rates per 100 000 by calendar year, for selected populations, cervical cancer 1975 2012.
Age-standardized (World) incidence rates per 100 000 by calendar year, for selected populations, cervical cancer 1975 2012.
Cervical (incl. uterus part unspecified) cancer mortality, 25-49 years
Cervical cancer incidence by registry stratified by level of human development. Estimated Annual Percentage Change 1993-2007. Source: Cancer Incidence in Five continents
Site Males Females Sousse 1 Kampala 2 Harare 3 Sousse 1 Kampala 2 Harare 3 All cancers -0.1% +2.3 +0.6 +1.0 +2.2 +2.7 Breast +2.2 +3.7 +4.9 Prostate +2.4 +5.2 +6.4 Colorectal +4.8 +1.6 +4.0 +2.3 +4.1 +3.8 Lung +0.4 +1.8-3.5-7.1 +14.3 +0.2 Cervix -6.1 +1.8 +3.3 Liver +2.8-5.4 +4.0-0.6 Stomach -1.3 +3.7-0.4 +2.5-0.7 Oesophagus +3.3-1.2 +1.6-4.1 Kaposi sarcoma -2.1-0.3 1 Missaoui et al, Int J Cancer 2010 (period 1993-2006) 2 Wabinga et al, Int J Cancer 2014 (period 1991-2010) 3 Chokunonga et al, Int J Cancer 2013 (period 1991-2010)
Predic'on of cervical cancer incidence
Future cancer incidence prediction 2030: Building in a trends scenario Demographic changes + average trends in rates (101 cancer registries 1988 2002): 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
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
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
Cancer Incidence in Five Continents: geographical representation % of regional population represented Volume I 1965 Volume V 1985 Volume X 2005 Africa 0.4 0.0 1.9 Asia 0.3 2.0 5.7 C/S America 5.1 4.9 7.5 ----------------- Europe 7.3 17.0 41.7 Oceania 19.4 83.0 77.8 N America 7.8 28.2 94.7 Total 2.6 6.3 14.3 http://ci5.iarc.fr
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
Need ۰ Inequity Opportunity Action