Globalization of Cancer and the Challenge of Improving Cancer Cure and Care in Developing Countries Robert Burton Monash University 33 0 SYDNEY PERTH EQUATOR SkinCan AD145
A New Platform To join forces with other partners To fight cancer comprehensively To have an effective, efficient and well coordinated IAEA cancer programme that is aligned with the work of WHO in this area To mobilize new resources International Network for Cancer Treatment and Research Tata Tata Memorial Memorial Centre Centre Private Private Sector Sector IAEA PACT July 2008 2
The Global Epidemic of Chronic Noncommunicable Diseases (NCD): NCD Burden, Longevity, Risks and Cancer IAEA-PACT and Cancer Care and Cure: Advocacy and Assistance across the Spectrum of Cancer Control for Developing Countries
Chronic Non-communicable Diseases-NCD Cardiovascular disease, mainly heart disease and stroke Cancer Chronic respiratory diseases Diabetes
Deaths from Non- Communicable Illnesses Territories are sized in proportion to the absolute number of people who died from all chronic disease in one year.
Main NCD and their Causes BEHAVIORAL Tobacco Diet Physical Activity Alcohol ENVIRONMENTAL Socio-cultural Policy Economic Physical NON-MODIFIABLE Age, Sex, Genes INTERMEDIATE RISK FACTORS Hypertension Blood lipids Obesity Precancers END-POINTS Ischemic Heart Dis. Stroke Cancer Chronic Lung Dis. Diabetes
Major contributions to cancer 35% 30% 25% 20% 15% 10% 5% 0% Contributing factors Diet Smoking Infections Hormones Radiation, UV Alcohol Occupation Pollution Inactivity Doll, 1998 PubHealRes
REVIEW of the KEY CANCER FACTS 2000 6 million deaths 10 million new cases 22 million living with cancer 2020 10 million deaths 16 million new cases (2/3 in developing countries) 30 million living with cancer WHO-UICC Global Action Against Cancer 2002
Life Expectancy in the 20 th Century Life Expectancy (years) 90 80 High-income countries 70 60 Middle-income countries 50 Low-income countries 40 1962 1967 1972 1977 1982 1987 1992 1997 2002
Breast Cancer Incidence by age -1990 (CI5) 1000.0 US, SEER White SWEDEN ITALY, Florence Rates/100,000 population 100.0 10.0 JAPAN, Miyagi THAILAND, Khon Kaen SINGAPORE, Malay CHINA, Shanghai 1.0 5 0.1 25-45- 85+ age
Social Determinants of Health EARLY LIFE: Effects of early development last a lifetime. Nutritional deficiencies during pregnancy and poor fetal development is a risk for poor health later in life. A good start means supporting mothers & children.
Changing Diets: More Westernised, larger Portions, more Energy-Dense 1955 Fries 72g Coke 200ml 2001 Fries 205g Coke 950ml Standard serves 1955 and 2001 Source: Swinburn B, Influencing Environments to Reduce Obesity Prevalence 2002
Overweight Obesity & Cancer USA 2003 Body Mass Index >= 25 Attributable Cancer Mortality Women 25% Men 14% Calle et al NEJM 2003; 348: 1625 ACS Cohort 900,000 adults, 16 year results
Men smoking Territories are sized in proportion to the number of men smoking cigarettes in 2005
Adult per capita consumption of tobacco products in the 20th Century in Australia Annual amount of tobacco dutied per adult over 15 (kgs) 4.0000 3.5000 3.0000 2.5000 2.0000 1.5000 1.0000 0.5000 0.0000 Introduction of manufactured cigarettes 1903 1906 1909 1912 1915 1918 1921 1924 1927 1930 1933 1936 1939 1942 1945 1948 1951 1954 Depression Early research on health effects of smoking Report of the US Surgeon General Uptake by women Broadcast of tobacco advertising phased out World War II Year Commencement of Quit Campaigns Tobacco Taxation 1957 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 Workplace smoking bans introduced New health warnings
Tax:: units of 100 million Yuan 1400 1200 Consumption: units of 100 thousand packs 4000 3500 1000 800 600 400 Consumption Tax 3000 2500 2000 1500 1000 200 500 0 0 1980 1985 1990 1995 2000 2005
IMMUNISATION AGAINST CANCER Cancer Cause Vaccine When Hepatoma HBV Yes 1980 Cervix HPV Yes 2007 Stomach Helicobacter In development? Pylori Nasal cancer EBV In development? and lymphoma PrevScreen AD057
PREVENTABILITY OF GLOBAL CANCERS-2000* CANCER NEW CASES PREVENTABLE FACTOR Millions % LUNG 1.3 85 tobacco STOMACH 1.0 90 H.pylori / diet BREAST 1.0 10 screening/ diet/ exercise COLORECTAL 0.9 60 diet / exercise/ screening HEAD AND NECK 0.6 75 tobacco/ alcohol /screening CERVIX 0.5 90 HPV/ screening LIVER 0.5 75 HBV / HCV / alcohol OESOPHAGUS 0.5 75 tobacco / diet URINARY TRACT 0.5 30 tobacco OTHER 4.3 10 TOTAL 10.1 50 * Skin Cancers excluded PrevScreen AD196
All Cancer 1.0 0.9 Mortality/Incidence ratios, 2002 for selected countries 0.8 Male 0.7 0.6 0.5 0.4 0.3 Female Mortality/Incidence 0.2 0.1 0.0 Egypt Russia Kenya Viet Nam Nigeria Turkey China India South Africa Czech Republic Greece Japan UK Brazil Italy Germany Sweden Canada New Zealand Australia USA J. Ferlay, F. Bray, P. Pisani and D.M. Parkin. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARCPress, Lyon, 2004.
IAEA-PACT and CANCER CONTROL PRIMARY PREVENTION AND DIAGNOSIS OF PRECANCERS with CURATIVE TREATMENT can REDUCE CANCER INCIDENCE which then REDUCES CANCER MORTALITY LITTLE or NO IMPACT BEFORE 2020 BUT AN ESSENTIAL LONG TERM INVESTMENT IN CANCER CONTROL
IAEA-PACT and RADIOTHERAPY MOST CANCER TREATMENT IS PALLIATIVE THIS WILL NOT CHANGE by 2020 UNLESS The Challenge of Late Diagnosis is MET with STRATEGIES for EARLY DIAGNOSIS
early detection = cure Mortality rate per 100,000 5 4 3 2 1 0 1950 1960 1970 1980 MALE Breast FEMALE 1990 Australian Melanoma mortality per 100,000 people 1950 99 1999 YEAR OF DEATH SkinCan AD145
Cervical cancer mortality rate 1982~1996 1982 1984 1986 1988 1990 1992 1994 1996 4 3.5 3 2.5 2 1.5 age-standardised rate per 100,000 women
IARC s s CERVICAL CANCER SCREENING PROGRAMME STUDY LOCATIONS
HOW EFFECTIVE ARE THE TREATMENT OF PRECANCERS IN THE DEVELOPING WORLD? Cryotherapy: Data from Indian studies Lesion Total Cured at 1 year CIN 1 1264 90% (N=1137) CIN 2 & 3 234 79% (N=184) LEEP: Data from Indian studies Lesion Total Cured at 1 year CIN 1 296 96% (N=283) CIN 2 & 3 336 86% (N=288) Overall 1 cure rate in CIN = 89% (1892/2130) Supported by the ACCP through the Bill & Melinda Gates Foundation
SCREENING MAMMOGRAPHY & MORTALITY FROM BREAST CANCER 13 YEAR SURVIVAL ages 50 69 CANADIAN RCST SWEDISH 2 COUNTY TRIAL Mammogram BCE Mammogram Nil + BCE 83% 83% 83% 75% CONCLUSION: BREAST CLINICAL EXAM may be as good as MAMMOGRAPHY FOR SCREENING FOR BREAST CANCER
PET/CT in Oncology Hepatocellular Carcinoma Previous treatment with surgery, RF ablation and chemoembolization Restaging for rising AFP levels
, by moving its radiotherapy programmes to a public health model 30
Need for Radiotherapy: 100 Million Cases in Developing World by 2020 18 16 Worldwide, total: 260 M num of cases (millions) 14 12 10 8 6 Developing countries, total: 150 M suitable for RT: 100 M 4 2000 2005 2010 2015 2020 year 50% in Asia, 30% in L. America, 20% in Africa 31
Cancer Control Knowledge into Action WHO Guide for Effective Programmes Planning http://www.who.int/cancer/modules/planningmodule.pdf 2006