Global Cancer Epidemic: Impact, Challenges and Future Trends

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. SummaryofPresentation • 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. The Worldwide Burden of Cancer in Men (Top 10 Cancer Sites) Total: 4,225,700 Total: 6,629,100 Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90

6. Most Common Cancer Site in Males Source: GLOBOCAN 2008 via the American Cancer Society

7. The Worldwide Burden of Cancer in Women (Top 10 Cancer Sites) Total: 3,345,800 Total: 4,225,700 Data Source: Jemal, A. et al., CA CANCER J CLIN 2011;61:69–90

8. Most Common Cancer Site in Females Source: GLOBOCAN 2008 via the American Cancer Society

9. Causes of CancerVary Worldwide

10. Genetic Pre-disposition vs Environment Exposure 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/

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 Cancers Other Medical Conditions The Health Consequences of Smoking: A Report of the Surgeon General , 2004

14. Infections cause about: • 18% of cancers globally • (>2 million cases/year) • 26% of cancers in LMICs • 40% of cancers in Africa

15. 10 Liver Cancer Kills 1% of the World’s Population S.Korea China Territories are sized in proportion to the absolute number of people who died from liver cancer annually India Taiwan Japan (from Worldmapper, www.worldmapper.org Cancer of the liver cause ~1% of all deaths worldwide (~100 deaths per million people per year) and 9% of all deaths from cancer.

16. Impact of Socioeconomic Status on Cancer Burden

17. Overall (non-adjusted) Cancer Incidence Rates (Per 100K, Both Genders; All Cancers Except Non-Melanoma Skin) Data Source: Globocan 2008

18. Trends in Cancer Incidence Developed vs. Less Developed Countries Cancer incidence with age in USA 64% Annual Cancer Cases (Millions) Incidence per 100,000 57% Data derived from GLOBOCAN 2008 Data from SEER 2010

19. Cancer in 0-14 yr olds as % of all cancer % of All Cancers Globocan 2002 • 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. Female Breast Cancer Incidence(Per 100,000) Breast Cancer and Socioeconomic Status Total Expenditure on Health (for 2011 in US$) Data Source: Globocan 2008

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. NCI - CGH Global Footprint This is for title • This is for text

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