Marrakech, Morocco, June 2010 Contents Global burden of cancer Recommendations Regional challenges in cancer prevention and control Regional burden of cancer Cancer control strategy and framework for country action

Marrakech, Morocco, June 2010 Contents Global burden of cancer Recommendations Regional challenges in cancer prevention and control Regional burden of cancer Cancer control strategy and framework for country action ✓

Cancer is the second most common killer today, 13% of death worldwide are currently caused by it. By 2030, cancer will become the leading cause of death, ahead of ischemic heart disease & stroke. The estimated number of cases of cancer is expected to rise each year from 11 million in 2002 to 27 million by The majority of new cases are expected to occur in less developed countries. Cancer projected global deaths ( )

Cancers Stroke Recent IARC Report, June Cancer projected global deaths In 2008, best estimates: 12.7 million new cancer cases and 7.6 million cancer deaths. Over half (56%) of new cancer cases and 63% of deaths in developing regions of the World. Approx million new cases will be diagnosed and 13.2 million deaths from cancer will occur in 2030.

Cancers Stroke Road traffic accidents HIV/AIDS TB Malaria Acute respiratory infections Ischaemic heart disease Perinatal ( ) Cancer projected global deaths

Marrakech, Morocco, June 2010 Contents Global burden of cancer Recommendations Regional challenges in cancer prevention and control Regional burden of cancer Cancer control strategy and framework for country action ✓

Cancer is the 4th ranked cause of death in the Eastern Mediterranean Region, following cardiovascular diseases, infectious diseases and injuries; It is estimated that cancer kills 272,000 people each year in the Region; Half of the cancer occur before age 55 years; The majority of cancer cases diagnosed at relatively advanced stage. Regional burden of cancer

Summary Statistics WHO EAST MEDITERRANEAN REGION (EMRO)MaleFemaleBoth sexes Population (thousands) Number of new cancer cases (thousands) Age-standardised rate (W) Risk of getting cancer before age 75 (%) WHO EAST MEDITERRANEAN REGION (EMRO)MaleFemaleBoth sexes Number of cancer deaths (thousands) Age-standardised rate (W) Risk of dying from cancer before age 75 (%) Reference: Globocan 2008 (IARC), Country Fast State Regional Statistics

Most common cancers in the Region Eastern Mediterranean countries, incidence (all ages) GLOBOCAN 2002 estimates:

5 Most common cancers in the Region MaleFemaleBoth sexes LungBreast BladderCervix uteriLung StomachColorectum Non-Hodgkin lymphomaOvaryStomach ColorectumNon-Hodgkin lymphoma Reference: Globocan 2008 (IARC), Country Fast State

Most frequent cancers (Incidence & Mortality) in MEN Reference: Globocan 2008 (IARC), Country Fast State ♂

Most frequent cancers (Incidence & Mortality) in WOMEN Reference: Globocan 2008 (IARC), Country Fast State ♀

Most frequent cancers (Incidence & Mortality) in BOTH SEXES Reference: Globocan 2008 (IARC), Country Fast State ♀ ♂

Incidence of childhood cancer in the Region is comparable to that in industrialized countries, but mortality is much higher. All sites In the Region, the most common childhood cancers are cancers of the blood. EMR countries Childhood cancers Regional burden of cancer

40% of cancers can be prevented. 40% of cancers can be detected early and cured. Suffering from the remaining 20% of cancers can be reduced by palliative therapy. Lessons learned From international experiences

Prevalence of tobacco smoking Among adults in the Region

Prevalence of overweight & obesity in the Region

World cancer burden caused by infection in 2002 The major infections are: Schistosomiasis (bladder cancer) Helicobacter pylori (stomach cancer) Hepatitis B and C (liver cancer) Human papillomavirus (cervical cancer) Source: Parkin DM. International journal of cancer, 2006, 118(12):3030–44. Total caused by infection, 17.8%

Cancer related to infection and corresponding burden In EMR CancersInfectious agent (attributable fraction for the whole world) Crude incidence in the Eastern Mediterranean Regiona (per population) Bladder Schistosoma (3%)5.0 StomachHelicobacter pylori (63%)3.8 Non-Hodgkin lymphoma HTLV-I (18%)3.3 Cervix HPV (100%)2.8 LiverHBV, HCV (86%)2.4 Hodgkin lymphomaEBV (46%)1.5 Nasopharyngeal carcinoma EBV (98%)0.9 Source: The cancer atlas. American Cancer Society, 2006.

Marrakech, Morocco, June 2010 Contents Global burden of cancer Recommendations Regional challenges in cancer prevention and control Regional burden of cancer Cancer control strategy and framework for country action ✓

In the Region, the vast majority of cancers are diagnosed at an advanced stage when cure is improbable even with the best treatment. 1. Screening and early detection Regional challenges in cancer prevention

Human resources (oncologists, nurses) are insufficient in the majority of countries; Medicine availability and affordability for patients in the majority of countries (out-of-pocket expense); Radiotherapy machines, radio-oncologists and radio- technicians are not sufficient to cover the needs in many countries; Multidisciplinary management of cases is not instituted in all referral centres. 2. Cancer management in the Region Regional challenges in cancer prevention

3. Palliative care Regional challenges in cancer prevention Misconceptions about pain relief use; Training Gaps; Lack of awareness; Inadequate policies restricting access to pain relief medications; Accessibility & affordability of medication for pain relief

11 countries have hospital-based cancer registry and published reports, but the quality of the data and reports from these registries is very heterogeneous. Cancer registry is not exist in 8 Member States have no cancer registry. Data about stage at presentation, mortality and survival are lacking in almost all Member States. 4. Cancer data Regional challenges in cancer prevention