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

2. Summary of Presentation
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: 6,629,100
Total: 4,225,700
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: 4,225,700
Total: 3,345,800
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 Cancer Vary 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. 10

11. Eight Risk Factors Account for 50% of Deaths from Cancer

12. Percentage of Cancers Attributable to Risk Factor
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
Cardiovascular Diseases
Respiratory Diseases
Asthma control
Lung
Oral
Bladder
Larynx
Esophagus
Pancreas
Colorectal
Stomach
Leukemia
Cervix
Sudden infant death
Fetal death, stillbirth
Reduced fertility
Low birth weight
Pregnancy complications
Lung function in infants
Low bone density
Erectile Dysfunction
Peptic ulcer disease
Dental diseases
The Health Consequences of Smoking: A Report of the Surgeon General , 2004

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

15. Liver Cancer Kills 1% of the World’s Population10
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,
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%
Incidence per 100,000
Annual Cancer Cases (Millions)
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 19

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 % 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
Female Breast Cancer Incidence (Per 100,000)
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: )
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: )
Obesity & “lifestyle” factors

23. Incidence of Breast Cancer & Outcomes Correlate with GDP
Source: Harford JB, Lancet Oncol Mar;12(3):

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
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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