1. Oncology in midlife and beyond 2013 Oncology in midlife and beyond

2. 2013  57.8 years in low-income countries  69.3 years in lower–middle-income countries  74.4 years in upper–middle-income countries  82.4 years in high-income countries Life expectancy for women at birth (Anderson BO et al. 2010. Lancet Oncol 2011;12:387–98)

3. Oncology in midlife and beyond 2013 Cancer is an important cause of death but not the primary cause of mortality  Cardio/circulatory diseases represent 35 – 40% of causes of death in most developed countries, 32 – 48% in Latin America and the Caribbean (PAHO 2011), 70% in Eastern Europe, 60% in Central Europe and Central Asia, and 45% in North Africa and the Middle East (healthmetricsandevaluation, 2010)  20 – 25% of women will die from cancers in Western Europe, Australasia, high-income North America, high- income Asia Pacific, East Asia and Southern Latin America

4. Oncology in midlife and beyond 2013 Main cancers: breast, lung, colorectal and cervical  breast cancer : 13.7% of the mortality from cancer in women  lung cancer : 12.8%  colorectal cancer : 8.6%  cervical cancer : 8.2%.  ovarian cancer :4.2%  uterine corpus (endometrial) cancer :2.2%

5. Oncology in midlife and beyond 2013 Breast cancer  In 2010, 1,643,000 new cases and 458,503 deaths (Globocan 2008)  as common in developed countries (49%) as in developing countries (51%)  is the first cause of mortality by cancer in Argentina (20.6%), Belgium (20%), Israel (19%), France (18.6%), Germany (17.3%), Switzerland (17%), Italy (16.8%), Portugal (16.5%), Austria (16.2%), Brazil (14%) and Chile (12.3%)  Histological differentiation varies among different populations  It is a predominantly post menopausal in developed countries and premenopausal in Asia, north Africa

6. Oncology in midlife and beyond 2013 Lung Cancer  In 2010, 515 999 new cases and 427,586 deaths (Globocan 2008)  Main risk factor: smoking  Increasing incidence in non smokers (adenocarcinoma) from 15.9% in the 1970s to 32.8% in the 2000s (Lee et al, BMC Cancer 2013; Yano et al, Int J Clin Oncol 2011)  Incidence decreases in western countries because of the decrease in smoking, but it continues to increase in Asia and especially in China  leading cause of cancer mortality, in the USA, Canada, Hong Kong, China, UK, Denmark, Norway, Sweden and Korea

7. Oncology in midlife and beyond 2013 Cervical cancer  In 2010, 454,000 new cases and 200,000 deaths (IHME, Lancet 2011)  76% of cervical cancer cases occur in developing countries: hallmark of low income countries and low access to health care system  Pap smears is an extremely potent method of screening and when implemented has help to decrease incidence and mortality rates in many countries  HPV vaccination could also help to decrease the burden but remains expensive

8. Oncology in midlife and beyond 2013 Colorectal cancers  571,204 new cases and 288,654 deaths (Globocan 2008)  10.1% of all incident cancers in women world-wide  63% in developed countries  highest incidence rates in Australia, New Zealand, Canada, the USA and parts of Europe (Haggar et al, Clin Colon Rectal Surg 2009)  lowest risk in China, India, and parts of Africa and South America (Haggar et al, Clin Colon Rectal Surg 2009)

9. Oncology in midlife and beyond 2013 Risk factors and burden of diseases (IHME)  The three leading risk factors for global disease burden in 2010 were high blood pressure, tobacco smoking (including second-hand smoke) and household air pollution, accounting for 7%, 6.3% and 4.3%, respectively, of disability-adjusted life years (DALYs).  Dietary risk factors and physical inactivity accounted for 10% of DALYs  Obesity / overweight are the leading disease risk factor in Australasia, high-income North America, Western Europe, North Africa, the Middle East, Southern, Central and Andean Latin America, the Caribbean and Oceania

10. Oncology in midlife and beyond 2013 Risk factors and deaths in 2010 Risk factor Number of deaths95% intervals of uncertainty Smoking1,443,924920,763–1,743,849 Second-hand smoke346,304252,702–439,439 Alcohol1,720,0591,541,469–1,886,125 High body mass index1,738,4661,454,008–2,036,059 Dietary factors and physical inactivity 5,815,7485,380,274–6,261,225 (Lim SS et al, Lancet 2012, from IHME)

11. Oncology in midlife and beyond 2013 Risk factors for lung cancer  Smoking  Role of particules/pollution  Second-hand smoking  Paints or paint thinners  Welding equipment, smoke soot or exhaust  Pre-existing lung diseases such as inflammation  Dietary intake of grilled or barbecued meat

12. Oncology in midlife and beyond 2013 Mortality/incidence of the 4 main cancers

13. Oncology in midlife and beyond 2013 Preventive strategies to decrease the risk of cancer  Stop smoking  Control weight  Exercise (vigorous exercise for at least 2–3 h/week)  < 15 g/day alcohol intake  Diet rich in vegetables, fibers and fruits (five fruit and vegetables/day but only two fruits, maximum three), low intake of animal fat, and a low proportion of carbohydrates

14. Oncology in midlife and beyond 2013 (From Globocan 2008)

15. Oncology in midlife and beyond 2013 (From Globocan 2008)

16. Oncology in midlife and beyond 2013 (From Globocan 2008)