world cancer report - iarc

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PERSPECTIVES AND PRIORITIES SUMMARY > Current smoking levels and the adoption of unhealthy lifestyles, together with a steadily increasing proportion of elderly people in the world, will result in a doubling of new cancer cases, from 10 million worldwide in 2000 to 20 million in 2020, with an annual death toll then reaching 12 million. > Strategies exist to reduce the predictable burden of cancer through research, education, prevention, early detection, treatment and palliative care. Political will and international collaboration are now required for effective cancer control. > Application of existing knowledge, technology and control strategies could prevent at least a quarter of all cancer cases, and cure at least a third of all cancer cases in the next 20 years. Thanks to social and economic advances that the world has witnessed during the late 20th century, humanity is facing rapid change and many challenges. During the last five decades, food supply has more than doubled and increased much faster than population growth; per capita gross domestic product in real terms has risen by at least two and a half times, and adult literacy by more than 50% since 1970. Dramatic increases have been observed in the number and proportion of children at school and the proportion of chronically undernourished children has declined considerably. These changes are having a major impact on global disease patterns and on the health and quality of life of human beings. Without question, the face of humanity is being rapidly reshaped due to political, economic and sociocultural interaction; the world of 2050 will be radically different from today’s and will be almost unrecognizable from that of 1950. 320 Cancer control Population health is no exception to this dynamic evolution, with global changes influencing and conditioning the way individuals and communities live, work and age. Increasing life expectancy and population ageing Globally, life expectancy at birth has increased from 45 years in 1950 to 66 years in 2000 and is expected to reach about 77 years in 2050 [1,2]. By 2025, the majority of countries, covering about 96% of total world population, will have a life expectancy at birth of greater than 60 years; for no country will it be less than 50 years (Fig. 7.14). The global population is expected to increase by 60% during the next 50 years, from 6 billion people in 2000 to 9.4 billion people in 2050; the number of people aged 60 years and above will more than triple, from 610 million to 1.9 billion, during this period. With a slow and steady decline in fertility rates, the population of the world is thus ageing rapidly. The median age of the global population will have risen from 23.5 years in 1950 to 36.5 years in 2050. The global proportion of the population aged 60 years and over will increase from 10% in 2000 to more than 20% in 2050. The most rapid increase is, however, expected among the number of “oldest-old” - those aged 80 years and over. This population will increase by a factor of five between 2000 and 2050. The number of centenarians is increasing at an accelerating rate. In France, for example, the estimated number of centenarians was about 200 in 1950, and 8,500 in 2000, and will reach 150,000 by 2050. The life span of many individuals extends beyond the age of 115 in some countries. In the early 1950s, the great majority of the global population died before the age of 50; today, the great majority is dying after the age of 50. It has been estimated that among 100 persons aged 20 years in 1955, at least 60 will be able to celebrate their 65th birthday and that among 100 persons aged 20 years in 1995, at least 80 persons will have that privilege. This represents an increase of more than 30% in survival chances between the two generations and has been achieved through advances in medicine and public health, in science and technology and above all in the adaptation and application of medicoscientific knowledge for the improvement of health for all. These advances offer real hope for a longer, and hopefully a healthier future for humankind [3]. While extending life expectancy is desirable in itself, it is equally important that increased expectancy is accompanied by freedom from any prospect of years of suffering as a consequence of chronic diseases, pain or disability. Individuals are becoming conscious about their health expectancy, defined as life expectancy in good health. Unfortunately, while much is known about the determinants of population health in terms of life expectancy, very little is known about human longevity - the maximum duration of an individual’s life and its determinants. Cancer trends and prognosis WHO reported that in 2000 [4] there were more than 6 million deaths caused by cancer, i.e. about 12% of a total of more than 55 million deaths from all causes worldwide. Infectious and parasitic diseases accounted for about 26% and diseases of the circulation for about 30% of total deaths. During the period 1985-1997, the number of deaths from cancer is estimated to have increased by 35%, from 4.5 million deaths in 1985 to 6.1 million deaths in 1997 [5] (Fig. 7.17). Deaths from circulatory diseases increased by about 30%, from 11.5 million to 15.1 million. These increases were not, however, geographically uniform. From 1985 to 1997, in more developed countries, there was a slight decline in the number of deaths due to circulatory diseases, but an increase of about 9% in the number of deaths due to cancer. During the same period, in developing countries the number of deaths increased
68% 1955 1975 1995 2025 32% 40% by at least 62% both for circulatory diseases and for cancers. In 2000, there were 6.2 million cancer deaths, 10.1 million new cases of cancer and 22.4 million persons living with cancer worldwide [6]. This represents a global increase of about 22% in cancer deaths and in cancer incidence during the period 1990-2000. By 2020, the number of new cancer cases is expected to reach at least 15 million a year and cancer deaths 10 million a year. WHO in 1998 [5] reported that in 1960 cancer was one of the five leading health problems in three of the six WHO regions (The Americas, Europe and Western Pacific). Moreover, it will be one of the top five leading health problems by 2025 in all the WHO regions, except for the Africa region. Cancer is emerging as a major problem globally, both in more developed and in less developed countries. Priority areas for action Opportunities are clear at national and international levels for initiatives to control and reduce incidence, mortality and avoidable suffering and pain due to cancer. With a better understanding of the causes, mechanisms and progression of cancer, vigorous implementation of proven interventions, systematic experimentation and evidence-based choice of efficient delivery procedures, it is possible to reduce the burden of cancer. WHO (1998) [5] concludes that by taking 60% effective action now, cancer incidence can be reduced substantially. Even modest efforts to adapt and apply available treatments, early detection methods and healthy lifestyle approaches will have farreaching effects on the cancer burden worldwide. Achieving these goals is predicated on a commitment to coordinate global and national priorities for research, development and implementation of cancer control strategies. It requires a broad focus. In addition to providing evidencebased, cost-effective clinical interventions targeting selected cancer sites in individual patients, the task is to deliver essential yet comprehensive evidence-based, costeffective medical and health interventions covering prevention, diagnosis and treatment. To achieve cancer control, a costefficient approach is required in order to deliver programmes as a part of the existing health systems infrastructure (see: Cancer control package and its delivery, p323). In some instances, different measures may be appropriate for the developed and the developing world, but many aspects of prevention and treatment are relevant to almost all communities. Prevention From a global perspective, cancer prevention can be justifiably focused on three cancer-causing factors: tobacco, diet and infection. These factors are responsible for at least 4.6 million cancer deaths (73%) Above 60 years 60 years or less Fig. 7.14 Worldwide life expectancy at birth is steadily increasing. It is estimated that by 2025, approximately 90% of the total population of all WHO Member States (representing >90% of the global population) will live for 60 years or more. WHO World Health Report, 1998. 14% 86% 4% 96% and 7.5 million new cancer cases (75%) annually, and for at least 15.8 million persons living with cancer (72%) in 2000 [8]. Effective promotion of a healthy diet, smoking avoidance/cessation and safe sex may be complemented with improved access to prophylactic and preventive vaccination and appropriate screening for high-risk populations. Infection is responsible for about 17% of cancer incidence worldwide (varying from about 7% in developed countries to about 25% in developing countries) [9]. Present knowledge offers means by which transmission of infectious agents, such as hepatitis B virus (HBV) and Heliobacter pylori, can be reduced. Preventive HBV vaccination is already available worldwide and prophylactic vaccination against hepatitis C virus (HCV) and human papillomaviruses (HPV) may be introduced in the near future. The infrastructure for existing immunization services at national and international levels could be utilized in this context. Early detection Early detection can lead to a rapid and complete return to health. Established methods of screening, whether technology-based or undertaken by direct inspection, have reduced the mortality of cervical cancer. HPV testing, when combined with a conventional cervical smear test, improves the identification of cancerous Perspectives and priorities 321
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WORLD HEALTH ORGANIZATION WHO OMS I
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WORLD CANCER REPORT Editors Bernard
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CONTENTS Foreword 9 1 The global bu
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The global burden of cancer Cancer
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Fig. 1.2 Incidence and mortality of
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Central and Southern Europe differ
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Incidence of cancer in South Centra
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from documentation of disease to a
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TOBACCO SUMMARY >In addition to lun
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Fig. 2.3 Smoking by children is inc
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Cancers positively Sex Standardized
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PHARMACOLOGICAL APPROACHES TO SMOKI
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level the dose—response relations
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lipoprotein-associated cholesterol,
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Agent Cancer site/cancer Main indus
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Industry, occupation Cancer site/ca
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to occupational exposures in develo
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Air pollutant WHO Air Quality Guide
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der cancer of the order of 50% is p
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AFLATOXIN B 1 HEPATITIS VIRUS (chro
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Fig. 2.30 Correlation between regio
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MEDICINAL DRUGS SUMMARY > Certain d
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Drug or drug combination Cancer IAR
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Agent or substance Cancer site/canc
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sources of electromagnetic fields [
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CHRONIC INFECTIONS SUMMARY > Infect
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Infection Subclinical Mutagenic fac
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TUMOURS ASSOCIATED WITH HIV/AIDS Ap
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DIET AND NUTRITION SUMMARY > Up to
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Fig. 2.54 The age-adjusted mortalit
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OVERWEIGHT, OBESITY AND PHYSICAL AC
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IMMUNOSUPPRESSION SUMMARY >Persiste
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Fig. 2.64 Cancer following immunosu
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Syndrome Gene Location Cancer site/
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viduals, confirmation of a gene def
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REPRODUCTIVE FACTORS AND HORMONES S
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PHYTO-ESTROGENS AND CANCER PEVENTIO
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Indicator Number of oral contracept
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Mechanisms of tumour development Th
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The stages in tumorigenesis have be
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PRECURSOR LESIONS IN CHEMOPREVENTIO
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CARCINOGEN ACTIVATION AND DNA REPAI
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adducts, a few weeks or months for
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I Reactive oxygen species Methylati
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which remove the mismatched bases,
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Common human oncogenes Many common
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product of the RB1 gene (pRb) and a
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ates a molecular bridge between p53
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potential cancer genes altered thro
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One of the earliest genes to be ide
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Regulation of the cell cycle and co
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CELL-CELL COMMUNICATION SUMMARY > C
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Connexin genes and tumour suppressi
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APOPTOSIS SUMMARY > The term apopto
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Caspase-8 Caspase-3 c-FLIP Procaspa
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ways. Several options are under inv
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INVASION AND METASTASIS SUMMARY > T
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laminin, entactin and also heparan
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Target Example of agent Comments Ad
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organs, and to respond to local gro
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TOBACCO CONTROL SUMMARY > Tobacco-i
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Region Deaths due to % of total dea
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ipated, is primarily attributable t
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smoke. This may be achieved in part
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there is no evidence for the effica
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industries, processes and occupatio
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stoves arises in rural areas of dev
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Climbing plants on trellis at end r
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HEPATITIS B VACCINATION SUMMARY > P
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Fig. 4.17 Chronic active HBV-associ
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HUMAN PAPILLOMAVIRUS VACCINATION SU
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Vaccine Site of trial Number of pat
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prolonged use. Similar drugs, that
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aspirin and other non-steroidal ant
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SCREENING FOR BREAST CANCER SUMMARY
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Fig. 4.35 Cumulative mortality from
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SCREENING FOR PROSTATE CANCER SUMMA
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Fig. 4.39 Poster designed for an an
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is around 10% for cancer (out of ev
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45 with one positive rehydrated FOB
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eing based on (i) time trends in th
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Fig. 4.48 Women at a clinic in Indi
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SCREENING FOR ORAL CANCER SUMMARY >
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India will provide useful informati
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cer incidence following cure of inf
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100 50 25 10 5 2.5 1 Japan Males Fe
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Human cancers by organ site Maligna
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tobacco smoking: age at start, aver
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diagnosis is usually confirmed by h
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is frequent and survival rates are
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Fig. 5.14 Physician reading digital
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Markers of prognosis in breast canc
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cer in the contralateral breast (Ch
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100 50 25 10 5 2.5 1 Japan Chile Po
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depends on staging. Small intramuco
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Fig. 5.30 A diet rich in fresh frui
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ane protein involved in cell adhesi
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LIVER CANCER SUMMARY > About 560,00
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Fig. 5.39 A woman in the Gambia pre
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REFERENCES 1. Ferlay J, Bray F, Par
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Certain Possible Uncertain Age Andr
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Management The dramatic division be
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TUMOUR NORMAL Gastrula PGC 2n Impri
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CANCERS OF THE FEMALE REPRODUCTIVE
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Fig. 5.62 Five-year relative surviv
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Inheritance of high-penetrance gene
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invasive malignant. Malignant germ
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OESOPHAGEAL CANCER SUMMARY >Cancer
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Fig. 5.76 A radiographic view of an
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with a stent; laser recannulation,
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Fig. 5.82 Risk of bladder cancer am
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Partial cystectomy is appropriate f
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poorly known since hypopharyngeal c
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Fig. 5.92 Oral leukoplakia with mil
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LYMPHOMA SUMMARY > Malignant lympho
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T Fig. 5.101 Nuclear magnetic reson
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Fig. 5.106 Five-year relative survi
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Fig. 5.109 The immediate aftermath
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A B Fig. 5.113 Acute myeloid leukae
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Fig. 5.118 Five-year relative survi
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Fig. 5.120 Age-specific incidence a
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Hereditary condition Mode of inheri
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MELANOMA SUMMARY > Approximately 13
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Fig. 5.131 Primary melanoma with a
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THYROID CANCER SUMMARY > Cancer of
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Papillary carcinoma RET/PTC TRK BRA
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KIDNEY CANCER SUMMARY > Cancer of t
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Stage Clear cell carcinoma Papillar
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TUMOURS OF THE NERVOUS SYSTEM SUMMA
Page 261 and 262: ing the optic tract, brain stem and
Page 263 and 264: mut = mutant p53 wt = wildtype p53
Page 265 and 266: SURGICAL ONCOLOGY SUMMARY > Surgica
Page 267 and 268: Year Radical mastectomy (%) Modifie
Page 269 and 270: TELEMEDICINE The prospects for tele
Page 271 and 272: Equipment Energy 50% depth dose App
Page 273 and 274: CANCER EDUCATION IN MEDICAL COURSES
Page 275 and 276: Fig. 6.10 Crystals of cisplatin: mo
Page 277 and 278: Responsiveness Cancer (in decreasin
Page 279 and 280: Most of the world’s most common c
Page 281 and 282: treatment of cancer. The problems l
Page 283 and 284: duction. It is clear that tumour ce
Page 285 and 286: REHABILITATION SUMMARY > Rehabilita
Page 287 and 288: cer and its associated disability.
Page 289 and 290: REFERENCES 1. Garden FH, Gillis TA
Page 291 and 292: Cancer pain relief varies and in so
Page 293 and 294: EMERGING ISSUES IN PALLIATIVE CARE
Page 295 and 296: Cancer control The negative impact
Page 297 and 298: priority to cancer control activiti
Page 299 and 300: Prevention of cancer Every country
Page 301 and 302: - Assessing the magnitude of the ca
Page 303 and 304: high-risk women. Further details on
Page 305 and 306: ecords departments are either rudim
Page 307 and 308: THE INTERNATIONAL AGENCY FOR RESEAR
Page 309 and 310: in the capitals/urban areas of four
Page 311: in the overall cancer strategy. WHO
Page 315 and 316: Fig. 7.15 A grandfather at work in
Page 317 and 318: Fig. 7.17 Main causes of death in d
Page 319 and 320: Contributors and Reviewers Sources
Page 321 and 322: Dr Vera Luiz da Costa e Silva Tobac
Page 323 and 324: Georgia Moore Centers for Disease C
Page 325 and 326: REVIEWERS Dr Sandra E. Brooks 405 W
Page 327 and 328: 2.53 T. Norat and E. Riboli, IARC 2
Page 329 and 330: Gastroenterology, 118(2 Suppl 1): S
Page 331 and 332: 5.106 & 5.107 IARC/SEER/Osaka Cance
Page 333 and 334: 4.17 R. Lambert, IARC/Adapted from
Page 335 and 336: Brain cancer, see nervous system tu
Page 337 and 338: Fibroblast growth factor (FGF), 117
Page 339 and 340: Microarray, 240 Micronutrients, 65,
Page 341 and 342: S Saccharin, 64, 85 Salicin, 153 Sa
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