Global Cancer Burden

1. Global Cancer Burden
Dr Tajali Nazir Shora
MBBS, MD, PGDEpi

2. Contents
• Cancer
• Incidence and Prevalence
• Mortality
• Common types
• Trends
• Cancer in Saudi Arabia
• Causes and Risk factors
• WHO response to Cancer epidemic

3. What is Cancer?
Cancer is a generic term for a large group of
diseases that can affect any part of the
body.
Other terms used are malignant tumours
and neoplasms.
Metastases are a major cause of death from
cancer

4. •Worldwide, there were an estimated 14.1 mn new
cancer cases and 8.2 mn deaths in 2012 which
amounts to nearly
“1 in 6 deaths”
•Cancer now causes more deaths than HIV/AIDS,
tuberculosis, and malaria combined.
•Of these, 57% (8 million) of new cancer cases and
65% (5.3 million) of the cancer deaths occurred in
the less-developed regions of the world.

5. Economic Impact and Health Service disparity
•Economic impact of cancer
•The total annual economic cost of cancer in 2010
was estimated at approximately US$ 1.16 trillion
•Late-stage presentation and inaccessible
diagnosis and treatment are common
•In 2017, only 26% of low-income countries
reported having pathology services generally
available in the public sector.
•While in high-income countries it was more than
90%

14. Estimated global numbers of new cases and deaths with proportions by major world regions, for all
malignant cancers (excluding non-melanoma skin cancer) in both sexes combined, 2012

16. •The most common causes of cancer
death are due to cancers of:
•Lung (1.69 million deaths)
•Liver (788 000 deaths)
•Colorectal (774 000 deaths)
•Stomach (754 000 deaths)
•Breast (571 000 deaths)

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

18. 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

19. The increase In cancer mortality in LMIC is
largely due to:
Delay in accurate diagnoses
Lack of awareness about cancer and
potential value of therapy
Lack of access and ability to deliver
potentially curative therapy
Abandonment of therapy

20. •By the year 2025, there will be an
estimated
•19.3 million new cancer cases and
•11.4 million cancer deaths,
•The proportions of these occurring in
less developed regions will increase to
59% and 68% respectively.

21. Common Cancers in Men and Women
•Lung and prostate cancers are the most
common cancers in men, followed by
colorectal, stomach, and liver cancers.
•Breast cancer is by far the most common
cancer diagnosed in women, followed by
colorectal, cervix, and lung cancer.

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

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

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

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

27. Lung Cancer
•Lung cancer is responsible for 1 in 5 cancer
deaths worldwide—and largely preventable
•There were an estimated 1.8 million new
cases of lung cancer diagnosed in 2012 (13%
of all new cancer cases)
•Because survival from lung cancer varies little
by region, global patterns of lung cancer
mortality mirror those of incidence.

29. •Recent trends in lung cancer reflect historical
patterns of tobacco smoking.
•In men, incidence rates have peaked and are
now falling in several highly-developed
countries, consistent with the initial adoption
and subsequent decline in smoking some
decades earlier.
•In most of these same countries, rates
continue to rise among women as there has
been no decline in smoking similar to that in
men.

31. Breast cancer
•Breast cancer is the most common cancer in
women worldwide, with slightly more cases
estimated in 2012 in less-developed (883,000
cases) than in more-developed (794,000)
regions.
•Breast cancer is the most common cause of
cancer death in women in less-developed
countries, and the second among women in
developed countries.

33. •Incidence rates vary nearly fourfold across the
world regions, ranging from 27 per 100,000 in
Middle Africa and Eastern Asia to 96 per 100,000 in
Western Europe, and tend to be elevated in
countries with highest development
•Incidence rates continue to increase in all countries
except in a few high-income countries.

34. •In contrast, mortality rates are decreasing in
many high-income countries but increasing in
low- and middle-income countries.
• Differences in incidence between countries
with and without mammography screening
programs are also influenced by earlier
diagnosis and the over-diagnosis associated
with detecting breast cancers in
asymptomatic women.

36. Variation in Common Cancers
•In Men:
•Prostate cancer is the most commonly diagnosed
cancer in 87 countries worldwide, including all
those in the Americas and in much of Europe,
Australia, and parts of Africa.
•Lung cancer is the most common cancer in
Russia, China, Eastern Europe, and parts of
Northern Africa (38 countries).
•In Africa and Asia, there is more diversity in the
most common sites in men.

37. •In Women:
•Breast cancer is the most commonly occurring
cancer in 140 countries of the world, while
cervical cancer is the most common in 39
countries.
•Some countries have other cancer types as
the most common in women, notably
•lung cancer in China,
•liver cancer in Mongolia, and
•thyroid cancer in South Korea.

38. Cancer in Children
Estimated rates per million of cancer incidence and mortality in children (age 0-14
years), 2012

39. HDI and Cancer
As countries develop, their cancer burden changes in scale and type

40. Evolution of cancers in women with change in HDI

41. Why study Cancer Variation?
•The variation gives some indication of the
proportion of cancers that could be prevented by
modifying specific harmful lifestyle or
environmental factors, e.g
• Removal of HPV infection would substantially reduce the
burden of cervical cancer;
• Smoking and Indoor and Outdoor air pollution explain
over two-thirds of lung cancer incidence.

42. •Yet, for many cancers, the causes remain largely
unknown.
• Only 5–20% of all prostate, colorectal and breast cancers
could be prevented by better diet, increased physical
activity, or reduced alcohol consumption.

43. Estimated number of new cancer cases (2012) and percent attributable to
unknown risk factors by cancer site

44. Cancer Survival
• Proportion of Cancer survivors is proportional to HDI

45. Percent of 5-year Cancer Prevalence (15+yrs) 2012

46. Why does Cancer statistics Vary
across nations?
•Differences in risk factors
•Level of awareness in the population
•Early detection and treatment practices
•Less access to diagnosis and treatment facilities
for prostate cancer is partly responsible for the
higher mortality observed in low-income settings.
•Cancers for which treatment does not greatly
affect survival, e.g. liver cancer, the regional
mortality profile mimics that of incidence.

47. Cancer in
Saudi Arabia

48. Saudi Arabia: Over all Prevalence of Cancer in
Saudi Nationals and Saudi Adults

49. Common cancers among Saudi Nationals and Saudi Adults

50. Cancer among Saudi Children

51. Regional differences of Common Cancers in
Saudi Arabia

63. Risk Factors Vary In Their Contribution
To Cancers In Different Settings
Percentage of
Cancers
Attributable to
Risk Factor
Source: The Cancer Atlas

64. Globocan
http://globocan.iarc.fr/Default.aspx

65. What causes cancer?
•Cancer occurs due to abnormal
interaction between:
•Person's genetic factors and
•3 categories of external agents, including:
•Physical carcinogens, such as ultraviolet and ionizing
radiation;
•Chemical carcinogens, such as asbestos, components of
tobacco smoke, aflatoxin (a food contaminant), and
arsenic (a drinking water contaminant); and
•Biological carcinogens, such as infections from certain
viruses, bacteria, or parasites.

66. Risk Factors
•Around one third of deaths from cancer
are due to the 5 leading behavioural and
dietary risks:
•high body mass index,
•low fruit and vegetable intake,
•lack of physical activity,
•tobacco use, and
•alcohol use.

67. •Others are:
•sexually transmitted HPV-infection
•infection by hepatitis or other carcinogenic
infections
•ionizing and ultraviolet radiation
•urban air pollution
•indoor smoke from household use of solid
fuels.

68. •Tobacco use is the single most important risk
factor for cancer and is responsible for
approximately 22% of cancer-related deaths
globally

69. Diseases Associated with Tobacco Exposure
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
Cardiovascular Diseases
Respiratory Diseases
Asthma control
Low bone density
Erectile Dysfunction
Peptic ulcer disease
Dental diseases
The Health Consequences of Smoking: A Report of the Surgeon General , 2004
Cancers Other Medical Conditions

70. •Infections causing cancer
•Approximately 15% of cancers diagnosed in
2012 were attributed to carcinogenic
infections, including
•Helicobacter pylori
•Human papillomavirus (HPV)
•Hepatitis B virus
•Hepatitis C virus, and
•Epstein-Barr virus.

72. •Ageing
•The incidence of cancer rises dramatically
with age
•The overall risk accumulation is combined
with the tendency for cellular repair
mechanisms to be less effective as a person
grows older.

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

74. 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

75. Incidence of Breast Cancer & Outcomes Correlate with GDP
Source: Harford JB, Lancet Oncol. 2011 Mar;12(3):306-12.

76. Reducing the Cancer Burden
•Between 30–50% of cancers can
currently be prevented by avoiding risk
factors and implementing existing
evidence-based prevention strategies.
•The cancer burden can also be reduced
through early detection of cancer and
management.

77. Broader Social Context
Healthcare System
National Cancer
Control Program
Primary
Prevention
Early
Detection
Palliative
Care
Curative
Treatment
Survivorship

78. 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.
Appropriate Technology

79. WHO response to Cancer
•In 2017, the World Health Assembly passed the
resolution Cancer Prevention and Control through
an Integrated Approach(WHA70.12), urging
governments and WHO to accelerate action to
achieve the targets specified in the Global Action
Plan and 2030 UN Agenda for Sustainable
Development to reduce premature mortality from
cancer.
•Global action plan for the prevention and control
of NCDs 2013-2020

80. •WHO and IARC collaborate with other UN
organizations within the UN Interagency Task Force
on the Prevention and Control of Noncommunicable
Diseases and partners to:
•Increase political commitment for cancer prevention
and control;
•Coordinate and conduct research on the causes of
human cancer and the mechanisms of carcinogenesis;
•Monitor the cancer burden (as part of the work of the
Global Initiative on Cancer Registries);
•Identify “best buys” and other cost-effective, priority
strategies for cancer prevention and control;

81. •Develop standards and tools to guide the planning and
implementation of interventions for prevention, early
diagnosis, screening, treatment and palliative and
survivorship care including for childhood cancers;
•Strengthen health systems at national and local levels
to deliver cure and care for cancer patients including
improving access to cancer treatments;;

82. •Provide global leadership as well as technical assistance
to support governments and their partners build and
sustain high-quality cervical cancer control programmes
through the UN Global Joint Programme on Cervical
Prevention and Cancer; and
•Provide technical assistance for rapid, effective
transfer of best practice interventions to countries.

83. References
•Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C et al. GLOBOCAN
2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11
Lyon, France: International Agency for Research on Cancer; 2013.
•GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative
risk assessment of 79 behavioural, environmental and occupational, and
metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global
Burden of Disease Study 2015. Lancet. 2016 Oct; 388 (10053):1659-1724.
•Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of
cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob
Health. 2016 Sep;4(9):e609-16. doi: 10.1016/S2214-109X(16)30143-7.
•Stewart BW, Wild CP, editors. World cancer report 2014
Lyon: International Agency for Research on Cancer; 2014.
•Global Initiative for Cancer Registry Development. International Agency for
Research on Cancer
Lyon: France.
•The Cancer ATLAS
•Saudi Cancer Registry
•GLOBOCAN

84. Thank You