Cancer in transition: the human development index and the global disease burden 2008 and 2030 Freddie Bray
Global Burden of Cancer Estimated cancer incidence, mortality and 5-year prevalence by continent Prevalence (5 years) Incidence Mortality Africa 5.1% Africa Americas 5.7% 23.7% Americas Africa 19.8% 7.2% South- Northern Central Northern Northern South- Central South- Southern Southern Eastern South- Southern Central Central- South-Eastern Eastern Europe Central South- Northern 22.7% Eastern Southern Northern Central Asia Western Eastern Europe Eastern Southern 40.4% Eastern Asia 25.3% Asia 48.1% Western 53.8% Northern Oceania 0.7% Southern Oceania Europe 1.1% Western 29.4% Oceania 1.4% 28 800 000 12 700 000 7 600 000 persons new cases deaths
Human Development Index 2007(HDI) • A country's average achievements in three basic aspects of human development: – Health • life expectancy at birth – Knowledge • adult literacy rate / primary, secondary, tertiary enrolment – Standard of living • GDP per capita (PPP US$) United National Development Programme 1990-2011
HDI trends 1970-2011 (UNDP 2010) A world in transition 1 Norway Sweden Qatar Uruguay Russia Colombia China Morocco Kenya Uganda Congo (Dem. Rep.) circa 2007 0 2011 1970
Human Development Index 2007 (4 levels) HDI<0.5 0.5 ≤ HDI<0.8 0.9 ≤ HDI<0.8 HDI>0.9 0.4 billion 4.4 billion 0.9 billion 1.0 billion • Sub-Saharan • Southern & • Latin America • North America Africa Eastern Asia • Central & Eastern • Northern & Western • Africa Europe Europe • Australia & New Zealand
Incidence by HDI 2008 Bray et al, Lancet Oncol 2012
Incidence by HDI 2008 Bray et al, Lancet Oncol 2012
Incidence by HDI 2008 Males Females Most common forms of cancer in Africa 2008. Bray et al, Lancet Oncol 2012 Jemal et al, Cancer 2012
Cancer and Infection: attributable fraction (%) 2008 PAF by site De Martel et al Lancet Oncol 2012
DALYs by HDI 2008 DEFINE dalyS Disability-Adjusted Life Years (DALYs) = Years of Life Lost (YLD) + Years of Life with Disability Soerjomataram et al. Lancet 2012 .
World 2050: 9.30 billion World 1950: 2.53 billion World 2010: 6.95 billion World 2030: 8.3 billion World 2008: 6.8 billion
• Assuming(incidence(rates(in(2008(do(not(change :## – Approx.#20.3#million#new#cases#will#be#diagnosed#in#2030## • Up#61%#from#12.7#million#in#2008# Bray et al, Lancet Oncol 2012
Gersten and Wilmoth, Demographic Research 2002
Female#breast#cancer#incidence#1967M2008 # ##Low → #Medium#HDI# #High# → #Very#High#HDI# Source: Cancer Incidence in Five Continents Volumes 1-9 *: Colombia (Cali), China (Hong Kong and Shanghai), India (Mumbai and Chennai), Philippines (Manila), Canada (except Quebec and Prince Edward Island), Japan (Miyagi, Osaka and Yamagata)
Prostate#cancer##incidence#1967M2008 # ##Low → #Medium#HDI# #High# → #Very#High#HDI# Source: Cancer Incidence in Five Continents Volumes 1-9 *: Colombia (Cali), China (Hong Kong and Shanghai), India (Mumbai and Chennai), Philippines (Manila), Canada (except Quebec and Prince Edward Island), Japan (Miyagi, Osaka and Yamagata)
Colorectal#cancer#incidence#1967M2008,#men # ###Low → #Medium#HDI# #High# → #Very#High#HDI# Source: Cancer Incidence in Five Continents Volumes 1-9 *: Colombia (Cali), China (Hong Kong and Shanghai), India (Mumbai and Chennai), Philippines (Manila), Canada (except Quebec and Prince Edward Island), Japan (Miyagi, Osaka and Yamagata)
Stomach#cancer##incidence#1967M2008,#men # ###Low → #Medium#HDI# #High# → #Very#High#HDI# Source: Cancer Incidence in Five Continents Volumes 1-9 *: Colombia (Cali), China (Hong Kong and Shanghai), India (Mumbai and Chennai), Philippines (Manila), Canada (except Quebec and Prince Edward Island), Japan (Miyagi, Osaka and Yamagata)
Cervical#cancer#incidence#1967M2008 # ###Low → #Medium#HDI# #High# → #Very#High#HDI# Source: Cancer Incidence in Five Continents Volumes 1-9 *: Colombia (Cali), China (Hong Kong and Shanghai), India (Mumbai and Chennai), Philippines (Manila), Canada (except Quebec and Prince Edward Island), Japan (Miyagi, Osaka and Yamagata)
Cervical#cancer##incidence:#ageMadjusted#rates#vs.#cohort#analyses # Age Japan: Miyagi, Osaka and Yamagata Birth Cohort Calendar Period Vaccarella et al. Manuscript in preparation
Changing cancer incidence in Kampala, Uganda, 1991–2006. Males Females Cervix Prostate Breast KS Oesophagus KS Liver Oesophagus 2000 1992 2005 1992 2005 2000 Parkin et al, Int J Cancer 2010
Jha, Nature Rev Cancer 2009
Bray et al, Lancet Oncol 2012
• Assuming(trend4based(scenarios(for(six(cancers(con8nue :# – Approx.#22.2#million#new#cases#diagnosed#by#2030# • Up 75% from 12.7 million in 2008 Bray et al, Lancet Oncol 2012
How can we reduce the increasing burden? - the need for evidence-based implementation scenarios • Impact of reduction in risk factors: • Tobacco • Alcohol • Obesity • Physical activity • Impact of vaccination programmes (HBV, HPV) • Impact of early diagnosis programmes • Cervix, breast, colorectal
References Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008-2030): a population- based study. Lancet Oncol 2012. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 2012. de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol 2012. Jemal A, Bray F, Forman D, O'Brien M, Ferlay J, Center M, Parkin DM. Cancer burden in Africa and opportunities for prevention. Cancer 2012. Soerjomataram I, Lortet-Tieulent J, Parkin DM, Ferlay J, Mathers C, Forman D, Bray F. Disability-adjusted life years: country-specific estimates for 27 cancers in 12 world regions. Lancet 2012, in press . Reprints: brayf@iarc.fr
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