Cancer in transition: the human development index and the global disease burden

2008 and 2030

Freddie Bray

Europe 25.3% Asia

48.1%

Africa 5.7%

12 700 000 new cases

7 600 000 deaths

28 800 000 persons

Incidence Mortality Prevalence (5 years)

Estimated cancer incidence, mortality and 5-year prevalence by continent

Northern

Americas 19.8%

Southern

Oceania 1.1%

Eastern

South-Central

Europe 22.7%

Oceania 0.7%

Africa 7.2%

Asia 53.8%

Europe 29.4%

Americas 23.7%

Oceania 1.4%

Africa 5.1%

Asia 40.4%

South-Eastern Central

Northern

Western

Southern

Eastern

South-Eastern

South-Central

Western

Southern

Northern

Northern

Southern

Southern

Southern

Northern

Northern

Central-Eastern

Eastern

South-Eastern

South-Central

Western

Central

Global Burden of Cancer

Human Development Index 2007(HDI)

United National Development Programme 1990-2011

•  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$)

A world in transition Norway Sweden

Qatar Uruguay Russia Colombia China

Morocco

Uganda

Kenya

Congo (Dem. Rep.)

1

0 2011 1970

circa 2007

HDI trends 1970-2011 (UNDP 2010)

HDI<0.5

0.4 billion

•  Sub-Saharan Africa

0.5≤HDI<0.8

4.4 billion

•  Southern & Eastern Asia

•  Africa

HDI>0.9

1.0 billion

•  North America •  Northern & Western

Europe •  Australia &

New Zealand

0.9 ≤ HDI<0.8

0.9 billion

•  Latin America •  Central & Eastern

Europe

Human Development Index 2007 (4 levels)

Incidence by HDI 2008

Bray et al, Lancet Oncol 2012

Bray et al, Lancet Oncol 2012

Incidence by HDI 2008

Bray et al, Lancet Oncol 2012 Jemal et al, Cancer 2012

Females

Males

Incidence by HDI 2008

Most common forms of cancer in Africa 2008.

PAF by site

De Martel et al Lancet Oncol 2012

Cancer and Infection: attributable fraction (%) 2008

Disability-Adjusted Life Years (DALYs) = Years of Life Lost (YLD) + Years of Life with Disability . Soerjomataram et al. Lancet 2012

DEFINE dalyS

DALYs by HDI 2008

World 1950: 2.53 billion World 2010: 6.95 billion World 2050: 9.30 billion

World 2008: 6.8 billion World 2030: 8.3 billion

Bray et al, Lancet Oncol 2012

•  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#

Gersten and Wilmoth, Demographic Research 2002

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)

##Low→#Medium#HDI# #High#→#Very#High#HDI#Female#breast#cancer#incidence#1967M2008#

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)

Age Birth Cohort Calendar Period

Vaccarella et al. Manuscript in preparation

Japan: Miyagi, Osaka and Yamagata

Cervical#cancer##incidence:#ageMadjusted#rates#vs.#cohort#analyses##

KS

Prostate

Oesophagus

Liver

Cervix

Breast

KS

Oesophagus

Males Females

Changing cancer incidence in Kampala, Uganda, 1991–2006.

Parkin et al, Int J Cancer 2010

2000 1992 2005 1992 2005 2000

Jha, Nature Rev Cancer 2009

Bray et al, Lancet Oncol 2012

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

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