GLOBAL ACTION - WHO

FACTS AND FIGURES

CAUSES OF CANCER

PREVENTION

EARLY DETECTION

CURE AND CARE

CONTACTS

Statistics are peoplewith the tears wipedaway. Professor Irving Selikoff

“”

World HealthOrganization


We can save two million lives in our lifetime

ISBN 92 4 159314 8

NOW!GLOBAL ACTION

AGAINST CANCER

UPDATED EDITION 2005

Think of the people you know. How many of them have had cancer? How many more will get it?

WHO Library Cataloguing-in-Publication Data

Global Action Against Cancer - Updated version.

1.Neoplasms – epidemiology 2.Neoplasms – mortality 3.Neoplasms – prevention andcontrol 4.World health 5.International cooperation I.World Health OrganizationII.International Union Against Cancer.

ISBN 92 4 159314 8 (WHO) (LC/NLM classification: QZ 200)ISBN 2-9700492-1-X (UICC)

© World Health Organization and International Union Against Cancer, 2005

All rights reserved.

Publications of the World Health Organization can be obtained from WHO Press, WorldHealth Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476;fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduceor translate WHO publications – whether for sale or for noncommercial distribution –should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]).

Publications of the International Union Against Cancer can be obtained from theCampaigns & Communications Cluster, 3 rue du Conseil-Général, 1205 Geneva,Switzerland (tel: +41 22 809 1811; fax: +41 22 809 1810). Requests for permission to repro-duce or translate UICC publications – whether for sale or for noncommercial distribution– should be addressed to UICC Publications, at the above address (email:[email protected]).

The designations employed and the presentation of the material in this publication do notimply the expression of any opinion whatsoever on the part of the World HealthOrganization and the International Union Against Cancer concerning the legal status ofany country, territory, city or area or of its authorities, or concerning the delimitation of itsfrontiers or boundaries. Dotted lines on maps represent approximate border lines for whichthere may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not implythat they are endorsed or recommended by the World Health Organization and theInternational Union Against Cancer in preference to others of a similar nature that are notmentioned. Errors and omissions excepted, the names of proprietary products are distin-guished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization and theInternational Union Against Cancer to verify the information contained in this publication.However, the published material is being distributed without warranty of any kind, eitherexpress or implied. The responsibility for the interpretation and use of the material lies withthe reader. In no event shall the World Health Organization and the International UnionAgainst Cancer be liable for damages arising from its use.

Printed in SwitzerlandDesign: Helena Zanelli Création

Contacts

CONTACTS

Further Reading

World Health OrganizationProgramme for Cancer ControlChronic Diseases Prevention and Management20 Avenue Appia1211 Geneva 27SwitzerlandTel: +41 22 791 33 14Fax: +41 22 791 42 97

International Union Against CancerCampaigns & Communications Cluster3 rue du Conseil-Général1205 GenevaSwitzerlandTel: +41 22 809 18 11Fax: +41 22 809 18 10

José Julio Divino UICCJacques Ferlay IARCIsabel Mortara UICCPaola Pisani IARCPáraic Réamonn UICC

Cecilia Sepúlveda WHOEva Steliarova-Foucher IARCAndreas Ullrich WHOMaria Villanueva WHO

Web sitesWorld Health Organization: www.who.int/cancerWHO Tobacco Free Initiative: www.who.int/tobaccoInternational Agency for Research on Cancer: www.iarc.frInternational Union Against Cancer: www.uicc.orgUICC GLOBALink Tobacco: www.globalink.org

AcknowledgementsThe following people have provided valuable input to this second edition:


International UnionAgainst Cancer

Contacts:

World Health OrganizationProgramme for Cancer ControlChronic Diseases Prevention andManagement20 Avenue Appia1211 Geneva 27Switzerland Tel: +41 22 791 33 14Fax:+41 22 791 42 97

International Union AgainstCancerCampaigns & Communications Cluster3 rue du Conseil-Général1205 GenevaSwitzerlandTel: +41 22 809 18 11Fax: +41 22 809 18 10

Curbing the Epidemic: Governments and the Economics of Tobacco Control World Bank, 1999.

National Cancer Control Programmes: Policies and Managerial Guidelines2nd edition, Geneva, World Health Organization, 2002.

World Cancer ReportLyon, International Agency for Research on Cancer, 2003.

A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Sub-Saharan Africa

Geneva, World Health Organization, 2004.

References available on request

6.7 million

deaths

10.9 million

new cases

24.6 million

people living with cancer*

*Figure based on a 5-year prevalence between 1998-2002.

GLOBAL ACTION

AGAINST CANCER

Our knowledge about the preventionand treatment of cancer is increasing,yet the number of new cases grows

every year. If the trend continues, 16 millionpeople will discover they have cancer in 2020,two-thirds of them in newly-industrialized anddeveloping countries.

It is time to put current knowledge into actionin order to save lives and prevent suffering.This requires concerted action between inter-national organizations, governments, publicand private institutions, and individuals.

That action has already begun. We each havean important role to play.

This booklet presents the challenge.

1

Source: IARC, Globocan 2002

Central America,South America and the Caribbean479,900245,000234,900

North America631,900331,200300,700

Cancer killed more than Year 2002:

Cancer deathsCancer knows no borders. It is the secondleading cause of death in developed countriesand is among the three leading causes ofdeath for adults in developing countries.

12.5% of all deaths are caused by cancer.That’s more than the percentage of deathscaused by HIV/AIDS, tuberculosis, andmalaria put together.

Cancer is a public health problem worldwide.It affects all people: the young and old, therich and poor, men, women, and children.

“

”FACTS AND FIGURES3FACTS AND FIGURES 2

people around the world6.7 million

Men Women

Percentage of deaths due to cancer in 2002

Northern Europe241,100126,300114,800

Western Europe475,100264,700210,400

Southern Europe348,400208,100140,300

Sub-Saharan Africa412,100201,900210,200

Northern Africa and Western Asia224,000123,700100,300

South Central Asia845,200434,600410,600

South-Eastern Asia363,400195,700167,700

Oceania49,50027,30022,200

Eastern Asia2,016,3001,278,300

738,000

Central and Eastern Europe

637,000359,200277,800

Source: IARC, Globocan 2002; WHO 2004<5% 5-10% 10-15% 15-20% 20-25% >25%

Cancer represents a tremendous burden onpatients, families, and societies. It is one of theleading causes of death in the world and is stillincreasing, particularly in developing countries.Almost seven million people die each year of can-cer, and many of these deaths can be avoided ifappropriate measures are put in place to prevent, early detect, cure and care. With thisgoal in sight, cancer is an important issue on theWHO agenda. With the support of MemberStates and other partners worldwide, we aredeveloping the WHO Cancer Control Strategy,which aims at accelerating the translation ofknowledge into action in order to save millions oflives and reduce unnecessary suffering.

Dr LEE Jong-wookDirector-General, WHO

Northern Europe426,400

Western Europe873,700

Southern Europe617,300

Sub-Saharan Africa530,100

Northern Africa and Western Asia319,800

South Central Asia1,261,500

South-Eastern Asia524,900

Oceania111,400

Eastern Asia2,890,300

Central and Eastern Europe903,400

ProstateLungColorectal

BreastColorectalLung

LungProstateColorectal

BreastColorectalUterus


BreastColorectalLung

LungBladderColorectal

BreastCervixColorectal

OralLungPharynx

CervixBreastOral Lung

LiverColorectal


ProstateColorectalLung

BreastColorectalMelanoma

StomachLungLiver

StomachBreastLung

LungColorectalStomach

BreastColorectalStomach

Kaposi sarcomaLiverProstate

CervixBreastKaposi sarcoma

The three most common cancers in men and women per region

Central America,South America

and the Caribbean833,100

North America1,570,500


BreastLungColorectal

ProstateLungStomach


FACTS AND FIGURES5FACTS AND FIGURES 4

Types of cancerLung cancer kills more people than any othercancer.

More men than women get cancer of thelung, stomach, throat, and bladder.

Cancers triggered by infections – liver, stom-ach and cervix cancers – are more prevalentin the developing world.

In richer countries, prostate, breast and coloncancers are more common than in poorercountries.

Cancers that are most often cured are breast,cervix, prostate, colon and skin, if they arediagnosed early.

Year 2002:10.9 million

new cases around the world

24.6 millionpeople living with cancer

Men Women Source: IARC, Globocan 2002

By 2020, cancer could kill

Central America,South America and the Caribbean833,800425,100408,700

North America951,400514,700436,700


TrendsThe biggest rates of increase are in develop-ing and newly industrialized countries.

The relative increase is smallest in someWestern countries where populations arerejecting tobacco and adopting healthierlifestyles.

10.3 millionpeople per year unless we act

Men Women

Percentage increase in cancer deaths since 2002

Source: IARC, Globocan 20020-25% 25-50% 50-75% 75-100%

Northern Europe297,600159,600138,000

Western Europe617,100357,100260,000

Southern Europe427,300259,100168,200




719,600670,200


Oceania77,30043,30034,000

Eastern Asia3,223,7002,033,5001,190,200


742,800432,600310,200

FACTS AND FIGURES 8

TrendsA steadily increasing proportion of elderlypeople in the world will result in approxi-mately a 50% increase in new cancer casesover the next 20 years. If current smokinglevels and the adoption of unhealthylifestyles persist the increase will be evengreater.

The number of new caseseach year could rise from

10.9 million in 2002

Central America,South America and the Caribbean1,404,700

680,700724,000

North America2,295,2001,264,8001,030,400

FACTS AND FIGURES9

to 16 million in 2020nearly a 50% increase

Men Women

Northern Europe516,900266,600250,300

Western Europe1,104,300

622,300482,000

Southern Europe745,700430,100315,600




981,8001,059,200


Oceania169,700

92,80076,900

Eastern Asia4,495,7002,715,5001,780,200


1,030,200553,100477,100

The estimated number of new cases in men and women per region in 2020. Source: IARC, Globocan 2002

What will the futurepicture be if we act

NOW?

We can save

2 million lives by 2020,

and 6.5 million livesby 2040.


??

??

?

?

Cancer is potentially the most preventable andmost curable of the major life-threatening dis-eases facing humankind. By applying existingknowledge and promoting evidence-based actionsin cancer control, we will turn this truth into reality for all people everywhere.

Dr John R. SeffrinPresident, UICC

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”

CAUSES OF CANCER13CAUSES OF CANCER 12

TobaccoTobacco consumption is the world’smost avoidable cause of cancer. Inmost developed countries, smokingis responsible for up to 30% of allcancer deaths. Worldwide, it isresponsible for more than 80% oflung cancer cases in men, and 45%in women.

Tobacco also causes cancer at manyother sites including throat, mouth,pancreas, bladder, stomach, liver,and kidney cancers.

DietIn developed countries, almost asmany cancer cases are attributableto an unhealthy diet and an inactivelifestyle as to smoking.

Overweight and obesity are associ-ated with colon, breast, uterus,oesophagus, and kidney cancers.

Excessive alcohol consumptionincreases the risks of cancers of the oral cavity, pharynx, larynx,oesophagus, liver and breast. Forsome of these cancers, the risks areeven greater if you smoke.

The incidence of stomach cancerhas gone down because of reducedintake of salt and improved livingconditions.

InfectionOne-fifth of cancers worldwide aredue to chronic infections, mainlyfrom hepatitis viruses (liver),pap i l lomav i ruses ( ce rv ix ) ,Helicobacter pylori (stomach),schistosomes (bladder), the liverfluke (bile duct) and humanimmunodeficiency virus (Kaposisarcoma and lymphoma).

43% of cancer deaths are due to tobacco, diet and infection.

These factors were responsible for

4.4 millionnew cancer cases in 2002

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Sub-Saharan Africa

Total: 37%

Europe (Northern, Southern and Western)

Total: 49%

From a global perspective, there is strong justification for focusing cancer prevention activities on these three

main cancer-causing factors.

Source: WHO, IARC 2003Source: IARC 2000

Source: World Bank 1994

PREVENTION15PREVENTION 14

The battle against tobacco

If current trends persist, about 500 million people alivetoday will eventually be killed by tobacco, half of them inproductive middle age, losing 20 to 25 years of life.World Bank, 1994

“”

Tobacco use is the most preventable cause ofdeath. Halving tobacco consumption nowwould prevent 20-30 million people fromdying before 2025 and 170-180 millionpeople from dying before 2050 from alltobacco-related diseases including cancer.

To quit smoking, or even better, to avoidstarting to smoke, is the single best thing aperson can do for his or her health. For thosewho do smoke, there are immediate healthbenefits to be gained from quitting.

Smoking is a public health threat and justifiesthe involvement of society as a whole incombating it.

Exposure to tobacco smoke (passive smok-ing) increases the risk of lung cancer by 20%in non-smokers.

The economic cost of tobacco, includingtreatment of the ill and loss of productivity,outweighs tax revenues derived from tobacco.

Make this the last generation

that smokes

200000

0

400000

600000

800000

1000000

1200000

1400000

1600000

2000 2010 2020 2025

Developed countries

Developing countries

Transition

The number of smokers is increasing particularly in the developing world.

Num

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f sm

oke

rs (

in t

ho

usa

nd

s)

Source: WHO & World Bank 2003

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PREVENTION17PREVENTION 16

In many countries, people are

eating more and exercising less

and there is a potential danger for other countries adopting this lifestyle

Promoting a healthy diet

and an active lifestyle

Germany(1998)

Lithuania(1997)

Peru(2000)

Russia(1996)

South Africa(1998)

USA(2002)

Women

Obesity (BMI≥30.0)Body Mass Index kg/m2

Men

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In high income countries, people are eatingmore and exercising less – with resultingincreases in body weight. In many developedcountries, as much as half of the adult popu-lation may be overweight and more than 25%obese.

Societies reliant on salted and pickled foodhave higher incidences of gastric cancers.

Through diet and exercise, we can prevent upto a third of cancer cases. Physical activity,avoidance of overweight and frequent dailyintake of fresh fruits and vegetables reducethe risk of breast, colon, oral cavity, lung,cervix, and other cancers.

Source: WHO Global Data Base on BMI, 2005

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% o

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EARLY DETECTION19PREVENTION 18

Preventing cancers caused

by infection…

Early detection can save lives

by preventing the infection

Chronic infection with Hepatitis B virus(HBV) increases the risk of liver cancer atleast 40-fold. In the Gambia, where infectionwith this virus is endemic, a programme isunderway to vaccinate children againstHBV.* Surveys of the first 60,000 childrenvaccinated between 1986 and 1990 havealready shown that 90 to 95% of chronicHBV infection can be prevented.** In theyears to come researchers will be watchingthese children to see whether the expecteddecrease in liver cancer also results.

The sexually-transmitted human papillo-mavirus (HPV) can increase the risk of cervi-cal cancer 100-fold. Vaccines against HPVare being developed and tested. Early resultslook promising.

Prevention of HIV infection will also reducethe incidence of related cancers such asKaposi sarcoma and lymphoma.

The chances of surviving the onset of somecommon cancers depend largely on howearly they are detected and how well they aretreated. Early detection is based on the obser-vation that treatment is more effective whencancer is detected early. It includes aware-ness of early signs and symptoms of cancer(e.g. lumps, sores, bleeding), and screening.Screening is the mass testing of people whoappear to be healthy. Pap test for cervicalcancer is the screening method that has sub-stantially checked the mortality rates in mostdeveloped countries and the programmesin some middle-income countries using Paptests are working.

In many developing countries, where theseare not feasible, several other low technologyapproaches are being studied and lookpromising.

The success of public health programmes indetecting cancer early depends on the alloca-tion of resources, availability of qualifiedspecialists, and access to follow-up treatment.

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”*Source: IARC 2004**Source: Viviani S. et al., 1999

In Guatemalan culture, it is taboo to speak aboutcervical cancer, and there is little to no educationabout the disease. Husbands are reluctant tobring their wives to doctors for screening or treat-ment. And often, when they do, it is too late.Today, midwives, nurses and social workers aresucceeding in breaking taboos, establishing a sys-tem of trust. With the husbands' approval, weaccompany the women from the home to the doc-tor so that they receive the care they need.

Magdalena Tepeu, Midwife, PIENSASan Juan Sacatepequez, Guatemala

CURE AND CARE21EARLY DETECTION 20

The world average is between 30 to 40%

Cancer also affectschildren

Source: IARC 1998

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Each year, more than 160,000 children arediagnosed with cancer, and it is estimatedthat 90,000 will eventually die of cancer.

Although childhood cancers represent asmall percentage of all cancers, most of themcan be cured provided prompt and essentialtreatment is accessible. However, as 80% ofchildren with cancer live in developing coun-tries where effective treatment is not avail-able, one in two children diagnosed with can-cer will die.

Universal access to high-quality care andsupport, together with a commitment to allo-cate resources for health education mustbecome a priority. A coordinated strategy bythe global cancer control community – onethat combines innovative science and soundpublic health policies – can save a large pro-portion of the 90,000 young lives lost everyyear. The time to act is now.

Survival strategiesEffective treatment exists for many cancers.Optimal treatment combined with earlydetection leads to a high rate of cure forcancers of the cervix, breast, oral cavityand colon.

For some cancer sites such as the oesopha-gus, treatment has limited effectivenessregardless of country. However, there are sig-nificant inequalities between countries treat-ing the more curable cancers such as breastand leukaemia.

The success of public health systems intreating potentially curable cancers dependson the appropriate allocation of resourcesand equal access to good quality care andinformation for all cancer patients.

“

”

The best treatment for allIn high-income countries the 5-yearsurvival rate is between 50 to 60%

5-y

ea

r C

an

ce

r S

urv

iva

l R

ate

(%)

US

A

US

A

US

A

EU

RO

PE

EU

RO

PE

EU

RO

PE

CH

INA

CH

INA

CH

INA

Cancers

Leukaemia Oesophagus Breast

Survival outcomes vary dramatically throughoutthe world – not just between countries, not justbetween cities, but even between institutions with-in the same city. Wide variation in access to qual-ity cancer care is a major cause of thesediscrepancies.

Dr Ketayun A. DinshawDirector, Tata Memorial CentreMumbai, India Source: IARC, Globocan 2002

The PINDA programme (National Childhood Programme ofAntineoplastic Drugs) was initiated in 1988 as part of the NationalCancer Control Programme. Initially, it treated leukaemias, lym-phomas and some solid tumors, and provided psychosocial support.Later on it included all cancers, as well as a Bone MarrowTransplant Programme. Chile now has a National Pediatric OncologyProgramme where 400 new cases (that is 85% of all childhood can-cers) are given free treatment each year. Thanks to this programme,over 4,000 patients have received the full treatment and more than2,600 have been cured.

Dr Myriam Campbell, Pediatric HematoncologyHospital Roberto del Río, SantiagoNational Coordinator PINDA, Chile

“

”

CURE AND CARE23CURE AND CARE 22

Today, 24.6 million peopleare living with cancer

and 6.7 million are dyingof cancer every year

Improving the quality of lifeby meeting patient needsImproving the quality of life of patients livingwith cancer and dying from cancer is anurgent humanitarian need. More people arediagnosed with cancer, and need adequatecare. Many of them, particularly in less devel-oped countries present in very late stages. Forall of them the best type of care is palliativecare, that is the physical, psychosocial, andspiritual support that can considerablyimprove their quality of life and that of theirfamilies by relieving unnecessary suffering.

Palliative care is not only end of life care, butis part of the continuum of care from the timecancer is diagnosed throughout the course ofthe disease, alongside treatment. It becomesmore intensive towards the end of life astreatment interventions become less effec-tive. Palliative care also goes beyond death,and includes bereavement care for families.

Improving health systemsas a part of the concertedaction against cancerPositive results for chronic diseases, such ascancer, can only be achieved when patients,families, societies, and health care teams jointheir efforts in an organized and motivatedway.

Health systems need to be adapted to meetthe needs of the healthy and the sick bydeveloping comprehensive cancer controlprogrammes that seek to prevent, detect earlycure and care.

Uganda: Personal storyA young Ugandan woman had severe painbecause she was in the last stages of a termi-nal illness. She had been unable to sleepbecause of severe pain for more than threemonths before she heard of Hospice AfricaUganda. She was given palliative care includ-ing oral morphine to control her pain.Although this young woman died eightmonths later, she died in peace and withoutpain. As she was reaching the end of her life,she asked her hospice nurse to pass on hermessage:

The International Narcotics Control Board(INCB) continues to be concerned about the lowconsumption of opioid analgesics for the treatmentof moderate to severe pain in many countries. TheBoard encourages Governments that have not yetdone so to examine the extent to which theirhealth-care systems and laws and regulations per-mit the use of opioids for medical purposes, andto develop plans of action, with a view to facili-tating the supply and avaibility of narcotic drugsfor all appropriate indications.

Mr Koli Kouame, Secretary International Narcotics Control Board

“

”

Source: Hospice Africa Uganda

Please thank all. Because of your help I am painfree and able to make provisions for my familyafter my death.

“”

GLOBAL ACTION AGAINST CANCER 24

Global action against

cancer

health - people around the world are alsodealing with other diseases, war, famine andpolitical instability. Partly because cancer is acomplex disease with many forms. There isno one answer. There is no one solution.

Each individual has a role to play. Healthcare professionals, patients, survivors, pol-icy makers, journalists, researchers anddonors can each contribute to the globaleffort against cancer. The strategies areavailable and the tools ready – the science,the legislative frameworks, the pro-grammes and an enormous body of infor-mation on one of the world’s most studieddiseases.

We've tried working alone, and we have hadlimited success. Now is the time for a newapproach - all sectors, public and private,working together to achieve a common goal -the control of cancer.

We know the facts. The inexorable rise of alargely avoidable disease is exacting an unac-ceptable human and social cost in everycountry. Every year almost 7 million peopledie of cancer worldwide.

We know what can be done. We can save2 million lives by 2020. A great deal hasalready been done but it’s not enough.

The World Health Organization and theInternational Union Against Cancer areworking together to address the cancer situa-tion at a global level and to promote concert-ed action against cancer.

The challenge is clear and many possiblesolutions - prevention, early detection, cureand care - are well known to us. So whyhaven’t we achieved greater success inreversing the trends? Perhaps partly becausecancer is only one of the many challenges to

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