Cancer Control Opportunities in Low- and Middle-Income Countries (2007) / Chapter Skim
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3 The Cancer Burden in Low- and Middle-Income Countries and How It Is Measured
3 The Cancer Burden in Low- and Middle-Income Countries and How It Is Measured
Pages 69-105
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From page 69... ...
. Quantification of risk factors known to be associated with specific diseases is also part of the measurement of burden of disease (Lopez et al., 2006)
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From page 70... ...
Most of these deaths will be from chronic, noncommunicable diseases. As many as half of these "premature" deaths could be prevented if patterns in major risk factors were modified, allowing people to live longer and die in old age.
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From page 71... ...
It conveys the risk that an individual with cancer will die, while the mortality rate describes the average risk of dying from cancer in the population. Mortality rates are often used as proxies for cancer incidence, especially where incidence data are not available.
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From page 72... ...
Cancer survival statistics are derived by calculating the proportion of people originally diagnosed with a type of cancer who are still alive at specified points after diagnosis, such as 1-year survival. For many cancers, 5year survival is synonymous with "cure," because relatively few of those surviving 5 years go on to die from the cancer (breast cancer is the most important exception)
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From page 73... ...
Peto, University of Oxford, June 2006. BASIC CANCER STATISTICS In 2002, about 11 million new cases of cancer occurred and about 7 million people died of cancer worldwide.
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From page 74... ...
, All Causes and Cancers by Country Income Level, 2002 (all figures in millions) All Causes of Death Cancer Deaths YLLa DALYsb Deaths YLLa DALYsb Population Country Income Level Low 28.5 606.4 877.7 1.8 20.8 21.4 2,560,762 Lower middle 17.2 221.0 402.6 2.7 29.4 30.3 2,214,697 Upper middle 3.4 42.2 90.4 0.6 5.9 6.3 513,406 High 7.9 52.4 118.7 2.1 15.4 17.4 933,917 All LMCs 49.1 869.6 1,370.7 5.1 56.1 58.0 5,288,865 World 57 922.5 1,490.1 7.1 71.6 75.5 6,224,985 LMC share of global 86% 94% 92% 72% 78% 77% 85% burden aThe component of the DALY that measures years of life lost by a population due to premature mortality.
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From page 75... ...
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From page 76... ...
9% China 24% India Europe 9% 24% Asia 51% Other Asia Oceania 13% 1% Japan 5% Africa 8% LAC 7% ~7 million deaths FIGURE 3-1 Cancer incidence and mortality by geographic area, 2002. LAC = Latin America and the Caribbean.
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From page 77... ...
Population-based data are not available, but a number of hospital-based studies have been published that report the cancer stage distribution of patients at those hospitals. Table 3-7 is a compilation of these studies for breast cancer.
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From page 80... ...
The incidence of stomach cancer, on the other hand, has declined over at least the past 50 years in most high-income countries for reasons that are only partially understood. The current global toll in incidence and mortality for the common cancers is depicted in Figure 3-2.
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From page 81... ...
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From page 82... ...
Lung cancer is at once one of the most deadly common cancers -- average 5-year survival in Europe is 10 percent, barely better than the 8 to 9 percent in developing countries -- and the most preventable. Stomach Cancer Stomach cancer ranks fourth in incidence worldwide, but because of its lethality, second among causes of cancer death.
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From page 83... ...
Of the estimated 411,000 women who died of breast cancer worldwide in 2002, 221,000 were in developing countries and 190,000 were in industrialized countries. Worldwide, there are more survivors of breast cancer than of any other cancer type (excluding the common and relatively harmless skin cancers)
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From page 84... ...
Cervical Cancer After breast cancer, cervical cancer is the next most common cancer among women worldwide. It is much more important in developing countries.
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and the risk of large bowel cancer are well accepted, as are findings from epidemiologic studies implicating obesity and a lack of physical activity. In countries where rates are already high, incidence rates are more or less stable, but mortality rates are falling.
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. More recently data are being collected on major risk factors for cancer and other chronic diseases through population surveys; concentrating on smoking habits, diet, and physical activity; and physiological and biochemical measurements (e.g., blood pressure and cholesterol)
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From page 87... ...
Cancer Data Collection in LMCs The amount and quality of vital and health statistics correlate generally with the economic status of countries. About 18 percent of low-income countries have recorded mortality data any time since 1950, and about 35 percent have published some population-based incidence data, although fewer than half of them are represented in the most recent edition of IARC's Cancer Incidence in Fie Continents.
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other single disease. Accordingly, decisions to invest in new or upgraded vital statistics systems, which entail long-term, sustained support, will not be made on the narrow basis of benefits to cancer control alone.
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. Including the sample systems in China and India, mortality data are available for about 72 percent of the world's population.
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From page 90... ...
If resources become available, such systems can be expanded. Cancer Incidence Data Cancer incidence data are collected by specialized cancer registries.
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The first and only comparative analysis of cancer survival from other parts of the world waited until 1998, when IARC published Cancer Surial in Deeloping Countries (Sankaranarayanan et al., 1998)
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Vojvodina Upper Middle Income Croatia Nationwide Czech Republic Nationwide Estonia Nationwide Latvia Nationwide Lithuania Nationwide Malta Nationwide Poland Cracow; Kielce; Lower Silesia; Warsaw City Slovak Republic Nationwide South and Central America/Caribbean Lower Middle Income Colombia Cali Cuba Villa Clara Ecuador Quito Upper Middle Income Argentina Bahia Blanca; Concordia Brazil Campinas; Goiania Costa Rica Nationwide Uruguay Montevideo SOURCE: Parkin et al.
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From page 93... ...
We also expect that, given cancer registries, we can track people until their deaths (or link to death records) and thereby calculate survival rates from different types of cancer, and more narrowly, using data in the patient records on, for example, stage and co-morbidities.This capability is not built into systems in poor countries, where mortality data are not continued
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From page 94... ...
. In comparison with African Americans, survival was similar only for those cancers that were rarely treated successfully anywhere, including esophageal, stomach, liver, and lung cancers.
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Large gaps between the two populations also were apparent for nasopharyn geal, colorectal, cervical, ovarian, and prostate cancers. Discussion Cancer patients in Uganda have very poor survival odds -- lower than the few other developing countries where survival has been documented (Sankaranarayanan et al., 1998)
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From page 96... ...
They are often detected at advanced stages in both low- and high-income countries, because no TABLE 3-10 Registries Included in Cancer Surial in Deeloping Countries Cancer Registration Closing Date Registry Area Period (diagnosis) of Follow-Up China Qidong 19821991 31 Dec 94 Shanghai 19881991 31 Dec 94 Cuba 19881989 31 Dec 94 India Bangalore 19821989 31 Dec 93 Barshi 19881992 31 Dec 95 Bombay 19821986 31 Dec 93 Madras 19841989 31 Dec 93 Philippines: Rizal 1987 31 Dec 93 Thailand Chiang Mai 19831992 30 Jun 94 Khon Kaen 19851992 31 Dec 95 SOURCE: Sankaranarayanan et al.
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From page 97... ...
3. Cancers with effective diagnostic and treatment interventions that require improved logistics: A third group of cancers, including leukemia, lymphoma, and testicular cancer, are marked by an even greater variability in survival between developing and developed countries.
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From page 98... ...
. Cancer shares risk factors with other major causes of death from noncommunicable diseases, and it is surveillance of these major, shared risk factors that are the basis of two approaches described in the next sections.
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The major noncommunicable diseases are cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. The most important common risk factors that are amenable to intervention are identified as smoking, unhealthy alcohol consumption, unhealthy diet (specifically, low intake of fruits and vegetables)
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In each such study, hundreds of thousands of adults are interviewed briefly about major risk factors (e.g., smoking, diet) and have basic physical measurements taken (and blood samples stored, in some cases)
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There may be a misperception that little more can be learned from further studies of this kind, particularly for established risk factors (such as smoking and blood lipids)
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From page 102... ...
, and Mexico. These studies have documented the unique patterns of diseases and their risk factors, such as the strong link between smoking and tuberculosis deaths in India or smoking and lung cancer and chronic lung disease in China.
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Longitudinal studies of chronic disease risk factors and mortality should be initiated in a few additional middle-income countries. Cancer registries should be developed in conjunction with cancer control activities, mainly in urban areas where diagnostic and treatment serices exist.
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From page 104... ...
2006. Global Burden of Disease and Risk Factors.
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From page 105... ...
2003. The World Health Report 00: Shaping the Future.
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