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Contents Marrakech, Morocco, 18-19 June 2010 1 Global burden of cancer 2 Regional burden of cancer 3 Regional challenges in cancer prevention and control 4 Cancer control strategy and framework for country action 5 Recommendations Contents Marrakech, Morocco, 18-19 June 2010 ✓ 1 Global burden of cancer 2 Regional burden of cancer 3 Regional challenges in cancer prevention and control 4 Cancer control strategy and framework for country action 5 Recommendations Cancer projected global deaths (2004-2030) • Cancer is the second most common killer today, 13% of death worldwide are currently caused by it. • By 2030, cancer will become the leading cause of death, ahead of ischemic heart disease & stroke. • The estimated number of cases of cancer is expected to rise each year from 11 million in 2002 to 27 million by 2030 . • The majority of new cases are expected to occur in less developed countries. Cancer projected global deaths Recent IARC Report , June 2010. •In 2008, best estimates: 12.7 million new cancer cases and 7.6 million cancer deaths. Cancers Stroke •Over half (56%) of new cancer cases and 63% of deaths in developing regions of the World. •Approx. 21.4 million new cases will be diagnosed and 13.2 million deaths from cancer will occur in 2030. Cancer projected global deaths (2004-2030) 12 Cancers Deaths (millions) 10 Ischaemic heart disease Stroke 8 6 Acute respiratory infections 4 Road traffic accidents 2 Perinatal HIV/AIDS TB Malaria 0 2000 2005 2010 2015 2020 2025 2030 Contents Marrakech, Morocco, 18-19 June 2010 ✓ 1 Global burden of cancer 2 Regional burden of cancer 3 Regional challenges in cancer prevention and control 4 Cancer control strategy and framework for country action 5 Recommendations Regional burden of cancer • Cancer is the 4th ranked cause of death in the Eastern Mediterranean Region, following cardiovascular diseases, infectious diseases and injuries; • It is estimated that cancer kills 272,000 people each year in the Region; • Half of the cancer occur before age 55 years; • The majority of cancer cases diagnosed at relatively advanced stage. Summary Statistics Regional Statistics WHO EAST MEDITERRANEAN REGION (EMRO) Male Female Both sexes 297428 282779 580208 214.7 214.8 429.5 109.3 104.4 106.3 11.7 10.8 11.2 WHO EAST MEDITERRANEAN REGION (EMRO) Male Female Both sexes Number of cancer deaths (thousands) 169.9 144.5 314.3 88.6 73.2 80.5 9.6 7.9 8.7 Population (thousands) Number of new cancer cases (thousands) Age-standardised rate (W) Risk of getting cancer before age 75 (%) Age-standardised rate (W) Risk of dying from cancer before age 75 (%) Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993 Most common cancers in the Region Eastern Mediterranean countries, incidence (all ages) GLOBOCAN 2002 estimates: http://www-dep.iarc.fr/ 5 Most common cancers in the Region Male Female Both sexes Lung Breast Breast Bladder Cervix uteri Lung Stomach Colorectum Colorectum Non-Hodgkin lymphoma Ovary Stomach Colorectum Non-Hodgkin lymphoma Non-Hodgkin lymphoma Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993 Most frequent cancers (Incidence & Mortality) in MEN ♂ Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993 Most frequent cancers (Incidence & Mortality) in WOMEN ♀ Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993 Most frequent cancers (Incidence & Mortality) in BOTH SEXES ♀ Reference: Globocan 2008 (IARC), Country Fast State http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=993 ♂ Childhood cancers Regional burden of cancer EMR countries In the Region, the most common childhood cancers are cancers of the blood. All sites Incidence of childhood cancer in the Region is comparable to that in industrialized countries, but mortality is much higher. Lessons learned From international experiences • 40% of cancers can be prevented. • 40% of cancers can be detected early and cured. • Suffering from the remaining 20% of cancers can be reduced by palliative therapy. Oman United Arab Emirates Saudi Arabia Sudan 90 80 70 60 50 Bahrain Islamic Republic of Iran Kuwait Morocco Egypt Pakistan Qatar Palestine Lebanon Jordan Syrian Arab Republic Djibouti Tunisia Yemen Prevalence of tobacco smoking Among adults in the Region Males > 15 yr Females > 15 yr 40 30 20 10 0 Yemen Afghanistan Somalia 60 Pakistan 70 Sudan 80 Djibouti Oman Iraq Lebanon Morocco Syrian Arab Republic Islamic Republic of Iran Libyan Arab Jamahiriya United Arab Emirates Qatar Saudi Arabia Tunisia Bahrain Jordan Egypt Kuwait Prevalence of overweight & obesity in the Region 90 BMI ≥ 25 Males BMI ≥ 25 Females 50 40 30 20 10 0 World cancer burden caused by infection in 2002 Total caused by infection, 17.8% 6.0% 4.9% 5.2% 5.6% (bladder cancer) 5.0% • Helicobacter pylori 4.0% (stomach cancer) 3.0% • Hepatitis B and C 2.0% 1.0% The major infections are: • Schistosomiasis 0.9% 1.0% 0.1% 0.1% 0.1% (liver cancer) • Human papillomavirus (cervical cancer) Sc hi st os om ia si s H TL Li ve V-1 rf l H u ke IV /H s H V -B H E BV B V & H C V H PV H .P yl or i 0.0% Source: Parkin DM. International journal of cancer, 2006, 118(12):3030–44. Cancer related to infection and corresponding burden In EMR Cancers Infectious agent (attributable fraction Crude incidence in the Eastern for the whole world) Mediterranean Regiona (per 100 000 population) Bladder Schistosoma (3%) 5.0 Stomach Helicobacter pylori (63%) 3.8 Non-Hodgkin lymphoma Cervix HTLV-I (18%) 3.3 HPV (100%) 2.8 Liver HBV, HCV (86%) 2.4 Hodgkin lymphoma EBV (46%) 1.5 Nasopharyngeal carcinoma EBV (98%) 0.9 Source: The cancer atlas. American Cancer Society, 2006. Contents Marrakech, Morocco, 18-19 June 2010 ✓ 1 Global burden of cancer 2 Regional burden of cancer 3 Regional challenges in cancer prevention and control 4 Cancer control strategy and framework for country action 5 Recommendations 1. Screening and early detection Regional challenges in cancer prevention • In the Region, the vast majority of cancers are diagnosed at an advanced stage when cure is improbable even with the best treatment. Stage of diagnosis Breast cancer Cervical cancer United States EMR Country United States EMR Country Early stage 65% 25.5% 58% 35.9% Advanced stages 30% 58% 33% 53.2% 5% 16.5% 9% 10.9% 2. Cancer management in the Region Regional challenges in cancer prevention • Human resources (oncologists, nurses) are insufficient in the majority of countries; • Medicine availability and affordability for patients in the majority of countries (out-of-pocket expense); • Radiotherapy machines, radio-oncologists and radiotechnicians are not sufficient to cover the needs in many countries; • Multidisciplinary management of cases is not instituted in all referral centres. 3. Palliative care Regional challenges in cancer prevention • Misconceptions about pain relief use; • Training Gaps; • Lack of awareness; • Inadequate policies restricting access to pain relief medications; • Accessibility & affordability of medication for pain relief 4. Cancer data Regional challenges in cancer prevention • 11 countries have hospital-based cancer registry and published reports, but the quality of the data and reports from these registries is very heterogeneous. • Cancer registry is not exist in 8 Member States have no cancer registry. • Data about stage at presentation, mortality and survival are lacking in almost all Member States.