Understanding the Burden of Cancer in Developing Countries
Susan Higman, PhD Director, Research and Analysis Global Health Council March 11, 2010
21st century cancer burden Like infectious diseases and MCH/RH issues, cancer is a health problem in developing countries.
• Global cancer burden doubled in past 30 years • Expected to double between 2000 and 2020
• More than half of the cancer burden is borne by low- or middle-income countries • In 2007, 72% of cancer deaths in developing countries • By 2020, 60% of new cases in least developed • In 1970, 15% of new cases in developing countries
Why is cancer increasing? • Lifestyle changes – diet/weight, tobacco • Environmental exposures • Increased life expectancy • Population growth • Emerging or problematic infectious diseases • Lack of health care services • Primary care system – prevention, early screening • Routine reproductive health care
• Increased reporting and data collection
Scale of the problem • More than 4 million people in developing countries die of cancer each year • Nearly 6 million new cases reported Leading Cancers in Developing Countries Type
Lung Stomach Liver Esophogeal Cervical Breast Colorectal TOTAL
Men Incidence (in 1000s)
Deaths (in 1000s)
481 405 366 256
423 316 344 210
196 1,704
118 1,411
GLOBOCAN 2002 database
Women Incidence Deaths (in 1000s) (in 1000s) 191 214 147 130 409 514 160 1,765
168 170 142 109 234 221 96 1,140
Total Incidence (in 1000s)
Deaths (in 1000s)
672 619 513 386 409 514 356 3,469
591 486 486 319 234 221 214 2,551
Regional view Africa Tobacco use
No data in many countries
Asia
Latin America
40-60% of men <20% of women
30-40% of men <20-30% of women
H. pylori infection >75% of adults (SSA) 65-74% in NA
>75% of adults in SE and SC
65-74% of adults
Major cancers in men
Lung (N) Liver (W, C) Oral cavity (E) Prostate (S, W) Kaposi sarcoma (S) Esophagus (E)
Lung (SE, China, C) Liver (N, SE) Oral cavity (India) Stomach (SC)
Lung (S) Prostate (Mexico, CA, Northern SA) Stomach (Chile)
Major cancers in women
Cervical (C) Breast (N, S) Liver (SE)
Cervical Breast (SC, C, SE) Liver (N) Stomach (China)
Cervical (Mexico, CA, Northern SA Breast (SA)
The Cancer Atlas. 2006. American Cancer Society
Infectious diseases In 2002, 1.9 million cases attributable to infections • 8-10% of cancers in high-income countries • 20-26% of cancers in developing countries
• Human papilloma virus – cervical cancer • Hepatitis B & C viruses – liver cancer • H. pylori (bacteria) – stomach cancer • Epstein-Barr virus – Burkitt’s lymphoma and nasopharyngeal cancer • HIV – Kaposi sarcoma and other lymphomas • Herpes virus 8 & T-lymphotropic viruses – adult T-cell leukemia and other lymphomas
Reproductive health • Breast cancer – most common cancer among women; 2nd most common cancer worldwide • Increasing in developing countries • More aggressive than in high-income countries
• Cervical cancer – intersection of infectious diseases (HPV), reproductive health and cancer • Endometrial cancer – 3rd most common cancer in women; ~ 190,000 new cases/year • Ovarian cancer – 6th most common cancer in women; data is limited • Prostate cancer – 5th most common cancer; 2nd most common in men
Risk Factors Some risk factors are modifiable; others are not. Some require systemic change; others individual change • Use of tobacco or alcohol • Behaviors/lifestyle – unsafe sex; lack of physical activity • Unhealthy diet – high fat foods, obesity, contaminants • Ultraviolet or ionizing radiation • Occupational or environmental exposure • Aging – greater risk with age • Ethnicity or race – prevalence and severity • Heredity – directly, 4% of cancers; susceptibility factors • Sex/gender
Resources needed In 2009, estimated 12.9 million cases of cancer • Cost of new cases: US$ 286 billion in medical and non-medical costs (e.g., productivity) • 5% of cancer resources go to developing countries • Chronic nature of disease – long-term investment of resources and delivery system; palliative care • Different tools/equipment, training and medicines than usually thought of for developing countries • Requires negotiating with different actors • Requires partnering in different ways
• For additional information, please contact shigman@globalhealth.org • Report issued in June 2010 with results from: – Focus groups – Member survey – Working group notes – Literature review – Events
Thanks to Novartis for support of this work
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