Global cancer rates could increase by 50% to 15 million by 2020

By 2020, the number of cancer cases worldwide could rise by 50% to 15 million.

According to the World Cancer Report, smoking, poor food, and infections can prevent one third of cancer cases, while another third can be treated.

Geneva, April 3, 2003 According to the World Cancer Report, the most thorough global analysis of the disease to date, cancer rates could rise by another 50% to 15 million new cases in 2020. The paper also offers convincing evidence that governments and health professionals may halt this trend and prevent up to one third of cancer cases worldwide by promoting healthy lifestyles and other public health initiatives.

13% of the almost 56 million deaths globally due to all causes in 2000 were caused by malignant tumors. More than 25% of fatalities worldwide are attributed to cancer. Malignant tumors were diagnosed in 5.3 million men and 4.7 million women in 2000, and the disease claimed the lives of 6.2 million people overall. The survey also demonstrates that, like its impact in industrialized countries, cancer has become a significant public health issue in developing countries.

According to the World Cancer Report, cancer rates are projected to rise at an alarming rate over the world. By acting now, we can change the world. We have a chance to stop its growth. This report urges governments, medical professionals, and the general public to act quickly. Dr. Paul Kleihues, Director of the International Agency for Research on Cancer (IARC) and co-editor of the World Cancer Report, stated that if action is taken now, one third of cancers could be prevented, another third could be cured, and the remaining third that requires it could receive good, palliative care.

The World Cancer Report is a brief guide that discusses the burden of cancer worldwide, its causes, the main types of malignancies, early identification, and treatment. The World Health Organization’s IARC division released the 351-page worldwide report (WHO).

“The study provides a basis for public health action and aids us in our mission to reduce the morbidity and mortality from cancer, and to improve the quality of life of cancer patients and their families, everywhere in the globe,” said Dr. Gro Harlem Brundtland, director-general of WHO.

Examples of areas where intervention can help stop the rise in cancer rates and prevent one-third of instances include:

• the reduction of cigarette use. It is still the biggest preventable cancer risk. In the 20th century, diseases linked to tobacco use claimed the lives of almost 100 million people worldwide.
• A healthy food and way of living can help. Regular fruit and vegetable eating, together with exercise, can have an impact.
• For cervical and breast cancers in particular, early detection through screening paves the way for effective treatment and prevention.

From 10 million new cases globally in 2000 to 15 million in 2020, the predicted sharp increase in new cases will primarily be caused by steadily aging populations in both developed and developing countries, as well as current trends in smoking prevalence and the growing adoption of unhealthy lifestyles.

Bernard W. Stewart, Ph.D., co-editor of the report, director of cancer services, and professor, faculty of medicine, University of New South Wales, Australia, says that governments, doctors, and health educators “at all levels could do much more to help people change their behavior to avoid preventable cancers.” “Over the next twenty years and beyond, we would make significant advancements in the prevention and treatment of malignancies if the knowledge, technology, and control techniques indicated in the World Cancer Report were used internationally.”

The two primary cancer-causing factors, tobacco and diet, should be the emphasis of cancer prevention efforts from a global viewpoint. Infections that result in cancer must also be prevented, according to Dr. Rafael Bengoa, WHO Director of Noncommunicable Disease Management. “These factors contributed to 40% of all new cases of cancer, or four million new cases, and 43% of all cancer deaths in 2000, totaling 2.7 million fatalities.”

WHO is working to reverse this trend by reducing tobacco use and promoting a healthy diet, regular exercise, and improved nutrition. The biggest preventable cancer risk is still smoking. In order to reduce tobacco usage globally, the paper evaluates and suggests a number of measures. These strategies call for the coordinated participation of government and community health groups, health care professionals, and individuals. A potent tool to assure the implementation of such measures is the ground-breaking public health treaty, the Framework Convention on Tobacco Control, which the Member States of WHO have decided to submit to the World Health Assembly in May 2003.

In accordance with a mandate from Member States issued in May 2002, WHO is also working on developing a worldwide strategy on diet, physical activity, and health to address the rising global burden of chronic diseases, such as cancer, cardiovascular diseases, diabetes, and obesity. The strategy, which will be presented to the World Health Assembly in May 2004, is the subject of extensive consultation by WHO with Member States, other UN agencies, the commercial sector, and civil society. The strategy will offer advice to governments on population-based measures to lower the prevalence of chronic diseases like cancer as well as targets for diet and physical activity.

THE MAJOR FINDINGS FROM THE WORLD CANCER REPORT

The major prevention of tobacco use

The biggest preventable cancer risk is still smoking. In the 20th century, tobacco-related diseases claimed the lives of almost 100 million people worldwide (cancer, chronic lung disease, cardiovascular disease and stroke). Regular smokers lose half of their lives to the habit. Smokers have a 25% chance of dying young in middle age (35 to 69 years).

Regular smokers have a 20–30 fold higher relative risk (RR) of developing lung cancer than non-smokers. Approximately 90% of lung cancers in both men and women are caused by cigarette smoking in nations with high smoking prevalence and where many women have smoked cigarettes their entire adult lives. The RR for the bladder and renal pelvis is 5–6, although this indicates that smoking is the primary cause of more than 50% of cases.

The risk ratio (RR) is larger than six in cases of pancreatic cancer and between three and four in cases of oral cavity, oral cavity, pharynx, larynx, and squamous cell carcinoma of the oesophagus. Sadly, additional cancer sites with an RR of 2–3 have been identified as being associated with tobacco smoking, including cancers of the stomach, liver, uterine cervix, kidney (renal cell carcinoma), nasal cavities and sinuses, esophagus (adenocarcinoma), and myeloid leukemia. These risk estimates are higher than those previously estimated.

Passive smoking is cancer-causing and may raise the risk of developing lung cancer by 20%. There is currently no proof that smoking causes uterine, breast, or prostate cancer.

In many emerging and newly industrialized nations, as well as Central and Eastern Europe, the fatal smoking habit is especially concerning. Young people all around the world have a propensity to start smoking at younger and younger ages, which puts them at significant risk for serious consequences later in life.

Although it is ideal to never start smoking, epidemiological research shows that quitting has huge advantages. Within the next few decades, those who give up the habit will be responsible for the biggest decrease in the number of cancer fatalities. The best outcomes come from quitting smoking in your early 30s, but even after 50, you can still experience a very impressive risk reduction of more than 60%.

In order to reduce tobacco usage globally, the paper evaluates and suggests a number of measures. These strategies call for the coordinated participation of government and community health groups, health care professionals, and individuals. The Framework Convention on Tobacco Control, a ground-breaking public health agreement, is an effective tool to ensuring that such initiatives are put into practice.

Cancer and infection: early intervention is crucial

Up to 23% of malignancies in underdeveloped nations are brought on by infectious agents, such as Helicobacter pylori, the human papillomavirus, and the hepatitis B and C viruses (which cause liver cancer and cervical and ano-genital cancer, respectively) (stomach cancer). Chronic infection-related cancers account for only about 8% of all malignancies in affluent nations. This difference is especially noticeable in cervical cancer. Early cytological detection of cervical cancer (PAP smear) has significantly decreased mortality in developed nations with excellent public health infrastructure and high levels of female compliance, but in other parts of the world, such as Central America, South East Africa, and India, incidence and mortality rates are still very high. More than 80% of cervical cancer deaths today take place in underdeveloped nations.

The secret to preventing these malignancies may lie in vaccinations. Human papillomavirus (HPV) vaccination is likely to become a reality in 3 to 5 years. In high-incidence nations, HBV immunization has already been proved to prevent liver cancer.

Any chronic tissue damage with necrosis and regeneration in the gastro-intestinal tract (GIT) increases the risk of cancer. Examples include drinking very hot beverages (squamous cell carcinoma of the esophagus), gastro-oesophageal reflux, chronic gastritis brought on by H. pylori infection (stomach cancer), Crohn’s disease (cancer of the small intestines), and ulcerative colitis (colon cancer).

Poverty, wealth, and the burden of cancer worldwide

The likelihood of receiving a cancer diagnosis is more than twice as high in wealthy countries as it is in poor ones. However, in developed nations, 80% of cancer victims already have late-stage, incurable tumors when they are detected, indicating the need for far improved screening systems. In rich countries, roughly 50% of cancer patients pass away from the disease.

The earlier commencement of the tobacco epidemic, earlier exposure to occupational carcinogens, and Western eating and lifestyle are the key causes of the larger cancer burden in rich cultures. However, many nations experience rapid lifestyle changes as a result of rising prosperity and industrialisation, which will significantly raise their burden of disease in the future.

The Report emphasizes that more than 50% of the world’s cancer burden, in terms of both numbers of cases and fatalities, already occurs in developing nations. Cancer was once thought to be a “Western” disease. For the first time, cancer has become a significant public health issue in emerging countries, mirroring its impact in affluent countries. This is a rising problem on a global scale. IARC Director and co-editor of the World Cancer Report Paul Kleihues, MD, thinks that we can take action to reduce this development.

The health risks of the Western way of life

A high calorie diet full of fat, processed carbs, and animal protein, paired with little physical activity, characterizes the Western way of life, which leads to an overall energy imbalance. It is linked to a wide range of medical disorders, including as cancer, diabetes, cardiovascular disease, obesity, and arterial hypertension.

Cancers of the breast, colon/rectum, uterus (endometrial carcinoma), gallbladder, kidney, and oesophageal adenocarcinoma are common in wealthy societies. Additionally, there is an ethnic component to the relationship between prostate cancer and the Western way of life; black people seem to be at a higher risk than white people, who in turn are at a higher risk than Asian populations. A similar tumor burden is linked to similar lifestyles. These neoplasms commonly coexist because they share a common etiology. No area in the world experiences a high incidence of breast cancer without also experiencing a burden from colon cancer.

Obesity is a global disease that is developing rapidly. It depicts a persistent energy imbalance and serves as a standalone risk factor, notably for cancers of the uterine endometrium, kidney, and gall bladder.

The World Cancer Report offers policymakers the most recent data on which to base recommendations, together with the independent Expert Report on nutrition and chronic illness that was published in March 2003 by WHO and FAO (Food and Agriculture Organization).

Cancer and nutrition: the good news

With around 870,000 new cases and 650,000 fatalities per year, stomach cancer is one of the most prevalent cancers in the world. The majority of cases—60%—occur in developing nations, with Eastern Asia, the Andean areas of South America, and Eastern Europe having the highest incidence rates. The good news is that there is a global decline in stomach cancer, very substantially so in some places. One generation saw a 60% decrease in mortality in Switzerland and surrounding European nations. Within the next 30 years, stomach cancer may become a rare disease in several parts of the world if this trend holds. The primary cause of this positive development is the advent of the refrigerator, which made it possible to preserve fish and meat without the need of salt. Therefore, it is particularly impressive that incidence and fatality rates have decreased in Nordic nations like Iceland, where fish consumption has historically been high. Although stomach cancer rates are still high, they have started to drastically fall in communities that still favor salty foods, such as those in Portugal, Brazil, and Japan (salted pickles and salad), as well as Korea (salted cod, bacalao), among others. The year-round availability of fresh fruit and vegetables in many nations is another factor influencing this trend.

A balanced diet can aid in the prevention of cancer!

According to epidemiological research, consuming fruit and vegetables frequently may lower the chance of getting malignancies of epithelial origin, such as pharyngeal, laryngeal, lung, oesophageal, stomach, colon, and cervical carcinomas. According to recent findings from the European Prospective Investigation into Cancer and Nutrition (EPIC), eating 500 grams (1.1 pounds) of fruits and vegetables each day may reduce the risk of digestive tract malignancies by up to 25%.

According to the paper, many nations should promote the use of locally produced fruits, vegetables, and agricultural products and discourage the adoption of Western-style dietary practices due to the complex relationship between diet and cancer risk. According to the IARC, such interventions would have health advantages beyond cancer because they share risk factors with other prevalent non-communicable diseases like diabetes and cardiovascular disease.

The best approach, second only to primary prevention, is early detection Avoiding exposure to cancer-causing substances remains the best method of cancer prevention; this is referred to as primary prevention (eg tobacco, industrial carcinogens, etc).

There is strong evidence that early identification is largely to blame for the current drop in cancer mortality that has been seen in various nations. Improvements in imaging technologies (mammography, MR, and CT imaging) as well as increased illness knowledge and educational initiatives on typical early signs are to blame for this achievement. The earliest detection of breast cancer and cervical cancer to date has been accomplished using mammography and cytology, respectively. According to a recent study by an IARC Working Group, mammography screening may cut breast cancer mortality by 25–30% under trial conditions, and a reduction of 20% seems doable in nationwide screening programs. There is also growing evidence that PSA level monitoring during prostate cancer screening may reduce mortality rates, albeit early lesion therapy is still quite invasive. Colonoscopy is regarded as the gold standard for detecting colon cancer, but its use in population-based screening programs would be expensive.

cancer prevention techniques

The goal of cancer control is to improve the quality of life for cancer patients and their families while reducing the incidence of the disease and its related morbidity and mortality. The possibility of early detection, treatment, and palliative care is highlighted in the World Cancer Report in addition to the significant chances for primary prevention. It exhorts all nations to create thorough national cancer control programs with the intention of lowering the disease’s occurrence and enhancing the quality of life for cancer patients and their families. An early diagnosis and the provision of proper palliative care and pain treatment are urgently needed, especially in developing countries where a high percentage of malignancies are discovered late in the course of the disease.

Cancer Statistics

With 1.2 million new cases each year, lung cancer leads all cancers in the world. Breast cancer comes in second with just over 1 million cases, followed by colorectal cancer with 940,000 cases, stomach cancer with 870,000 cases, liver cancer with 560,000 cases, cervical cancer with 410,000 cases, head and neck cancer with 390,000 cases, bladder cancer with 330,000 cases, malignant non-Hodgkin lymphomas with 290,000 cases, leukemia with 250,000 cases, prostate and testicular

Lung cancer, stomach cancer, and liver cancer are the three most deadly types of cancer, respectively, accounting for 17.8%, 10.4%, and 8.8% of all cancer-related fatalities overall.

The United States, Italy, Australia, Germany, The Netherlands, Canada, and France are among the industrialized nations with the highest incidence of cancer overall. Northern Africa, the Southern Hemisphere, and Eastern Asia were the developing nations with the lowest cancer rates. (You may find a comprehensive list of cancer rates by nation at http://www-dep.iarc.fr/.

female lung cancer

Every year, lung cancer kills 900,000 men and 330,000 women. More than 80% of lung cancer cases in men are due to smoking. Smoking causes over half of all lung cancers in women worldwide, but more than 70% in North America and Northern Europe. Lung cancer is less common in men and women before the age of 40 and more common till the age of 70 or 75.

A significant public health concern is the increase in female smoking prevalence. In the US, lung cancer caused by smoking kills more women than breast cancer, and in several Nordic nations, such as Iceland and Denmark, the number of women dying from lung cancer has started to surpass that of men who also smoke. Given that up to 50% of young women in several European nations are currently frequent smokers, this will result in a disease load that will dramatically worsen women’s health over the course of decades.

stomach cancer

The second most common malignancy in wealthy civilizations, colon and rectal cancers are uncommon in poor nations. Around 500,000 people die from it each year, and there are more than 940,000 cases each year worldwide.

A diet high in fat, processed carbs, and animal protein mixed with insufficient exercise is a major contributing factor. Less than 5% of cases appear to be influenced by genetic predisposition. According to epidemiological research, risk can be decreased by eating more vegetables and fruit and less meat (especially processed meat). Another indication that environmental influences are important is the speed with which migrant populations rise to the higher risk levels of the adopted country.

The most reliable method for early detection is colonocopy. A 50% five-year survival rate is the outcome of steadily better diagnosis and therapy.

Key statements

• The primary preventable cause of cancer in the world is tobacco usage.
• Numerous details about cancer will be revealed through molecular genome research, however it is unclear how easily these findings will transfer into actual lives saved. These discoveries may also only apply to rare tumors.
• Developing nations will see significantly increased incidences of cancer, especially breast, colon, prostate, and uterine cancers, when they succeed in establishing lifestyles similar to those in Europe, North America, Australia, New Zealand, and Japan (endometrial carcinoma).
• Researchers will show that successfully altering one’s diet, drinking habits, and cigarette use will prevent considerably more cancers than removing contaminants like dioxins, industrial pollution, and car exhaust;
• The most effective method of cancer screening is the Pap test for cervical cancer. The medical community needs to create a variety of tests for various malignancies and is now assessing a number of techniques to see if they are efficient and practicable;
• The predominance of lung, liver, stomach, esophageal, and bladder cancer in males is one of the main differences in cancer susceptibility between the sexes. For the most part, these differences result from patterns of exposure to the causes of the cancers, but they also partially reflect inherent gender differences.
• Breast cancer affects more than one million people worldwide every year, with 580,000 cases occurring in developed nations (>300/100,000 population annually) and the remainder in developing nations (typically 1500/100,000 population annually), despite the latter’s significantly higher overall population and younger median age.
• Around 400,000 women lost their lives to breast cancer in 2000, the last year for which there available global data, accounting for 1.6% of all female fatalities. In wealthy nations, the prevalence of breast cancer fatalities was much greater than in economically depressed areas (2% of all female deaths) (0.5per cent).
• “The good news is that early detection and treatment programs, such as chemotherapy and tamoxifen, have improved, leading to a drop in breast cancer mortality rates in North America, Western Europe, and Australia,” adds Dr. Stewart. “In most wealthy countries, five-year survival rates are higher than 75%.”
• According to the report, a number of variables, such as reproductive history, genetics, radiation (particularly during breast development), and the Western lifestyle, which includes a high-calorie diet, obesity, and a lack of exercise, are to blame for the global breast cancer epidemic.
• Dr. Kleihues states that initiatives for the prevention of various linked non-communicable diseases, primarily cardiovascular diseases, chronic obstructive pulmonary diseases, and diabetes, must closely coordinate with dietary recommendations.

Considering how few nations presently have effective education initiatives, IARC also urges for robust and rigorously assessed tobacco-free and healthy eating programs in schools. The IARC, based in Lyon, France, also urges governments to implement national cancer control programs to assist ensure that the public is encouraged to adopt healthy personal habits.

According to Dr. Stewart, new medications “won’t necessarily get rid of tumors, but when used in conjunction with other agents, may change many cases of quickly deadly cancer into “manageable” chronic sickness.” Control — According to the IARC research, society must shift their focus from treatment and detection to prevention in order to have the greatest influence on the cancer problem.

The heart of this cancer prevention plan consists of a cost-effective combination of interventions for tobacco control, infection control, good eating, a program to treat curable cancers, and palliative care.

“Countries may achieve major reductions in cancer incidence and cancer mortality by the year 2020 by acting now,” claims Dr. Stewart. These opportunities are there; the only issue is whether we will seize them in order to advance humankind as a whole.

Dr. Kleihues claims that this book will be given to general bookstores, medical schools, and government health ministries. “This book is unique in the entire globe. What this book has attempted to do has never been attempted before. We made an effort to write a book with a lot of technical information that is relevant and understandable to both laypeople and specialists.

For further information:

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Nicolas Gaudin, Chief, IARC Communications, International Agency for Research on Cancer, Tel: +33 472 738 567 Mobile : +33 680 572 966, Fax: +33 472 738 311, E-mail: com@iarc.fr

Rebecca Harding, Communications Officer, World Health Organization, Mobile (+41) 79 509 0651.

Please note that high resolution photos will be available on WHO website from 3rd April for downloading.