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Cancer • What is cancer?

• Cancer statistics

• Risk Factors

• Reducing burden and preventing cancer

• Cancer Treatment

• WHO/International Response

What is cancer?

• Large group of diseases where abnormal cells divide without control and are able to spread to other tissues and organs

• The latter process is called metastasis

• More than 100 types of cancer

• No two cancers are the same.

• Globally, 18.1 million cases of cancer were diagnosed in 2020

• Nearly 10 million deaths

• Each year approximately 400,000 children are diagnosed

What Causes Cancer?

• Changes result from interaction of a person's genetic factors and external agents, including:

• Physical carcinogens, such as ultraviolet and ionizing radiation;

• Chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and

• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites

• Cancer incidence rises dramatically with age

• Likely due to a build-up of risks for specific cancers that increase with age

• Combined with the tendency for cellular repair mechanisms to be less effective as a person ages

Risk Factors

• Tobacco use, alcohol consumption, unhealthy diet, physical inactivity and air pollution

• Some chronic infections

• In particular, low- and middle-income countries

• Approximately 13% of cancers diagnosed in 2018 globally were attributed to carcinogenic infections, including Helicobacter pylori, human papillomavirus (HPV), hepatitis B virus, hepatitis C virus, and Epstein-Barr virus.

• Hepatitis and some types of HPV increase the risk for liver and cervical cancer, respectively

• Infection with HIV increases the risk of developing cervical cancer six-fold and substantially increases the risk of developing select other rare cancers such as Kaposi sarcoma

Cancer Global Statistics

Worldwide Cancer Diagnoses in 2020

2.26 2.21

1.93

1.41

1.2 1.09

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0.5

1

1.5

2

2.5

Breast Lung Colon Rectum Prostate Skin Stomach

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Cancer Type

Worldwide Cancer Deaths in 2020

1.8

0.92

0.83 0.77

0.69

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

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Lung Colon and Rectum Liver Stomach Breast

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Cancer Type

Cancer Prevalence

• Who has cancer at a specific moment in time out of everyone in the population

• Includes people who are living with cancer

• Incidence and survival impact specific cancer prevalence

• Increasing incidence increases prevalence

• Increased survival time increases prevalence

• More people are living with the disease

Cancer Prevalence

• Globally 43.8 million persons were living with cancer at the end of 2018

• Asia - 17.4M (39.7%)

• Europe - 11.87M (27.7%)

• The Americas – 11.43M (26.1%)

Prevalence of Cancer by Type

• Breast cancer globally the most prevalent form

• 2nd & 3rd most common - prostrate and colon & rectum cancer

Global Burden from Cancer

Cancer Mortality Rates

Cancer Risk Factors

Risk Factors

• Globally, one half of cancer deaths are caused by modifiable risk factors

• Tobacco smoking - Predominant cause of cancer in most high-income countries

• 1.1 billion smokers worldwide

• Infections play a major role in many sub-Saharan African and Asian countries

• Excess body weight as a major risk factor for cancer rising in most parts of the world.

Risk Factors

• Outdoor air pollution causes between 6 and 8 million premature deaths from lung cancer and other diseases each year

• International Agency for Research on Cancer (IARC) classifies outdoor air pollution and particulate matter in outdoor air pollution as known human carcinogens

• Outdoor air pollution levels particularly high in rapidly-growing cities in low- and middle-income countries

• Diesel exhaust, also classified as a lung carcinogen by IARC, contributes to outdoor air pollution and is also an occupational lung carcinogen.

Risk Factors

• Approximately 3–6% of all cancers worldwide are caused by exposures to carcinogens in the workplace

• Numerous substances are known to cause cancer in workers

• Exposure to occupational carcinogens a concern in low- and middle-income countries

• Exposures are likely to be higher than in high-income countries

• Regulations and enforcement are often less strict

Risk Factors

• High proportion of cancers caused by infection in many lower-income countries

• Infectious agents responsible for approximately 15% of all new cancer cases annually worldwide

• Two-thirds of which occur in less developed countries

• Lower income countries account for up to one quarter of all cancer

• HPV vaccination is suboptimal globally, particularly in Africa, where infection prevalence is highest

Reducing Cancer Burden and Prevention

Reducing the cancer burden

• Between 30 and 50% of cancers can currently be prevented by avoiding risk factors

• Can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer

• Many cancers can be cured if diagnosed early and treated appropriately

Cancer Prevention

• Between 30-50% of all cancer cases are preventable

• Cancer risk can be reduced by:

• Not using tobacco

• Maintaining a healthy body weight

• Eating a healthy diet, including fruit and vegetables

• Engage in regular physical activity

• Avoiding or reducing consumption of alcohol

• Getting vaccinated against HPV and hepatitis B

• Avoiding ultraviolet radiation exposure

• Minimizing occupational exposure to ionizing radiation; and

• Reducing exposure to outdoor air pollution and indoor air pollution

Early Detection

• Cancer mortality reduced when detected and treated early

• Two components of early detection: early diagnosis and screening

• Early diagnosis

• Cancer is more likely to respond to treatment and can result in a greater probability of survival with less morbidity when diagnosed early

• Three components of early diagnosis

• Being aware of the symptoms of different forms of cancer and quickly seeking medical advice when abnormal findings are observed

• Access to clinical evaluation and diagnostic services

• Timely referral to treatment services

• For example, in the US, White women are slightly more likely to develop breast cancer than Black, Hispanic, and Asian women

• Black women more likely to die from breast cancer

Early Detection (Screening)

• Aims to identify individuals with findings suggestive of a specific cancer or pre-cancer before developing symptoms.

• When abnormalities are identified, further tests to establish a definitive diagnosis should follow, as should referral for treatment if cancer is proven to be present

• Patient selection for screening is based on age and risk factors

• Examples of screening methods are:

• HPV test for cervical cancer screening

• Mammography screening for breast cancer for women aged < 45 years

Cancer Treatment

Cancer Treatment

• A correct cancer diagnosis essential for appropriate and effective treatment

• Usually includes surgery, radiotherapy, and/or systemic therapy (chemotherapy, hormonal treatments, targeted biological therapies)

• Proper selection of a treatment regimen takes into consideration both the cancer and the individual being treated

• Goals of treatment is an important first step.

• Primary goal is generally to cure cancer or to considerably prolong life

• Improving the patient's quality of life also an important goal

Cancer Treatment

• Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer, and colorectal cancer, have high cure probabilities when detected early and treated according to best practices.

• Some cancer types, such as some types of leukemia and lymphoma in children, also have high cure rates if appropriate treatment is provided

• Significant variation in treatment availability between countries of different income levels

• Comprehensive treatment is reportedly available in more than 90% of high-income countries but less than 15% of low-income countries

Palliative Care

• Used to relieve, rather than cure, symptoms and suffering caused by cancer and to improve the quality of life

• Can help people live more comfortably, particularly among patients in advanced cancer stages where there is little chance of cure

• Relief from physical, psychosocial, and spiritual problems through palliative care is possible for more than 90% of patients with advanced stages of cancer

• Improved access to oral morphine strongly recommended for moderate to severe cancer pain

WHO Response

WHO response

• In 2017, the World Health Assembly passed the Resolution Cancer prevention and control

• Urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan for the prevention and control of non communicable diseases 2013-2020 and the 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer

• WHO and International Agency for Research on Cancer (IARC) collaborate with other UN organizations, including the International Atomic Energy Agency

• Promote international collaboration on cancer research

• Describe the global cancer burden

Global Cancer Initiatives

• Increase political commitment for cancer prevention and control

• Coordinate and conduct research on the causes of human cancer

• Strengthen health systems at national and local levels to help improve access to cancer treatments

• Support governments and partners build and sustain high-quality cervical cancer control programs

• Global Breast Cancer Initiative (GBCI) – Aims to reduce breast cancer by 2.5 percent per year

• Over a 20-year period would save 2.5 million lives

Global Cancer Initiatives

• WHO Global Initiative for Childhood Cancer

• Brings together stakeholders from around the world and across sectors with the joint goal of increasing the survival rate at least by 60% by 2030

• Reducing suffering and improving quality of life for children with cancer globally

• Global Platform for Access to Childhood Cancer Medicines

• Goal - Increase access to essential cancer medicines

Thank you