Epidemiology of Cancer in EMR

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

10
Ischaemic heart disease
Stroke

8
Deaths (millions)

6
Acute respiratory infections
4 Road traffic accidents

Perinatal
2 HIV/AIDS
TB

0 Malaria

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

Population (thousands) 297428 282779 580208
Number of new cancer cases (thousands) 214.7 214.8 429.5
Age-standardised rate (W) 109.3 104.4 106.3
Risk of getting cancer before age 75 (%) 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

Age-standardised rate (W) 88.6 73.2 80.5

Risk of dying from cancer before age 75 (%) 9.6 7.9 8.7

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 All sites

In the Region, the most common childhood Incidence of childhood cancer in the Region is
cancers are cancers of the blood. 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.
 0
10
20
30
40
50
60
70
80
90
Yemen

Tunisia

Djibouti

Syrian Arab Republic

Jordan

Lebanon

Palestine
Among adults in the Region

Qatar

Pakistan

Egypt

Morocco

Kuwait
Prevalence of tobacco smoking

Islamic Republic of Iran

Bahrain

Sudan

Saudi Arabia
Males > 15 yr
Females > 15 yr

United Arab Emirates

Oman
 0
10
20
30
40
50
60
70
80
90
Kuwait

Egypt

Jordan
in the Region

Bahrain

Tunisia

Saudi Arabia

Qatar

United Arab Emirates

Libyan Arab Jamahiriya

Islamic Republic of Iran

Syrian Arab Republic

Morocco

Lebanon

Iraq

Oman

Djibouti
Prevalence of overweight & obesity

Sudan

Pakistan
BMI ≥ 25 Males

Somalia
BMI ≥ 25 Females

Afghanistan

Yemen
World cancer burden caused by infection
in 2002

Total caused by infection, 17.8%

6.0% 5.6% The major infections are:

4.9%
5.2% • Schistosomiasis
5.0% (bladder cancer)
4.0% • Helicobacter pylori
(stomach cancer)
3.0%
• Hepatitis B and C
2.0% (liver cancer)
0.9% 1.0%
1.0% • Human papillomavirus
0.1% 0.1% 0.1% (cervical cancer)
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 HTLV-I (18%) 3.3

lymphoma
Cervix HPV (100%) 2.8

Liver HBV, HCV (86%) 2.4

Hodgkin lymphoma EBV (46%) 1.5

Nasopharyngeal EBV (98%) 0.9

carcinoma

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 Breast cancer Cervical cancer
diagnosis United EMR Country United EMR Country
States States
Early stage 65% 25.5% 58% 35.9%
Advanced 30% 58% 33% 53.2%
stages
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 radio-
technicians 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.