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Global Cancer in Women: Burden and Trends

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Global Cancer in Women: Burden and Trends Published OnlineFirst February 21, 2017; DOI: 10.1158/1055-9965.EPI-16-0858 CEBP FOCUS: Global Cancer in Women Global Cancer in Women: Burden and Trends Lindsey A. Torre, Farhad Islami, Rebecca L. Siegel, Elizabeth M. Ward, and Ahmedin Jemal This review is an abbreviated version of a report prepared for the American Cancer Society Global Health department and EMD Serono, Inc., a subsidiary of Merck KGaA, Darmstadt, Germany, which was released at the Union for International Cancer Control World Cancer Congress in Paris in November 2016. The original report can be found at https://www.cancer.org/health-care-professionals/our-global-health-work/ global-cancer-burden/global-burden-of-cancer-in-women.html. Staff in the Intramural Research Department of the American Cancer Society designed and conducted the study, including analysis, interpretation, and presentation of the review. The funding sources had no involvement in the study design, data analysis and interpretation, or preparation of the review. Abstract There are striking disparities in the global cancer burden in largely due to inadequate access to early detection and treatment. women, yet few publications highlight cancer occurrence in this For example, the top mortality rates are in Zimbabwe (147 deaths population, particularly for cancers that are not sex specific. This per 100,000) and Malawi (138). Furthermore, incidence rates of article, the first in a series of two, summarizes the current burden, cancers associated with economic development (e.g., lung, breast, trends, risk factors, prevention, early detection, and survivorship of colorectum) are rising in several LMICs. The burden of cancer all cancers combined and seven sites (breast, cervix, uterine corpus, among women could be substantially reduced in both HICs and ovary, colorectum, lung, and liver) that account for about 60% of LMICs through broad and equitable implementation of effective the cancer burden among women worldwide, using data from the interventions, including tobacco control, HPV and HBV vaccina- International Agency for Research on Cancer. Estimated 2012 tion, and screening (breast, cervix, and colorectum). Cancer Epide- overall cancer death rates in general are higher among women in miol Biomarkers Prev; 26(4); 1–14. Ó2017 AACR. low- and middle-income countries (LMICs) than high-income See related article by Islami et al. in this CEBP Focus section, countries (HICs), despite their lower overall incidence rates, "Global Cancer in Women." Introduction prevalence of cancer risk factors as countries experience economic transition. These risk factors include smoking, excess body weight, Cancer is a leading cause of death worldwide among women in physical inactivity, and changes in reproductive patterns, such as a both high-income countries (HICs) and middle-income coun- later age at first childbirth and fewer childbirths. As a result, tries. Moreover, the cancer burden is expanding in countries of all cancers that were once common only in HICs are becoming more income levels due to the growth and aging of the population. prevalent in LMICs. Females make up 49.5% of the world population; however, they Addressing the cancer burden in women is important not form a larger proportion of the population over 60 years, among only for its health impact, but also to confront gender inequal- whom cancer occurs most frequently, in both HICs and low- and ities and recognize the role of women as societal and economic middle-income countries (LMICs) due to differences in life expec- participants, as well as family caretakers (3). There is signifi- tancy and leading causes of mortality (1). The increasing cancer cant potential to reduce the suffering from cancer and to burden is expected to be particularly pronounced in LMICs, where alleviate the economic burden to individuals, families, and the average life expectancy is increasing due to public health societies. Numerous prevention and early detection interven- advances, such as the control of infectious diseases and reductions tions are proven to avert cancer cases and deaths in both high- in maternal, infant, and childhood mortality (2). In addition to and low-resource settings. Although LMICs may have limited these increases due to population growth, the cancer burden is resources for screening, a number of common cancers among also growing among women in LMICs due to changes in the females have known means of prevention and/or early detec- tion that can be applied in resource-appropriate settings. This report is the firstoftwoinaseriesoncancerinwomen.It Intramural Research, American Cancer Society, Atlanta, Georgia. summarizes the current burden, trends, risk factors, preven- Note: Supplementary data for this article are available at Cancer Epidemiology, tion, early detection, and survivorship of all cancers combined Biomarkers & Prevention Online (http://cebp.aacrjournals.org/). and for cancers of the breast, cervix, uterine corpus, ovary, Corresponding Author: Lindsey A. Torre, American Cancer Society, 250 Wil- colorectum, lung, and liver, which account for about 60% of liams Street, Atlanta, GA 30303. Phone: 404-327-6591; Fax: 404-321-4669; cancer cases and deaths among women worldwide. The second E-mail: [email protected] report addresses policy approaches to the most important doi: 10.1158/1055-9965.EPI-16-0858 cancer control priorities, with specificexamplesofproven Ó2017 American Association for Cancer Research. interventions focusing on primary prevention in LMICs. www.aacrjournals.org OF1 Downloaded from cebp.aacrjournals.org on October 1, 2021. © 2017 American Association for Cancer Research. Published OnlineFirst February 21, 2017; DOI: 10.1158/1055-9965.EPI-16-0858 CEBP FOCUS Materials and Methods (largely attributed to overdiagnosis) drive the high rates in South Korea (4, 10). Incidence rates are lowest in the LMICs of Estimates of the cancer burden in 2012, including incidence, South-Central Asia (<100; e.g., Maldives, Bhutan), South-East- mortality, and survivorship, are from the GLOBOCAN data- ern Asia (<125; e.g., Laos, Vietnam), and Africa (<100; e.g., base produced by the International Agency for Research on Niger, The Gambia). Cancer incidence rates reflect not only the Cancer (IARC; Lyon, France) of the World Health Organization cancer risk in a population, but also awareness, the prevalence (WHO; ref. 4). Additional cancer incidence data for trends of cancer screening, and detection practices. come from the Cancer Incidence in Five Continents (CI5) In contrast to incidence, overall cancer mortality rates among database of the International Association of Cancer Registries females are highest in LMICs in Oceania, sub-Saharan Africa and and IARC. CI5 collects and publishes high-quality cancer Asia, followed by North America, Europe, Australia, and New incidence data from registries around the world; the most Zealand. The top five estimated mortality rates worldwide in 2012 recent volume X (2003–2007) contains 290 population-based were in Zimbabwe (147 deaths per 100,000), Malawi (138), registries in 68 countries (5). Cancer incidence data for more Kenya (133), Mongolia (127), and Papua New Guinea (125; recent years were accessed from the Surveillance, Epidemiology ref. 4). Mortality rates are lowest in Northern and Western Africa, and End Results Program (6) for the United States and NORD- Central America, select islands of Oceania, and South-Central CAN for Nordic countries (7). Mortality trend data through Asia. Mortality rates reflect underlying incidence as well as cancer 2014 are from the WHO Cancer Mortality Database (8). mix and access to early detection and appropriate treatment. Annual trend data are graphed using 5-year adjacent average Among females, breast, colorectal, and lung cancers are the smoothing. We present age-standardized rates adjusted to the three most frequently diagnosed cancers and the three leading 1960 Segi world standard population, modified by Doll and colleagues (9). Data on leading causes of death worldwide and Table 1. Estimated new cancer cases and deaths worldwide for leading cancer several risk factors are from the WHO. Other risk factor sites among females, by level of development, 2012 information is drawn from the American Cancer Society/World Cases Deaths Lung Federation's Tobacco Atlas (smoking data) and peer- Worldwide reviewed literature. Breast 1,671,100 Breast 521,900 Colorectum 614,300 Lung, bronchus, 491,200 Results and Discussion & trachea Lung, bronchus, 583,100 Colorectum 320,300 Overall cancer burden & trachea Among females, cancer is the second leading cause of death Cervix uteri 527,600 Cervix uteri 265,700 worldwide and in the Americas, Europe, and Western Pacific Stomach 320,300 Stomach 254,100 regions (Supplementary Tables S1 and S2). It is the third Corpus uteri 319,600 Liver 224,500 Ovary 238,700 Pancreas 156,600 leading cause of death in the Eastern Mediterranean, fourth Thyroid 229,900 Ovary 151,900 in South-East Asia, and sixth in Africa (Supplementary Table Liver 228,100 Esophagus 119,000 S2). There were an estimated 6.7 million new cancer cases and Non-Hodgkin 168,100 Leukemia 114,200 3.5 million deaths among females worldwide in 2012 (Table 1; lymphoma à à ref. 4). Of these, 56% of cases and 64% of deaths were in less All sites 6,657,500 All sites 3,548,200 developed countries. Worldwide numbers are expected to More developed increase to 9.9 million cases and 5.5 million deaths annually Breast 788,200 Lung, bronchus, 209,900 by 2030 as a result of the growth and aging of the population & trachea alone (4). Colorectum 338,000 Breast 197,600 By region, the greatest numbers of cancer cases and deaths Lung, bronchus, & trachea 267,900 Colorectum 157,800 Corpus uteri 167,900 Pancreas 91,300 among females are in Eastern Asia, with 1.7 million cancer cases Ovary 99,800 Stomach 68,000 and 1 million deaths estimated in 2012 (Supplementary Table Stomach 99,400 Ovary 65,900 S3;ref.4).Thesefigures reflect population size as well as cancer Thyroid 93,100 Liver 42,700 risk and are dominated by China, which constitutes about three Pancreas 92,800 Leukemia 40,300 quarters of female cancer cases and deaths in the region (4).
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