world cancer report - iarc

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CANCER CONTROL IN THE USA: CENTERS FOR DISEASE, CONTROL AND PREVENTION One of the focuses of the Centers for Disease Control and Prevention (CDC) is developing, implementing, supporting and evaluating cancer prevention and control efforts in the USA. CDC’s many activities related to cancer include the following: cancer registries, cancer risk and behavioural surveillance systems, tobacco control, comprehensive cancer control and occupational, environmental and infectious disease-related cancers. CDC’s educational initiatives and interventions include those for breast, cervical, colorectal, prostate, skin, and ovarian cancers, for infectious-disease related cancers (e.g. hepatitis C-related liver cancer and Helicobacter pylori-related stomach cancer) and tobacco-related cancers (e.g. lung and oral cancers). Recognizing the importance of physical activity and nutrition in preventing disease, including cancer, CDC also has programmes in physical activity and nutrition. Developing and strengthening cancer surveillance systems Cancer registry data are used to identify and monitor cancer trends, gaps, disparities, barriers and successes, to develop and guide state-wide, comprehensive cancer prevention and control plans, to prioritize allocation of resources, to serve as the basis for research, and to evaluate prevention and control efforts. Such data are, therefore, the foundation upon which all cancer prevention and control efforts should be based. Many countries, including the USA, need to establish, support or strengthen an integrated, nationwide cancer surveillance system and use the system’s data as a basis for decision making. In a step towards development of such a system in the USA, CDC launched the National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS) in January 2001. The system will receive, assess, enhance, aggregate and share data from the National Program of Cancer Registries-funded programmes. Established 310 Cancer control in 1992, the National Program of Cancer Registries supports registries in 45 states, 3 territories, and the District of Columbia. The goal of the NPCR-CSS is to maximize the benefits of state- and territory-based cancer registries by providing feedback for improving data quality and usefulness and to provide public-use data for regional and national studies. Once cancer registries are established, decision- and policymakers should support and strengthen them in the following ways: - Provide adequate funding and staffing to ensure that registries are fully equipped and that their personnel are adequately trained so as to provide complete, timely, accurate data, obtain certification of data and conduct research. - If needed, develop, enact, and implement legislation and regulations that strengthen and support registries. - Ensure that the data are certified as meeting standards for completeness, timeliness, and quality. - Encourage integration of cancer registry data with those of other relevant data systems, such as geographic information or behaviour and risk factor surveillance systems. Linked data may provide more clues to risk factors for cancer, how to prevent cancer and how to increase survival and improve the health care delivery system. - Use registry data to develop and review policies and programmes, develop and update comprehensive cancer control plans, allocate scarce resources and evaluate the effectiveness of actions taken. Preventing tobacco use Use of tobacco products is the single most preventable cause of disease (including cancer) and death, yet tobacco use remains a problem worldwide. In 1999, CDC launched the National Tobacco Control Program. The programme provides funds to all 50 states, the District of Columbia, and USA territories to conduct tobacco control activities. It has the following goals: - Eliminate exposure to environmental tobacco smoke. - Prevent initiation of tobacco use among young people. - Promote quitting of tobacco use among adults and young people. - Eliminate disparities in tobacco use among various populations. The programme’s goals are being achieved through four components: community interventions, anti-tobacco marketing in the media, policy and regulation, and surveillance and evaluation. For tobacco control programmes to succeed, decision-makers and policymakers need to provide leadership, support research evaluating tobacco control efforts, and support training of health care professionals. CDC has developed and disseminates Best Practices for Comprehensive Tobacco Control Programs (http://www.cdc.gov/ tobacco/bestprac.htm). A new approach: comprehensive cancer control. Globally, cancer control activities are fragmented, uncoordinated and often categorized and funded by cancer type. In the USA, CDC has been supporting development of an integrated approach called comprehensive cancer control. This includes surveillance, policy, research, education and intervention programmes, services, and evaluation. By integrating these activities and services, health agencies, policymakers and others can better prioritize, maximize use of limited resources, reduce duplication of or unnecessary efforts, evaluate and improve the effectiveness of all actions. The approach also aims to increase cooperation and collaboration among risk-factor and cancer-specific programmes and activities (including surveillance systems). CDC and its partners have developed a comprehensive cancer control framework (http://www.cdc.gov/cancer/ncccp/ cccpdf/09Abed67-78.pdf) that will help states and other entities address major cancers, establish priorities and apply limited resources. CDC currently is providing USA states, territories and tribes with guidance and, in some cases, funding to develop and implement comprehensive cancer control programmes.
high-risk women. Further details on planning are provided in the National Cancer Control Programmes handbook [1]. Achievements of effective National Cancer Control Programmes National Cancer Control Programmes permit a better use of available funds, ensure a sound scientific basis to programme components, and promote social justice by ensuring equitable coverage of the population. Development of a Programme following an internationally accepted framework results in an understanding of the broader issues by both health care professionals and the general public. Of particular importance in many countries are avoiding the misuse of available resources, both public and personal, and an ethical obligation to relieve suffering at reasonable costs. Barriers to effective National Cancer Control Programmes There are a number of potential barriers to an effective Programme. These may include competing interests that could prevent the resources intended for cancer control being allocated to this purpose. In addition, the future patient is unknown and under-represented, so the importance of prevention may be down- 1. World Health Organization (2002) National Cancer Control Programmes: Policies and Management Guidelines, 2nd Edition. Geneva, WHO. 2. World Health Organization (1998) Guidelines for Controlling and Monitoring the Tobacco Epidemic, Geneva, WHO. 3. WHO/FAO (2003) Expert Consultation on Diet, Nutrition, and the Prevention of Chronic Diseases. Geneva, WHO. In preparation. 4. IARC (2002) Breast Cancer Screening (IARC Handbooks of Cancer Prevention, Vol. 7), Lyon, IARCPress. 5. Sikora K, Advani S, Koroltchouk V, Magrath I, Levy L, Pinedo H, Schwartsmann G, Tattersall M, Yan S (1999) Essential drugs for cancer therapy: a World Health Organization consultation. Ann Oncol, 10: 385-390. graded as there is a lack of knowledge on the potential for prevention, both among health professionals and the public. Further, in both early detection and therapy, there tends to be excess reliance on high technology, with a failure to recognize the potential for contribution from low technology approaches. In the palliative care area, although the principles have been carefully set out by WHO, there may be a failure to ensure the availability of oral morphine, and also a failure to ensure that morphine is prescribed correctly, both in hospital and in home care. Other major barriers include: - Lack of essential drugs and minimum standards of health care in low-income countries and disadvantaged populations - Lack of appropriate human resources - Lack of effective linkages with control programmes of other diseases (other noncommunicable diseases, HIV/AIDS, reproductive health etc.) - Lack of effective intersectional approaches necessary for primary prevention - Insufficient involvement of the community and nongovernmental organizations. Monitoring impact of cancer control As part of Programme planning, mechanisms must be set up to monitor the impact of cancer control activities. In REFERENCES WEBSITE 6. World Health Organization (1996) Cancer Pain Relief, Geneva, WHO. 7. World Health Organization (1998) Symptom Relief in Terminal Illness, Geneva, WHO. 8. World Health Organization (1998) Cancer Pain Relief and Palliative Care in Children, Geneva, WHO. 9. World Health Organization (2000) Achieving balance in national opioids control policy – guidelines for assessment. Geneva, WHO. general, this is best centred on a population-based cancer registry and an established vital statistics system. However, it is possible to set up ad hoc mechanisms, especially if the programme is initially concentrating on a few cancer sites. The basic measures are: - Trends in cancer incidence - to assess the impact of prevention (and screening for those cancers detected in the precursor stage, especially cervical) - Trends in cancer mortality - to assess the impact of screening and treatment - Change in tumour stage - to assess the impact of early detection - Change in cancer survival - to assess the impact of treatment. These should be supplemented by process measures, such as reduction in the prevalence of smoking in adults, and take-up of smoking in children and adolescents, measurement of the proportion of the target population receiving screening, and the proportion of patients with curable cancers receiving therapy, and the proportion of those with non-curable cancers receiving oral morphine. Process measures can be applied in all countries. In countries without population-based cancer registries or vital statistics systems, it will be impossible to assess changes in incidence and mortality. The WHO Programme on Cancer Control: http://www.who.int/cancer/ Cancer control: a global outlook 311
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WORLD HEALTH ORGANIZATION WHO OMS I
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WORLD CANCER REPORT Editors Bernard
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CONTENTS Foreword 9 1 The global bu
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The global burden of cancer Cancer
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Fig. 1.2 Incidence and mortality of
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Central and Southern Europe differ
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Incidence of cancer in South Centra
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from documentation of disease to a
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TOBACCO SUMMARY >In addition to lun
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Fig. 2.3 Smoking by children is inc
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Cancers positively Sex Standardized
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PHARMACOLOGICAL APPROACHES TO SMOKI
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level the dose—response relations
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lipoprotein-associated cholesterol,
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Agent Cancer site/cancer Main indus
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Industry, occupation Cancer site/ca
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to occupational exposures in develo
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Air pollutant WHO Air Quality Guide
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der cancer of the order of 50% is p
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AFLATOXIN B 1 HEPATITIS VIRUS (chro
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Fig. 2.30 Correlation between regio
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MEDICINAL DRUGS SUMMARY > Certain d
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Drug or drug combination Cancer IAR
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Agent or substance Cancer site/canc
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sources of electromagnetic fields [
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CHRONIC INFECTIONS SUMMARY > Infect
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Infection Subclinical Mutagenic fac
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TUMOURS ASSOCIATED WITH HIV/AIDS Ap
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DIET AND NUTRITION SUMMARY > Up to
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Fig. 2.54 The age-adjusted mortalit
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OVERWEIGHT, OBESITY AND PHYSICAL AC
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IMMUNOSUPPRESSION SUMMARY >Persiste
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Fig. 2.64 Cancer following immunosu
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Syndrome Gene Location Cancer site/
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viduals, confirmation of a gene def
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REPRODUCTIVE FACTORS AND HORMONES S
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PHYTO-ESTROGENS AND CANCER PEVENTIO
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Indicator Number of oral contracept
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Mechanisms of tumour development Th
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The stages in tumorigenesis have be
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PRECURSOR LESIONS IN CHEMOPREVENTIO
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CARCINOGEN ACTIVATION AND DNA REPAI
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adducts, a few weeks or months for
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I Reactive oxygen species Methylati
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which remove the mismatched bases,
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Common human oncogenes Many common
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product of the RB1 gene (pRb) and a
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ates a molecular bridge between p53
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potential cancer genes altered thro
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One of the earliest genes to be ide
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Regulation of the cell cycle and co
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CELL-CELL COMMUNICATION SUMMARY > C
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Connexin genes and tumour suppressi
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APOPTOSIS SUMMARY > The term apopto
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Caspase-8 Caspase-3 c-FLIP Procaspa
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ways. Several options are under inv
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INVASION AND METASTASIS SUMMARY > T
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laminin, entactin and also heparan
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Target Example of agent Comments Ad
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organs, and to respond to local gro
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TOBACCO CONTROL SUMMARY > Tobacco-i
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Region Deaths due to % of total dea
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ipated, is primarily attributable t
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smoke. This may be achieved in part
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there is no evidence for the effica
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industries, processes and occupatio
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stoves arises in rural areas of dev
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Climbing plants on trellis at end r
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HEPATITIS B VACCINATION SUMMARY > P
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Fig. 4.17 Chronic active HBV-associ
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HUMAN PAPILLOMAVIRUS VACCINATION SU
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Vaccine Site of trial Number of pat
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prolonged use. Similar drugs, that
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aspirin and other non-steroidal ant
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SCREENING FOR BREAST CANCER SUMMARY
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Fig. 4.35 Cumulative mortality from
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SCREENING FOR PROSTATE CANCER SUMMA
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Fig. 4.39 Poster designed for an an
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is around 10% for cancer (out of ev
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45 with one positive rehydrated FOB
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eing based on (i) time trends in th
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Fig. 4.48 Women at a clinic in Indi
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SCREENING FOR ORAL CANCER SUMMARY >
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India will provide useful informati
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cer incidence following cure of inf
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100 50 25 10 5 2.5 1 Japan Males Fe
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Human cancers by organ site Maligna
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tobacco smoking: age at start, aver
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diagnosis is usually confirmed by h
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is frequent and survival rates are
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Fig. 5.14 Physician reading digital
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Markers of prognosis in breast canc
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cer in the contralateral breast (Ch
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100 50 25 10 5 2.5 1 Japan Chile Po
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depends on staging. Small intramuco
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Fig. 5.30 A diet rich in fresh frui
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ane protein involved in cell adhesi
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LIVER CANCER SUMMARY > About 560,00
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Fig. 5.39 A woman in the Gambia pre
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REFERENCES 1. Ferlay J, Bray F, Par
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Certain Possible Uncertain Age Andr
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Management The dramatic division be
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TUMOUR NORMAL Gastrula PGC 2n Impri
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CANCERS OF THE FEMALE REPRODUCTIVE
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Fig. 5.62 Five-year relative surviv
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Inheritance of high-penetrance gene
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invasive malignant. Malignant germ
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OESOPHAGEAL CANCER SUMMARY >Cancer
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Fig. 5.76 A radiographic view of an
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with a stent; laser recannulation,
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Fig. 5.82 Risk of bladder cancer am
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Partial cystectomy is appropriate f
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poorly known since hypopharyngeal c
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Fig. 5.92 Oral leukoplakia with mil
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LYMPHOMA SUMMARY > Malignant lympho
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T Fig. 5.101 Nuclear magnetic reson
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Fig. 5.106 Five-year relative survi
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Fig. 5.109 The immediate aftermath
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A B Fig. 5.113 Acute myeloid leukae
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Fig. 5.118 Five-year relative survi
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Fig. 5.120 Age-specific incidence a
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Hereditary condition Mode of inheri
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MELANOMA SUMMARY > Approximately 13
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Fig. 5.131 Primary melanoma with a
Page 251 and 252: THYROID CANCER SUMMARY > Cancer of
Page 253 and 254: Papillary carcinoma RET/PTC TRK BRA
Page 255 and 256: KIDNEY CANCER SUMMARY > Cancer of t
Page 257 and 258: Stage Clear cell carcinoma Papillar
Page 259 and 260: TUMOURS OF THE NERVOUS SYSTEM SUMMA
Page 261 and 262: ing the optic tract, brain stem and
Page 263 and 264: mut = mutant p53 wt = wildtype p53
Page 265 and 266: SURGICAL ONCOLOGY SUMMARY > Surgica
Page 267 and 268: Year Radical mastectomy (%) Modifie
Page 269 and 270: TELEMEDICINE The prospects for tele
Page 271 and 272: Equipment Energy 50% depth dose App
Page 273 and 274: CANCER EDUCATION IN MEDICAL COURSES
Page 275 and 276: Fig. 6.10 Crystals of cisplatin: mo
Page 277 and 278: Responsiveness Cancer (in decreasin
Page 279 and 280: Most of the world’s most common c
Page 281 and 282: treatment of cancer. The problems l
Page 283 and 284: duction. It is clear that tumour ce
Page 285 and 286: REHABILITATION SUMMARY > Rehabilita
Page 287 and 288: cer and its associated disability.
Page 289 and 290: REFERENCES 1. Garden FH, Gillis TA
Page 291 and 292: Cancer pain relief varies and in so
Page 293 and 294: EMERGING ISSUES IN PALLIATIVE CARE
Page 295 and 296: Cancer control The negative impact
Page 297 and 298: priority to cancer control activiti
Page 299 and 300: Prevention of cancer Every country
Page 301: - Assessing the magnitude of the ca
Page 305 and 306: ecords departments are either rudim
Page 307 and 308: THE INTERNATIONAL AGENCY FOR RESEAR
Page 309 and 310: in the capitals/urban areas of four
Page 311 and 312: in the overall cancer strategy. WHO
Page 313 and 314: 68% 1955 1975 1995 2025 32% 40% by
Page 315 and 316: Fig. 7.15 A grandfather at work in
Page 317 and 318: Fig. 7.17 Main causes of death in d
Page 319 and 320: Contributors and Reviewers Sources
Page 321 and 322: Dr Vera Luiz da Costa e Silva Tobac
Page 323 and 324: Georgia Moore Centers for Disease C
Page 325 and 326: REVIEWERS Dr Sandra E. Brooks 405 W
Page 327 and 328: 2.53 T. Norat and E. Riboli, IARC 2
Page 329 and 330: Gastroenterology, 118(2 Suppl 1): S
Page 331 and 332: 5.106 & 5.107 IARC/SEER/Osaka Cance
Page 333 and 334: 4.17 R. Lambert, IARC/Adapted from
Page 335 and 336: Brain cancer, see nervous system tu
Page 337 and 338: Fibroblast growth factor (FGF), 117
Page 339 and 340: Microarray, 240 Micronutrients, 65,
Page 341 and 342: S Saccharin, 64, 85 Salicin, 153 Sa
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