The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

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Global cancer statistics

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21660

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

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Global cancer statistics, 2012

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Thus,PNBrepresentsanimportant transition in breast cancer management of speciﬁc in-terest to surgeons.Surgical biopsy was the “gold standard” for breast diagnosisbefore the early 1990s, when most patients with breast cancerpresentedwithclinicalsymptomsandwerereferredtosurgeonsfordiagnostic work-up. The growth in the rate of mammographicscreening in the 1980s signiﬁcantly increased the number of non-palpable breast lesions that required diagnostic work-up. Im-proved methods for tissue sampling were needed to alleviate thegrowing numbers of surgical biopsies that require cumbersomewire localization operations and to simplify biopsy of palpablelesions in the ofﬁce using only local anesthetic.Fine needle aspiration biopsy (FNAB) was the ﬁrst percutaneousneedle sampling technique introduced as an alternative to surgical exci-sional or incisional biopsy.

https://ascopubs.org/doi/pdf/10.1200/JCO.2014.55.6324

Needle Biopsy for Breast Cancer Diagnosis: A Quality Metric for Breast Surgical Practice

Breast cancer early detection and resources: where in the world do we start?

Breast cancer is the most common cancer in women, accounting for 23% of all female cancers around the globe. There were an estimated 1.15 million cases diagnosed in 2002.1 There is marked geographical variation in incidence rates, being highest in the developed world and lowest in the developing countries in Asia and Africa. The highest age-standardised incidence is in North America, at 99.4 per 100,000 population, while the lowest is in central Africa, at 16.5 per 100,000.2 However, in most lowand middle-income countries (LMCs), incidence rates are increasing at a more rapid rate than in areas where incidence rates are already high. Global breast cancer incidence rates have increased by about 0.5% annually since 1990, but cancer registries in China are recording annual increases in incidence of 3–4%.1 In a population-based cancer registry in Western Turkey in 1992, breast cancer incidence and prevalence were 24.4/100,000 and 0.3%, respectively; cervical cancer was relatively rare (age-standardised incidence rate of 5.4).2 Breast cancer incidence has increased in Turkey, and the estimated number of breast cancer cases in 2007 was 44,253.3 The distribution of breast cancer incidence varies significantly among different regions of Turkey due to geographical, economic, social and cultural factors. The breast cancer incidence in Western Turkey (50/100,000 in 2000) is more than two times that of Eastern Turkey (20/100,000) due to ‘Westernised’ lifestyles (early menarche, late menopause, first birth >30 years of age, less breastfeeding, etc.) and other factors in the last decades.4,5

http://www.touchoncology.com/system/files/private/articles/1306/pdf/anderson.pdf

The Challenge of Breast Cancer in Low- and Middle-income Countries - Implementing the Breast Health Global Initiative Guidelines

PURPOSE Brain drain is the migration of educated and skilled individuals from a less developed region or country to a more economically established one. The Trump administration proposed a merit-ba...

Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries.

Among women around the world, breast cancer is the most common cause of cancer-related deaths (1). Breast cancer mortality is highest in economically disadvantaged countries (2). Although countries with developed and well-established health care systems have comparatively higher rates of breast cancer diagnosis, they also have higher rates of breast cancer survival (3). The reason for the better survival observed in financially advantaged countries is multifactorial. Screening for and earlier diagnosis and comprehensive treatment of breast cancer appear to play synergistic roles in creating better outcomes. A key step in improving overall health care for women is to establish general guidelines for breast health care. Many guidelines have been developed for breast cancer screening, diagnosis, and treatment (4–6). Such guidelines define evidence-based approaches to breast health care. However, guidelines from countries with abundant resources have limited applicability in countries with limited resources. Health care resources vary tremendously in different parts of the world because of differing socioeconomic factors, health care systems, and political and geographic factors. Furthermore, it is possible that the biologic behavior of breast cancer varies in different regions of the world due to genetic and environmental factors. As a result, optimal approaches to breast health care may vary in different parts of the world. General guidelines for early detection, diagnosis, and treatment of breast cancer need to be established. Such guidelines can be used as a benchmark for growth of and improvement in health care, particularly in countries with limited resources. However, many regions of the world have no organized programs for breast health care. Since health care systems cannot be transformed all at once, a primary question becomes where initial efforts should be directed to best alleviate the devastating effects of this disease.

Benjamin O. Anderson

Papers

Needle Biopsy for Breast Cancer Diagnosis: A Quality Metric for Breast Surgical Practice

Breast cancer early detection and resources: where in the world do we start?

The Challenge of Breast Cancer in Low- and Middle-income Countries - Implementing the Breast Health Global Initiative Guidelines

Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries.

Global Summit Consensus Conference on International Breast Health Care: guidelines for countries with limited resources.