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

There are limited published data on recent cancer incidence and mortality trends worldwide. We used the International Agency for Research on Cancer's CANCERMondial clearinghouse to present age-standardized cancer incidence and death rates for 2003-2007. We also present trends in incidence through 2007 and mortality through 2012 for select countries from five continents. High-income countries (HIC) continue to have the highest incidence rates for all sites, as well as for lung, colorectal, breast, and prostate cancer, although some low- and middle-income countries (LMIC) now count among those with the highest rates. Mortality rates from these cancers are declining in many HICs while they are increasing in LMICs. LMICs have the highest rates of stomach, liver, esophageal, and cervical cancer. Although rates remain high in HICs, they are plateauing or decreasing for the most common cancers due to decreases in known risk factors, screening and early detection, and improved treatment (mortality only). In contrast, rates in several LMICs are increasing for these cancers due to increases in smoking, excess body weight, and physical inactivity. LMICs also have a disproportionate burden of infection-related cancers. Applied cancer control measures are needed to reduce rates in HICs and arrest the growing burden in LMICs.

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Global Cancer Incidence and Mortality Rates and Trends—An Update

Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2814%2962038-9.pdf

Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

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 reviewThere are striking disparities in the global cancer burden in women, yet few publications highlight cancer occurrence in this population, particularly for cancers that are not sex specific. This article, the first in a series of two, summarizes the current burden, trends, risk factors, prevention, early detection, and survivorship of all cancers combined and seven sites (breast, cervix, uterine corpus, ovary, colorectum, lung, and liver) that account for about 60% of the cancer burden among women worldwide, using data from the International Agency for Research on Cancer. Estimated 2012 overall cancer death rates in general are higher among women in low- and middle-income countries (LMICs) than high-income countries (HICs), despite their lower overall incidence rates, largely due to inadequate access to early detection and treatment. For example, the top mortality rates are in Zimbabwe (147 deaths per 100,000) and Malawi (138). Furthermore, incidence rates of cancers associated with economic development (e.g., lung, breast, colorectum) are rising in several LMICs. The burden of cancer among women could be substantially reduced in both HICs and LMICs through broad and equitable implementation of effective interventions, including tobacco control, HPV and HBV vaccination, and screening (breast, cervix, and colorectum). Cancer Epidemiol Biomarkers Prev; 26(4); 444-57. ©2017 AACRSee related article by Islami et al. in this CEBP Focus section, "Global Cancer in Women."

https://cebp.aacrjournals.org/content/cebp/26/4/444.full.pdf

Global Cancer in Women: Burden and Trends

The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality

Objective: To investigate the extent of participation in cervical cancer screening among women who live in discrete rural and remote Indigenous communities in Queensland. Design: Descriptive analysis of data from the Queensland Health Pap Smear Registry for the period March 1999 to February 2001. Subjects: Women aged 20-69 years who had given their address of usual residence as one of 13 discrete rural and remote Indigenous communities in Queensland. Main outcome measures: Proportion of women who participated in cervical screening over a two-year period ("biennial participation percentage") and variation in participation across the 13 communities. Results: Overall, the biennial participation percentage in the Indigenous communities was 41.1%. This was 30% lower (risk ratio, 0.70; 95% Cl, 0.67-0.72) than that for the rest of Queensland. There was statistically significant variation among communities, with biennial participation percentage ranging from 19.9% to 63.5%. Conclusions: The variation in participation across the communities suggests that the problem of low participation among Indigenous women is not intractable. Achieving participation rates similar to the highest rates found in our study would be of major benefit to Indigenous women.

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Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland

Epidemiological trends of neuroendocrine tumours over three decades in Queensland, Australia

Objectives To examine the association of alcohol consumption with well-being in mid-aged Australian women, taking into account other lifestyle factors.Methods A prospective, observational study was carried out among 438 urban Australian women aged 45–55 years at baseline. They were assessed annually for 8 years using a questionnaire on health and lifestyle, including self-ratings of well-being and daily ‘hassles’. Statistical analyses were performed using cluster and repeated measures analyses.Results About 80% of the women had consumed alcohol in the week preceding the interview. Alcohol intake was weakly associated with well-being overall (p = 0.094). Women who consumed alcohol at moderate levels had higher well-being scores than non-drinkers or heavy drinkers, however, provided they were also non-smokers and exercised weekly or more (p for interaction = 0.023) (21% of all study participants). Everyday symptoms and stresses had a negative impact on well-being (all p values < 0.001).Conclusions Among wom...

Moderate alcohol consumption contributes to women's well-being through the menopausal transition.

Although mammography screening programs aim to diagnose breast cancer at an early stage, not all tumours are detected during the regular screening examination. This study examines the influence of various characteristics, including geographical residence, on the survival between screen- and interval-detected breast cancers among participants of a public population-based breast screening program in Queensland, Australia. The investigation was performed using the linked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry for the period of 1997–2008 for women aged 40–89 years at diagnosis. A Bayesian spatial relative survival modelling approach that accommodates rare outcomes in small geographic regions was adopted, with the use of Markov chain Monte Carlo computation, to evaluate the relative excess risk of breast cancer. In the multivariate Bayesian spatial model, higher relative excess risk of mortality was observed in interval-detected cancer (RER = 1.59, 95 % credible interval = [1.33, 1.89]) compared to screen-detected cancer. Higher cancer survival among the study cohort was also observed among younger women (40–59 years), those of non-Indigenous ethnicity, with localised (stage I) tumour stage as well as those not in the work force. There was no independent association with marital status. Moreover, there was no substantive evidence of either measured geographical or latent random spatial inequalities in survival among screening participants across Queensland, meaning the higher survival for screen-detected breast cancer patients compared to interval-detected women was consistent across the state. These results provide suggestive evidence supporting the effectiveness of the BreastScreen Queensland screening program in reaching socio-economically disadvantaged women as well as those living in rural and remote areas of the state, but also highlights the need for any interval cancer awareness programs to be geographically widespread.

Nathan Dunn

Papers

The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality

Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland

Epidemiological trends of neuroendocrine tumours over three decades in Queensland, Australia

Moderate alcohol consumption contributes to women's well-being through the menopausal transition.

Does geographic location impact the survival differential between screen- and interval-detected breast cancers?