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

Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.25516

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.

SOURCES AND EFFECTS OF IONIZING RADIATION : United Nations Scientific Committee on the Effects of Atomic Radiation UNSCEAR 2000 Report to the General Assembly, with Scientific Annexes

Background—Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. Methods and Results—We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P 0.001) and burden of disease (P 0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. Conclusions—There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required. (Circulation. 2011; 124:314-323.)

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International Statistical Classification of Diseases and Related Health Problems

Estimates of the worldwide incidence and mortality from 36 cancers and for all cancers combined for the year 2018 are now available in the GLOBOCAN 2018 database, compiled and disseminated by the International Agency for Research on Cancer (IARC). This paper reviews the sources and methods used in compiling the cancer statistics in 185 countries. The validity of the national estimates depends upon the representativeness of the source information, and to take into account possible sources of bias, uncertainty intervals are now provided for the estimated sex- and site-specific all-ages number of new cancer cases and cancer deaths. We briefly describe the key results globally and by world region. There were an estimated 18.1 million (95% UI: 17.5-18.7 million) new cases of cancer (17 million excluding non-melanoma skin cancer) and 9.6 million (95% UI: 9.3-9.8 million) deaths from cancer (9.5 million excluding non-melanoma skin cancer) worldwide in 2018.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.31937

Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods

Long-Term Survival and Cure of Patients Diagnosed With Breast Cancer Before Age 50 Years

In spite of the increasing amount of clinically relevant information for survival from breast cancer, the amount of data recorded in a population-based cancer registry is limited and the registry-based survival predictions are routinely made without clinical details. To find out how important is the role of screening and clinical tumor characteristics in addition to cancer registry information in describing the breast cancer survival. A representative clinical database on 483 breast cancer patients diagnosed during 1996–1997 in Tampere University Hospital Area was linked with Finnish Cancer Registry data and a survival model including the available registry variables was compared to models including screen-detection information and clinical tumor characteristics also. Estimates of registry stage and age act as surrogates for clinical variables and mammography-detection. The surrogacy was found to be almost complete indicating that clinical variables are not necessarily needed when making breast cancer mortality predictions based on a population-based cancer registry. In cases with dissimilar staging cancer registry stage gave a better picture of the breast cancer survival than the clinical stage.

Comparison of cancer registry and clinical data as predictors for breast cancer survival.

Baker and Bray (1) continue Bray’s thoughtful development of a particular Bayesian age-period-cohort model for cancer rate projections. This model has an elegant formulation and has brought to the forefront a Bayesian interpretation of cancer projections. However, we feel that there are more appropriate models for cancer rate projections. Why? The Bayesian age-period-cohort model suffers from very wide credible intervals for predictions outside observed data (2), which can be attributed to the choice of model priors. Although the second-order autoregressive priors for the age, period, and cohort effects are flexible, alternative priors allow for realistic projections with considerably improved precision. Predictive performance can be measured by splitting observed data into a training data set and a test data set (3, 4). The model is fitted with the training data set, and then the deviance or another loss criterion is calculated for predictions on the test data. Taking a Bayesian perspective, we can calculate 1) the plug-in deviance, which is the deviance of the mean predicted values, and 2) the predictive deviance,

/pdf/re-bayesian-projections-what-are-the-effects-of-excluding-47c7y1a749.pdf

Re: “bayesian projections: what are the effects of excluding data from younger age groups?”

The aim of this study is to present a methodology for taking into account the mass-screening invitation data in breast cancer mortality predictions, particularly in assessing impacts of screening policy changes on the short-term predictions. The methodology is applied to a database that includes observed year- and age-specific screening invitation schemes in Finnish municipalities from the time period 1987-2001. The target year for predictions is 2012. To predict mortality, breast cancer incidence and patients' survival from breast cancer are modelled with the screening data included. The knowledge of breast cancer survival together with the other cause survival is then used to calculate the number of breast cancer deaths caused by observed (1987-2001) and predicted (2002-2012) incident cases in Finland. Survival from breast cancer was estimated with a parametric mixture model where the patient population is assumed to be a combination of cured and uncured patients. This approach provides a way of modelling the hazard of fatal cases and the proportion of cured cases simultaneously. In other cause survival, the patients' hazard was allowed to differ from that of the general population. Breast cancer mortality predictions are presented according to three alternative future scenarios of screening policy. The results show no major differences between predictions yielded by alternative scenarios: Any policy change would have at the most a 3.0 per cent impact on breast cancer mortality in the near future.

Predicting impacts of mass-screening policy changes on breast cancer mortality.

In the 1960s, lung cancer among Finnish men was about 3.5 times as common as among Norwegian men. A study by Pedersen et al. in 1962 indicated that the difference in contemporary smoking habits could account for only part of the difference in lung cancer incidence in men between the countries. In that study, smoking habits in Finland and Norway were investigated via interviews of 8,700 people from six areas of each country. For the present study the Finnish and Norwegian cancer registries have followed lung cancer morbidity in those areas. When the interval between the recording of smoking habits and lung cancer incidence was 15 years, after adjustment for age and smoking habits, the Finnish males had a relative risk between 1.1 and 1.6 compared with Norwegian men. The results suggest that, given a sufficiently long latency period, almost the entire difference between Finnish and Norwegian men could be attributed to smoking habits.

Timo Hakulinen

Papers

Long-Term Survival and Cure of Patients Diagnosed With Breast Cancer Before Age 50 Years

Comparison of cancer registry and clinical data as predictors for breast cancer survival.

Re: “bayesian projections: what are the effects of excluding data from younger age groups?”

Predicting impacts of mass-screening policy changes on breast cancer mortality.

Is smoking sufficient to explain the large difference in lung cancer incidence between Finland and Norway