Source: The Lancet, Volume 380, Issue 9856, Pages 1797 – 1799, 24 November 2012

In The Lancet, Isabelle Soerjomataram and colleagues report that about 169 million years of healthy life were lost due to cancer worldwide in 2008 alone, based on a summary measure (disability-adjusted life-years [DALY] lost) that combines years lived with disability and years of life lost because of premature death. By contrast with mortality rates and counts, which emphasize deaths occurring at old ages, DALY give more weight to deaths occurring at young ages at which people are more likely to be working, raising children, and supporting other family members. Worldwide, the highest DALY rates were noted in eastern African countries (eg, Uganda, Zimbabwe, and Zambia) in women and in several high-income and middle-income countries (eg, Hungary and Uruguay) in men. Despite the substantial limitations inherent in the modeling of sparse cancer registry data and various assumptions about the natural history of every disease and related variables, these findings emphasize the growing burden of cancer in economically developing countries. This burden is partly due to the ageing and growth of the population and marketing-driven adoption of unhealthy lifestyles such as tobacco use and consumption of high-calorie food, as well as limited progress in reduction of infection-related cancers.2
Opportunities exist to reduce these major risk factors and the associated cancer burden through broad implementation of proven interventions specific to every country’s economic development level.

These interventions include tobacco control, improvement of opportunities for physical activity and healthier dietary patterns, and vaccinations against hepatitis B virus (HBV) and carcinogenic human papilloma virus (HPV) infections, which cause liver or cervical and other genital and oropharyngeal cancers, respectively.


Worldwide, more than a million cancer deaths are due to tobacco use every year.3 Although cigarette consumption and smoking-related cancer death rates are generally decreasing in developed countries, they are increasing in many developing countries because of intensive marketing by tobacco companies and increased affordability of cigarettes as economies develop.4, 5 In 2003, WHO established the Framework Convention on Tobacco Control (FCTC) to combat globalization of the tobacco epidemic through the coordinated implementation of proven tobacco control measures such as increases in taxes on tobacco products, smoke-free air laws, bans on tobacco advertising and promotion, and counter-advertising.6 However, progress in the implementation of these measures has been slow.6 As of 2010, only 31 countries had nationwide comprehensive smoke-free laws in public places to protect against exposure to second-hand smoke, and only 26 countries and one territory had total taxes of more than 75% of the retail price, with most of these being high-income countries.7

Obesity and physical inactivity have been associated with increased risk of cancers of the endometrium, colon and rectum, post-menopausal breast, kidney, and pancreas, and adenocarcinoma of the esophagus.8 Incidence rates for most of these cancers are on the rise in several countries partly because of the obesity pandemic in recent decades.9, 10 If no action is taken to halt or reverse these trends, they might wipe out the gains from the reduction in smoking-related cancers, especially in developed countries; notably, one study in the USA forecasted a potential decrease in life expectancy in the 21st century based on present obesity trends.11 In 2004, WHO published a global strategy to combat the unhealthy diets and physical inactivity that have led to the obesity epidemic.12 Recognizing obesity as a societal problem, WHO recommends a setting-based approach (eg, school, workplace, and community) to promote healthy eating habits and a physically active lifestyle.


Full-size image (99K) Corbis

Infectious agents cause some of the most commonly diagnosed cancers (cervix, liver, and stomach cancers, and Kaposi’s sarcoma) in developing countries, accounting for about 22% of total cases.13 WHO has recommended HBV vaccine as part of routine national infant immunization programs since 1992 to reduce the disproportionately high burden of liver cancer in these countries. Although 179 (93%) of 193 of WHO member states have introduced HBV vaccine into their immunization program as of 2010, coverage is suboptimum (with less than 80% of infants receiving the third dose of the vaccine) in many countries in sub-Saharan Africa, where levels of chronic infection with HBV are among the highest worldwide.14 Furthermore, in 2006, a substantial proportion of infants did not receive the first dose within 24 h after birth to prevent potential transmission of infection from chronically infected mothers.15 The future burden of cervical cancer in low-income and middle-income countries could also be substantially reduced through an increase in the availability and dissemination of HPV vaccines to adolescent girls in these regions. The high burden of HIV infection-related cancers in sub-Saharan Africa could be reduced by greater efforts to promote safe sex and by a more widespread provision of highly active antiretroviral therapy to HIV-infected individuals.

Implementation of comprehensive and sustainable interventions to challenge the growing cancer burden in low-income and middle-income countries will require the coordinated efforts of many stakeholders from the public and private sectors, including national and international public health agencies, health industries, philanthropic and government donors, and local and regional policy makers. The UN High-level Meeting on Non-Communicable Diseases held on Sept 19—20, 2011, in New York, USA, could serve as a catalyst to mount such responses.

References

1 Soerjomataram I, Lortet-Tieulent J, Parkin DM, et al. Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions. Lancet 2012. published online Oct 16. http://dx.doi.org/10.1016/S0140-6736(12)60919-2.
2 Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 2012; 9: e1001235. CrossRef | PubMed
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5 Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010; 19: 1893-1907. CrossRef | PubMed
6 WHO. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization. http://whqlibdoc.who.int/publications/2003/9241591013.pdf. (accessed July 18, 2012).
7 WHO. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva: World Health Organization. http://www.who.int/tobacco/global_report/2011/en/. (accessed July 18, 2012).
8 World Cancer Research Fund and American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR, 2007.
9 Eheman CHS, Ballard-Barbash R, Jacobs EJ, et al. Annual report to the nation on the status of cancer, 1975—2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012; 9: 2338-2366. PubMed
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11 Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138-1145. CrossRef | PubMed
12 WHO. Global strategy on diet, physical activity and health. http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf. (accessed July 18, 2012).
13 de Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol 2012; 13: 607-615. Summary | Full Text | PDF(731KB) | CrossRef | PubMed
14 WHO. Immunization surveillance, assessment and monitoring: immunization coverage. Geneva: World Health Organization. http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index.html. (accessed July 18, 2012).
15 Morbidity and Mortality Weekly Report. Implementation of newborn hepatitis B vaccination—worldwide, 2006. MMWR Morb Mortal Wkly Rep 2008; 57: 1249-1252. PubMed

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.