Cancer control—a global challenge requiring collaborative solutions

Abstract

In 2008, there were 12.4 million new cases of cancer worldwide and 7.6 million cancer deaths. It is projected that there will be between 20–26.4 million new cases and 12.9– 17.0 million cancer deaths by 2030 (low estimates are based on no change in underlying rates; high estimates are based on an assumption of 1% increase per annum in the cancer incidence rate)[1]. The number of cancer cases worldwide doubled in the last third of the 20th century and will double again between 2008 and 2030 [1]. While the global average mortality:incidence ratio approximates 65%, this ratio ranges from 45% in Westernized, high-resource nations to >90% in resource-challenged countries. Fiveyear survival rates posttreatment of cancer range from 65% and an acknowledgement that cancer is becoming a chronic disease in high-resource nations, to a situation where cancer is almost invariably a fatal disease with little access to therapy or symptom control for most of the world's population [2]. The numeric burden of cancer will not be borne equally—the developing/resource-constrained nations will see the number of new cases rise disproportionately from six million in 2005 to in excess of nine million in 2020, compared with approximately four million rising to five million over the same time period in developed/ high-resource countries. Over the same time period, cancer mortality will increase by 25% in Westernized/ free-market economies but will increase by between 140 and >180% in more resource-challenged regions of the world, a situation reflecting population age structure change, growth, and resource availability [3]. Thus, those least able to address the growing burden of cancer will be those who inherit the greatest challenge of cancer control. Resource-challenged countries face the growth in mortality from non-communicable diseases (currently estimated to be approximately 60% of population mortality), as infectious diseases are contained and cancer risk follows the aging of the population. Concomitant with the rising incidence of cancer will be increasing prevalence, with consequent impacts upon resources for cancer control planning and for services directed to the needs of survivors [4]. These statistics define the burden of cancer in numeric terms (the volume of the problem). They do not describe the personal burden–the physical, emotional, spiritual, and financial burden–the impact on productivity, role, and contribution to community and society, and socioeconomic burden–the loss of contribution to the economy and the costs of illness [4–6].Nor do they reflect the impact of potential years of life gained through effective interventions, both the socio-economic benefits of longevity and productivity as well as the supportive care resources needed to achieve these potential gains—a significant challenge for resource-constrained nations. This was a plenary presentation for MASCC/ISOO Supportive Care in Cancer, June 24–26, 2010, Vancouver entitled “The Importance of International Communication in Optimizing Cancer Care”.