the magnitude of the cancer problem in latin...
TRANSCRIPT
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The magnitude of the cancer problem in Latin America
Eduardo Cazap MD, PhD, FASCO
Latin American and Caribbean Society of Medical Oncology (SLACOM)
International Union for Cancer Control (UICC)
Latin American Masterclass in Clinical Oncology – Bogota, Colombia, April 2016
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EC :Disclosures
• Leadership Position ( no honoraria) SLACOM, UICC, BHGI, NCI of Argentina
• Consultant or Advisory Role : Bayer; Schering Pharma• Honoraria : Bayer; Bristol-Myers Squibb ; Fresenius,
Pfizer• Research Funding: Paid to Institution: Poniard
Pharmaceuticals ; Daiichi Sankyo Pharma ; Breast Cancer Research Foundation (BCRF)
I have not relevant disclosures related with this presentation
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Agenda
• General overview, LA picture• All cancer in both genders• Epidemiology of main cancers in the
region• The Argentina example• Take home messages
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Overview• The world is facing a critical health care
problem: in the next few years cancer willbecome a leading global public healthproblem disproportionately increasing in low and middle income countries (LMCs)
• Good epidemiological data are key todevelop adequate national cancer plans
Source. E. Cazap et al. / The Breast 20 (2011) S1–S2
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Overview , cont.
ØAlthough the overall incidence of cancer is lower in Latin America (age-standardised rate of 163 per 100 000) than in Europe (264 per 100 000) or the USA (300 per 100 000), the mortality burden is greater.
ØThis is mainly due to presentation at more advanced stages, and also partly related to poorer access to proper cancer care
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Overview, cont.
ØIn USA, 60% of breast-cancer cases are diagnosed in the earliest stages, whereas in Brazil only 20% and in Mexico only 10% are diagnosed at an early stage
ØThe all-cancer mortality-to incidence ratio for Latin America is 0·59, compared with 0·43 for the European Union and 0·35 in the USA
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The cancer burden• About 1.1 million people are diagnosed with
cancer annually in Latin America with 600,000 cancer deaths.
• Lung cancer is the leading cause of cancer death for both sexes combined in this region.
• Notably, lung cancer mortality rates among females continue to increase in most countries of the Americas.
• While cervical cancer rates are decreasing, breast cancer rates are increasing in the region.
Ref. The Cancer Atlas, ACS-UICC
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Estimated numbers of new cancer cases and deaths,both sexes, 2012
Ref. The Cancer Atlas, ACS-UICC
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Human Developing Index (HDI) Transitions
• As countries develop, their cancer burden changes in scale and type
• Changes in fertility and life expectancy are leading to a rapidly growing and aging world population—and an unsurpassed scale of the cancer problem—as countries undergo major transitions in development
• As such, the traditional grouping of regions of the world into “more-developed” and “less-developed” is less relevant today.
Ref. The Cancer Atlas, ACS-UICC
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Recent (2012) and future (2025) cancer burden by HDI
Ref. The Cancer Atlas, ACS-UICC
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Planning cancer control in Latin America and the Caribbean
Paul E Goss, ProfMD, Brittany L Lee, MD, Tanja Badovinac-Crnjevic, MD, Kathrin Strasser-Weippl, MD, Yanin Chavarri-Guerra, MD, Jessica St Louis, BA, Cynthia Villarreal-Garza, MD, Karla Unger-Saldaña, PhD, Mayra Ferreyra, MD, Márcio Debiasi, MD, Pedro ER
Liedke, MD, Diego Touya, MD, Gustavo Werutsky, MD, Michaela Higgins, MD, Lei Fan, MD, Claudia Vasconcelos, MD, Eduardo Cazap,MD, Carlos Vallejos, MD, Alejandro Mohar, MD, Felicia Knaul, PhD, Hector Arreola, MD, Rekha Batura, MD, Silvana Luciani, MD,
Richard Sullivan, MD, Dianne Finkelstein, PhD, Sergio Simon, MD, Carlos Barrios, MD, Rebecca Kightlinger, DO, Andres Gelrud, MD,Vladimir Bychkovsky, MSc, Gilberto Lopes, MD, Stephen Stefani, ProfMD, Marcelo Blaya, MD, Fabiano Hahn Souza, MD, Franklin
Santana Santos, MD, Alberto Kaemmerer, MD, Evandro de Azambuja, MD, Andres Felipe Cardona Zorilla, MD, Raul Murillo, MD, JoseJeronimo, MD, Vivien Tsu, PhD, Andre Carvalho, MD, Carlos Ferreira Gil, MD, Cinthya Sternberg, PhD, Alfonso Dueñas-Gonzalez, MD,
Dennis Sgroi, MD, Mauricio Cuello, MD, Rodrigo Fresco, MD, Rui Manuel Reis, PhD, Guiseppe Masera, MD, Raúl Gabús, MD, Raul Ribeiro, MD, Renata Knust, MD, Gustavo Ismael, MD, Eduardo Rosenblatt, MD, Berta Roth, MD, Luisa Villa, MD, Argelia Lara Solares, MD, Marta Ximena Leon, MD, Isabel Torres-Vigil, DrPH, Alfredo Covarrubias-Gomez, MD, Andrés Hernández, MD, Mariela Bertolino, MD, Gilberto Schwartsmann, MD, Sergio Santillana, MD, Francisco Esteva, MD, Luis Fein, MD, Max Mano, MD, Henry Gomez, MD,
Marc Hurlbert, PhD, Alessandra Durstine, MBA, Gustavo Azenha, PhD
The Lancet OncologyVolume 14, Issue 5, Pages 391-436 (April 2013)
DOI: 10.1016/S1470-2045(13)70048-2
Copyright © 2013 Elsevier Ltd Terms and Conditions
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The Lancet Oncology 2013 14, 391-436DOI: (10.1016/S1470-2045(13)70048-2) Copyright © 2013 Elsevier Ltd Terms and Conditions
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The Lancet Oncology 2013 14, 391-436DOI: (10.1016/S1470-2045(13)70048-2) Copyright © 2013 Elsevier Ltd Terms and Conditions
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The Lancet Oncology 2013 14, 391-436DOI: (10.1016/S1470-2045(13)70048-2) Copyright © 2013 Elsevier Ltd Terms and Conditions
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Figure 2
The Lancet Oncology 2013 14, 391-436DOI: (10.1016/S1470-2045(13)70048-2) Copyright © 2013 Elsevier Ltd Terms and Conditions
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All cancers, both sexes
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All cancers, incidence
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All cancers, mortality
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Breast Cancer
Ref: A Review of Breast Cancer Care and Outcomes in Latin America. Justo N, Wilking N, Jönsson B, Luciani S, Cazap E. Oncologist. 2013 Feb 26
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Proprietary and Confidential. Do not distribute.
Breast Cancer Incidence and Age
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
Mexico
Panama
Ecuador
Colom
bia Peru
Venezue
la
CostaRica
Brazil
Chile
Argentina
Uruguay
25,0
30,0
35,0
40,0
CrudeInciencerate(CIR) Meanage
Crude incidence rate and mean age of the female population
Mean population age correlates with breast cancer incidence. Chile seems to be an outlier, however there seems to be an adjustment trend since in recent years, the incidence growth has been accelerating to reach ~11% per annum.
Data sources: Incidence: Globocan 2008. Age: ECLAC 2009
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Proprietary and Confidential. Do not distribute.
Breast Cancer Mortality
3
5
7
9
11
13
15
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
BC M
orta
lity,
cru
de ra
tes
per 1
00,0
00 w
omen
Chile
Costa Rica
Brazil
Venezuela
Colombia
Mexico
Panama
Peru
Ecuador
Numberofdeaths DALYslost2004/2008 36952 Change:
99%
612816 Change:38%2015 57782 726480
2030 73542 848665
In Argentina and Uruguay mortality rates seem to have stabilized at a high level.
As ageing and other risk factors increasingly impact incidence rates in the remaining countries, mortality figures are expected to rise as well.
Data sources: PAHO, Mortaliy Series and WHO The global burden of disease: 2004 Summary Tables. October 2008 update.
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Genito-urinary cancers
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Prostate - incidence
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Prostate - mortality
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Bladder cancer - incidence
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Bladder cancer .-mortality
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Kidney cancer- incidence
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Kidney cancer- mortality
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Gastro-intestinal tumours
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Stomach cancer -incidence
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Stomach cancer -mortality
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Gallblader- incidence
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Gallblader - mortality
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Colorectal cancer -incidence
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Colorectal cancer- mortality
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Pancreatic cancer- incidence
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Pancreatic cancer- mortality
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The Argentina example
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All cancers, men and women, mortality, country
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All cancers, men and women, mortality, Cuyo region
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All cancers, men and women, mortality, NE region
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Comment
• Even within the same country there are regional epidemiological variations. This situation is similar to other LA countries
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Breast, colon and lung mortality, women
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Prostate, colon and lung mortality, men
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Comment
• Breast and colon cancer are decreasing in women in Argentina, but lung is increasing
• Lung is decreasing in men in Argentina, colorectal is stable and prostate is stable/increasing
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Take home mesagges• The overall incidence of cancer is lower but the
mortality burden is greater in most countries• This is mainly due to presentation at more
advanced stages, poorer access to cancer care and economic and educational reasons
• Urbanization is very high in most countries of the region
• The epidemiological picture is variable, even within the same country
• As countries develop, their cancer burden changes in scale and type
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Thank you very much for your attention!