Monday, April 21, 2003
More cancer cases expected in 2020
By Henrylito D. Tacio
CANCER rates could further increase by 50 percent to 15 million new cases in the year 2020, according to the World Cancer Report, the most comprehensive global examination of the disease to date.
"The World Cancer Report tells us that cancer rates are set to increase at an alarming rate globally. We can make a difference by taking action Monday.
We have the opportunity to stem this increase," urged Dr. Paul Kleihues, director of the International Agency for Research on Cancer (IARC) and co-editor of the report.
The report listed lung cancer as the most common cancer worldwide, accounting for 1.2 million new cases annually. This is closely followed by breast cancer, just over one million cases; then colorectal, 940,000 cases; stomach, 870,000 cases; liver, 560,000 cases; and cervical, 470,000 cases. Other most common cancer worldwide include esophageal, 410,000 cases annually; head and neck, 390,000 cases; bladder, 330,000 cases; malignant non-Hodgkin lymphomas, 290,000 cases; leukemia, 250,000 cases; prostate and testicular, 250,000 cases; pancreatic, 216,000 cases; ovarian, 190,000 cases; kidney, 190,000 cases; endometrial, 188,000 cases; nervous system, 175,000 cases; melanoma, 133,000 cases; thyroid, 123,000 cases; pharynx, 65,000 cases and Hodgkin disease, 62,000 cases.
The three leading cancer killers are different than the three most common forms, with lung cancer responsible for 17.8 percent of all cancer deaths, stomach, 10.4 percent and liver, 8.8 percent.
The report is a concise manual describing the global burden, the causes of cancer, and major types of malignancies, early detection and treatment. The 351-page global report is issued by IARC, which is part of the World Health Organization (WHO).
"The report provides a basis for public health action and assists us in our goal to reduce the morbidity and mortality from cancer and to improve the quality of life of cancer patients and their families, everywhere in the world," said Dr. Gro Harlem Brundtland, the WHO director-general.
The report said that cancer could be avoided. It cited the case of tobacco consumption, the most important avoidable cancer risk. "In the 20th century, approximately 100 million people died world-wide from tobacco-associated diseases (cancer, chronic lung disease, cardiovascular disease and stroke)," it said. "Half of regular smokers are killed by the habit. One quarter of smokers will die prematurely during middle age (35 to 69 years)."
Intervention is another key to avoid cancer. In developing countries, up to 23 per cent of malignancies are caused by infectious agents, including hepatitis B and C virus (liver cancer), human papillomaviruses (cervical and ano-genital cancers), and Helicobacter pylori (stomach cancer). Monday, more than 80 percent of all cervical cancer deaths occur in developing countries.
"Vaccinations could be key to preventing these cancers," the report pointed out. "Vaccination against the hepatitis virus has already been shown to prevent liver cancer in high-incidence countries and it is likely that human papillomavirus (HPV) vaccination will become a reality in three to five years."
Even in cancer, there is discrimination. In developed countries, the probability of being diagnosed with cancer is more than twice as high as in developing countries. However, in rich countries, some 50 per cent of cancer patients die of the disease, while in developing countries, 80 per cent of cancer victims already have late-stage incurable tumors when they
are diagnosed, pointing to the need for much better detection programs.
Once considered a 'Western' disease, the report said that more than 50 per cent of the world's cancer burden, in terms of both numbers of cases and deaths, already occurs in developing countries.
"Cancer has emerged as a major public health problem in developing countries for the first time, matching its effect in industrialized nations. This is a global problem, and it's growing," deplored Dr. Kleihues.
On so-called "Western lifestyle," the report said: "The Western lifestyle is characterized by a highly caloric diet, rich in fat, refined carbohydrates and animal protein, combined with low physical activity, resulting in an overall energy imbalance. It is associated with a multitude of disease conditions, including obesity, diabetes, cardiovascular disease, arterial hypertension and cancer."
"A healthy diet can help prevent cancer," the report said. Epidemiological studies indicate that the frequent consumption of fruit and vegetables may reduce the risk of developing cancers of epithelial origin, including carcinomas of the pharynx, larynx, lung, esophagus, stomach, colon and cervix.
A study showed that a daily consumption of 500 grams of fruits and vegetables could decrease incidence of cancers of the digestive tract by up to 25 percent.
There is also emerging evidence that prostate cancer screening by assessment of serum PSA levels may result in lower mortality rates but management of early lesions is still very invasive. For colon cancer, colonoscopy is considered the gold standard although its application in population-based screening programs would require considerable medical resources.
"Governments, physicians, and health educators at all levels could do much more to help people change their behavior to avoid preventable cancers," says Dr. Bernard W. Stewart, co-editor of the report and a medical professor at the University of New South Wales in Australia.
"If the knowledge, technology and control strategies outlined in the World Cancer Report were applied globally, we would make major advances in preventing and treating cancers over the next twenty years and beyond."
(April 21, 2003 issue)
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