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Determing the Future Course of Cancer in the World

Determing the Future Course of Cancer in the World

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Determing the Future Course of Cancer in the World

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  1. Determing the Future Course of Cancer in the World Richard C. Wender, MD Chief Cancer Control Officer American Cancer Society

  2. Eight key challenges and trends will determine the future of cancer in Denmark and around the world

  3. The changing epidemiology of cancer deaths • The relentless spread of tobacco use • The obesity epidemic • The inversion of the age pyramid • Determining the true value of the early detection of cancer • The emergence of personalized treatment • The growing number of cancer survivors • The urgent need to reduce the cost of care

  4. Trend #1: The changing epidemiology of cancer deaths

  5. The Global Burden of Cancer Continues to Increase In 2012: 14.1 million cancer cases 8.2 million cancer deaths are estimated to have occurred

  6. Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries Jemal A, Bray F, et al. CA:Can J Clin. 2011;61:69-90

  7. In 2012, 57% of cases and 65% of deaths occurred in the economically developed world

  8. Affluence Contributes To Cancer • Associated with more obesity and more alcohol intake • Only aggressive counter-tobacco policies have helped to mitigate the interaction of affluence and tobacco use

  9. Countries With The Top 10 Cancer Rates

  10. In general, lower income countries are disproportionately impacted by cancers caused by infectious agents

  11. As we develop a global economy and relative affluence reaches more people in more countries, we can expect the transition of cancer epidemiology

  12. Colorectal Cancer Incidence Sedentary life-styles, increase in red meat consumption and obesity increase risk for colorectal cancer

  13. Cervical Cancer Incidence Yet infection-related cancer burden is still high

  14. The Other Side of the Cancer Epidemiology Story High resource nations are making dramatic progress in the war on cancer

  15. All Cancers Mortality Rates in Denmark Estimated annual change latest 10 years: -1.5% 143 113

  16. Cancer Mortality Rates in Denmark, by Major Cancer, Men

  17. Cancer Mortality Rates in Denmark, by Major Cancer, Women

  18. We are making great progress in cancer amenable to prevention or early detection … and very little progress in all other solid tumors

  19. Trend #2: The relentless spread of tobacco use

  20. Tobacco use remains the leading cause of preventable death and illness in Denmark, with 24% of deaths attributed to smoking in 2007 (Risk factors and Public Health in Denmark – Summary Report) • Half of all smokers will die from a smoking related illness • The proportion of smokers has fallen steadily in recent decades – for men from 68% in 1970 to 31% in 2006; for women it fell from 47% to 25%. (The Public Health Report Denmark 2007)

  21. The Future Tobacco Worldwide Toll “Unless action is taken, tobacco’s annual death toll will rise to more than eight million” by the year 2030, with over 80% of those deaths occurring in low-income countries (WHO Report on the Global Tobacco Epidemic, 2008 The MPOWER Package)

  22. Key Questions In The Worldwide Tobacco Fight Policy change is paramount • Are there global, national or regional policies that can: • Put restrictions on the tobacco industry • Reduce access to youth • Encourage reduction or cessation • De-normalize tobacco use • Raise the price of tobacco products

  23. Trend #3: The worldwide obesity epidemic

  24. The Obesity Epidemic If we are going to accelerate cancer prevention, we must find strategies to address the public heath challenge of our time – the epidemic of overeating and sedentary lifestyle

  25. Select Countries’ Obesity Rates

  26. Denmark: Men 11% of adults and Women 12% of adults are obese Obesity and the economics of prevention – Fit not fat. OECD 2010

  27. Danish and Global Obesity • 41% men and 26% women were overweight in Denmark • 12% and 11%, respectively, obese (SUSY-2005, in The Public Health Report Denmark 2007) • Worldwide, obesity rates doubled between 1980 and 2008

  28. Obesity and Cancer • 85,000 U.S. cases per year are obesity-related Basen-Engquist K, Chang M. CurrOncol Rep. 2011 Feb;13(1) 71-6.

  29. Continuation of the current obesity trend will lead to about 500,000 additional cancer cases in the US by 2030

  30. Obesity is Associated With Increased Risk of These Cancers … and Probably Others: • Esophogus • Gallbladder • Colon and rectum • Breast (after menopause) • Endometrium • Kidney • Thyroid • Pancreas www.cancer.gov/cancertopics/factsheet/risk/obesity

  31. Does weight loss reduce cancer risk?

  32. Bariatric surgery offers the most provocative data linking weight loss and reduction in cancer risk

  33. McGill University 1,000 surgery patients and 5,700 matched controls followed for 5 years Cancer diagnosis Surgery group 2% Controls 8.5% Christov NV, et.al.: Surg Obes Relat Dis. 2008 4(6) 691-5.

  34. The Swedish Obese Subjects (SOS) Study Surgery Group: 2,010 Contemporaneously Matched controls: 2,037 Sjostrom L, et.al. Lancet Oncology 2006. Vol. 10(7) 653-662.

  35. S.O.S. (cont’d) CI 0.53-0.85 p=0.0009 • Entire beneficial effect seen in women • Eliminating cancers found in the first 3 years did not change results

  36. NCI Best Estimate If every adult reduced their BMI by 1 percent, this could actually result in the avoidance of 100,000 new cases www.cancer.gov/cancertopics/factsheet/risk/obesity

  37. Obesity and Policy ResearchAre Taxes An Answer To The Obesity Epidemic? Denmark 2011 • Tax on foods containing more than 2.3% saturated fats • Up to 30% more for a pack of butter; 8% more on chips; 7% more on olive oil 2010 • 25% tax on chocolate, ice cream, and sugary drinks http://www.oecd.org/dataoecd/1/61/497/6427.pdf

  38. Are Taxes An Answer To The Obesity Epidemic? Hungary • 2011: Tax on high sugar, salt, and caffeine foods Finland • 2011: Tax on confectionary products, biscuit buns, and pastries France • 2012: Tax on soft drinks

  39. Trend #4: The inversion of the age pyramid

  40. US population 2008

  41. Population Pyramids, USA

  42. Population Pyramids, China

  43. Population Pyramids, Denmark

  44. Geriatric Oncology Demographics • Leading cause of death men/women age 60-79 • 80% cancer-related deaths in US are 65 and older • 20% of US population over age 65 by 2030 • 70% of all cancers • 85% of all cancer related deaths • Behavior of certain cancers change with age

  45. Our aging population will lead to a tsunami of cancer

  46. A New Team-Based Approach To Care Is Emerging:Senior Adult Oncology • Oncologist addresses different disease characteristics, different pharmaco-dynamics, and difference response to treatment • Geriatrician addresses goals of care, geriatric syndromes, co-morbidities, nutrition, and ability to tolerate therapy • Involvement of geriatrician has led to a change in management in 50% of patients

  47. Challenge #5: Determine the true value of the early detection of cancer

  48. Based on what we know about cancer today, there are only two ways to reduce mortality from the solid cancers that affect adults • Stop carcinogenesis • Block metastasis through early detection and destruction or removal of the primary cancer

  49. “Any cancer can be cured if it’s caught early enough” “Cancer develops in a place in the body, in any organ. As long as it hasn’t spread to other organs, it generally can be removed” - Bert Vogelstein