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Understanding Cancer Frequency and Burden: Metrics and Global Statistics

Learn about cancer frequency metrics such as incidence, mortality, prevalence, survival, and more. Explore global cancer statistics, major cancer types, and trends to understand the burden of cancer worldwide.

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Understanding Cancer Frequency and Burden: Metrics and Global Statistics

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  1. World Burden of Cancer Epi 242 Cancer Epidemiology Binh Goldstein, Ph.D. October 7, 2009

  2. Measures of Cancer Frequency: Incidence • number of new cases occurring • can be expressed as an absolute number of cases per year or as a rate per 100,000 persons per year. • incidence rate provides approximation to average risk of developing a cancer and is necessary to compare risk of disease between populations • reduction in incidence is the appropriate statistics to use when considering impact of primary prevention strategies

  3. Measures of Cancer Frequency: Mortality • number of deaths occurring • mortality rate is the number of deaths per 100,000 persons per year • mortality rates measure average risk of dying from a specific cancer • number of deaths is one measure of outcome or impact of cancer • Fatality, (1-survival), is probability that an individual with cancer will die from it and is generally assumed to be most severe sequelae of disease

  4. Measures of Cancer Frequency: Prevalence • NO agreed definition of “prevalence” of cancer • number of persons in a defined population alive at a given time who have had cancer diagnosed at some time in past • partial prevalence limits number of patients to those diagnosed during fixed time in past and is more useful prevalence measure of cancer burden • prevalence for cases diagnosed within 1, 3, 5 years are likely to be of relevance to different stages of cancer therapy: initial treatment (1 year), clinical follow-up (3 years) and cure (5 years) • patients still alive 5 years after diagnosis are considered “cured” since their death rates are similar to general population (some exceptions, like breast cancer)

  5. Other Measurements: Survival • survival time defined as time that elapsed between diagnosis and death • most basic measure of patients’ survival is the observed survival • 5-year observed survival is percentage of patients alive after 5 years of follow-up from date of diagnosis

  6. Other Measurements: Relative Survival • deaths from other competing causes will lower the observed survival rates and preclude comparison between groups where probability of death in the general population vary • relative survival rate can be calculated to avoid this problem • relative survival rate is observed survival rate in a patient group divided by expected survival of a comparable group in the general population with respect to age, sex, and calendar period of investigation

  7. Measures of Cancer Frequency • How are the different measures related? • M = I x F, where F is fatality • M ≈ I(1-S), where S is 5-year survival • P = I x D, where D is duration • F = (1-S)

  8. Other Measurements of Burden • PYLLs (Potential Years of Life Lost) • QALYs (Quality Adjusted Life Years) • DALYs (Disability Adjusted Life Years)

  9. Global Cancer Statistics

  10. Incidence by sex and cancer site, World 2002 Source: Table 1: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  11. Mortality by sex and cancer site, World 2002 Source: Table 1: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  12. Estimated Age-adjusted Survival (%) Source: Table 2: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  13. Incidence and prevalent cases, World 2002 Source: Figure 3: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  14. The Major Cancers • Lung (ICD-10 C33 and C34) • Breast (female, C50) • Colon/rectum (C18-C20) • Stomach (C16) • Prostate (C61) • Liver (C22) • Cervix uteri (C53) • Esophagus (C15)

  15. Age Standardized Incidence Rates

  16. World Age Standardized Incidence and Mortality Rates

  17. Lung cancer • 1.35 million new cases and 1.18 million deaths worldwide estimated in 2002 • 50% new cases occurred in more developed countries (previously 69%) • more common in males (2.9 male:female ratio) • patterns of lung cancer occurrence determined largely by past exposure to tobacco smoking

  18. Age-standardized incidence rates for lung cancer Source: Figure 5: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  19. Lung cancer incidence trends • in countries where smoking was first established (UK, US, Australia, etc.), rates declining among men • in most other countries, rates rising • rates in women generally increasing since tobacco habit is fairly recent, except in countries where their smoking prevalence is declining

  20. Lung cancer mortality trends • similar to incidence trends

  21. Breast cancer • 1.15 million new cases and 410,000 deaths worldwide estimated in 2002 • most common cancer in women • Over half of new cases occurred in more developed countries • stage of disease at diagnosis is most important prognostic factor • most prevalent cancer in world because of its good prognoses • risk increases with age but slows at about 50 years because of menopause and lower estrogen levels

  22. Age-standardized incidence and mortality rates for breast cancer Source: Figure 6: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  23. Breast cancer incidence trends • generally increasing at all ages

  24. Breast cancer mortality trends • may be declining in recent years (like in US, Canada, and some European countries) due to screening and detection of early stage cancers and more effective treatment

  25. Colorectal cancer • About 1 million new cases and 529,000 deaths worldwide estimated in 2002 • 3rd most common cause of cancer in world but 2nd most common in developed countries. • good prognoses (40-50% 5-year survival) makes it the 2nd most prevalent cancer • males and females have similar rates

  26. Age-standardized incidence rates for colorectal cancer Source: Figure 7: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  27. Colorectal cancer incidence trends • increasing trend in low-risk areas • stabilized or decreasing trends in high-risk areas • greatest increases observed in Asia (especially Japan) and Eastern Europe (possibly from “westernization” of lifestyle/diet)

  28. Colorectal cancer mortality trends • decreasing trend in developed countries may be due to decreasing in incidence, improved treatment, and improvements in early detection (from screening)

  29. Stomach cancer • 934,000 new cases and 700,000 deaths worldwide estimated in 2002 • ranked 4th in number of new cancers but 2nd in most common cause of deaths from cancer • almost two-thirds of cases occur in developing countries • more common in males (1.75 male:female ratio) • however, in younger age groups (<40 years) rates in women are greater than men

  30. Age-standardized incidence rates for stomach cancer Source: Figure 8: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  31. Stomach cancer incidence trends • general decline in rates among both developed and developing countries because of improved food preservation practices (refrigerators) and better nutrition (higher vegetable and fruit intake)

  32. Stomach cancer mortality trends • generally declining in both less and more developed regions

  33. Prostate cancer • 679,000 new cases and 221,000 deaths worldwide estimated in 2002 • 2nd most common new cancer and most prevalent form of cancer among males • 75% of cases occur in men aged 65+ • prostate-specific antigen assay introduced in mid to late ‘80s

  34. Age-standardized incidence rates for prostate cancer Source: Figure 5: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  35. Prostate cancer incidence trends • in many developed countries incidence increased greatly, especially among younger men (<65 yrs) • most dramatic increases are in high-risk areas partly due to detection of prevalent latent cancers using PSA • less developed countries also increasing

  36. Prostate cancer mortality trends • generally increasing but not as dramatically as incidence • since 1990s, decline in several developed countries attributed to earlier detection and improved treatment

  37. Liver cancer • 626,000 new cases and 598,000 deaths worldwide estimated in 2002 • 6th most common cancer and 3rd most common cause of deaths from cancer • 82% of cases occur in developing countries (55% in China) • male:female ratio is about 2.4

  38. Age-standardized incidence rates for liver cancer Source: Figure 10: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

  39. Liver cancer incidence trends • difficult to interpret because of ICD revisions • 7th revision includes gall bladder cancer • 9th revision includes category of “unspecified 10 or 20” • ↓ among Chinese because of ↓ in prevalence of HBV • ↑ in Japan because of ↑ alcohol consumption and HCV prevalence • ↑ in developed countries possibly from ↑ HCV infection (from transfusions and drug use)

  40. Liver cancer mortality trends • similar to incidence trends • increase in mortality among developed countries not necessarily from alcohol (since mortality from liver cirrhosis is decreasing)

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