the 2nd edition of the cancer atlas · 2014. 12. 19. · the 2nd edition of the cancer atlas cancer...
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![Page 1: The 2nd Edition of The Cancer Atlas · 2014. 12. 19. · The 2nd Edition of The Cancer Atlas Cancer Interventions and Potential for Impact Ahmedin Jemal, DVM, PhD ... Vaccination,*](https://reader033.vdocuments.net/reader033/viewer/2022051920/600c943ae664d874445736a0/html5/thumbnails/1.jpg)
www.worldcancercongress.org
Session code:
The 2nd Edition of The Cancer Atlas
Cancer Interventions and Potential for Impact
Ahmedin Jemal, DVM, PhD American Cancer Society
CTS.4.230
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PRIMARY PREVENTION
EARLY DETECTION
TREATMENT
SURVIVORSHIP & QUALITY OF
LIFE
END-OF-LIFE CARE
e.g.,
Tobacco control
Vaccination
e.g.,
Pap test/VIA
Mammography
Colonoscopy
e.g.,
Radiotherapy
Surgery
Chemotherapy
e.g.,
Psychosocial care
e.g.,
Pain control
Interventions Across the Cancer Continuum
05 December, 2014
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Tobacco
• 1.3 billion smokers worldwide (most in LMIC)
• 1 in 2 regular smokers die of smoking-related diseases, about 6 million deaths each year (Doll et al. BMJ 1994)
• Compared to never smokers, smokers shortened their life expectancy by:
• ≥10 years (all smokers) • ~ 20 years (die from smoking-related diseases in middle age) (Doll et al. BMJ 2004, Jha et al NEJM 2013)
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Effect of Smoking Cessation on Survival to 80 Years of Age, According to Four Age Groups at the Time of Quitting
Jha and Peto. N Engl J Med 2013;368:341-350.
Age 45-54
Age 35-44
Age 55-64
Age 25-34
10 years gained
9 years gained
6 years gained
4 years gained
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Tools to Promote Cessation & Discourage Initiation
MPOWER In 2008, WHO introduced the MPOWER measures to assist in country-level implementation of the WHO FCTC provisions.
MPOWER MEASURES M
MONITOR tobacco use and prevention policies P
PROTECT people from tobacco smoke O
OFFER help to quit tobacco use W
WARN about the dangers of tobacco E
ENFORCE bans on tobacco advertising, promotion, and sponsorship R
RAISE taxes on tobacco
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48%
14% 6%
14%
8% 10%
Tax contribution Ad bans Anti-smoking campaigns Smoke-free laws Warning labels Cessation programs
• Aggressively implemented tobacco control measures since 1989 • Smoking prevalence decreased by 46% by 2010
Effects of Tobacco Control Policies in Brazil
Levy D, et al. PLoS Med. 2012; 9(11): e1001336.
Estimated contributions of tobacco control measures to declines in tobacco use:
ü 420,000 deaths (1989-2010) ü 6.6 million deaths in 40 years
Averted Deaths
Cigarette price ↑ 230%
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Share of Total Taxes in the Retail Price of the Most Widely Sold Brand of Cigarettes, 2012
WHO Report on the Global Tobacco Epidemic, 2013
Note: Tobacco sales were banned in Bhutan in 2012.
In only 32 countries does the share of cigarette tax exceed 75% of retail price
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Vaccinations
Hepatitis B virus (HBV) infection
Human papillomavirus (HPV) infection
Infections cause 16% of cancers worldwide, 2 million cases/year
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HBV Infection & Vaccine (Background) HBV Infection Vaccine
• 2 billion total population infected
• 360 million chronically infected (sub-Saharan Africa, Asia)
• 340,000 liver cancer cases (500,000-700,000 deaths from liver cancer & cirrhosis) each year
• Available since 1982
• 3 doses, 1st dose within 24 hrs after birth
• Taiwan, 1st country to introduce nationwide infant vaccination program in 1984
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The Effect of Taiwan’s 30-Year National Hepatitis B Immunization Program on Liver Cancer Incidence Rates
Chiang et al. JAMA. 2013;310(9):974-976.
80% lower
Rate
per 1
00,00
0
Age-specific incidence rate by sex in cohorts born before and after the implementation of the program, 1984
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*Countries with no data may represent countries where hepatitis B is not endemic (e.g. Scandinavian countries) and national hepatitis B vaccination programs have not been introduced.
WHO, 2013.
Percentage of One-year-olds Given the Three-series Hepatitis B Vaccination,* 2012 183 countries introduced
national HBV vaccination program as of 2012
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HPV Vaccination (Background) • 12 high-risk oncogenic HPV types are responsible for
• Nearly all cervical cancers (530,000 cancer cases/year) • 40-90% of vaginal, vulvar, penile, anal cancers • 26% of oropharyngeal cancers
• HPV 16/18 infections account for • 70% of cervical cancers • 90% of remaining HPV-related cancers
• HPV 6/11 (low risk) cause 90% of genital warts
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Two Prophylactic Vaccines Against HPV infections • Quadrivalent vaccine (16/18/6/11): available since 2006 • Bivalent vaccine (16/18): available since 2007
• WHO recommends 2-dose series for girls aged 9-13 years, prior to initiation of sexual activity (Weekly epidemiological record, No. 43, 24 October 2014)
• Indicated for prevention of cervical, anal, vaginal, vulvar, and penile
pre-cancerous lesions and genital warts
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Real World Evidence for the Effectiveness of the HPV Vaccine
<18 years 18-20 years
21-25 years 26-30 years
≥30 years
Australia introduced 3-dose HPV vaccine in 2007
Figure: Trends in incidence of high-grade cervical abnormalities before and after the implementation of the program in Victoria, Australia, in four age groups (Brotherton et al. Lancet. 2011; 377:2085-92)
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HPV Vaccine Introduction 45 countries have introduced the vaccine nationally as of 2013 Cost of vaccine (US$100 per dose): major barrier to the introduction of vaccine in LMIC GAVI: low price (US$4.50 per dose) for low-income countries
WHO, 2013
Since 2013, GAVI has funded HPV vaccine demonstration projects in 20 countries (yellow dots), and funds the national HPV vaccine program in Rwanda
Rwanda: 93% coverage
US: 37% coverage
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9-Valent Vaccine, Under FDA Regulatory Assessment
Luxembourg, Sanjose et al. Lancet Oncol. 2010; 11:1048-56.
Contribution of 9-valent vaccine to cervical cancer worldwide
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Early Detection
Cervical cancer Colorectal cancer Breast cancer Lung cancer
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0
10
20
30
40
50
60
1980 1985 1990 1995 2000 2005
Limited Progress in Reducing Cervical Cancer in LMIC
High-Income Countries Low- and Middle-Income Countries R
ate
per 1
00,0
00
CI5 Plus
Uganda (Kyadondo County)
0
10
20
30
40
50
60
1980 1985 1990 1995 2000 2005
Denmark
UK (Scotland)
Australian Capital Territory
USA (SEER 9, White) Brazil (Goiania) Colombia
(Cali)
Philippines (Manilla)
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Most of the countries without HPV vaccine introduction also lack screening programs
IARC, 2014.
Countries without Large-scale Cervical Cancer Screening
Note: Countries without large-scale screening may have subnational programs or limited availability of screening
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0.65
0.34 0.55
0.99
0.0
0.5
1.0
1.5
2.0
0 1 2 3 4
Visual Inspection With Acetic Acid & HPV DNA Test
Cumulative prevalence of high-grade cervical abnormalities at 12 months, South Africa (Denny et al, JAMA 2005)
1.42
2.91
5.41
0.0
2.0
4.0
6.0
8.0
0 1 2 3 HPV DNA Group
N=2,163
VIA Group
N=2,227
Delayed Evaluation
(Control) Group N=2,165
Overall 30-59 years
30-39 years
50-59 years
40-49 years
Pre
vale
nce
(%)
Haz
ard
ratio
Hazard ratio for cervical cancer deaths by age, India- VIA Screening (Sankaranarayanan et al. Lancet 2007)
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Integration of cervical cancer screening programs into health systems of LMICs
• Rwanda, national cervical cancer screening program using Care HPV DNA Test and VIA with support from Merck (Binagwaho et al., Bull World Health Organ 2013)
• HIV care services, Zambia, Zimbabwe, Kenya, Botswana
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Inequalities in Availability of Cancer Treatment
Surgery Radiation Chemotherapy
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International Atomic Energy Agency, 2014.
Availability of Radiotherapy for Percentage of Cancer Patients by Country
*Disparities in access to radiotherapy may still exist in those countries with 100% coverage
• 1 radiotherapy machine treats 500 patients per year • 60% of cancer patients benefit from radiotherapy
5,000 additional radiotherapy machines are required to meet patient needs in LMIC
%= # 𝑚𝑎𝑐ℎ𝑖𝑛𝑒𝑠 ∗500 𝑐𝑎𝑠𝑒𝑠/0.6 ∗𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠/𝑦𝑒𝑎𝑟 * 100
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Conclusions
• Many proven interventions for primary prevention, early detection, and treatment—but large geographic inequalities in the availability of services remain
• Expansion of known interventions to low- and middle- income countries requires innovative solutions, commitment and collaboration
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Thank You!