World Cancer Report (International Agency for Research on Cancer Scientific Publications)

342 Pages·2003·59.86 MB·English

by  B. Steward

Contents 24/01/03 15:27 Page 3
WORLD HEALTH ORGANIZATION
WHO OMS
International Agency for Research on Cancer
WORLD CANCER REPORT
Edited by
Bernard W. Stewart
Paul Kleihues
IARCPress
Lyon 2003
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Published by IARCPress, International Agency for Research on Cancer,
150 cours Albert Thomas, F-69372 Lyon, France
 International Agency for Research on Cancer, March 2003
Reprinted with corrections June 2003.
Publications of the World Health Organization enjoy copyright protection in accordance with the
provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.
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For bibliographic citations, please use the following format:
Stewart B. W. and Kleihues P. (Eds): World Cancer Report. IARCPress. Lyon 2003.
IARC Library Cataloguing in Publication Data
World Cancer Report/editors, B. W. Stewart, P. Kleihues
1. Neoplasms - epidemiology 2. Neoplasms - etiology 3. Neoplasms - prevention & control 4.
Neoplasms - therapy 5. World Health I. Stewart B.W., II. Kleihues P., III. Title
ISBN 92 832 0411 5 (NLM Classification W1)
Contents 27/01/03 15:36 Page 5
WORLD CANCER REPORT
Editors Bernard W. Stewart, Ph.D.
Paul Kleihues, M.D.
Coordinating editor Heidi Mattock, Ph.D.
Layout Pascale Dia
Catrin Goebels
Sibylle Söring
Illustrations Catrin Goebels
Felix Krönert
Georges Mollon
Printed by Darantiere
21801 Quetigny, France
Publisher IARCPress
International Agency for
Research on Cancer (IARC)
World Health Organization (WHO)
69372 Lyon, France
www.iarc.fr/press
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Contributors
Alex A. Adjei Craig R. Nichols
Frank Alvaro Murray Norris
Ala Alwan Hiroko Ohgaki
Alain Barbin Kola Okuyemi
Daniele Bernardi Christian Partensky
Sheila A. Bingham Frederica Perera
Paolo Boffetta Paola Pisani
Sana Boivin-Angele
Roger R. Reddel
Freddie I. Bray
Elio Riboli
Eduardo Bruera
Jerry Rice
Elisabeth Cardis
Jens Ricke
Barrie R. Cassileth
Rodolfo Saracci
Maria Cavazzana-Calvo
Rengaswamy Sankaranarayanan
Pascale A. Cohen
Annie J. Sasco
Catherine Cohet
Cecilia Sepúlveda
Vera Luiz da Costa e Silva
Ki Shin
Louis J. Denis
Karol Sikora
Suzanne Eccles
Leslie H. Sobin
Hashem B. El-Serag
Manuel Sobrinho-Simoes
Jacques Ferlay
Michele Spina
Alain Fischer
Kenneth Stanley
Silvia Franceschi
Bernard W. Stewart
Emil J. Freireich
Muthu Subramanian
David Goldgar
Martin H.N. Tattersall
David Y. Graham
Keith Griffiths Umberto Tirelli
Salima Hacein-Bey Harri Vainio
Pierre Hainaut Stacey Vandor
Janet Hall Anew C. von Eschenbach
Peter Hersey Yoshiyuki Watanabe
Rudolf Kaaks Naohito Yamaguchi
Keiichi Kawai Hiroshi Yamasaki
Ausrele Kesminiene Graham A.R. Young
Greg Kirk
Paul Kleihues Reviewers
Stener Kvinnsland
René Lambert
Françoise Le Deist Sana E. Brooks
J. Norelle Lickiss Richard P. Gallagher
Julian Little Phillip C. Hoffman
Guy Maddern Clement W. Imrie
Norio Matsukura Anthony B. Miller
Heidi K. Mattock Inaneel Mittra
William H. McCarthy Marshall Posner
Anthony B. Miller Roger Stupp
Georgia Moore Peter Swann
Nubia Muñoz Alistair M. Thompson
M. Krishnan Nair Nicholas J. Vogelzan
For a complete list of contributors and their affiliations see pages 329-334.
Contents 6/02/03 8:41 Page 7
CONTENTS
Foreword 9 5 Human cancers by organ site 181
Lung cancer 182
1 The global burden of cancer 11 Breast cancer 188
Stomach cancer 194
2 The causes of cancer 21 Colorectal cancer 198
Tobacco 22 Liver cancer 203
Alcohol drinking 29 Cancers of the male reproductive tract 208
Occupational exposures 33 Cancers of the female reproductive tract 215
Environmental pollution 39 Oesophageal cancer 223
Food contaminants 43 Bladder cancer 228
Medicinal drugs 48 Head and neck cancer 232
Radiation 51 Lymphoma 237
Chronic infections 56 Leukaemia 242
Diet and nutrition 62 Pancreatic cancer 248
Immunosuppression 68 Melanoma 253
Genetic susceptibility 71 Thyroid cancer 257
Reproductive factors and hormones 76 Kidney cancer 261
Tumours of the nervous system 265
3 Mechanisms of tumour development 83
Multistage carcinogenesis 84 6 Cancer management 271
Carcinogen activation and DNA repair 89 Surgical oncology 272
Oncogenes and tumour suppressor genes 96 Radiotherapy 277
The cell cycle 104 Medical oncology 281
Cell-cell communication 109 Rehabilitation 292
Apoptosis 113 Palliative care 297
Invasion and metastasis 119
7 Cancer control 303
4 Prevention and screening 127 Cancer control: a global outlook 304
Primary prevention Cancer control in developing countries 312
Tobacco control 128 Perspectives and priorities 320
Reduction of occupational and environmental
exposures 135 Contributors and Reviewers 329
Reduction of exposure to ultraviolet radiation 141
Hepatitis B vaccination 144 Sources of figures and tables 335
Human papillomavirus vaccination 148
Chemoprevention 151 Subject index 343
Secondary prevention/screening
Breast cancer 156
Prostate cancer 160
Colorectal cancer 163
Cervical cancer 167
Oral cancer 172
Stomach cancer 175
Contents 24/01/03 15:27 Page 9
FOREWORD
The global burden of cancer continues to increase. In the year 2000, 5.3 million men and 4.7 million
women developed a malignant tumour and 6.2 million died from the disease. Given the current trends
in smoking prevalence and the adoption of unhealthy lifestyles, the number of new cases is
expected to grow by 50% over the next 20 years to reach 15 million by 2020. Worldwide, twelve per
cent of people die from cancer and in industrialised countries more than one in four will die from the
disease. Each of us will experience grief and pain as a result of cancer, as a patient, a family mem-
ber or a friend.
In developed countries, the overall cancer mortality is more than twice as high as in developing
countries. The main reasons for the greater cancer burden of affluent societies are the earlier onset
of the tobacco epidemic, the earlier exposure to occupational carcinogens and the Western diet and
lifestyle. In developing countries, up to one quarter of malignancies are caused by infectious agents,
including the hepatitis (HBV and HCV), and human papillomaviruses (HPV). HBV vaccination has
already been shown to prevent liver cancer in high-incidence countries and it is likely that HPV
vaccination will become a reality within the next 3-5 years. Today, more than 80% of women dying
from cervical cancer live in developing countries. Successful prevention of HPV infection would make
an immense contribution to women’s health.
Tobacco consumption remains the most important avoidable cancer risk. During the twentieth
century, approximately 100 million people died worldwide from tobacco-associated diseases. Half of
all regular smokers are killed by the habit and one quarter will die prematurely before the age of 70.
The World Health Organization and its member states will soon adopt the Framework Convention on
Tobacco Control, a major step towards reducing the enormous morbidity and mortality associated
with tobacco consumption.
During the past decade, research into the causes of human cancer, the molecular basis of malignant
transformation and gene-environment interactions that contribute to individual cancer risks has made
significant progress. Insight into cellular signalling pathways has led to the development of new
anticancer drugs that are more specific and carry a lesser burden for the patient.
It is possible to prevent at least one-third of the cases that occur every year throughout the world
through better use of existing knowledge. Where sufficient resources are available, current
knowledge also allows the early detection and effective treatment of a further one-third of cases. Pain
relief and palliative care can improve the quality of life of cancer patients and their families, even in
very low resource settings.
My colleagues at the International Agency for Research on Cancer in Lyon and more than 50
contributors from all over the world have compiled a summary of the current understanding of
cancer causes, cancer development, prevention and treatment. Together with the recently published
WHO guidelines for national cancer control programmes, it will provide a scientific basis for public
health action and assist 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.
Gro Harlem Brundtland, M.D.
Director-General,
World Health Organization
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111
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Cancer is a major disease burden worldwide but there are
marked geographical variations in incidence overall and at
specific organ sites. Reliable estimation of the number of new
cases (incidence) requires population-based cancer registra-
tion. Compilation of worldwide age-standardized cancer rates
allows the identification of countries and regions where par-
ticular tumour types are most common. Such differences usu-
ally reflect exposure to distinct causative environmental fac-
tors. In addition to providing data on the distribution of neo-
plastic disease, descriptive epidemiology provides the basis
for prevention, health service planning and resource alloca-
tion.
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THE GLOBAL BURDEN OF CANCER
SUMMARY
> Worldwide, approximately 10 million
people are diagnosed with cancer annu-
ally and more than 6 million die of the
disease every year; currently, over 22
million people in the world are cancer
patients.
> All communities are burdened with can-
cer, but there are marked regional
differences. The total cancer burden is
highest in affluent societies, mainly due
to a high incidence of tumours associat-
ed with smoking and Western lifestyle,
i.e. tumours of the lung, colorectum,
breast and prostate.
>In developing countries, up to 25% of
tumours are associated with chronic < 85.8 < 112.2 < 133.3 < 165.1 < 272.3
infections, e.g. hepatitis B virus (liver
Age-standardized rate /100,000 population
cancer), human papillomaviruses (cervi-
cal cancer), and Helicobacter pylori Fig. 1.1Mortality rates in men for all cancer sites combined, excluding non-melanoma skin cancer. The
(stomach cancer). highest rates are recorded in affluent countries.
>Differences in the regional distribution
of cancer and its outcome, as docu- Cancer involves a pathological break- The major cancer types
mented by a worldwide network of pop-
down in the processes which control cell In terms of incidence, the most common
ulation-based cancer registries, help to
proliferation, differentiation and death of cancers worldwide (excluding non-mela-
identify causative factors and those
particular cells. Most commonly, the noma skin cancers) (Fig. 1.2) are lung
influencing survival.
malignant cells which form a tumour (12.3% of all cancers), breast (10.4%) and
> In some Western countries, cancer mor- arise from epithelial tissue (i.e. tissue colorectum (9.4%). For any disease, the
tality rates have recently started to which has a secretory or lining function) relationship of incidence to mortality is an
decline, due to a reduction in smoking and are termed “carcinoma”. In many indication of prognosis, similar incidence
prevalence, improved early detection organs (breast, lung, bowel, etc.), most and mortality rates being indicative of an
and advances in cancer therapy. cancers are carcinomas. While having essentially fatal condition. Thus, lung can-
certain characteristics in common, dif- cer is the largest single cause of deaths
ferent types of cancer have very different from cancer in the world (1.1 million annu-
causes and show widely differing ally), since it is almost invariably associat-
response to treatment. The biological ed with poor prognosis. On the other
Cancer afflicts all communities. basis of malignant transformation, the hand, appropriate intervention is often
Worldwide, the burden of disease influence of environmental factors and effective in avoiding a fatal outcome fol-
impinges on the lives of tens of millions options for prevention, screening and lowing diagnosis of breast cancer. Hence
annually. Based on the most recent inci- treatment are addressed in this Report. this particular cancer, which ranks second
dence and mortality data available, there This chapter delineates the burden of in terms of incidence, is not among the
were 10.1 million new cases, 6.2 million cancer in numerical terms by reference top three causes of death from cancer,
deaths and 22.4 million persons living to incidence, mortality and prevalence which are respectively cancers of the lung
with cancer in the year 2000 [1]. This (Box: Terms used in cancer epidemiolo- (17.8% of all cancer deaths), stomach
represents an increase of around 19% in gy, p18) on the basis of data generated (10.4%) and liver (8.8%).
incidence and 18% in mortality since through cancer registries and vital statis- The most conspicuous feature of the dis-
1990. tics systems (death registration). tribution of cancer between the sexes is
12 The global burden of cancer
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ence to etiological factors. For example,
populations in developing countries are
vulnerable to cancers in which infectious
agents (and associated non-malignant dis-
eases) play a significant role [2] (Chronic
infections, p56). These include cancers of
the stomach, uterine cervix, liver and pos-
sibly oesophagus. Conversely, there are
other cancers – exemplified by cancers of
the colorectum and prostate – where the
burden of disease falls disproportionately
on the developed world. These observa-
tions seem to be largely attributable to dif-
ferences in lifestyle, with dietary factors
believed to be of major significance.
Monitoring
The extent of variation in the impact of
cancer between different regions of the
world has been studied for more than 50
years. Data permitting such comparisons
come from cancer registries and from
local and national health statistics, with
respect to deaths from cancer. The com-
pleteness and accuracy of data accumu-
lated by cancer registries has progressive-
ly increased, as has the proportion of the
Fig. 1.2Incidence and mortality of the most common cancers worldwide.
the male predominance of lung cancer ine cervix, for example, are the cause of
(Fig. 1.2). Stomach, oesophageal and death in only a minority of patients diag-
bladder cancer are also much more com- nosed.
mon in males. For the most part, differ- The burden of cancer is distributed
ences in distribution between the sexes unequally between the developing and
are attributable to differences in exposure developed world, with particular cancer
to causative agents rather than to varia- types exhibiting different patterns of dis-
tions in susceptibility. For other tumour tribution (Fig. 1.7). All of Europe, Japan,
types, including cancers of the colorec- Australia, New Zealand and North America
tum and pancreas, there is little difference are classified here as more developed
in the sex distribution. Generally speaking, regions, whilst Africa, Latin America and
the relationship of incidence to mortality the Caribbean, Asia (excluding Japan),
is not affected by sex. Thus, for example, Micronesia, Polynesia and Melanesia are
the prognosis following diagnosis of liver classified as developing or less developed
or pancreatic cancer is dismal for both regions.
males and females. Many other tumour As discussed in later chapters, many dif-
Fig. 1.3In some regions, waters are the source of
types are more responsive to therapy, so ferences in the distribution of cancer chronic Schistosoma haematobium infection
that cancers of breast, prostate and uter- between regions are explicable with refer- which may cause bladder cancer.
The global burden of cancer 13