GLOBOCAN results: war against cancer is far from being won

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GLOBOCAN project is a comprehensive cancer surveillance database managed by the International Association of Cancer Registries (IARC), whose aim is to calculate incidence and cancer mortality worldwide and prevalence from major type of cancers for 184 countries of the world. GLOBOCAN collects data from every continent and about major types of cancer, and estimates are presented for 2012, separately for each sex. GLOBOCAN represents an enormous source for scientists. Last December, The Lancet dedicated a special editorial to these data and published a series of studies based on GLOBOCAN database, which analyzed the whole phenomenon of the incidence of cancer around the world and some aspects of the war against it, concluding that four decades after such war was declared, a strategic rethink is needed along all battle lines: prevention, therapeutic approaches, and cancer inequalities.

Let's start from the numbers. At a glance, in 2012 there were 14.1 million new cancer cases worldwide and 8.2 million deaths, compared with 12.7 million and 7 million in 2008. As Paolo Vineis – an Italian researcher at Imperial College London – suggests, we are faced with the evidence that cancer is a global and growing phenomenon; therefore primary prevention is a particularly effective way to fight cancer.

However, even cancer incidence is a worldwide problem, since there are still differences between regions. As the graph shows, the gap between the developed countries and the rest of the world in terms of incidence and mortality is still significant. More than half of all cancer cases in 2012 occurred in low-resource countries and researchers estimate that these proportions will increase further by 2025, even if comparisons are actually difficult, due to the lack of national cancer registries in many resource-poor settings, particularly in Africa.

For instance, although breast cancer incidence remains highest in more developed countries (500,000 new cases registered in WHO European Region compared with 100,000 cases in Africa), mortality is relatively much higher in low-income countries because of late diagnosis and insufficient effective treatment. Dramatically interesting is China, where has been registered more than 3 million new cases of cancer, which corresponds to 20 percent of all cases worldwide, and over 2000 deaths, that is 25 percent of all deaths. In particular, 50 percent of the new cases in cancer of liver, esophageal and stomach occurs amongst Chinese.

In general, GLOBOCAN statistics show that the cancer incidence rate is almost 25 percent higher in men than in women, with rates of 205 and 165 per 100,000, respectively. Male incidence rates vary almost five-fold across the different regions of the world, with rates ranging from 79 per 100,000 in Western Africa to 365 per 100,000 in Australia/New Zealand. In terms of mortality, there is less regional variability than for incidence, the rates being 15 percent higher in more developed than in less developed regions in men, and 8 percent higher in women.

Regarding Europe, there have been 2,657 thousand new cases of cancer in 2012 (18 percent of the all cases) and  1,276 thousand of deaths (9 percent of the all cases). Europe in particular is among the top positions in the world for the number of cases of colorectal cancer (25 percent of the all cases) and prostate cancer (32 percent of the all cases), and it is even more significant if we consider its surface.

The estimates of GLOBOCAN do not take into consideration only the continents in their entirety. On the website, it is possible to run a search system in order to derive the data for each individual country regarding incidence and mortality for most types of cancer in 2012, and the estimation of the incidence and mortality rates in 2015, 2020, 2025, 2030 and 2035. The main trend is clear: the incidence of cancer and the rate of mortality in the coming years are likely to increase. If we consider just the situation in 2015, we see that in Italy we will pass from 354,456 new cases in 2012 to 367,905 in 2015. Furthermore, if we exclude the male and female specific types of cancer, data show an unbalanced perspective between male and female population.  For instance, in 2015 the number of new cases of bladder cancer in the male population will be five times as compared to the female population, twice with concerns liver cancer and they will be affected three times as compared to women with regard to lung cancer. Conversely, the female population will be most affected by thyroid cancer.

At a glance, the overall situation, revealed by a series of studies published on The Lancet and based on these data, seems to speak about a battle still far to being won. “At a gathering of thought-leaders from across cancer research and treatment at the World Oncology Forum in Lugano, in late 2012, a question was asked: are we winning the war on cancer, 40 years on? The conclusion was, in general, no” says Douglas Hanahan, director of the Swiss Institute for Experimental Cancer Research of the Swiss Federal Institute of Technology in Lausanne, on his paper Rethinking the war on cancer. “Although the dual metaphors of the war on cancer and of magic bullets to kill cancers have been useful, now is the time to refine them, factoring in extraordinary advances in knowledge about cancer science and medicine. […] Such an integrative and dynamically refined cancer battlespace philosophy — by factoring in the diversity of cancer’s armamentarium of weapons, the organization of its specialized armed forces, and its distinctive battlefields and war zones within a cancer patient, integrated across the spectrum of cancer types and subtypes and, in turn, patient individuality — could contribute to substantial progress in the treatment of cancer, enabling more battles and even certain wars to be won.”

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Mortality trends in Europe have been decreasing in recent years, differently from what happened in the United States with the rise in the so-called “deaths of despair” among low educated middle-aged white Americans. Most of all, such trends in Europe show no interruptions due to the economic crisis. This is the conclusion of a study published on PNAS by LIFEPATH, a project funded by the European Commission, which investigates the biological pathways underlying social differences in healthy ageing.