Cancer remains a scourge in America, but new government figures show that for the first time, both new cases and deaths from cancer declined simultaneously. What's more, while cancer rates for men and women often diverge, with one group making progress while the other loses ground, in the latest report, both sexes improved. The news, however, was not as happy elsewhere. The World Health Organization's International Agency for Research on Cancer (IARC) released its World Cancer Report, revealing that the burden of cancer around the world has more than doubled over the past 30 years. What's most disturbing is that the disease is growing fastest in low- and middle-income countries that are least equipped to control it.
"In the U.S., we pay a lot of attention to cancer trends, and the trend has been encouraging," says Dr. Richard Schilsky, president of the American Society of Clinical Oncology. "But we have forgotten that there is a big wide world out there. Cancer is a global problem." (See pictures of Cancer survivors.)
The latest estimates show just how widespread that problem is. In 2007 there were 12 million new cancer cases worldwide, a record high; in 2000, the number was 10 million and in 1975 it was 5.9 million. Of the new cases last year, nearly half struck in developing countries. If these trends continue, health officials predict that by 2030, 17 million people will die worldwide of cancer, and 75 million people will be living with the disease and require treatment and follow-up care. That makes cancer the leading killer in the world, claiming more lives than AIDS, TB and malaria combined. "It is a crisis for public health and health systems worldwide," says Peter Boyle, director of IARC.
But, say leading cancer experts, it doesn't have to be that way. Organizations including the American Cancer Society, Susan G. Komen for the Cure and the Lance Armstrong Foundation joined the IARC in releasing the report and proposing an action plan to help nations control the growth of the disease. "Although cancer is a great, growing and devastating disease," says Boyle, "it is largely preventable." (Read "5 Truths About Health Care in America.")
Tobacco, for example, is responsible for a third of cancer deaths in North America and Europe. Recent efforts to corral tobacco use by countries such as Scotland and Ireland, which banned smoking in bars, restaurants and public places, have led to significant drops in cigarette use and in hospitalizations for heart attacks. Any changes in the incidence of cancer, which takes longer to develop, may appear in coming years. A wide-ranging cancer prevention program adopted by the European Union in 1985 helped the continent avoid 98,000 cancer deaths by 2000.
Such intervention is uncommon in the low-resource nations that are home to the most smokers. In 1992, for example, China reached a smoking rate of 10 cigarettes per person per day — the peak level in the U.S. in the 1950s. Forty years later, Americans paid the price of all that lighting up, with a record 33% of all middle-aged deaths caused by cigarettes. If smoking in China continues to climb in coming years — and without public health programs to discourage it, it likely will — an even higher proportion of its population will succumb to cancer after 2030.
Curbing global cancer rates is not simply a matter of transferring the successful prevention methods from the U.S. and Europe to the developing world, however. The most common cancers outside our borders are caused by chronic infections with viruses — very different from the ones that afflict us. In Africa, for example, the three most common cancers are Kaposi's sarcoma (related to HIV infection) and liver and cervical cancer. In China, liver cancer is a huge problem. The good news is that while researchers are still working on an effective AIDS vaccine, they can vaccinate against the hepatitis B virus that causes liver cancer and the human papillomavirus responsible for cervical cancer. "Hepatitis B vaccination could potentially wipe out much of liver cancer in Africa if it is applied broadly," says Schilsky, "and the same is likely true of HPV vaccination and cervical cancer."
Such proactive measures would require a combined effort by governments, health organizations and citizens, both to provide medical intervention such as screenings and immunizations and to encourage lifestyle changes that help individuals reduce their risk in the first place. "This report should serve as a clear and concise reminder that we are in the middle of a growing cancer crisis worldwide," says Boyle. It should also remind us that we have the power to contain it.