As I write this, I am en route to New York to participate in the lighting of the Empire State Building tonight in honor and recognition of World Cancer Day.
Spearheaded by the Union for International Cancer Control (better known as UICC)--an international organization devoted to reducing the burden of cancer worldwide--and vigorously supported by the American Cancer Society and many other notable organizations, people, and governments worldwide, World Cancer Day is intended to highlight the growing number of cancer cases and deaths around the world and the need for us to pay serious attention to the problem and institute measures to reduce that burden.
As part of World Cancer Day, the American Cancer Society is releasing the second edition of Global Cancer Facts and Figures, a monograph that assembles in one place what we currently know about the worldwide burden of cancer. A special section in the booklet highlights the growing cancer burden in Africa, and what needs to be done to address what could well become an epidemic of cancer on that continent.
When you look at cancer globally, you begin to realize there are several parts to understanding and addressing the problem. And although the increasing number of cancer cases and deaths is universal, the solutions are local.
What strikes you first and foremost are the sheer numbers:
In 2008--the latest year for which we have some reasonable estimates--there were 12.7 million new cancer deaths around the world, and 7.6 million deaths. 2.8 million of those deaths occurred in economically developed countries like the United States, and 4.8 million occurred in economically emerging nations.
But the toll doesn't end there.
By 2030, we can estimate that there will be 21.4 million new cases of cancer annually, and 13.2 million deaths.
It is sobering to realize that of the 7.6 million deaths that occurred in 2008, about one out of three was avoidable. That means 2.6 million people died needlessly. As pointed out in an editorial appearing in our journal, CA: A Cancer Journal for Clinicians, that's 7300 people every day.
And what makes these statistics even more gruesome is that we already know what to do to avoid many of those deaths.
As you look around the world, and you take measure of the cancers that cause these deaths, you appreciate the overwhelming role played by tobacco in developed countries, the role of infections in developing countries, the impact of diet and obesity as well as the contribution of lack of physical activity.
The opportunities for avoiding deaths from cancer differ from one part of the world to another, but the concept of encouraging programs to take advantage of what we already know is something that can be applied everywhere.
For example, cervical cancer is a leading cause of cancer deaths in women in developing countries (it used to be the leading cause of cancer deaths in women, but has now been surpassed by breast cancer). We know how to reduce the risk of death from that disease, and until recently it was primarily through effective screening and treatment. That type of program has worked exceptionally well here in the United States, but there are other parts of the world that simply don't have the financial resources or medical resources to screen and treat women in their countries.
Alternatives do exist, such as special techniques to examine the cervix for abnormal lesions instead of using screening. But if you can't get to a doctor or hospital, and if you don't have but one radiation therapy machine in an entire country--which, for example is the case in Ethiopia where they have one machine for 80 million people--the odds of getting treated appropriately simply aren't very good.
But, in this example, there is a solution and that is the use of the vaccine to prevent transmission of the most common forms of human papilloma virus, which is the cause of cervical cancer. If we did that, we could substantially reduce cervical cancer deaths in many parts of the world. However, even that vaccine may be cost-prohibitive in countries were annual income is a pittance compared to what we have in the United States.
When we talk about developing countries, we also have to note the role of other infectious diseases which contribute to many cancer deaths. Hepatitis and AIDS are but two examples of infectious agents--in addition to HPV--that have a significant impact on cancer deaths worldwide.
We certainly can't ignore the scourge of tobacco. While we here in the United States have already passed our peak of tobacco use (there are still many hard core users), the tobacco companies are reaching out across the world to take advantage of their opportunity to market death. And they are succeeding for many reasons. (I previously wrote about this in a blog in January 2008).
We know what tobacco not only can do but will do to people in these targeted countries once they become addicted. It will take a couple of decades, but have no doubt that millions will die needlessly, not only from lung cancer but from any of the 15 types of cancer related to tobacco use. And that doesn't count heart disease, stroke, vascular disease and chronic lung disease.
Perhaps more subtle than tobacco is the role of diet and exercise.
As Tom Friedman noted in his book "The World Is Flat", our lifestyles are becoming more and more similar everywhere. When my wife travelled to a Middle Eastern country 18 months ago, one of the things that struck her were the number of fried chicken outlets run by a United States-based company all over their major capital city. That is happening everywhere around the world (maybe not the fried chicken part, but you get the point). People for some reason want to be like us when it comes to diet and exercise. And as they become more like us, their rates of cancer and other chronic diseases are going to follow suit, along with all the associated health problems, including cancer (in the United States, overweight and obesity contribute to 14% of cancer deaths in men and 20% in women, according to research done by the American Cancer Society).
So on World Cancer Day, let's make a commitment to the world to do what we already know works. Let's take our knowledge, conform it to local cultures and governments, and do what we can to not only reduce the burden of cancer around the world but to reduce the epidemic that is certain to come over the next 20 and 30 years.
The world doesn't have to experience the sadness that has touched so many of us in this country. We can do something, and we should do something. To sit idly by and watch the world die around us is not an option.
And, if you happen to be in New York City tonight and see the top of the Empire State Building bathed in orange and blue, take a moment to think of those who are gone from our midst as the unfortunate result of an avoidable cancer and make a commitment to support those who don't have to go.