Cancer burden in the year 2000. The global picture
Section snippets
Indices of ‘burden’
Although the general idea of ‘burden’ of a disease to a community seems fairly straightforward, there are multiple dimensions in which it may be expressed, either in terms of disease frequency (the ‘need’ for services) or the demand which it places upon them. In this review, we confine ourselves to three elementary measures of cancer frequency: incidence, mortality and prevalence.
Incidence is the number of new cases occurring. It can be expressed as an absolute number of cases per year (the
The major cancers: burden, cause, trends and prevention
In this section, we consider the eight most common cancers today in terms of their overall frequency and geographical distribution, their recent trends in incidence and mortality and the more important causes (risk factors) which explain these observations. A brief summary of the most promising strategy for prevention, in the current state of knowledge, is also included.
With the exception of Africa, where presently there is a paucity of historical data, incidence and mortality trends over time
The future
Making provision for health services for cancer (prevention, early detection, treatment, rehabilitation and palliative care) requires not only a sound knowledge of the current pattern of occurrence, but also an estimate of the likely evolution of the cancer burden in the future. The future cancer burden can be projected on the basis of trends of incidence and mortality in the past. Recent methodological advances in forecasting allowed the researcher to use a Bayesian approach to specify smooth
Conclusions
Compared with most diseases, cancer is relatively easy to enumerate. As a result, disease registration is more successful as a means of surveillance than for almost any other condition. Our ability to supplement statistics on deaths with information on risk and survival greatly strengthens our ability to infer cause and to evaluate the effects of early diagnosis and therapy. For most countries of the world, some form of cancer data is available which permit us to estimate incidence, mortality
Acknowledgements
We would like to thank several of our colleagues for the substantial contributions which they have made to this paper. At IARC, especially Jacques Ferlay and Paola Pisani for their assistance in preparing the global estimates of incidence, mortality and prevalence. At the National Cancer Institute of the United States, we are particularly grateful for the extensive comments and criticisms of Dr J.F. Fraumeni, Jr. and of Dr A. Hildesheim. We also thank Ms K. Pitaksaringkarn for preparing many of
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