Are we fighting a losing battle? WHO predicts 75 per cent increase in cancer cases

Despite medical advances, the World Health Organisation warns that cancer cases could rise by 75 per cent in two decades, due to changing lifestyles and ageing populations, but most cases will be in the developing world.

It seems a contradiction to say that the better we get at treating cancer, the more people are dying from it.

But for all the advances in drugs and diagnosis, the expectation is that within two decades the number of cases is expected to rise by 75 per cent.

The figure, which is part of the World Cancer Report 2014, flies in the face of a United Nations pledge two years ago that countries would significantly reduce the burden of cancer through greater awareness, diagnosis and treatment.

Delegates at the World Health Organisation (WHO) Assembly agreed to work towards a 25 per cent decrease in deaths caused by cancer by 2020, along with cardiovascular disease, diabetes and chronic respiratory diseases.

They are targets that now seem hopelessly optimistic.

Dr Margaret Chan, WHO director general and one of the report’s authors, warns that the greatest impact of the increase would be in low and middle-income countries, many of which are “ill-equipped to cope”.

“Many developing countries find themselves in the grip of cancers from two vastly different worlds,” says Dr Chan in the report.

“Those associated with the world of poverty, including infection-related cancers, are still common, while those associated with the world of plenty are increasingly prevalent, owing to the adoption of industrialised lifestyles, with increasing use of tobacco, consumption of alcohol and highly processed foods, and lack of physical activity.”

Health systems in developing countries are under enormous strain, and even wealthy nations are suffering from ageing populations and spiralling costs of cancer treatment, she says.

On World Cancer Day on Wednesday, Dr Jamal Khader, head of Jordan Oncology Society and a director for the Union for International Cancer Control, is urging countries to start preparing now before a flood of cases emerges.

“We will have a tsunami of cases in developing countries, and action should be taken,” says Dr Khader.

“Unfortunately, in the developing countries in the coming 20 to 30 years we will witness a great increase in the numbers of cancer cases.

“Sixty per cent of the increase from now until 2030 will be in developing countries.”

The number of new cases in a year increased from 12.7 million in 2008 to 14.1 million last year, according to the World Cancer Report, produced by the WHO’s International Agency for Research on Cancer.

The highest rates are generally associated with high-income countries, with only a few countries bucking the trend.

Mongolia, for example, has an “extraordinarily” high rate of liver cancer because of the incidence of hepatitis B and C, the report states. Uruguay has high rates of cancers linked to smoking.

The highest incidences of cancer generally occur in resource-rich countries that also have “the best services for detection, diagnosis, and treatment”, the report states.

But with changing lifestyles and ageing populations, Dr Khader warns this trend is likely to change and says developing countries need to start preparing themselves.

“This is in contrast to the last 30 or 40 years where the cancers were mostly in developed countries,” he says.

“Most of the developing countries had problems with infections, but not cancer.

“But many of the cancers are infection-related and many are a result of the western style of living, with more junk food, less activity, more obesity – which wasn’t there in developing countries before. The change in lifestyle, less awareness about cancer, less screening. All the efforts are going toward fighting infections; there is no real awareness about the importance of cancer.”

Already more than six out of 10 cancer cases occur in Africa, Asia, and Central and South America, with these regions accounting for 70 per cent of cancer-related deaths, according to the WHO.

“Many drugs are not available in the developing countries,” says Dr Khader.

“In Africa there are many countries that severely lack the human resources – trained personnel in cancer. There are at least 10 countries that do not have a single machine for radiotherapy.

“Some countries need to send their patients outside the country for treatment, so you lose the multidisciplinary treatment where it’s all under one umbrella.

“The awareness of cancer is not there. If we don’t highlight the issue, the number will increase and if they will act, they will act late. The myth that cancer is a deadly disease whatever we do, is not true.”

By 2025, the number of new cases is expected to surpass 20 million a year. Based on the Human Development Index (HDI), which ranks countries according to life expectancy, education and income, there are specific cancers that are expected to increase in great numbers.

Female breast cancer, prostate cancer and colorectal cancer are most linked to HDI, so as countries become more developed and resource-rich, the incidences will increase, says the WHO.

There will also be a large increase in the number of tobacco-related cancers, especially lung cancer, mainly due to the international strategies of tobacco companies looking to boost sales. As countries such as China see increasing levels of smoking, they will need to prepare for a rise in smoking-related cancers.

“A smoking epidemic is unfolding in many countries with lower HDI that are in transition, potentially impeding human development by consuming scarce resources; increasing pressures on already weak healthcare systems, and inhibiting national productivity,” says the WHO.

According to the WHO, the largest increase in cancer cases in the next 15 years is likely to be in the eastern Mediterranean region, which includes Middle Eastern and Gulf countries, as well as parts of North Africa.

“The projected increase in cancer can be attributed to population ageing, better detection and registration, and most importantly, to increased exposure to risk factors.”

The most significant risk factor, it says, is tobacco.

But globally, the biggest contributor is an ageing population. As life expectancy grows, so will the incidence of cancer increase.

“Incidence is largely going up because people are living longer,” says Dr Alan Worsley, of Cancer Research UK.

More people are getting cancer because they are not getting something else first, he says.

“Health systems across the world have to deal with the fact that more people are getting cancer; globally that is something all health systems have to tackle.”

But as incidence increases, he says, so too do survival rates. Ever-improving screening, diagnosis and treatments has lifted survival rates of at least 10 years in the UK and similar countries from one in four 40 years ago, to half of those diagnosed with cancer today.

“Part of our ambition is to make that three in four in the next 20 years,” says Dr Worsley.

More research into the science of cancer will be essential to improving survival rates.

Discoveries such as identifying the relationship between a certain bacteria and stomach cancer has already led to a drop in the incidence of that disease.

Funding for research and health system development is crucial, Dr Worsley says.

“When you’re looking globally, one of the big issues is the healthcare systems. Even in the United States, with their insurance model, it means a lot of people aren’t getting early screening tests of preventive measures such as vaccines.

“It’s about understanding that paying for something now is saving you paying a hell of a lot more 20 years down the line.

“There’s a massive difference between catching it early when you don’t know there’s a problem and waiting until you have to get it diagnosed in an emergency room.”

Dr Khader also warns about the long term effects of various conflicts in the Middle East – something which no amount of research can fix.

“We are suffering very badly and the effect will be seen in years to come,” he says.

“The war and the poverty in many countries around us; people are suffering so badly.

“If they have a problem they don’t have any kind of comprehensive treatment for cancer, or any other diseases.

“We will discover in the future; the numbers will increase in places like the Gaza Strip, Yemen, Libya, Iraq and Syria.

“These countries will have a very tough time unfortunately, especially with cancer.

“Cancer is neglected in war and conflict. We will see a huge number of cancer, neglected disease and death unfortunately. We need to act.”

munderwood@thenational.ae