Women’s rising cancer death rate a ‘sober summary’

There is a pandemic on the horizon that must be addressed. The cancer rate for women is spiraling out of control. The American Cancer Society projects 5.5 million women will die from cancer by 2030.

To put that number into perspective:

• The population of Finland is 5,523,904.
• The population of the world’s smallest 50 countries is 3,858,226.

Basically the ACS’s Global Burden of Cancer in Women report points out that in 13 years the number of women who will die from cancer would wipe out the population of Finland, or Denmark (5,690,750), or Turkmenistan (5,438,670), or Slovakia (5,429,418), or more than the combined population of the world’s 50 smallest countries. [1]

“It's not shocking but gives a fairly sober summary of what's happening at a global level,” Dr. Nestor Esnaola, associate director of cancer health disparities and community engagement at Fox Chase Cancer Center Temple Health, told CNN.

Cancer is a leading cause of death worldwide among women in both high-income countries and middle-income countries. This increasing burden is expected to be particularly pronounced in low- and middle-income countries, due to smoking, excess body weight, and physical inactivity.

Among females, cancer is the second leading cause of death worldwide, accounting for 14 percent of all deaths, and in the Americas, Europe, and the Western Pacific regions. Cancer is the third leading cause of death in the Eastern Mediterranean, fourth in South-East Asia, and sixth in Africa.

The ACS study listed these as “malignant neoplasms” — growth that infiltrates the tissue, metastasizes, and often recurs after attempts at surgical removal. … Let that sink in for a moment: The women have cancer, cancer moves to other parts of the body, and cancer returns even after surgery.

According to estimates from the World Health Organization’s International Agency for Research on Cancer, there were 6.7 million new cancer cases and 3.5 million deaths among females worldwide in 2012. Of these, 56 percent of cases and 64 percent of deaths were in less developed countries. These numbers are expected to increase to 9.9 million cases and 5.5 million deaths among females annually by 2030 as a result of the growth and aging of the population. [2]

“The global community cannot continue to ignore the problem — hundreds of thousands of women are dying unnecessarily every year,” said Richard Sullivan, director of the Institute of Cancer Policy at King's College London.

Among females, breast, lung, and colorectal cancers are the three most frequently diagnosed cancers worldwide and in more economically developed countries. In less developed countries, however, the top three most diagnosed cancers are breast, cervix, and lung.

Breast, lung, and colorectal cancers are also the leading causes of cancer death among females worldwide. In more developed countries, the leading causes of cancer death are lung, breast, and colorectum, while the leading causes of death in less developed countries are breast, lung, and cervix.

Breast cancer

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among women worldwide, with an estimated 1.7 million cases and 521,900 deaths in 2012. It is also the most frequently diagnosed cancer in the majority (140 of 184) of countries and accounts for 25 percent of cancer cases and 15 percent of cancer deaths among women worldwide.

The highest breast cancer incidence rates are in North America, Australia / New Zealand, and Northern and Western Europe. Breast cancer incidence rates increased in western countries between 1980 and the late 1990s. These increases are thought to be due to changes in reproductive factors, use of menopausal hormone therapy, and increased screening. [3] Since around 2000, however, rates in several of these countries have stabilized or decreased, which is thought to be due to decreased use of menopausal hormone therapy or plateaus in screening participation. [4]

These declines also have been attributed to mammography screening and better treatments, although the relative contribution of each is debated. [5-7]

About 20 percent of breast cancers worldwide are due to modifiable risk factors including alcohol use, excess body weight, and physical inactivity, and thus the adoption of a healthy lifestyle could substantially reduce the risk of breast cancer. [8]

Excess body weight increases the risk of postmenopausal breast cancer. Women with BMI >35 kg / m2 are at a 1.6-fold higher risk of breast cancer and 2.1-fold higher risk of breast cancer death than those with normal BMI <25 kg / m2. [9]

• Body Mass Index (BMI) calculator

Excess body weight is associated not only with breast cancer risk but also with indicators of poorer prognosis after the development of breast cancer, such as larger tumor size and local and distant extension of cancer. The proportion of postmenopausal breast cancers attributable to excess body weight was 10.2 percent globally in 2012. The highest proportions were in the United States, Bahamas, South Africa, Samoa, and a number of countries in the Middle East and Northern Africa.

When breast cancer is detected at an early stage, treatment is more effective and a cure is more likely. In high-income countries, breast cancer is often diagnosed at an early stage and the prognosis is good; in LMICs, however, breast cancer is more often diagnosed at a later stage after the disease has progressed, and survival is poorer.

Orthodox medicine's five-year survival rate is 85 percent or higher in the U.S., Canada, Australia, Israel, Brazil, and many Northern and Western European countries, while it is 60 percent or lower in many low- and middle-income countries, such as South Africa, Mongolia, Algeria, and India. [10]

The average cost per treatment of breast cancer in 2009 was $67,000 in the U.S., the highest in the world.

Cervical cancer

Cervical cancer was the fourth most frequently diagnosed cancer with an estimated 527,600 cases and the fourth leading cause of cancer death with 265,700 deaths among women worldwide in 2012. Almost 90 percent of cervical deaths in the world occur in developing countries, with India alone accounting for 25 percent of the total cases.

However, cervical cancer incidence rates have decreased by as much as 80 percent during the past four decades in several high-income countries with available screening. [11]

The main risk factor for cervical cancer is infection with human papillomavirus (HPV), which is believed to have a causal role in all cases of cervical cancer. More than 100 types of HPV have been identified, but only some of the HPV types have been shown to cause cervical cancer.

HPV 16 and 18 are the most common subtypes identified in cervical cancer; together they are responsible for 70 percent of cervical cancers worldwide. [12]

The estimated five-year survival rate from cervical cancer is between 60-70 percent in many high-income countries. Among low- and middle-income countries, the five-year survival is 46 percent in India, 56 percent in Thailand, and 62 percent in Ecuador. In 2012, there were an estimated 1.5 million women worldwide who had survived since cervical cancer diagnosis during the preceding five years. [2]

Cervical cancer survivors may suffer from impaired sexual function due to treatment, and quality of life may also be diminished. They are also at higher risk of second cancers associated with radiation therapy, HPV, or smoking.

Lung cancer

Lung cancer is the third most frequently diagnosed cancer and the second leading cause of cancer death among females worldwide, with an estimated 583,100 cases and 491,200 deaths in 2012. It also is the leading cause of cancer death in more developed countries and the second leading cause of cancer death in less developed countries, following breast cancer.

Lung cancer was the cause of death of an estimated 1.1 million men and 0.5 million women worldwide in 2012, corresponding to 24 percent and 14 percent of all cancer deaths in males and females.

Geographic variation in lung cancer is primarily related to tobacco use, the major cause of the disease. Incidence and mortality rates are highest in North America, Northern and Western Europe, Australia / New Zealand, and Eastern Asia.

Lung cancer mortality rates begin to increase about 20 to 30 years after widespread smoking begins in a population, and they peak about 30 to 40 years following peak smoking prevalence. [13] Although overall lung cancer mortality rates among women are increasing in many countries, rates among younger women have begun to decrease in recent years in several of these countries as tobacco control measures take effect.

Exposure to secondhand smoke is estimated to cause 21,400 lung cancer deaths annually in non-smokers worldwide. Another important risk factor for lung cancer among non-smoking women is indoor air pollution because of the unventilated combustion of solid fuels (notable coal) in the household for heating and cooking.

Because symptoms often do not appear until lung cancer is advanced, it is often diagnosed at later stages. Orthodox treatment is based on whether the tumor is a small cell or non-small cell and other tumor characteristics, and generally includes surgery, radiation therapy, chemotherapy, and/or targeted therapies.

For lung cancer cases diagnosed from 2005 to 2009, the five-year survival rate was less than 20 percent. In the U.S., only 22 percent of women with lung cancer diagnosed in 2006- 2012 survived for at least 5 years. [14, 15]

Colorectal cancer

Colorectal cancer is the second most frequently diagnosed cancer and the third most common cause of cancer death among women worldwide, with an estimated 614,300 cases and 320,300 deaths in 2012. Decreases in incidence in the U.S. have been attributed to reductions in the prevalence of risk factors like smoking as well as screening, which can detect and remove precancerous lesions.

Risk factors for colorectal cancer include a family history of colorectal cancer, smoking, excess body weight, and alcohol drinking. In the US, about 8 percent of colorectal cancers among women are estimated to be caused by smoking. Also, red meat consumption is likely to increase the risk of colorectal cancer. [16]

On the other hand, physical activity, diets high in dietary fiber, hormone replacement therapy, and the use of nonsteroidal anti-inflammatory drugs reduce the risk for colorectal cancer.

Currently, WHO has no specific recommendation with regard to red or processed meat intake other than moderation. Some institutions recommend limiting red meat consumption — beef, pork, lamb, and goat — to no more than 300-500 grams per week and avoiding processed meat. [17]

In screenings, endoscopists can identify and remove adenomas (benign tumors of glandular tissue) during the procedure, which can reduce colorectal cancer incidence.

For orthodox medicine, surgery is the treatment of choice for non-metastatic colorectal cancer. Surgery for colon cancer generally can be done by a general surgeon. Rectal cancer surgery is usually more complicated. Surgery may be accompanied by chemotherapy and/or radiation therapy. Radiation is more important for rectal cancer and may improve local control of Stage II and Stage III rectal cancer. Adjuvant chemotherapy has been recommended for Stage III colon cancer and stage II and III rectal cancer.

Survival for colorectal cancer varies worldwide and depends on early detection and treatment. However, fewer than half of colorectal cancers are diagnosed early. In North America, Australia / New Zealand, and many high-income countries of Europe colon and rectum, the five-year relative survival rate is 60-65 percent.

Cancer's economic burden

The estimated global economic burden of cancer in 2009 was $286 billion, which included medical costs ($151 billion), non-medical costs ($66 billion), and productivity loss ($69 billion). An additional $19 billion was spent on cancer research.

The cancers with the highest economic burden worldwide in 2009 in both sexes:

• Lung — $53 billion
• Colorectal — $33 billion
• Breast — $24 billion

The cost was $5 billion each for endometrial and ovarian cancer and $3 billion for cervical cancer.

A major part of the economic costs of cancer to society result from loss of productivity. One way to estimate this loss is to calculate years of productive life lost (YPLL) due to premature death. In the United States, YPLL from all cancers in 2006 was 4.5 million in men (15.4 per death) and 4.7 million in women (17.5 per death), corresponding to a productivity loss of $94 billion in men and $82 billion in women. [18]

Even in high-income countries, financial hardship after diagnosis of cancer is common. For example, in a study in the U.S., 32 percent of cancer survivors reported cancer-related financial problems. These people were at a higher risk of forgoing or delaying medical care than others. [19]