Climacteric
ISSN: 1369-7137 (Print) 1473-0804 (Online) Journal homepage: http://www.tandfonline.com/loi/icmt20
Deadly forecast A. Pines To cite this article: A. Pines (2015): Deadly forecast, Climacteric, DOI: 10.3109/13697137.2015.1025206 To link to this article: http://dx.doi.org/10.3109/13697137.2015.1025206
Published online: 27 Mar 2015.
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Article views: 11
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=icmt20 Download by: [University of Birmingham]
Date: 06 November 2015, At: 12:46
CLIMACTERIC 2015;18:1–2
Invited Editorial
Deadly forecast A. Pines Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Key words: CANCER INCIDENCE, LIFETIME RISK OF CANCER, BREAST CANCER
Downloaded by [University of Birmingham] at 12:46 06 November 2015
ABSTRACT Recent epidemiological studies from various countries point at the mounting incidence of cancer. This continuous increase in the number of cancer cases will keep its pace in the future. The lifetime risk of cancer for people born since 1960 is forecast to be more than 50%. Thus cancer becomes the major health problem, and policy-makers should plan ahead how to implement effective prevention programs, on the one hand, and optimize the strategy for better diagnosis, treatment and surveillance of cancer patients on the other hand.
Biblical Methuselah lived almost 1000 years, but current longevity is only in the range of 80–85 years. However, compared to the corresponding figures 100 years ago, people now live much longer and experience a better quality of life. But a recent study from the UK tells us that cancer is becoming a major component among the list of diseases we should expect during our lifetime1. In this study, the probability of being diagnosed with cancer was estimated for individuals born in a given year, by assessing future risks as the cohort ages. Lifetime risk of cancer was performed separately for men and women born in each year from 1930 to 1960. The investigators projected rates of all cancers (excluding nonmelanoma skin cancer) and of all cancer deaths forwards using a flexible age-period-cohort model and backwards using age-specific extrapolation. The results showed that the lifetime risk of cancer increased from 38.5% for men born in 1930 to 53.5% for men born in 1960. For women, it increased from 36.7% to 47.5%. The lifetime risk of cancer for people born since 1960 is more than 50%. Over half of the people who are currently adults under the age of 65 years will be diagnosed with cancer at some point in their lifetime. In fact, several previous epidemiological studies from other countries came up with similar incidence curves. Data presented by the American Cancer Society showed that, according to the 2011 US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) records, the lifetime risk for developing any cancer in women was 37.8%; the figure for dying from cancer was 19.3%2. The corresponding percentages in men were 43.3% and 22.8%, respectively. According to the Lebanese Cancer Registry, there
was a gradual increase in cancer incidence between 2003 and 2008: the corresponding figures of overall annual increase for males and females were 4.5% and 5.4%3. The Greater Poland Cancer Registry pointed at an increase by 24% in new cancer cases when the year 2010 was compared to 20014. The cancer prevalence in Italy was around 600 000 patients in 1990, and will reach an estimated figure of 1 600 000 in 20155. Do we have the right tools and statistical models to calculate cancer incidence forecasts 10–20 years ahead of 2015? The above-mentioned British investigators published another study earlier, in which the absolute annual projected numbers of cancer patients for the year 2030 were compared to historical data in previous years6: for women, there were 107 658 patients in 1984, 148 716 in 2007, and the number will reach 200 929 in 2030, pointing at a mean annual increase of 1.3%. The corresponding numbers in men were 108 556, 149 169, and 231 026, translating into a mean annual increase of 1.9%. A recent publication addresses the complexity of developing a good cancer forecast method7. These future prevalence and incidence projections are based on multiple assumptions, which might actually be a major limitation to any forecast. The authors recommend the creation of a dynamic model weighing by which uncertainty can be minimized by statistically determining how to combine the best predictions from multiple models. Predictive oncology deals not only with the occurrence of disease in populations, but may also be engaged in forecasting the individual response to therapy, the personal outcomes and prognosis.
Correspondence: Professor A. Pines, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; E-mail: [email protected]
INVITED EDITORIAL © 2015 International Menopause Society DOI: 10.3109/13697137.2015.1025206
Received 14-02-2015 Accepted 16-02-2015
Downloaded by [University of Birmingham] at 12:46 06 November 2015
Deadly forecast Here are some relevant gender-specific aspects. In women, breast cancer incidence increased from 1995 to 2001, decreased from 2002 to 2006, and then remained relatively stable from 2007 to 20118. Interestingly, in China the mortality rate of breast cancer has increased yearly during 1991–2011, and data predict that the trend will continue to increase in the ensuing 5 years9. Currently, the risk of developing breast cancer in the US is about one in eight women, and the risk of dying from breast cancer is one in 37 women2. The predicted cancer incidence counts will increase by 17.8% during 2010–202010. These trends in breast cancer are related to lifetime changes, such as increasing obesity, women having fewer children, at later ages, and breast screening detecting more breast cancers at younger ages. The corresponding risks for developing or dying from lung cancer in women are 1 in 16 and 1 in 20; from colorectal cancer 1 in 22 and 1 in 54; from ovarian cancer 1 in 75 and 1 in 102, respectively. In men, there has been an increase in the incidence of prostate and bowel cancer. A large proportion of the increase in prostate cancer diagnoses has been caused by the detection of cancers by prostate-specific antigen testing that would not otherwise have been diagnosed. The increase in bowel cancer rates is thought to be related to an increase in red meat consumption and obesity. Reading the relevant epidemiological data may be misleading for the lay physician. On the one hand, there is a sustained decline in the overall age-standardized cancer incidence rate6. In the 23-year period 2007–2030, the age-standardized incidence in the UK is projected to decrease by ⫺ 1.0% (equivalent to an average annual change of ⫺ 0.04%) in males and 1.9% (⫺ 0.08% per year) in females, largely because of a decrease in the incidence of lung cancer in men and a decrease
Pines in colorectal cancer incidence in both sexes. However, because of the increase in the size of the population and aging, the number of cases is projected to increase for practically all types of cancer, even for those with decreasing rates. In addition, this increase also reflects the mere consequence of improved longevity, since the risk of being diagnosed with cancer generally increases with age. What steps should be taken based on these projections10? An increase in the number of incident cases of cancer has implications for the cancer surveillance and control community and for the health-care system. A greater emphasis on primary prevention and early detection is needed to counter the effect of an aging and growing population on the burden of cancer. Predicting future incident cases helps health planners and policy-makers to anticipate the resources needed to screen, diagnose, and treat patients newly diagnosed with cancer, while providing ongoing care to cancer survivors. For example, the infrastructure of the health services must be prepared to allow proper diagnosis and treatment of cancer in a growing population. Are there enough oncologists? Operating rooms? Imaging facilities? Pathology labs? Infusion centers? It is true that such predictions should be viewed with caution since they are based on assumptions and complicated models. Nevertheless, these data are vital for policy-makers and health authorities. Conflict of interest The author reports no confl ict of interest. The author alone is responsible for the content and writing of this paper. Source of funding
Nil.
References 1. Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer 2015 Feb 3. Epub ahead of print 2. http://www.cancer.org/cancer/cancerbasics/lifetime-probabilityof-developing-or-dying-from-cancer 3. Shamseddine A, Saleh A, Charafeddine M, et al. Cancer trends in Lebanon: a review of incidence rates for the period of 2003–2008 and projections until 2018. Popul Health Metr 2014;12:4 4. Dyzmann-Sroka A, Malicki J. Cancer incidence and mortality in the Greater Poland Region: Analysis of the year 2010 and future trends. Rep Pract Oncol Radiother 2014;19:296–300 5. Gatta G, Rossi S, Capocaccia R. Cancer burden estimates and forecasts: uses and cautions. Tumori 2013;99:439–43 6. Mistry M, Parkin DM, Ahmad AS, Sasieni P. Cancer incidence in the United Kingdom: projections to the year 2030. Br J Cancer 2011;105:1795–803
2
7. Yankeelov TE, Quaranta V, Evans KJ, Rericha EC. Towards a science of tumor forecasting for clinical oncology. Cancer Res 2015 Jan 15. Epub ahead of print 8. Liu Z, Zhang Y, Franzin L, et al. Trends and variations in breast and colorectal cancer incidence from 1995 to 2011: a comparative study between Texas Cancer Registry and National Cancer Institute’s Surveillance, Epidemiology and End Results data. Int J Oncol 2015 Feb 6. Epub ahead of print 9. Shi XJ, Au WW, Wu KS, Chen LX, Lin K. Mortality characteristics and prediction of female breast cancer in China from 1991 to 2011. Asian Pac J Cancer Prev 2014;15: 2785–91 10. Weir HK, Thompson TD, Soman A, Møller B, Leadbetter S. The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer 2015 Feb 3. Epub ahead of print
Climacteric
ISSN: 1369-7137 (Print) 1473-0804 (Online) Journal homepage: http://www.tandfonline.com/loi/icmt20
Deadly forecast A. Pines To cite this article: A. Pines (2015): Deadly forecast, Climacteric, DOI: 10.3109/13697137.2015.1025206 To link to this article: http://dx.doi.org/10.3109/13697137.2015.1025206
Published online: 27 Mar 2015.
Submit your article to this journal
Article views: 11
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=icmt20 Download by: [University of Birmingham]
Date: 06 November 2015, At: 12:46
CLIMACTERIC 2015;18:1–2
Invited Editorial
Deadly forecast A. Pines Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Key words: CANCER INCIDENCE, LIFETIME RISK OF CANCER, BREAST CANCER
Downloaded by [University of Birmingham] at 12:46 06 November 2015
ABSTRACT Recent epidemiological studies from various countries point at the mounting incidence of cancer. This continuous increase in the number of cancer cases will keep its pace in the future. The lifetime risk of cancer for people born since 1960 is forecast to be more than 50%. Thus cancer becomes the major health problem, and policy-makers should plan ahead how to implement effective prevention programs, on the one hand, and optimize the strategy for better diagnosis, treatment and surveillance of cancer patients on the other hand.
Biblical Methuselah lived almost 1000 years, but current longevity is only in the range of 80–85 years. However, compared to the corresponding figures 100 years ago, people now live much longer and experience a better quality of life. But a recent study from the UK tells us that cancer is becoming a major component among the list of diseases we should expect during our lifetime1. In this study, the probability of being diagnosed with cancer was estimated for individuals born in a given year, by assessing future risks as the cohort ages. Lifetime risk of cancer was performed separately for men and women born in each year from 1930 to 1960. The investigators projected rates of all cancers (excluding nonmelanoma skin cancer) and of all cancer deaths forwards using a flexible age-period-cohort model and backwards using age-specific extrapolation. The results showed that the lifetime risk of cancer increased from 38.5% for men born in 1930 to 53.5% for men born in 1960. For women, it increased from 36.7% to 47.5%. The lifetime risk of cancer for people born since 1960 is more than 50%. Over half of the people who are currently adults under the age of 65 years will be diagnosed with cancer at some point in their lifetime. In fact, several previous epidemiological studies from other countries came up with similar incidence curves. Data presented by the American Cancer Society showed that, according to the 2011 US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) records, the lifetime risk for developing any cancer in women was 37.8%; the figure for dying from cancer was 19.3%2. The corresponding percentages in men were 43.3% and 22.8%, respectively. According to the Lebanese Cancer Registry, there
was a gradual increase in cancer incidence between 2003 and 2008: the corresponding figures of overall annual increase for males and females were 4.5% and 5.4%3. The Greater Poland Cancer Registry pointed at an increase by 24% in new cancer cases when the year 2010 was compared to 20014. The cancer prevalence in Italy was around 600 000 patients in 1990, and will reach an estimated figure of 1 600 000 in 20155. Do we have the right tools and statistical models to calculate cancer incidence forecasts 10–20 years ahead of 2015? The above-mentioned British investigators published another study earlier, in which the absolute annual projected numbers of cancer patients for the year 2030 were compared to historical data in previous years6: for women, there were 107 658 patients in 1984, 148 716 in 2007, and the number will reach 200 929 in 2030, pointing at a mean annual increase of 1.3%. The corresponding numbers in men were 108 556, 149 169, and 231 026, translating into a mean annual increase of 1.9%. A recent publication addresses the complexity of developing a good cancer forecast method7. These future prevalence and incidence projections are based on multiple assumptions, which might actually be a major limitation to any forecast. The authors recommend the creation of a dynamic model weighing by which uncertainty can be minimized by statistically determining how to combine the best predictions from multiple models. Predictive oncology deals not only with the occurrence of disease in populations, but may also be engaged in forecasting the individual response to therapy, the personal outcomes and prognosis.
Correspondence: Professor A. Pines, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; E-mail: [email protected]
INVITED EDITORIAL © 2015 International Menopause Society DOI: 10.3109/13697137.2015.1025206
Received 14-02-2015 Accepted 16-02-2015
Downloaded by [University of Birmingham] at 12:46 06 November 2015
Deadly forecast Here are some relevant gender-specific aspects. In women, breast cancer incidence increased from 1995 to 2001, decreased from 2002 to 2006, and then remained relatively stable from 2007 to 20118. Interestingly, in China the mortality rate of breast cancer has increased yearly during 1991–2011, and data predict that the trend will continue to increase in the ensuing 5 years9. Currently, the risk of developing breast cancer in the US is about one in eight women, and the risk of dying from breast cancer is one in 37 women2. The predicted cancer incidence counts will increase by 17.8% during 2010–202010. These trends in breast cancer are related to lifetime changes, such as increasing obesity, women having fewer children, at later ages, and breast screening detecting more breast cancers at younger ages. The corresponding risks for developing or dying from lung cancer in women are 1 in 16 and 1 in 20; from colorectal cancer 1 in 22 and 1 in 54; from ovarian cancer 1 in 75 and 1 in 102, respectively. In men, there has been an increase in the incidence of prostate and bowel cancer. A large proportion of the increase in prostate cancer diagnoses has been caused by the detection of cancers by prostate-specific antigen testing that would not otherwise have been diagnosed. The increase in bowel cancer rates is thought to be related to an increase in red meat consumption and obesity. Reading the relevant epidemiological data may be misleading for the lay physician. On the one hand, there is a sustained decline in the overall age-standardized cancer incidence rate6. In the 23-year period 2007–2030, the age-standardized incidence in the UK is projected to decrease by ⫺ 1.0% (equivalent to an average annual change of ⫺ 0.04%) in males and 1.9% (⫺ 0.08% per year) in females, largely because of a decrease in the incidence of lung cancer in men and a decrease
Pines in colorectal cancer incidence in both sexes. However, because of the increase in the size of the population and aging, the number of cases is projected to increase for practically all types of cancer, even for those with decreasing rates. In addition, this increase also reflects the mere consequence of improved longevity, since the risk of being diagnosed with cancer generally increases with age. What steps should be taken based on these projections10? An increase in the number of incident cases of cancer has implications for the cancer surveillance and control community and for the health-care system. A greater emphasis on primary prevention and early detection is needed to counter the effect of an aging and growing population on the burden of cancer. Predicting future incident cases helps health planners and policy-makers to anticipate the resources needed to screen, diagnose, and treat patients newly diagnosed with cancer, while providing ongoing care to cancer survivors. For example, the infrastructure of the health services must be prepared to allow proper diagnosis and treatment of cancer in a growing population. Are there enough oncologists? Operating rooms? Imaging facilities? Pathology labs? Infusion centers? It is true that such predictions should be viewed with caution since they are based on assumptions and complicated models. Nevertheless, these data are vital for policy-makers and health authorities. Conflict of interest The author reports no confl ict of interest. The author alone is responsible for the content and writing of this paper. Source of funding
Nil.
References 1. Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer 2015 Feb 3. Epub ahead of print 2. http://www.cancer.org/cancer/cancerbasics/lifetime-probabilityof-developing-or-dying-from-cancer 3. Shamseddine A, Saleh A, Charafeddine M, et al. Cancer trends in Lebanon: a review of incidence rates for the period of 2003–2008 and projections until 2018. Popul Health Metr 2014;12:4 4. Dyzmann-Sroka A, Malicki J. Cancer incidence and mortality in the Greater Poland Region: Analysis of the year 2010 and future trends. Rep Pract Oncol Radiother 2014;19:296–300 5. Gatta G, Rossi S, Capocaccia R. Cancer burden estimates and forecasts: uses and cautions. Tumori 2013;99:439–43 6. Mistry M, Parkin DM, Ahmad AS, Sasieni P. Cancer incidence in the United Kingdom: projections to the year 2030. Br J Cancer 2011;105:1795–803
2
7. Yankeelov TE, Quaranta V, Evans KJ, Rericha EC. Towards a science of tumor forecasting for clinical oncology. Cancer Res 2015 Jan 15. Epub ahead of print 8. Liu Z, Zhang Y, Franzin L, et al. Trends and variations in breast and colorectal cancer incidence from 1995 to 2011: a comparative study between Texas Cancer Registry and National Cancer Institute’s Surveillance, Epidemiology and End Results data. Int J Oncol 2015 Feb 6. Epub ahead of print 9. Shi XJ, Au WW, Wu KS, Chen LX, Lin K. Mortality characteristics and prediction of female breast cancer in China from 1991 to 2011. Asian Pac J Cancer Prev 2014;15: 2785–91 10. Weir HK, Thompson TD, Soman A, Møller B, Leadbetter S. The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer 2015 Feb 3. Epub ahead of print
Climacteric
