The study published in The Lancet used a measure known as disability-adjusted life-years (DALYs) to take account of not only the effects of fatal cancer, but also the effects of disabling non-fatal disease outcomes (eg mastectomy for breast cancer or infertility for cervical cancer). The researchers analysed data from the cancer registries worldwide to estimate that globally, 169.3 million years of healthy life were lost due to cancer in 2008.

‘€œOur study represents an important first step towards establishing an evidence base for fatal and non-fatal cancer-related outcomes that is urgently needed to set priorities in cancer control,’€ said the lead author Dr Isabelle Soerjomataram, at the International Agency for Research on Cancer (IARC) in Lyon, France.

‘€œWhile overall DALYs are remarkably similar across different levels of human development, they reflect a higher average premature mortality in lower income countries and a higher average disability and impairment in higher income countries.’€œ

Dr Freddie Bray, one of the paper’€™s co-authors and Deputy Head of the IARC’€™s Section of Cancer Information, added: ‘€œOur findings illustrate quite starkly how cancer is already a barrier to sustainable development in many of the poorest countries across the world and this will only be exacerbated in the coming years if cancer control is neglected.’€

Asia and Europe were the main contributors to the global burden of years of healthy life lost due to cancer, with men in Eastern Europe facing the largest cancer burden worldwide (3 146 age-adjusted DALYs lost per 100 000 men). For women, the highest burden was found in sub-Saharan Africa (2 749 age-adjusted DALYs lost per 100 000 women).

Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs rates in most regions, accounting for between 18 to 50 percent of the total cancer burden. The contribution of infection-related cancers to the overall DALYs (primarily liver, stomach, and cervical cancer) was high in Sub-Saharan Africa (25 percent of all cancers) and eastern Asia (27 percent of all cancers), compared to other regions.

The study also highlights the fact that improved access to high-quality treatment has not greatly improved survival for a number of common cancers associated with poor prognoses (especially lung, stomach, liver, and pancreatic cancers), emphasising the crucial role that primary prevention will need to play if the global cancer burden is to be reduced.

In a comment linked to the article, Dr Ahmedin Jemal from the American Cancer Society in the United States, outlined the difference between the measure used in this study and other commonly used measures: ‘€œBy contrast with mortality rates and counts, which emphasise deaths occurring at old ages, DALY give more weight to deaths occurring at young ages at which people are more likely to be working, raising children, and supporting other family members.’€

However, Jemal points out that addressing the challenges highlighted by the new study will require a major effort. ‘€œImplementation of comprehensive and sustainable interventions to challenge the growing cancer burden in low-income and middle-income countries will require the coordinated efforts of many stakeholders from the public and private sectors, including national and international public health agencies, health industries, philanthropic and government donors, and local and regional policy makers.’€

Source: The Lancet